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Daniel Johnson: What is a life worth? Why is cancer the one illness that provokes these deep moral issues in a way that nothing else quite does? Lionel, what made you angry enough to write your latest novel So Much For That?

Lionel Shriver: Part of it is that I went through the death of a close friend from peritoneal mesothelioma. Obviously, cancer is very emotive and very expensive.

Karol Sikora: The nice thing about the book is that you have four different illnesses in there and the problems are really the same in all of them — even with the girl with familial dysautonomia, which I'd never really heard about since I was a medical student. I had to look it up. The same can be said for your character, Jackson, with his complex psyche and his penis problem, asking for cowboy surgery and then going for expensive corrective surgery. Then there's his tragic end — cheap in terms of healthcare. We also have the father who fractures his femur, then ends up with a care problem and not a medical one. Who's going to look after this old boy who can't look after himself?  

LS: I tried to cover the bases. 

KS: It's been written with the US system in mind, and at a time when there's been a lot of interest in the healthcare debate there. But over here we have the same problem.

LS: The issue of costs and what you're willing to pay for a certain amount of life which may not even be very high-quality life, maybe even miserable, is huge. There's that cliché in the US: you can't put a dollar value on human life. That's exactly what we've got to do. It's not feasible to spend an infinite amount of money on each citizen. Yet you get these articles such as the one in today's Daily Mail which seem so scandalous. Here's this mother of twins with a rare disease and the mean NHS won't fund the expensive treatment of an off-label drug. 

KS: It's so topical. The Conservatives are promising to put £1 billion into cancer drugs because it's so easily understandable by the voter. But, talking as an oncologist, the effect of these drugs is not great. Is cancer worth £1 billion? Probably not. That's what I really like about the book. One thing I'd like to ask you: Goldman is the fictional oncologist. He doesn't have his character developed in any way. He's sort of aloof and patronising and yet we don't really hear about him. Only maybe a little towards the end...

LS: There is a section where I try to give him a character. 

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Abigail M.
May 15th, 2010
7:05 PM
I thought the quote in large print was rather mean-spirited: Lionel Shriver says everyone should have a rational set of resorts which "probably" would not include sex change operations, but the quote omitted the "probably". Whereas genital reconstruction surgery was liberating for me, I hated my body before, and love it afterwards, I felt dissociated from it and now feel wholly physical as well as a spiritual being, NICE would find huge numbers of QALYs from this cheap operation and should make it available to all who need it. I had to pay for mine, life-saving though it was.

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