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HOPING FOR A MIRACLE CURE

At the little cemetery on Rarotonga, the largest of the Cook Islands north of New Zealand, the graves of the dead slipped off the coast and were swallowed by the sea. Sixty or so headstones remain, marking the final resting place for the cancer patients — Australians, most of them; desperate, all of them — who travelled here in the late 1970s hoping for a cure. The rows of graves on this eroding parcel of land are wedged between the break and the one runway servicing the small island’s airport. Officially, this place is called Nikao Cemetery. But to locals, it’s Brych Yard, named after Milan Brych, a self-styled cancer therapist who gave false hope to the terminally ill and left a trail of bodies across the Pacific.

Brych (pronounced Brick) came to New Zealand in 1968 as a refugee from communist Czechoslovakia. He claimed to be a doctor, and soon got a job as a cancer therapist in the oncology unit at Auckland Hospital. In the early 1970s, he treated terminal cancer patients with what he said was immunotherapy. His treatments were said to consist of multiple injections of a serum taken from the patient’s blood, although critics believed he used nothing more than standard chemotherapy and high doses of steroids, which can lead to short-term improvements and mask the severity of some conditions. Nevertheless, Brych’s patients, all whom faced imminent death, were staying alive longer. Before long, stories were spreading about the exotic young doctor in Ward Eleven who was working miracles. Brych courted the spotlight. He invited the media to meet with his dewy-eyed patients. ‘The Doctor They Call God,’ one newspaper called him in a headline.

Brych was a short man with a wide forehead and dark, receding hair. He had a stiff, measured walk, and was supremely confident and flamboyant: he liked bold shirts and white suits, and wore big, square glasses. He was flashy, and earned a reputation as a playboy. Brych revelled in being the in-demand cancer specialist of the day. But as his profile grew, so too did questions about his methods. When challenged to produce evidence that his treatment worked, Brych always baulked. He refused to run a double-blind trial, and never published any findings to support his work. If his treatment was so successful, why wouldn’t he share it? Opponents labelled him a quack and a charlatan, and, eventually, medical authorities discovered he was a fraud; it turned out he’d never studied medicine and was, in fact, in a Czech prison for robbery at the time he claimed to have earned his qualification as a doctor. An inquiry later found there was no evidence he had ever treated any of his patients with immunotherapy.

Brych had been outed as an imposter, but this didn’t seem to make a difference. He had a devoted following: patients who had outlived the terminal prognosis they were given by other doctors. Brych was celebrated and fiercely defended by these patients and their families. Like advocates for most questionable cancer treatments, Brych’s apologists argued he was doing something that nobody else would do. They clung to the idea that there was some kind of conspiracy at work — a cure that the government kept secret, or which threatened pharmaceutical companies’ profits. It didn’t matter that he wasn’t a doctor; he had the answer, and he should not be stopped from administering his life-saving treatment. Brych’s chief supporter was the late Queensland premier Joh Bjelke-Petersen, who wanted him to set up a cancer clinic in the city of Brisbane. Doctors railed against the government’s plan to make sure it never happened.

Brych left New Zealand, and moved to the nearby Cook Islands, and it was on the rugged island of Rarotonga that he headed up the local cancer unit. Hundreds of patients were lured from Australia. They called him Doctor, paying roughly $10,000 each for his treatment, which they described as a six-month regimen of drips and injections. Many of them died. There were no autopsies on Rarotonga, and, as was the custom, the dead were buried within 24 hours in the little cemetery overlooking the ocean. Over the years, about a dozen graves have slipped off the remote island and have been washed away, their crumbling headstones left stranded on the shore. The remaining ones are relics to the infinite desperation felt by the people who once came here asking for help.

The Milan Brych case is one of the most high-profile cancer scams in recent history, but it is by no means unique. Self-proclaimed healers and so-called alternative practitioners have always deceived the sick and the vulnerable, selling a swathe of potions and promises. Cancer patients top the list of desperate people ripe to be lured into this flourishing cottage industry. These shysters who prey on them have touted the curative powers of everything from supplements to spirituality. They’ve sold salt water and herbal tea and juice, and high-dose intravenous vitamins, hash oil, flax seeds, and mistletoe. They have pedalled their cure du jour in varying forms of special alkalising diets and detoxes. And prescribed black salve, and laetrile, which is found in the seeds of some fruit, such as apricot pits. They have pushed homeopathic remedies and extreme hyperthermia treatment, and magnet, ozone, and electrical therapies, and crystals and colonics and hypnosis.

