“We have the power to defy the selfish genes of our birth.” – Richard Dawkins, The Selfish Gene
Christopher Jackson was 18 when he read The Selfish Gene. He remembers it as one of the books that shaped the way he learned to think about science. There is something fitting about that choice. The young reader drawn to a book about the forces that shape us became an oncologist increasingly interested in the forces that shape cancer care and in whether those forces can be changed.
Today, Professor Christopher Jackson, a medical oncologist and co-lead of New Zealand’s Cancer National Clinical Network, has helped reshape cancer care far beyond the patients he treats. His work has touched clinical oncology, national cancer policy, quality improvement, advocacy, and the global conversation around Common Sense Oncology. But in his telling, none of this began with policy. It began with patients.
“It was always the patient in the clinic that was the big anchor and the big motivator.”
That patient in the clinic, the person waiting too long, diagnosed too late, or unable to access care on equal terms, became the thread running through Jackson’s career. It is also the thread running through the question his work keeps asking: when oncology says it is making progress, who is that progress really for?
Medicine Is Not Only About Cures
Jackson did not enter oncology because he was fascinated by one particular cancer or one specific treatment. He was drawn there through people.
He began in general medicine, where he found himself especially interested in communication and in the relationships doctors build with patients. That interest led him toward palliative care and eventually oncology.
It was there, he says, that his understanding of medicine began to change.
“Medicine wasn’t just about curing people. It was about being there and being present during suffering.”
For a young doctor, that realization mattered. Oncology exposed him to illness that could not always be reversed, and to patients whose needs went far beyond prescriptions or protocols.
“Many people, when they get into medicine when they are youngsters, they have this false idea that medicine is all about cures. But that element of just being there with someone and helping them through a tough time really felt very, very meaningful.”
Presence, in other words, became part of the work. But over time, listening closely to patients also revealed something else: many of the hardest problems they were facing were not random failures. They were patterns.
When Individual Stories Reveal Systemic Problems
In clinic after clinic, Jackson began hearing versions of the same story. Patients were diagnosed late. Screening did not reach everyone. Waiting times were too long. Access to oncology specialists and advanced drug therapies varied.
“When I was just listening to my patients coming in, appointment after appointment, new patient after new patient, it became pretty obvious that a lot of the problems they were facing with their diagnosis weren’t glitches, they were features.”
A single story could be dismissed as an exception. But repetition made that impossible.
“Any one individual patient’s story could say, oh, well, that’s just a single incident. But actually it was a consistent thing that was happening time and time again.”
That realization changed the scale of his work. If the same barriers kept appearing patient after patient, then helping people required more than being a good clinician inside one consultation room.
“If I wanted to help the patients with the problems in the clinic, you had to look more broadly than that and start thinking about systems-based interventions.”
That thinking led Jackson and colleagues into healthcare quality, cancer outcomes, and what he calls the “postcode lottery” of cancer care – the way a patient’s chance of timely diagnosis, treatment, and survival could depend on who they were and where they lived.
The Patient Who Made the Question Public
Then one patient brought those questions out of research and policy circles and into the public eye.
Blair Vining was a Southland farmer, husband, father of two, and former rugby player and coach. In Jackson’s account, Vining was 38 when pain in his calf led to the discovery of a DVT. Further scans revealed pulmonary embolism and liver metastases. By the time he was referred for specialist care, he had been told there could be a two-month wait.
He came to see Jackson privately and asked the same questions Jackson and colleagues had already been asking through their research.
“Why do people have to wait so long? Why is the system not delivering for people? Why do people living in one part of the country have a different outcome to others?”
Vining’s questions were direct because his situation was direct. He did not have the luxury of waiting for a system to gradually become fairer. But he also did not limit the question to himself. His story became a public challenge to the idea that cancer care could vary so sharply within one country.
Jackson describes him as a patient with “an enormous reach with the community,” someone who led a public-facing part of the campaign for a national cancer agency.
“That relationship was very influential for me in my journey as an advocate as well.”
