The Further Adventures of Contrick19 (or how the Digger saw the light)

INTERVIEW

‘This is an unfolding disaster. My advice? Don’t get cancer in 2020’

A misplaced obsession with Covid-19 fuelled by vested interests is killing tens of thousands, the leading oncologist Karol Sikora tells Rhys Blakely

Professor Karol Sikora at home in Buckinghamshire. He disputes the official Covid death toll, saying: “I don’t believe it’s as high as 41,000”
Professor Karol Sikora at home in Buckinghamshire. He disputes the official Covid death toll, saying: “I don’t believe it’s as high as 41,000”TIMES PHOTOGRAPHER JACK HILL

Saturday August 22 2020, 12.01am, The TimesShareSave

During the pandemic Britain was forced to make trade-offs in how we contained two killers — cancer and Covid-19. We got it badly wrong, says Karol Sikora.

A former head of the World Health Organisation’s cancer programme, Professor Sikora has become the country’s most prominent critic of the lockdown’s impact on NHS care for other diseases. The government became obsessed by Covid-19 deaths, says the senior oncologist. Its tunnel vision created a cancer crisis.

“Some estimates say a few thousand cancer patient lives could be lost. I think you can easily multiply that by ten,” he tells me via Zoom from his garden in Buckinghamshire. “It’s far worse than people appreciate.”

Studies suggest that more than a decade of progress in saving lives will be wiped out this year. “We have almost certainly caused the death of something like 30,000 patients,” he says. “I think it’s going to end up in that sort of number . . . 30,000 who would have probably been cured if it hadn’t been for Covid. I’ve seen a lot in my half a century in medicine. I’ve never been more worried about cancer care than I am now. This is an unfolding disaster and so many aren’t seeing it.” His advice for patients? “Don’t get cancer in 2020.”

Professor Sikora, 72, has worked in oncology since the 1970s. He has led NHS cancer departments and sat on advisory boards that wrestled with how to improve results at national level. He now works mostly in the private sector and has a third of a million Twitter followers.

He is a polarising figure. He’ll admit that he underestimated the seriousness of Covid-19 early on. But official statistics are proving that one central message was correct: the virus has been a disaster for cancer care.

A quarter of a million people who would normally have been urgently referred by their GP to a cancer specialist are missing from the diagnostic pipeline. This, as Professor Sikora points out, is the tip of the iceberg. Millions more have missed routine screening appointments or are waiting for diagnostic tests and treatments. Survival rates, analysts warn, are poised to sink.

He rejects the idea that lockdown was a necessary evil and disputes the Covid death toll. “I don’t believe it’s as high as 41,000. I think a lot of those people would have died anyway within a fairly rapid timeframe. Most people in care homes die within 18 months anyway. I got really screwed on Twitter for being unsympathetic, but those are the facts.”

Britain’s cancer diagnosis and treatment pipeline was already fragile and underfunded and Covid-19 policies effectively severed it, he says. Patients who should have gone to their GP with suspicious lumps, or blood in their stool or persistent coughs (a symptom of Covid-19 but also of lung cancer) were told to “stay home, protect the NHS, save lives”.

GPs “shut up shop”, he says, and directed patients to NHS 111 — no good for those with conditions such as pancreatic cancer, which typically requires more than four GP visits before a referral. Hospitals closed diagnostic services, postponed treatments and hunkered down for the Covid-19 maelstrom to pass.

“I’ve seen patients with colon cancer that almost certainly would have been stage one at the beginning of this.” The disease was missed and he now suspects that they have progressed to stage three.

The thing for most tumours is to find them early. “Early colon cancer — 90 per cent chance of cure. Stage three, when the lymph nodes are involved, high up in the abdomen, then the chances of cure are less than 20 per cent.”

Britain, already a mid-table player at best among the developed nations, will fall down the cancer treatment rankings and to the bottom of the European states, he predicts. “We’re so dependent on the speed of our diagnostic pathway, which is already slow — so my prediction is that we’re going to be the worst in Europe for the effect of Covid on cancer patients, for the simple reason we haven’t bought the capacity.”

In his view, the modelling that warned that Covid-19 could kill 500,000 Britons if left unchecked — a prediction he rejects — forced science-illiterate ministers into poor policy decisions. So who’s culpable? “The epidemiologists, to a certain extent. They have a vested interest in the whole thing running and running.”