In one particularly disturbing case, two dozen terminal cancer patients died after rejecting conventional medicine and paying tens of thousands of dollars for a so-called miracle cure. In 2005, in Perth, Australia, four patients were dead within two weeks of beginning the treatment, which included intravenous infusions containing laetrile, caesium chloride, and an industrial solvent called DSMO. The cocktail of drugs was administered in a suburban home at the direction of disgraced Austrian doctor Hellfried Sartori, who had previously been jailed in the US for practising medicine without a licence. It was promoted as having a 95 to 98 per cent cure rate if the patient truly believed in the treatment, and was sold as ‘natural’ and ‘safe’. West Australian deputy state coroner Evelyn Vicker ruled it was neither. ‘It requires high doses of industrially manufactured substances and is manifestly unsafe,’ she wrote in 2012. ‘There is no doubt [Sartori] now perceives families desperate enough to turn to him, as experimental subjects who will pay for a chance, any chance, to survive.’

Many, many thousands of patients have trawled the globe in search of a magic bullet, travelling to clinics in Europe, to markets in Asia, and to the neon-lit streets of Tijuana. What Brych shares with his nefarious alumni of snake-oil salesmen is a trail of exploits targeting the desperate and the dying with the expensive lure of false hope.

Andrew Kaye walks briskly down a narrow corridor to his sixth-floor office in his wing of the hospital, and closes the door behind him. Andrew is busy. He gestures towards the couch opposite a wall of shelves stocked with encyclopedias and medical books, models of skulls, framed photos, plaques, and awards. He sits, cross-legged, in front of the shelves, and starts talking about cancer scams even before we get to the couch.

‘The big problem with all this,’ Andrew begins, ‘and why I’m talking to you — because otherwise I wouldn’t be — is that people are in the most vulnerable situation when they’re told they have got an incurable cancer.’

Andrew doesn’t hold back what he thinks. He is the first to admit that he can be a bit tactless. But he has a warm manner. He seems discerning and caring; the type of person you would want to tell you if you had a tumour growing in your brain.

‘If you come to me with a malignant brain cancer that has recurred, I would have to say there is no way we are going to cure you,’ he says. Then he says it again: ‘There is no way. We may be able to help your life a bit, we may be able to. But we cannot cure you.

‘But if you go to someone who says there is a very small chance you can be cured, well, people will grasp at that, and they’ll sell their homes. And this happens over and over and over and over again through the whole range of cancers.

‘It’s an enormous issue.’

Andrew is one of Australia’s leading neurosurgeons. He is based at the Royal Melbourne Hospital in Parkville, Melbourne. Over his long career, Andrew has come across many different types of cancer scams. Everyone who works in oncology has. It’s an unfortunate part of the landscape. The oncologists we spoke to said much the same thing: patients generally don’t turn down life-saving or curative treatment. But, if the cancer comes back, if it spreads, if it is terminal, patients and their families will search for alternatives. Studies show that the use of complementary or alternative treatment is widespread among cancer patients (alternative therapies are used instead of conventional treatment, while complementary therapies are used in conjunction with conventional treatment). Tertiary-educated young women are the most likely to seek them out.

‘The biggest problem we’ve had is people going onto these “special treatments” instead of what is conventional, best treatment,’ Andrew says. ‘Sometimes people are lured into cancer scams because they have a distrust of the medical profession, and sometimes that distrust is justified. But, mainly, it’s the futility of the diagnosis, and the hope for something better. Commonly, they have had a [conventional] treatment, and then the cancer comes back, and then they go off and search for something else.

‘But it’s not going to help, and it could make it worse, and they’re going to spend a lot of money.’

The scams, Andrew says, run the full gamut. Often, they will have a very thin basis in science but, when scrutinised, the treatment simply doesn’t hold up. The person selling the therapy is usually a real salesperson, too; they’ll always over-promise, something that doctors are cautious to do. But the real test of it, says Andrew and his colleagues, is the cost of the so-called miracle treatment. Who is going to make a buck out of this?

In Belle Gibson’s case, where she herself claimed to be suffering from cancer, something more complicated was at play. She chose the scariest disease in one of its most aggressive forms. In doing so, she played off the public’s better nature. Australian ethicist Julie Crews explains that Gibson’s story was taken at face value because people reason — consciously or unconsciously — that a sick person is also a truthful person. ‘Belle Gibson took it to a whole other level,’ Julie says. ‘What’s really interesting is that a lot of the people who were taken in were young women. I’m interested in the principal question: why are young women willing to listen to someone like Belle Gibson or Jess Ainscough instead of the scientists who know what they are talking about?’

