Medical opinion: Atul Gawande's prose is as sharp as his scalpel. Photo: Erik Jacobs/NYT/Redux/Eyevine
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Rock doc: surgeon and writer Atul Gawande on old age and dying

What should doctors do when the drugs won’t work? Often it’s easier to push one more treatment than to acknowledge that “people have priorities other than living longer”.

Choosing a soundtrack for the operating theatre is not easy. “It has to be the kind of music that the nurses and the other doctors go along with,” the American surgeon Atul Gawande explains. “Country tends to be out, and most hip-hop, too.” He usually goes for indie. A journalist once told him that his problem was that he was too old for his iPod (he’s 49), which amused him. Gawande, sharply suited and drinking orange juice in a London café, lists his current surgery favourites: Alt J, the National and Weezer.

His musical taste is just one way in which Gawande defies convention as a surgeon. He is also a bestselling author who has been a staff writer for the New Yorker since 1998, and he’ll be giving this year’s Reith Lectures. He has a knack for identifying grand themes – how checklists can save millions of lives lost through medical mistakes, why some ideas (such as anaesthetic) catch on quickly and others (such as antiseptic) don’t, what hospitals can learn from the fast-food industry – and exploring these ideas through the stories of the patients he has treated. His writing is often moving – sometimes in a stomach-churning way: his account of the woman with an unstoppable itch who scratched all the way through to her brain is, perhaps regrettably, unforgettable.

Gawande’s latest book, Being Mortal, explores how the medical profession, and modern society, approach the end of life. What should doctors do when the drugs won’t work? Often it’s easier to push one more treatment – an operation, another round of chemo – than to acknowledge that “people have priorities other than living longer”.

This is a book about the “good life” and even though often sad, it is uplifting, too. We are wrong to assume that in order to be happy you need to be independent and healthy: elderly people dependent on help often report higher levels of happiness than the rest of us. As we age, we care less about wealth and public recognition, valuing close friends and family more.

Gawande admires those thinking imaginatively about geriatric care: the man who introduced cats, dogs and birds into a nursing home, or the staff who make sure an 85-year-old dementia patient can go out drinking margaritas every Friday. “I have nothing against the tech entrepreneur who wants to discover the immortality pill,” he says, but adds that it is wrong “that we don’t think there can be innovation in what happens in the last five years of your life that can make it incredibly better”.

The tenderest passages are those in which Gawande writes about his father’s death from cancer. Atmaram Gawande died before the book was published, but Atul’s research helped him support his father better. Both were surgeons, but initially they “couldn’t even wrap [their] minds around how to talk about the tumour that was advancing”.

For Atmaram Gawande, medicine was a path out of poverty. He grew up in India and decided to become a doctor – although he’d never met one – after his mother died of malaria. He met Gawande’s mother in the US and settled in rural Ohio, where Atul grew up. “I’m the son of two Indian immigrant physicians. Which means you practically have ‘You are going to be a doctor’ stamped on your head at birth,” Gawande jokes. He initially resisted this pressure: starting a rock band, winning a Rhodes scholarship to study philosophy, politics and economics at Oxford, working in the Clinton administration and for Al Gore’s presidential campaign. But then he realised he was “good at certain things in medicine, better than I was as a philosopher”. He seems pretty successful at both. 

Sophie McBain is a freelance writer based in New York. She was previously an assistant editor at the New Statesman.

This article first appeared in the 20 November 2014 issue of the New Statesman, The deep roots of Isis

CREDIT: CREATIVE COMMONS
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Prostate cancer research has had a £75m welcome boost. Now let’s treat another killer of men

Each week in the UK, 84 men kill themselves – three times the number of women.

The opening months of 2018 have seen a flurry of activity in men’s health. In February, figures were published showing that the number of male patients dying annually from prostate cancer – around 12,000 – has overtaken female deaths from breast cancer for the first time. Whether coincidence or not, this news was followed shortly by two celebrities going public with their personal diagnoses of prostate cancer – Stephen Fry, and former BBC Breakfast presenter Bill Turnbull.

Fry and Turnbull used their profiles to urge other men to visit their doctors to get their PSA levels checked (a blood test that can be elevated in prostate cancer). Extrapolating from the numbers who subsequently came to ask me about getting screened, I would estimate that 300,000 GP consultations were generated nationwide on the back of the publicity.

Well-meaning as Fry’s and Turnbull’s interventions undoubtedly were, they won’t have made a jot of positive difference. In March, a large UK study confirmed findings from two previous trials: screening men by measuring PSA doesn’t actually result in any lives being saved, and exposes patients to harm by detecting many prostate cancers – which are often then treated aggressively – that would never have gone on to cause any symptoms.

This, then, is the backdrop for the recent declaration of “war on prostate cancer” by Theresa May. She announced £75m to fund research into developing an effective screening test and refining treatments. Leaving aside the headline-grabbing opportunism, the prospect of additional resources being dedicated to prostate cancer research is welcome.

One of the reasons breast cancer has dropped below prostate cancer in the mortality rankings is a huge investment in breast cancer research that has led to dramatic improvements in survival rates. This is an effect both of earlier detection through screening, and improved treatment outcomes. A similar effort directed towards prostate cancer will undoubtedly achieve similar results.

The reason breast cancer research has been far better resourced to date must be in part because the disease all too often affects women at a relatively young age – frequently when they have dependent children, and ought to have many decades of life to look forward to. So many family tragedies have been caused by breast malignancy. Prostate cancer, by contrast, while it does affect some men in midlife, is predominantly a disease of older age. We are more sanguine about a condition that typically comes at the end of a good innings. As such, prostate cancer research has struggled to achieve anything like the funding momentum that breast cancer research has enjoyed. May’s £75m will go some way to redressing the balance.

In March, another important men’s health campaign was launched: Project 84, commissioned by the charity Calm. Featuring 84 haunting life-size human sculptures by American artist Mark Jenkins, displayed on the rooftops of ITV’s London studios, the project aims to raise awareness of male suicide. Each week in the UK, 84 men kill themselves – three times the number of women. Suicide is the leading cause of male death under 45 – men who frequently have dependent children, and should have many decades of life to look forward to. So many family tragedies.

I well remember the stigma around cancer when I was growing up in the 1970s: people hardly dared breathe the word lest they became in some way tainted. Now we go on fun runs and wear pink ribbons to help beat the disease. We need a similar shift in attitudes to mental health, so that it becomes something people are comfortable talking about. This is gradually happening, particularly among women. But we could do with May declaring war on male suicide, and funding research into the reasons why so many men kill themselves, and why they don’t seem to access help that might just save their lives. 

Phil Whitaker’s sixth novel, “You”, is published by Salt

This article first appeared in the 18 April 2018 issue of the New Statesman, Enoch Powell’s revenge