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Taking responsibility
Leading Edge
Taking responsibility Lifestyle changes: this simple phrase is often used in the context of cancer prevention, but its implications are far from straightforward. Unlike genetic factors, environmental effects on the human body are, more or less, controllable if sufficient measures are provided on a societal level and individuals have enough willpower. However, many people find the concept of change difficult, and this situation can result in obstinacy and, sometimes, the apportioning of blame on others. This type of irrational behaviour has helped strengthen an increase in the use of litigation, and now, more than ever, the consequences of a blame and compensation culture dictate our daily lives to an unprecedented extent. The latest example of this ethos is highlighted in a recent issue of Tourism Management, in which Peattie and colleagues (Cardiff Business School, Wales, UK) warn that travel companies may be leaving themselves liable to compensation claims from patients with skin cancer if they do not change their business practices by providing comprehensive advice on sun protection and by changing the methods used to market summer-sun holidays. The parallels between this warning to travel operators and the lawsuits seen in recent times against the tobacco and food industries about seemingly voluntary activities are palpable. And as Peattie and coauthors note, although it would be extremely difficult to establish causality between sun exposure on a certain vacation with presence of melanoma many years later, a defence on the part of travel agents that the consumer consented to the risk by choosing to book a particular holiday might not be sufficiently robust in court. Although travel agents must clearly improve their advice on sun protection to ensure that awareness among holidaymakers is raised to a level comparable with that attained for deep-vein thrombosis, vaccination, drinking-water purity, and food hygiene, any attempt to apportion directly legal culpability on the travel industry for the incidence of melanoma would be absurd. Compensation proceedings have an important role in ensuring a fair and just society, but their use in incredible situations is becoming overly abused, and curbs are needed urgently to prevent the increasing number of spurious http://oncology.thelancet.com Vol 6 September 2005
claims by people whose only objective is exploitation for personal gain. There is no denying the link between exposure to ultraviolet radiation and skin cancer, but the amount of time spent in the sun while on vacation is clearly the responsibility of the individual and is completely different, for example, to the liability employers potentially have towards workers whose job is done mainly outdoors. Likewise, prevention of a possible doubling in risk of developing malignant melanoma in later life for children who become sunburned during their family’s holiday is the responsibility of the parents—not a travel company who sold a vacation. In this situation, parents should be adopting a good sun-protection strategy for their family, such as the SunSmart code widely promoted in Australia by The Cancer Council Victoria and in Britain by Cancer Research UK. Despite these concerns, it often does not matter how much advice is given because a change in lifestyle to reduce personal risk is a choice that many are not prepared to take. For example, a review published on August 20, 2005, in the Journal of Clinical Oncology showed that even among cancer survivors many do not positively modify their lifestyles after diagnosis; changes such as improved diet, cessation of smoking, or a reduction in bodyweight are commonly not made despite obvious risks. In an accompanying editorial, Patricia Ganz (Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA) suggests that oncologists have an important role in this situation: “. . . the diagnosis of cancer and the transition to cancer survivor are teachable moments . . . that have the potential to motivate individuals to adopt risk-reducing or health-protective behaviours”. Ultimately, however, the effectiveness of such interventions relies heavily on the willingness of an individual to accept change. A change in lifestyle involves crossing a psychological barrier, and the rise in social acceptability of a blame and compensation culture has, for some people, reduced the incentive to take such a step. But by taking responsibility for one’s own actions, initiating even small changes can make a difference. And during the summer months, is it really that difficult to slip, slop, slap? ■ The Lancet Oncology
Tourism Management 2005; 26: 399–408 SunSmart programmes http://www.sunsmart.com.au http://www.cancerresearchuk/ sunsmart
633
Taking responsibility Lifestyle changes: this simple phrase is often used in the context of cancer prevention, but its implications are far from straightforward. Unlike genetic factors, environmental effects on the human body are, more or less, controllable if sufficient measures are provided on a societal level and individuals have enough willpower. However, many people find the concept of change difficult, and this situation can result in obstinacy and, sometimes, the apportioning of blame on others. This type of irrational behaviour has helped strengthen an increase in the use of litigation, and now, more than ever, the consequences of a blame and compensation culture dictate our daily lives to an unprecedented extent. The latest example of this ethos is highlighted in a recent issue of Tourism Management, in which Peattie and colleagues (Cardiff Business School, Wales, UK) warn that travel companies may be leaving themselves liable to compensation claims from patients with skin cancer if they do not change their business practices by providing comprehensive advice on sun protection and by changing the methods used to market summer-sun holidays. The parallels between this warning to travel operators and the lawsuits seen in recent times against the tobacco and food industries about seemingly voluntary activities are palpable. And as Peattie and coauthors note, although it would be extremely difficult to establish causality between sun exposure on a certain vacation with presence of melanoma many years later, a defence on the part of travel agents that the consumer consented to the risk by choosing to book a particular holiday might not be sufficiently robust in court. Although travel agents must clearly improve their advice on sun protection to ensure that awareness among holidaymakers is raised to a level comparable with that attained for deep-vein thrombosis, vaccination, drinking-water purity, and food hygiene, any attempt to apportion directly legal culpability on the travel industry for the incidence of melanoma would be absurd. Compensation proceedings have an important role in ensuring a fair and just society, but their use in incredible situations is becoming overly abused, and curbs are needed urgently to prevent the increasing number of spurious http://oncology.thelancet.com Vol 6 September 2005
claims by people whose only objective is exploitation for personal gain. There is no denying the link between exposure to ultraviolet radiation and skin cancer, but the amount of time spent in the sun while on vacation is clearly the responsibility of the individual and is completely different, for example, to the liability employers potentially have towards workers whose job is done mainly outdoors. Likewise, prevention of a possible doubling in risk of developing malignant melanoma in later life for children who become sunburned during their family’s holiday is the responsibility of the parents—not a travel company who sold a vacation. In this situation, parents should be adopting a good sun-protection strategy for their family, such as the SunSmart code widely promoted in Australia by The Cancer Council Victoria and in Britain by Cancer Research UK. Despite these concerns, it often does not matter how much advice is given because a change in lifestyle to reduce personal risk is a choice that many are not prepared to take. For example, a review published on August 20, 2005, in the Journal of Clinical Oncology showed that even among cancer survivors many do not positively modify their lifestyles after diagnosis; changes such as improved diet, cessation of smoking, or a reduction in bodyweight are commonly not made despite obvious risks. In an accompanying editorial, Patricia Ganz (Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA) suggests that oncologists have an important role in this situation: “. . . the diagnosis of cancer and the transition to cancer survivor are teachable moments . . . that have the potential to motivate individuals to adopt risk-reducing or health-protective behaviours”. Ultimately, however, the effectiveness of such interventions relies heavily on the willingness of an individual to accept change. A change in lifestyle involves crossing a psychological barrier, and the rise in social acceptability of a blame and compensation culture has, for some people, reduced the incentive to take such a step. But by taking responsibility for one’s own actions, initiating even small changes can make a difference. And during the summer months, is it really that difficult to slip, slop, slap? ■ The Lancet Oncology
Tourism Management 2005; 26: 399–408 SunSmart programmes http://www.sunsmart.com.au http://www.cancerresearchuk/ sunsmart
633