Before becoming an academic, Julie worked in the Australian Competition and Consumer Commission’s small-business division. She has been exposed to a lot of different types of scams. ‘Belle is no different from the countless potential fraudsters out there willing to deceive people to make money,’ Julie says. ‘Unlike being “done over” by someone selling, say, a dodgy car where you lose money, “cancer gurus” play to a vulnerable group who may abandon evidence-based medicine for the hope being peddled [by] unproven alternative therapies.’

Julie lists example after example of health scammers. Some have written books, or work as health coaches, or have ‘cured their cancer’. They are similar in a couple of distinct ways. ‘They all just cherry-pick the truth,’ Julie says, ‘and there’s always these tenuous links, like, I was given six months to live and now look at me, I’m cured.’

Julie has used Belle Gibson as a case study in her classes. She explains that snake-oil merchants have always existed, but the way in which they operate has become much more sophisticated. It’s not a face-to-face transaction anymore — victims are targeted online. She asks her undergraduate students what an appropriate response is when someone like Gibson makes such extreme claims. ‘Number one,’ Julie says, ‘is verify the facts. But you’d be very surprised by what people say. Social media is one of the main ways that young people get their information now, and even when presented with the facts, it doesn’t seem to matter. Opinion has morphed into fact.’

Another respected oncologist in Melbourne is Mark Rosenthal. He explains how patient-blaming is at the heart of many alternative treatments on the market. ‘Patients are told: “You lived a dirty life to get cancer, or you’ve done something wrong, or your psychology was wrong so you deserved to get it.”’ This is what Mark says underpins the sales pitch. He isn’t talking about diseases with known causative links to lifestyle habits, such as smoking and lung cancer. He’s talking about the concept that a person who has cancer is somehow responsible for getting the disease. From there, he explains, it’s not a far leap to another facile concept: that conquering cancer is dependent on the patient’s willingness, or desire, or positive attitude. ‘Take, for example, an aggressive brain cancer, and someone says to you that it can be conquered. Well, no, you can’t conquer it. So somehow you’ve failed because your cancer grew and you’re dying,’ Mark says. ‘Once you’ve got an incurable cancer, it’s incurable. This notion of war, battle … I have to dissuade people that it’s a “fight”, because if it’s a terminal cancer, that is a “fight” they are going to lose. We have to try to counterbalance that idea that the patient is to blame.’

Mark is the director of a clinical trials unit, and a senior oncologist who has worked across neuro-oncology, prostate, and kidney cancer. He has seen first-hand how cancer treatments have improved and become more targeted over the years. More is known about the disease now than ever before. But as the medical understanding of cancer improves, he says, the community’s thinking about the disease has become more irrational. We are becoming less trusting of the science. Simple remedies are far more appealing than complex discussions about a terminal diagnosis. Or mortality. Mark now pre-empts conversations with patients before they ask him. Because they will ask him. And he’s about as blunt as he can be.

‘I say: there will be lots of people with well-meaning advice, telling you to eat this, drink that, do this, don’t do that. It’s all bullshit. I wish there was magic, but there is no magic. I have this conversation every day of the week, I’ve done it for 15 years. If there was magic, and I didn’t have to have this terrible conversation, I’d be using magic. If standing in a bucket of manure was going to make a difference, you’d be standing in a bucket of manure, and there would be a long line of people out the door behind you. It doesn’t work. If drinking a glass of orange juice makes you feel better, or coffee enemas or shark cartilage make you feel better, then fine, but if it was going to help treat your cancer, then we would be doing it. Meditating, great. Yoga, great. Healthy diet, great. But if it sounds too good to be true, it’s too good to be true. And if it sounds crazy, it’s crazy.’

One of Mark’s patients died on an aeroplane en route home from Germany after undergoing experimental cancer therapy. That’s the worst outcome he’s come across involving an alternative medicine. But he points out that the people who prey on the sick are not confined to the shadows. He says some conventional doctors also sell false hope and have pushed questionable treatments. One of Brych’s biggest supporters was a Melbourne GP who referred his cancer patients to Rarotonga. Mark says there are surgeons in Australia (he won’t name them) who charge small fortunes to perform operations that may not be worthwhile. But that begs the question, What is worthwhile? Is it an extra two or three weeks of life? Or six or 12 months? Another of Mark’s patients died in intensive care after having an operation that he recommended against. That’s the worst outcome he’s come across involving conventional cancer medicine.

