Listen to the full interview online dulwich.org.uk/old-alleynians-home/oa-stories
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2020
UK a year; that is 30,000 a month and roughly 1,000 a day. In April 2020 there were almost no cancers being diagnosed – the number rose to 5,000 in May and 8,000 in June. A shortfall of some 47,000 expected diagnoses. Of all the most common cancers it was colon cancer that was possibly the most impacted because a colonoscopy, which is the main way of diagnosing the disease is an aerosol generating procedure putting everyone at much greater risk of contracting Covid. The extra safety measure that had to be put in place meant that the number of daily procedures fell by nearly seventy five percent. While things have improved generally, the current evidence suggest that cancer services are struggling most in the NW and NE of the country while London seems to be standing up pretty well.
Cancer - CCancer care has improved hugely during my career; When I first started working in oncology some 50 years ago we managed to cure 30% of patients with the various forms of the disease. Today it has increased to 50% of the 1000 daily diagnoses – yet it could still be better. We have made great strides in the use of technology. CT scan images provide more-detailed information than X-rays do and the use of combination drugs for testicular cancer – which all too recently killed a significant number of the young men who were diagnosed with the condition, now allow 98% to survive. Cancer patients were essentially ignored during the first three months of the pandemic; they were of course still getting sick but as the diagnostic pathways fell apart; it had become impossible for example to get CT or MRI scans and so they were not receiving the appropriate treatment as quickly as they should have. As identified by the number of biopsies being carried out, we expect to treat some 360,000 patients in the
Despite the early signs being positive there are still a number of unknowns about the vaccines that have so far been announced and we need to be aware of the possible risks that may accompany any of them. It clearly has not been possible to assess the potential long term risks, particularly Antibody Dependent Enhancement. ADE is one form of immune enhancement which occurs when components of our immune system that usually protect against viral infections somehow fail to do so allowing the virus to cause widespread infection. I am convinced that we can get a vaccine distributed quickly provided the training is supported for what is a comparatively simple procedure. While I would certainly encourage everyone to be vaccinated it might be that if you are in any way nervous of the potential side effects outweighing the benefits that you wait a few months. It soon became clear that social media had the power to reach those parts of the political and social system that I had never been able to reach before and that apart from restricting my tweets to cancer care I began to wonder if I could also influence the way we think about the way the whole health system works. A few tweets I posted on social media have reached millions of people – For decades we have been trying to raise awareness. Twitter has easily been the most effective platform for it. Since joining twitter I have met so many fantastic people I would never otherwise have met. It is not just a platform for popstars and footballers! However, not everything about social media is by any means positive and the use of various platforms by ‘anti vaxers is a concern’ and nothing prepared me for the level of sheer vitriol I and may other scientists and academics have experienced over the course of this year.
The Vaccine - As an older man and a healthcare worker, I might be near the front of the queue for the vaccine – I have no doubts taking it. It looks as though we are going to see several vaccines become available in the coming weeks and months and of course the government is desperate to have a vaccine announced before Christmas 2020. That would be good news but there are risks involved. It is clear that the world’s will have to come together to manage the roll out of the vaccine, for example some of the planet’s poorest countries will not be able to afford the cold chain infrastructure that the Pfizer vaccine needs to store it at the required -70 degrees. For them the AstraZeneca vaccine which can be stored in a domestic fridge may be a more viable alternative. Social media - My relationship with social media started almost as a joke. I was sitting with a retired oncologist who was proud of the fact that he had gained 128 followers on Twitter in the five years he had been using the platform. His enthusiasm piqued my curiosity and he helped me set up an account, sending me on my way with a merry ..’if you are lucky in five years you will have 100 followers’. I started with the intention of prioritising cancer care in the UK during the pandemic and I remember that one of my very first tweets at the beginning of March carried a simple and positive message - To those cancer patients concerned about Coronavirus my message is don’t panic. Take the sensible precautions of washing your hands, avoiding crowds and eating well. These small actions make a big difference. It received 87 likes and 54 re-tweets. Now I have over 340,000 followers, an irritating 20,00 less than Minister for Health, Matt Hancock, but still the highest number for any doctor in the UK.
MEDICINE IS WAKING UP TO THE POWER OF TECHNOLOGY IN ALL ITS FORMS .
Tony Blair did a great deal to invest in the NHS and he tripled the budget almost overnight. He did a huge amount, but so much was wasted. The health system in operation at the time was simply not efficient enough to take so much money thrown at it in such a short space of time. So keen was the government to be seen to be doing something that the money was given before there was a proper plan put in place to use it. Perhaps now we could consider how best we move forward? At a clinical level there is no doubt that personalisation is the way forward. That we become much better at looking at the specific needs of an individual patient and targeting them with bespoke treatments. There will be personalisation at a molecular level.
The Future - Medicine is waking up to to the power of technology in all its forms. Of course the advance of technology is not new but like so many other professions we are using simple and powerful ways of communicating with each other and with our patients. A recent trip to Dubai did not stop me from consulting with colleagues and patients. The simplicity of a zoom call saves time and while it cannot replace a physical examination the profession is quickly learning how to empathetic on-line. The pandemic could prove to be a golden opportunity to consider a redistribution of resources. Might we now see the benefit of a national medical database? The National Programme for Information Technology (NPfIT) which was launched in 2002 attempted a top down digitisation of the healthcare in the NHS in England. Yet it was mistrusted from the start and dismantled in 2011. In 2020 we still do not have a system that shares data across what is the National Health System.
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