Cancer specialist Dr Karol Sikora sees the NHS as a wasteful communist relic, but he is optimistic about the chances of improved cancer care. Johanna Gornitzki reports
Leaning comfortably back in a chair in his Harley Street office, Dr Karol Sikora does not seem afraid of expressing his opinions. Criticising the current public health system, he smiles as he nicknames the NHS "the last bastion of communism in Europe".
"I think it is dreadful. The whole system has to be chopped down. We need to demolish the icons of the past - waiting times, targets and political propaganda - and crack them apart like the statues of Lenin scattered around Eastern Europe," Dr Sikora argues.
He says it with a glimmer in his eye, but there is no mistaking his determination.
Dr Sikora started his medical career as a student at Cambridge. After graduating and working in various places in the UK, Dr Sikora spent most of his career at Hammersmith Hospital, first as clinical director of cancer services, then in his current role as visiting professor of cancer medicine and honorary consultant oncologist for Imperial College School of Medicine.
While he is vocal about the failings of the NHS, Dr Sikora is above all renowned for his cancer expertise. Seen as one of the foremost cancer specialists in the UK, in 1997 he was elected the head of the World Health Organisation's (WHO) cancer programme. It taught him that cancer is a global phenomenon not confined to the West and that well thought-out planning, rather than money, is the most effective way to combat the disease.
He says: "I think the problem with cancer is exactly the same in rich and poor countries. When trying to beat the illness, the important thing is to develop a strategic plan that maximises the resources.
"Politicians, of course, want to have high-tech breast cancer units offering high-class drugs, but that is not the way to go about it. Instead what the WHO is trying to do is persuade governments to think strategically about what to do for cancer rather than just investing in new technology."
"For example, in West Africa the most common cancer is hepatoma, liver cancer, because of the spread of hepatitis.
"Therefore, the most important thing for cancer in West Africa is to immunise children against hepatitis B. That only costs $2 per child," Dr Sikora says.
Finding simpler and cheaper ways to fight cancer will become crucial as the disease is getting more common in the poorer parts of the world. Dr Sikora explains why.
He says: "The reason cancer is going to become much more common in some middle income countries is that people live for longer.
"While cancer is relatively rare in people under the age of 50, the occurrence peaks between the ages of 65 and 75.
"So, as the population around the world ages, cancer is starting to spread."
Although this paints a gloomy picture, Dr Sikora believes it will only be a matter of time until we will be able to control cancer.
He says: "At the moment, most cancers are seen as critical illnesses, with only a few exceptions, like skin cancer. However, increasingly, small cancers are getting to that stage when they are becoming curable cancers and there will come a time, maybe in 10 or 15 years, when cancer will become a chronic controllable disease, a bit like diabetes."
This is likely to cause problems for the insurance industry, specifically in working out if policyholders with cancer should continue to be eligible for a payout on their critical illness (CI) insurance policies.
Dr Sikora is well aware of the issues facing the sector.
He says: "I think the insurance industry is sort of stuck. It has to be seen as very consumer-friendly, but people are taking advantages of any loopholes the system offers and with increasing advances in medicine, due to the breakthrough in molecular biology, there are more and more shades of grey.
"The insurance industry has to assess the future in terms of today's claims assessment. But if you take the definition of cancer, for example, what happens if you get a new diagnostic test?
"This is where the problem lies and because of these uncertainties the definitions have therefore become more difficult to make robust."
As far as CI goes, Dr Sikora thinks the industry needs to carefully watch the developments in cancer care.
"I think, increasingly, as the years go by, in terms of CI policies insurers have to review what is going on with cancer, both in terms of diagnostic and cancer therapy in order to balance their books."
One solution could be genetic testing. Back in the 1970s, Dr Sikora and his colleagues thought gene therapy would become part of everyday practices within a decade.
Dr Sikora still believes the day gene testing will be commonplace is not far away.
"What is likely to happen over the next 10 years is that certain genes - called cancer risk genes - will be identified.
"This means people will increasingly be able to find out whether they suffer an increased risk of developing cancer," he says.
He refuses to rule out insurers being allowed to run genetic tests, saying: "This is a very difficult area. I think you have to have complete openness between the client and the insurer. If you do not, the insurer will go bust and all the policies will come to an end."
Dr Sikora thinks the independent sector has to drive the future, arguing the pharmaceutical industry will lack financial incentives.
"It is clear that we are going through an era where we have a lot of costly drugs," he says.
"The future, therefore, has to be about developing diagnostic tests that can be used on patients to prevent them from developing cancer. This would help control healthcare costs.
"However, the incentives will not come from the pharmaceutical industry as they only want to sell drugs, but from the insurance industry."
He also does not think the NHS will be up to the task, saying the public health service will remain the "political football" that it currently is.
Using the recent debate about the breast cancer drug, Herceptin, to make his point, he says: "The Herceptin debate is politically very sensitive. The minute the Government says the women currently protesting can have the drug all women in the UK can have it.
"This shows the problem we have when politics is interfering and favours high-cost cancer drugs like Herceptin because if you give all the money to fund these drugs where do you get the money from? You either have to get new money or take it from somewhere else, like elderly care, for example," he says.
Moreover, the Government's decision to stop increasing NHS spending in 2008 will only make the system's shortcomings more apparent, adds Dr Sikora.
He ends with is a warning of what lies ahead: "In the last few years, we have seen money coming in and just about been covering up the cracks. But when the money seizes up, the cracks will appear again."
CV
1986-present: Professor of cancer medicine and honorary consultant oncologist, Imperial College School of Medicine, Hammersmith Hospital
1997-1999: Director, WHO cancer programme, Geneva
1986-1997: Clinical director for cancer services, Hammersmith Hospital
1972: Graduated (MBBChir) from Cambridge.