A live pandemic means that “their specialism is important — people look to them as the gurus of what’s going to happen next. If they say, ‘Well it’s all gonna blow away by Christmas’ . . . well that’s not what the epidemiology guys want to hear. They want to say, ‘You’re going to need me some years to come’ .”

Twitter and the pandemic have boosted Professor Sikora’s profile, too. For years he’s been one of the UK’s most-quoted cancer experts — and an arch-critic of NHS cancer care — but he joined the social media site only in March. “We were just going into Covid. I was having a drink with a colleague who’s a retired oncologist who’d been on Twitter for ten years and he’d got 117 followers. He said, ‘You could do Twitter to get your message over — what’s your message Karol?’ And I said, ‘The message is that cancer is going to be bigger as a killer than Covid if we go down the route of shutting everything down. If we do that, there are going to be more cancer deaths than Covid deaths’.”

He was told that he’d be lucky to get 200 followers — he now has 325,000. “I’m trying to catch up with Matt Hancock [the health secretary]. He’s on 338,000, I’m on 325,000 — so it’s a very childish contest.

He has been in the spotlight before. “Two things always come up,” he says. The first is his part in the release from prison in 2009 of the Lockerbie bomber Abdelbaset al-Megrahi. Professor Sikora’s prediction that the Libyan had months to live played a role in his release. Fury broke out when the professor said in 2010 that, actually, Al-Megrahi might hold on another decade. In the end, the bomber survived until 2012.

The second is a long-running spat with Imperial College. There were allegations that Professor Sikora misled the public by claiming he had an honorary professorship there. He puts it down to an acrimonious merger of the Royal Postgraduate Medical School, which he worked for, into Imperial. He is now a professor at the University of Buckingham.

His views certainly aren’t shared by oncologists across the board but being a loose cannon wouldn’t make him wrong on fundamental points. As the pandemic approached in February and March, ministers and officials promised that cancer services would be unaffected.

Those pledges clearly weren’t met. A study this week from the Institute for Public Policy Research (IPPR) and the healthcare management consultancy Carnall Farrar shone a light on how more than a quarter of a million urgent cancer GP referrals were missed between April and June. About 7 per cent of those people will have cancer. But these GP referrals account for about a quarter of the cases that are spotted. Other outpatient referrals account for about a fifth and are also sharply down.

Another fifth come from patients whose cancers are spotted after they go to A&E departments, which were often quiet during lockdown. In April a report by NHS Providers, which represents hospital bosses, reported that some oncology departments had seen 85 per cent reductions in referrals.

Patients already in the treatment pipeline have also faced disruptions. Operations have been postponed to avoid those with weakened immune systems braving hospitals that may be Covid-19 hotspots. Intensive care units were set aside for virus patients.

For those diagnosed this year, the five-year survival rates are projected to drop from 85 per cent to 83.5 per cent for breast cancer, from 58.4 per cent to 56.1 per cent for colorectal cancer, and from 16.2 per cent to 15.4 per cent for lung cancer. An NHS spokesman said the IPPR estimates did not correspond with what was happening on the ground as hospitals worked to return to normal. However, NHS figures released last week showed that 50,000 people waiting more than a year to begin routine treatments, the highest level for a decade.

What’s needed now, he says, is an urgent shift in focus. “The government is throwing everything at a potential second wave of Covid; what about the cancer disaster that is already unfolding?” The emphasis, he says, must be on getting the NHS’s diagnostic pathways fully open.

“And that means getting rid of the backlog — the only way through is to extend the working day in diagnostic departments. So, the same way we did with Covid, we’ve got to get the same drive, the same incentives for staff to actually turn out more CT scans, more MRIs, more bronchoscopies, more endoscopies — all that stuff has to be at much greater speed.”

These departments “tend to shut at five o’clock and tend to not open at weekends . . . we’ve got all this expensive equipment just sitting there for two days idle. That the staff won’t come in — that’s the excuse. Well, pay them to come in and work out how we can do it with less staff. “Certainly you don’t need to have very highly skilled people in at the weekend; you don’t need to have any decision making. You just do the scan and read it later.”

Professor Sikora, a co-founder of Rutherford Health, a company that runs private cancer treatment centres, thinks more use needs to be made of private hospitals. Meanwhile, he’s urging anybody with warning signs to see their GP. “Forget the rest of my tweets, these are by far the most important,” he said in a message posted on Thursday. “So many times we’ve been unable to help because the cancer wasn’t caught early enough. Unusual lumps. Abdominal pain. Blood in poo/urine. Unexplained weight loss. Any persistent symptoms. Please get checked!”