Mark holds up his hands as though they’re a set of scales, raising one as he lowers the other. ‘I do this all the time,’ he says. ‘The question is always: how much good can we do, versus how much harm can we do? It’s about balance. The balance of why we choose treatments, and why we don’t use treatments.’ Mark knows to the percentage point the chances of his patients surviving their incurable cancer for six months, 12 months, five years, and even 10 years. But he tries not to put circles on calendars. Rather, he tells his patients that every person with incurable cancer is different, that their illness is unique, and that time will tell.

Mark also knows the chances that his patients have of benefiting from a certain type of medicine, compared to how likely they are to be harmed by it. That is the fundamental difference between conventional and alternative medicine. Doctors have to rely on the best available research and scientific evidence to assess, diagnose, and treat their patients. Alternative medicine, on the other hand, is often based on anecdotal evidence: wisdom passed down from generations, expertise garnered from case studies, word-of-mouth endorsements, and, increasingly, endorsements on Google, Wikipedia, and Instagram. This does not mean that all alternative medicines are useless. But most haven’t been assessed for their efficacy and safety in double-blind, randomised, controlled trials. That means their scientific basis has not been established. There has been no rigorous evaluation by ethics committees, no oversight from regulatory bodies, and, therefore, no clarity over what the patient is actually getting. The point of relying on scientific evidence is to mitigate and clearly communicate the risk of harm. If we don’t, how can we know what risk was considered before one course of medical treatment was recommended over another? What risk of harm did Gibson consider when she gave health advice? What risk of harm did Apple and Penguin consider when they promoted her miraculous cancer-survival story?

Cancer is complicated. It is not a single disease. And it has been around for thousands of years. The path to getting a drug funded, trialled, approved, and peer reviewed is tortuous for a reason. The alternative is the equivalent to an online classified. Complementary therapies, on the other hand, can be beneficial for cancer patients. But scams such as Gibson’s give all forms of unconventional treatment a bad name; they widen the yawning divide between conventional medicine and complementary therapies that are proven to actually help patients.

Mark doesn’t criticise the terminal patients who don’t heed his advice and go searching for something else. There’s a cultural expectation, he says, to try everything possible, as futile as that might be. Sometimes it’s not even being driven by the patient themselves; it’s pushed for by their families. Of course, the alternatives are always sold as something that puts the power back into the hands of the patient, giving them autonomy and just a glimmer of hope. When he describes these patients, he uses words like brave, courageous, grateful, and gracious. He says they deserve a quiet, peaceful death. Often, though, in these cases, that doesn’t happen.

‘The conversation about “no more treatment” is a really tough conversation,’ Mark says. ‘There should be an acceptance and a recognition that someone is dying. It’s a special time, not an easy time, but a special time. It can be a profound time: things are said that need to be said, things are done, patients resolve matters, plan for their family, and settle their affairs. And I think with a lot of these treatments — you might go overseas, you might try certain things, spend a lot of money, put in a lot of effort — you lose that time. The time that should be spent holding hands, talking, comforting each other. That’s lost.’

There is just one headstone in Brych Yard that bears the Star of David. It belongs to Nathan Steinkoler. He died on Rarotonga on 12 September 1977. ‘I still don’t feel like I’m over it, to be honest with you,’ his son, Leon, says through tears, the first time he speaks to us about Milan Brych. ‘When I think about what Milan Brych did to me and my family … I think that he robbed us.’ Leon Steinkoler was 19 years old when his father died at Brych’s island clinic. He’s now about to turn 60.

Nathan, a Polish Jew, was a Holocaust survivor. His father and two brothers were murdered in Auschwitz; his mother died in the Lodz ghetto; his sister was tortured, and worse. Nathan came to Melbourne in 1950, and started a delicatessen on Nicholson Street in Footscray. He worked hard, and valued an education for his children, Leon and his older sister, Adele. But he was a damaged person and a very private man; he didn’t talk about the war or the camps. In the late 1970s, when he was diagnosed with mesothelioma, a cancer of the lung caused by asbestos exposure, a Melbourne doctor referred him to Brych. Leon was about to sit his second-year exams to become a pharmacist, and his dad wanted him to stay at home and study. Leon remembers the last words his father spoke to him at the airport. ‘He said, “Don’t worry, I’ll be back soon,”’ Leon recalls. Within a month, Nathan was dead. There were no embalming facilities on the island, and so his body was buried the next day.

