Message from the Chair, Professor Ian Davis Welcome to this latest edition of “A little below the belt.” 2020, eh? Isn’t it ironic that last year we had 2020 vision but we never saw it coming? We never considered how our lives would be turned upside down. We never thought we would be blocked from international or interstate or even inter-family travel. We never dreamed of feeling anxiety on seeing an unmasked face coming within a certain distance of us. We never imagined the possibility of breathing air that might kill us or the people we loved. Many of us had never even used Zoom; I read recently that Zoom shares were worth more than the top five international airlines combined. Wouldn’t it be lovely if we knew the future clearly? Or would it? Leaving aside strategies for winning lotto draws or betting on horse races, would it be helpful to know? Steven Wright is an American comedian known for his deadpan delivery of one-liners and short jokes. Here’s one: My girlfriend’s so intense... She woke me up the other night and asked, “If you could tell exactly when and how you were going to die, would you want to know?” I said, “Heck no, why?” “Doesn’t matter, just go back to sleep...” I often tell that to my patients who ask me how long they have to live (although you do have to pick your audience carefully!) It’s a fair question, and one that media and movies have primed everyone to think they must ask, but of course I don’t know the answer, and even if I did, I’m actually not sure that’s the question people are really asking. I think more often people might be trying to say other things, like: “I’m scared. I don’t know what’s going to happen to me. I don’t know how to navigate the system. You’re talking about frightening things like operations or chemotherapy. I don’t know how to make decisions about this. I’m not even sure what questions I should ask. Of course I’m going to die sometime but I’d like it to be as far away from now as possible. Actually now I’m not even sure
about that – maybe quality of life is more important than how long I’ve got. Surely we can do both. By the way, is there a God, and where can I send complaints?” The problem is uncertainty. Cancer is what I do, and I’ve been immersed in it for over 30 years, but for this person coming to see me it might be the very first time they’ve even thought about it, let alone had to make decisions about it. Life doesn’t get much more black and white than when you are faced with decisions you don’t know how to make, but that could have profound effects on your life and the lives of those around you. We need people to give advice, and we need confidence that the advice we are getting is sound and reliable. There’s a thing called “evidence-based medicine.” Health professionals like to think that wherever possible the care we give is based on evidence showing that it works, and that it is better in some way than the alternatives. Often evidence does exist to guide us, but humans and the diseases that affect them are very complex, and not every situation has been studied and researched carefully. Sometimes we rely on the opinions of experienced people, who know the evidence and can extrapolate from it to give reasonable advice in this situation. That “eminence-based medicine” is not quite as good but sometimes it’s all we have. And right down the list is the information you get from your neighbour down the street whose niece had cancer 20 years ago, or a random page that pops up on Google: some might call that “effluence-based medicine,” and I probably should stop at that point. The whole field of medicine is improving but it is almost never by big leaps or the “breakthroughs” you hear about in the media all the time. Most of those “breakthroughs” come to nothing, or are about someone killing cancer in a test tube (pretty easy, you could stomp on it) or in a mouse (also pretty easy, and they never ask me about Google). Look for the
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