Also, he says, be polite to NHS staff. “The problem with a complex system, and it doesn’t matter whether it’s a private hospital or a funded hospital, is that the people who are important may not be obvious. The pompous consultant with his Rolls-Royce in the car park may not be the key man you need to persuade to get him to do something for you. Maybe the relatively lowly receptionist is going to decide the order of play and can sort things out — so be pleasant.”

Karol Edward Sikora

Born June 17, 1948
Education
 Dulwich College, then Corpus Christi College, Cambridge, graduating with a double first. PhD from Stanford University, where he also served a clinical fellowship.
Career 
First worked in the NHS as a registrar at St Bart’s, London, in 1974. From 1985 to 1997 he was clinical director for cancer services at Hammersmith Hospital. He was also deputy director of clinical research at the Imperial Cancer Research Fund. From 1997-99 he led the World Health Organisation’s cancer programme. He co-founded Rutherford Health, a company providing cancer treatments.
Family 
Married to Allison, a former nurse, for 46 years, with three children and six grandchildren.HealthShareSave

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Comments are subject to our community guidelines, which can be viewed here.Comments(765)Most recommended

  • PP A Green21 AUGUST[Scanning departments] tend to shut at five o’clock and tend to not open at weekends . . . We’ve got all this expensive equipment just sitting there for two days idleI have often wondered about that. I was an airline pilot. I was well paid. But they expected me to turn up at all hours of the day or night, because we could not afford to keep our expensive equipment idle.Reply136RecommendReportShow 5 previous replies
    • JJohn22 AUGUSTP A GreenThe NHS has huge numbers of accountants and yiu would have thought at least some of them would know the financial strategy of “sweating the assets”.Reply6RecommendReport
    • GGrayling21 AUGUSTP A GreenI think the Prof has his own tunnel vision. I’ve worked in imaging for years. I do not know if an NHS imaging unit that isn’t working more than 9-5 weekdays. My unit is doing routine scanning 8-8 every day except Xmas day, Boxing Day and Easter Sunday. Emergency scanning is continuous. …See moreReply36RecommendReportShow all 7 replies
  • RRichard Fairbrass21 AUGUSTSo pleased I didn’t ‘clap’ the NHS. Politicised medicine exemplified by the NHS is killing people and wasting millions of taxpayer pounds. Not until we cut ourselves free from blind unquestioning support for the NHS will we be able to properly reform it and so improve patient outcomes and experience.Reply100RecommendReportShow 5 previous replies
    • RRedehelde22 AUGUSTRichard FairbrassYou are boasting about not clapping? It was for the people in the front line who risked and lost their livesReply2RecommendReport
    • TTECHNOPHOBEBLONDE21 AUGUSTRichard FairbrassI don’t think that people were clapping the NHS, they were clapping the people who work in the NHS who were (and are) struggling with a pretty dreadful set up at a time of mass hysteria. I don’t disagree that the NHS is a shambolic mess with a multitude of misguided notions and priorities, but the frontline workers are pretty low down the list of people to blame.Reply24RecommendReport
  • MMr Ali21 AUGUSTEditedThere really is so much wrong with the NHS. Not it’s not the frontline workers, but those who manage and organise it. It is riddled with self-congratulatory arrogance and complacency. But our sentimental reverence for a hugely inefficient, money-swallowing behemoth with outdated working hours, combined with politically motivated badge-wearing and virtue-parading cheerleaders, wilfully blinds us to being honest and properly critical about its many deep flaws. Just keep clapping, throwing the money and ignore all the innocent non-Covid sufferers who can be consciously ignored. Frankly, I am amazed that these sorts of scandalous statistics about cancer sufferers can be so lightly and casually ignored by the mainstream media, who are still fixated on the tiny number of Covid deaths and scaremongering about infection rates.Reply88RecommendReportShow 1 previous replies
    • MMissBrown22 AUGUSTMr AliI am amazed that these sorts of scandalous statistics about cancer sufferers can be so lightly and casually ignored by the mainstream media, ???Reply1RecommendReport
    • GGraham Gibson21 AUGUSTMr AliMr Ali, your post is refreshingly open and exposes the elephant in the room. You speak with authority that, I suspect, belies long experience. I have friends who are doctors, nurses and consultants working within the NHS who endorse your post. Frontline is exceptional but the rest are supernumerary dead weight. One dare not say that for fear of being judged a heretic.Reply18RecommendReport