The force of Vining’s advocacy was not only that he told a personal story. It was that his personal story exposed a national structure. The question was no longer whether one patient had been unlucky. The question was whether the system itself was organized in a way that made unfairness predictable.
When Your Postcode Changes Your Cancer Care
The inequities Jackson and collaborators were documenting became known as New Zealand’s “postcode lottery” of cancer care. Outcomes varied across the country, with major differences affecting Indigenous and rural New Zealanders and patients living in different regions.
At the time, New Zealand had about five million people and 20 regional authorities responsible for delivering healthcare, alongside a disconnected primary care network.
“We’re a country of 5 million people. So having 20 regional authorities for the management of 5 million people was just crazy.”
The issue was not only the number of authorities. It was the fragmentation that followed.
“In a small country of 5 million, that meant that the leadership was very diffused and it was very difficult to achieve anything meaningful in terms of structural change or coherence or consistency of care.”
Even when hospitals were shown where cancer care was falling behind, there was little national mandate to require change.
“You could do it one hospital at a time, take 20 lifetimes to achieve that, or you could do something fundamental and structural in terms of changing the environment.”
Twenty lifetimes were not an option. Structural change was.
But identifying a policy solution was not enough. The harder task was making the problem emotionally and politically impossible to ignore.
“The first challenge, I think, was, as always, hearts and minds.”
Jackson and colleagues knew that asking the public to support “a new government bureaucracy” would not move people. Instead, the campaign centered the people already living with the consequences of the system.
“We anchored the story and the experience of the patients and told a story of how people were missing out.”
That changed the campaign’s emotional center. It was not simply a critique of what was broken. It was an argument for what could be built.
“What we did was we said there’s an immediate solution that we can achieve, and that is a solution which is based in fairness and one which is based in hope.”
As patients and families shared their experiences, the issue moved beyond academic papers and policy conversations. It entered the public imagination.
“We got that juggernaut rolling. And after a while, the story started to tell itself.”
The government was not initially eager to proceed. But the pressure kept building until the idea of a national cancer agency became difficult to resist.
“After a while they saw it was something that the people wanted. And they gave us room to say, yep, okay, fine, get on with it.”
A National Agency Meets a Pandemic
For a moment, it seemed the hardest part had been won. Then, only a few months into establishing the agency, COVID-19 arrived.
The timing could hardly have been more dramatic. New Zealand had just started building a national cancer structure when the pandemic forced the health system to prove whether national coordination could actually work.
Being geographically distant gave the country something valuable: time. New Zealand could watch what was unfolding in Italy, the United States and the United Kingdom, and use those extra weeks to prepare.
“We could see what was happening in other places and get ahead of it a little bit more.”
One lesson was already clear: if screening, diagnosis and treatment simply stopped, cancer patients would pay the price later. So while services elsewhere were shutting down or slowing, New Zealand tried to keep cancer care moving.
“We managed to preserve and keep the services open. We managed to make sure that people who had cancer still got their treatments on time.”
That required constant communication. National teams met every day – sometimes several times a day – to share what was happening and coordinate decisions.
“We were all paddling in the same direction.”
The emergency response became a demonstration of what national leadership could do. It showed that coordination was not bureaucracy for its own sake; it could protect diagnosis, treatment, and continuity of care at precisely the moment a fragmented system might have failed.
After the urgency of the pandemic came the slower work: data systems, quality improvement, cancer genomics, drug access, and national standards. The moment of radical change had passed into the work of implementation.
“We’re in a process of evolution rather than revolution.”
That phrase could describe more than the New Zealand cancer system. It also describes the next part of Jackson’s work: not rejecting oncology’s progress, but asking whether its direction still reflects the values of the people it is supposed to serve.
When Cancer Progress Starts Looking Like The Emperor’s New Clothes
That question is part of what drew Jackson toward Common Sense Oncology. He joined the movement after Professor Chris Booth invited him to its first meeting in Kingston, Ontario, where only around 30 people gathered.
