The cynicism behind Blair's cancer pledge

It is a cause with blameless victims; something the middle classes feel strongly about

Surely it is unusual, to say the least, for a prime minister to direct his promises in the direction of a specific disease; particularly if it isn't one which public policy can influence. A government can, surely, worry about diseases stemming from obesity, smoking, alcohol or different social behaviour; these are things which it can hope to influence through policy.

Surely it is unusual, to say the least, for a prime minister to direct his promises in the direction of a specific disease; particularly if it isn't one which public policy can influence. A government can, surely, worry about diseases stemming from obesity, smoking, alcohol or different social behaviour; these are things which it can hope to influence through policy.

It's very odd, however, for the Prime Minister to make promises about breast cancer. Yet this week, the Prime Minister pledged that, by 2008, all women would be seen by a consultant within two weeks of being referred by a GP.

One's immediate response is "good", but rather quickly followed by the reflection that, in a modern health service, it is slightly surprising that it needs a prime ministerial pledge before you can get an appointment with a consultant in less than two weeks for a life-threatening disease.

But why is the Prime Minister focusing on breast cancer in particular? Is it entirely his job to decide which forms of cancer should receive priority treatment? Of course, breast cancer can be a tragic thing. No one would claim it isn't a very harrowing and distressing illness.

Nevertheless, in directing his attention towards breast cancer, the Prime Minister is choosing something which nobody will disagree with. It is a cause with blameless victims; it is something which the middle classes feel strongly about; it has an immediate poignancy, particularly if you've never directly experienced it.

Why did the Prime Minister not commit himself to providing a consultant's appointment within three weeks, say, in the case of all forms of cancer? The obvious answer is that it couldn't plausibly be done within budget constraints. The real answer is that if you commit yourself to breast cancer alone, then that will be good enough for your reputation.

Other forms of cancer are not quite so suitable for a prime minister's attention. One would have thought there was no less urgency about lung cancer - perhaps more, since it causes considerably more deaths - but of course there are no votes to be had out of a cancer widely perceived as self-inflicted. Prostate cancer is almost as dangerous as breast cancer, also "blameless" and just as humiliating for the victims; it is, however, slightly obscure, doesn't conjure up a clear picture, and is going to be neglected by the Prime Minister.

One doesn't have any objections to the Prime Minister expressing concern about breast cancer. Indeed, if it helps those suffering from breast cancer to get better and swifter treatment, nobody could seriously object.

Unless, of course, you consider that this sort of service should be available for all serious diseases; that treatment for less photogenic conditions should not be allowed to lag behind those which may be useful to politicians at election time.

In its third annual survey of sexual health services, the Terrence Higgins Trust has noted that considerable, worrying rises in the incidence of sexually transmitted diseases have not been reflected in any change of provision by health professionals. Worse, it hardly seems to have influenced anyone's planning. A third of primary care trusts don't include sexual health in their local delivery plans at all.

Two thirds of responding clinicians said they had had to turn away patients; 20 per cent of patients had to wait a month for a test for a sexually transmitted infection, and some, incredibly, had to wait up to four weeks for an HIV test. Now, there has been a considerable increase in the incidence of sexually-transmitted diseases in the past 10 years; some figures suggest an increase of nearly 1,000 per cent in the rate of syphilis since 1996. Year on year, there seems to be an increase in diagnosed HIV of around 20 per cent.

You will, however, wait a very long time before hearing the Prime Minister make any kind of commitment relating to sexually transmitted infections or HIV. There are no votes to be had out of sexual health, just as there are no votes to be had out of dozens of low-profile illnesses and conditions. The Prime Minister is going to stick to safer ground.

It is not really his job to specify diseases which are to receive a higher priority in treatment. That, inevitably, must remain a clinical decision.

It would be very worrying for doctors to have to say to cancer patients that they could see a consultant in two weeks, were it not that they have the "wrong" cancer.

It's frankly frightening that a condition where diagnoses are increasing 20 per cent, year on year, is not being specifically addressed because it doesn't, in any way, represent an electoral opportunity.