  • MMoor Park21 AUGUSTI have followed Karol Sikora throughout the pandemic, and he has been proven correct in several aspects (the date of peak deaths, and the likely trend of cases). He has remained positive thoughout. One of his strengths is that he realises there are many aspects of the virus that we just do not know about. The other person who has been proven correct on the virus is David Starkey. I know that soe of his views on other matters are abhorrent – but have a look at his discussion on “How we committed economic suicide to try and save NHS capacity”.Reply71RecommendReportShow 4 previous replies
    • BThis post violated our policy.
    • MMoor Park22 AUGUSTBen, Did you read the article before posting your link?ReplyRecommendReport
    • FFreddie Moran22 AUGUSTMoor ParkHe is just spot on and refreshing – plain talk, my kind of doctor.Reply4RecommendReport
  • OOh I say21 AUGUSTI completely agree with him, the single minded obsession with covid, partly fuelled by media panic, has not helped anyone.Reply68RecommendReport
    • MMarcella21 AUGUSTOh I sayI am a neurology nightmare. Have been for ten years. I was treated in the Queens Square in Feb 2020 to reset the electrodes to my brain nerves. They refuse to treat me. They told me to switch off my electrodes after waiting over two years to have the surgery. Now I am now on another long waiting list.Reply9RecommendReportShow all 1 replies
  • RRobert Gregory21 AUGUSTI write as someone who was a practitioner in the NHS for 30 years. This is the best article I have read in a long time. The NHS is long overdue for reform and modernisation and has been protected as akin to a national religion for too long. Why if it is so good do no other countries copy it?Reply69RecommendReport
    • PPat21 AUGUSTRobert GregoryWhy do so many from other countries opt to work in our NHS? Other EU countries have “satisfactory” health care systems. But none is better than ours or without their own shortcomings. Unless you know otherwise.Reply2RecommendReportShow all 2 replies
    • MMissBrown21 AUGUSTRobert GregoryIt’s largely historical because the NHS came directly out of wartime mobilisation but the more important question is how come other countries can’t do universal healthcare cheaper than we do? Comparable systems spend much more money. No amount of reforming the NHS will change that and any move to a system similar to comparable systems will simply mean making people put more money into the system. A good chunk of inefficiency comes from resource-pressure and any world-class business will tell you that system improvement requires space and resources – which in the case of the NHS = money. Interestingly, Covid actually created some space for improvement by virtue of the fact the government threw money at the system at the same time as reducing pressure – to the detriment of patients.Reply3RecommendReportShow all 2 replies
  • TThe Toy maker21 AUGUSTEditedI agree and have said for a while that the excess lockdown of the NHS ( NOT the economy they are totally different issues) was a severe error. I have heard from a consultant that in his major hospital about 20-25% of the NHS staff there worked on Covid. What the ….. were the rest doing? Why close so very many hospitals to cancer care half for covid and the nightingales should have easily been enough half for cancer? Why did the GPs run and hide? and mostly still are? under 60 etc get back to work please. There is also dare I say – maybe exagerrating for effect, a lack of spine in many even most medics these days. IN war they danced through machine gun fire to rescue injured soldiers. This time round many ran a mile and shut up shop to avoid a small risk of infection while the few fought the battle on the front line….See moreReply53RecommendReportShow 2 previous replies
    • MMarie21 AUGUSTThe Toy makerMy son, who lives in Australia, was shocked when I described how our GP practices were operating. Currently, at his practice, patients phone for an appointment, are asked if they have any symptoms which may be Covid related and, having cleared that hurdle, are asked to wear a mask when they attend and that’s that. One difference between British and Australian GP practices is that in Australia they are paid per consultation. Patients may be asked to pay at the time of the appointment and reclaim the cost from the health department but most GPs ‘bulk bill’ the health department for all the eligible patients seen. One or two GPs charge slightly more than others, with the additional charge being met by the patient, although the GP has to remain competitive or patients may take themselves elsewhere. I’ve visited a GP there and was required to pay although GB has a reciprocal health arrangement with Australia. I was, however, given a receipted invoice and form to reclaim the cost from the health department, however, I was so grateful to be seen promptly and to receive excellent care that I decided not to claim a refund but that was my choice.Reply16RecommendReport
    • Ggondolier21 AUGUSTThe Toy makerEditedIn which war did doctors ‘dance through machine gun fire to rescue injured soldiers’, please? In WW1 the field hospitals were well behind enemy lines. It was the stretcher bearers who risked their lives rescuing the injured and taking them to safety.Reply6RecommendReport

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