Leon has many unanswered questions about his father’s treatment, about why he deteriorated so quickly when he seemed well just weeks earlier, but he understands that the disease was terminal. It’s how his father died that haunts him still; how the final moments of his life were stolen from the family — precious moments when, sometimes, the dying say things that have gone unsaid for so long, moments that could have been life-changing for the next generation that inherited the trauma of war. Leon has seen it before. Australia has one of the largest Holocaust survivor populations per capita outside Israel. He was raised in Melbourne, home to more survivors than anywhere else in the country. He’s watched as a generation of Jews tattooed with Nazi ink has passed away.

‘It’s that critical time that was taken from us, that time when maybe he would have opened up, maybe he would have told me his story, like other survivors did as they neared closer to death,’ Leon says. ‘Dad was going to die, I know that, but he didn’t die with us. I’ve spent years trying to piece together bits and pieces, and it’s very hard because my father never told me anything, and then in the end he was taken, and I’m left feeling empty.’

Among the death records on Rarotonga is that of a young dancer from Melbourne, a farmer, and a lecturer. Christal Barker, 36, a mother of three, died on 7 June 1977. Joan Cossar, who had eight children, died four days later, and 21-year-old Christopher Homan passed away that same week. Thomas Fowler, 50, and Elisa Maree King, 9, both died in November. The youngest of Brych’s patients, five-year-old Jarred Nutt, who had a tumour in his head, died in the arms of his parents, Sonja and John, two days before Christmas.

Gloria Walker was a primary-school teacher in a Queensland farming region called the Darling Downs. She was diagnosed with advanced breast cancer when she was 35 years old. It was December 1976, a time when breast-cancer therapy was still in its infancy and when Brych was being hailed as a miracle worker. Gloria and her husband, Bob, flew to Rarotonga from Brisbane, and Gloria was treated at Brych’s clinic. At first, she responded well. Gloria sent her daughters a letter. She told her three girls she was looking forward to coming home; she’d bought them some little souvenirs on the island. In another letter, to her sister, Gloria wrote that she was ‘on the mend’. But after her fifth round of therapy, her condition suddenly deteriorated. Gloria died on Easter Sunday in March 1978. A week later, Bob returned to Australia without his wife, and collected his three girls from boarding school. ‘Brych was huge news at the time,’ says Cate, the middle daughter, now in her 50s. ‘But it was just a scam, a scam to make money out of terminally ill cancer patients. These were desperate people who were taken advantage of in the most cruel way.’ Cate’s father told her that Brych had cried with him after Gloria died; he was apparently upset because the cancer had been ‘cured’ — he claimed Gloria had succumbed to a blood clot caused by a drip administered before she got to the island. Her father believed him.

Like many other Australians who flew to Rarotonga in search of a cure, Gloria died in pain, in a foreign place, far away from her children. There was no chance for goodbyes, and there was no funeral service. For decades, all that was left was a deteriorating grave in an overgrown, neglected cemetery. That upset Cate so much that she spent many years leading the effort to preserve and restore the island graveyard where her mother is buried. Such is the importance of death and a final resting place that she’s come to know many of the families who lost loved ones at the hands of Milan Brych.

Not long after Nathan and Gloria were buried, Brych moved to the US, to California, where he started plying his trade again. This time, he added even more to his list of fake credentials: an honorary degree from Cambridge University, and claims to have treated Betty Ford and Happy Rockefeller. Business was as lucrative as ever: he drove a Rolls-Royce silver shadow, and lived in a Bel Air mansion.

On 15 September 1980, Brych was paid a visit. An undercover agent from the California Board of Medical Quality Assurance had been sent to meet him at a clinic in the eastern suburbs of Los Angeles. The agent was perfectly healthy, but told Brych that he had aggressive lung cancer. Brych took a blood sample from the agent, confirmed his cancer diagnosis, and promised the young man a cure. He prescribed a six-stage treatment using a special serum from Europe that would target and destroy the tumour. It would be shipped to the US, and it would cost $60,000. A week later, when the agent returned and paid the first instalment, $9,600 in cash, Brych was arrested. The ‘serum’, it turned out, was a common chemotherapy drug that, at the time, cost about $10 a vial.

Brych went down, convicted of numerous offences, including grand theft, practising medicine without a license, and selling a fake cancer cure. During his trial, he was described as a callous conman who preyed on terminally ill cancer patients. Superior Court judge David Aisenson said the crime targeted victims who were particularly vulnerable. Speaking after the court case, Lee Harris, the then LA district attorney, was asked if he could understand how Brych’s victims could be sucked in. ‘Certainly,’ he replied, ‘there were certainly people that testified for the defence, for Mr Brych in this proceeding, that spoke very highly of him, believing in good faith that they had been cured of cancer, when in fact, in certain instances, there was no evidence that they ever suffered from cancer, or if they had a malignancy, it was a low-grade malignancy characteristic of long-term survival.’ Brych was sentenced to six years’ jail, but released after three. Upon his release and deportation from the US, he was reported to be in Switzerland, and, most recently, the United Kingdom. It is unknown where he is now. If Brych is still alive, he would be in his late 70s.

On 5 May 2015, the tabloids in Britain reported that a young mother from Brighton had died after returning from a cancer clinic in Tijuana, Mexico. Samantha Beaven had been diagnosed with cervical cancer when she was pregnant with her second daughter. The primary-school teaching assistant had gone to doctors complaining of bleeding and cramps, but her symptoms were initially dismissed as part of the pregnancy.

Then, contraction-like pains started at 26 weeks. An internal exam in hospital found something on her cervix which, two days later, was confirmed as cancer. The plan was to try and make it to 30 weeks before scheduling a Caesarean and full hysterectomy, but, days later, Samantha woke up to find her waters had broken. Her second daughter, Daisy, was born the same day, in late October 2013, weighing just 1 kg.

The prognosis at that point was that the cancer could be fought with chemotherapy and radiation, which Samantha started immediately. But then, in early 2014, Samantha developed a cough. It didn’t go away after a couple of rounds of antibiotics, so an X-ray was ordered. The GP called back the same day. The cancer was now in her lungs. It was terminal.

Samantha married her husband, Alex. Their daughters Bracken, six, and baby Daisy were bridesmaids. Six months later, Samantha had a seizure. More tests revealed there were 30 to 40 tumours in her brain. She was given six months to live. Samantha was treated with cannabis oil and five sessions of palliative radiotherapy to the head. And then, she and her husband learnt about a clinic in Mexico, a city where dozens of clinics sell unconventional, unproven, and controversial cancer therapies. The family sold off their possessions, and launched a fundraiser so they could fly to Tijuana in late February 2015.

Samantha and her husband stayed there for 10 weeks, spending US$100,000 on the treatment. Then, days after returning home to the UK, Samantha died from pneumonia. She was 29 years old. The announcement on the family’s Facebook page about her death said it was a lung infection, ‘not the cancer’, that killed her. The tabloids referred to the experimental treatment, called hypothermia treatment, as a ‘pioneering’ cancer therapy.

About 18 months after her death, we asked Samantha’s husband, Alex, a stage builder, how he now felt about the treatment. ‘The treatment, the respect, and the love from all the doctors and nurses was fantastic, they cared so much,’ he told us. ‘They made daily visits to people’s apartments if they required it. Or even just to say hello. I strongly believe that Sam was cancer-free and feeling good after her treatment. Sadly, she caught pneumonia from the cold/air conditioning from the plane on the way home.’

He also said that two days after arriving in Tijuana, Samantha had a full body PET scan that showed her brain was cancer-free. ‘The high dose of oil was working,’ he said. We asked Alex for copies of the scan, so we could get them examined by an oncologist. He said he had them, but they were stored and locked away.

Hope is a difficult thing to define. Australian author Juliette O’Brien, whose cancer-specialist doctor father died of a brain tumour in 2009, wrote about it in This is Gail, a book about her mother’s life during her husband’s illness and after his death. She uses a graph showing patient survival rates for glioblastoma to capture this acute human emotion that drives us to do the extraordinary.

‘Along the y-axis,’ Juliette writes, ‘is the number of patients still alive, and along the x-axis is time. As the curve moves from left to right, it plunges from high to low. It sweeps through milestones — three months since diagnosis, six months, one year, two years — falling towards the x-axis and illustrating fewer and fewer survivors. The curve falls to a place just above the straight black line. But it never quite reaches it. A small gap remains between the curve and the axis.

‘This is where hope lives.’