The invitation resonated with him as a New Zealander. Although New Zealand is a high-income country, it has always had to be deliberate about how it spends healthcare resources. From that distance, some global oncology trends looked difficult to justify.
“Sometimes the stuff that goes on in other countries, we look at that and we feel like it’s an episode of The Emperor’s New Clothes.”
The uncomfortable question was whether oncology had become so eager to call something progress that it had stopped asking how much that progress was actually worth to patients.
“Are people really suggesting a $300,000, $400,000, $500,000-a-year therapy which extends people’s lives by four and five weeks? Is that really what we need to be doing? Is that really what’s important?”
Jackson is careful not to dismiss oncology’s real victories. He points to major advances in testicular cancer, lymphomas and leukemias, and to the impact of immunotherapy in melanoma and lung cancer.
Those are genuine successes. His concern is what happens when dramatically smaller gains are described with the same enthusiasm.
“You just can’t compare those sorts of changes to these tiny, tiny, tiny gains with horrific toxicities at massive costs in other areas.”
Once such numbers leave a conference presentation and enter the clinic, the calculation can look very different. Jackson describes telling patients that a treatment might help them live two or three months longer but cost something close to the value of their family home.
“They would look at me and go, are you crazy? Why would I do that? I want to spend time with my family and do things that matter to me.”
Those conversations are difficult to fit neatly into a progression-free survival curve. They involve financial toxicity, treatment toxicity, opportunity costs and time toxicity: time spent travelling, waiting, receiving therapy, managing side effects, and not being elsewhere.
Common Sense Oncology, as Jackson describes it, is an attempt to bring those realities back to the center.
“Oncology in some ways has become a victim of its own success.”
The field has become so hungry for faster progress that it has increasingly accepted surrogate endpoints and shortcuts intended to bring therapies to patients sooner. Sometimes, Jackson argues, those shortcuts leave uncertainty over whether what looks like progress on paper translates into something patients actually feel.
He is not asking oncology to stop moving forward. He is asking it to check its direction.
“We have just floated a little far from our core mission, and it is time just to nudge ourselves back towards that middle ground.”
The People and Books Behind the Advocate
Jackson’s willingness to ask uncomfortable questions was shaped by people around him as well as by books or institutions. When asked about mentorship, he broadened the idea.
“I think my career has been shaped more by collaborators than mentors.”
One early influence was Professor David Cunningham of The Royal Marsden, whom Jackson describes as “one of the clearest thinkers” he has ever met.
“He helped me understand where the top of the mountain was in terms of oncologic research, what could be achieved with excellence, and what world-class care looked like.”
Another important collaborator was Professor Diana Sarfati, whose expertise in epidemiology, public health and cancer inequalities complemented what Jackson was seeing in the clinic.
“She had a very deep understanding of epidemiology and of cancer control. I had a very deep understanding of the problems in the clinic that people faced day to day.”
That combination – public health evidence and clinical experience – helped turn variation in cancer outcomes into a national policy issue.
Books also gave Jackson language for the scale of change he was trying to understand. Siddhartha Mukherjee’s The Emperor of All Maladies helped him think about the long history of cancer and about how doctors, patients and governments can together create a “systems-based juggernaut for change.”
The Selfish Gene shaped his scientific thinking when he was 18. A book on Taibi Kahler’s Process Communication Method shaped the way he thinks about communication, personality, distress and leadership.
In oncology, he says, communication is not a special event. It is the work.
“In oncology, you’re doing communication all day, every day.”
The book helped him recognize that different people need different kinds of communication: emotional connection, information and structure, recognition of work, values-based framing, action, or reflection.
“If you’re trying to do communication to larger groups, you have to speak in multiple channels at once.”
That lesson matters in clinic, in policy, and in advocacy. Changing systems is not only about being right. It is about being understood by different audiences at the same time.
Leadership: A Title, Achievement, or an Opportunity?
The same logic shapes Jackson’s view of leadership. For him, leadership is not simply a title, a board seat or a sign of personal achievement. It is an opportunity that becomes meaningful only if it is used.
During his time as Medical Director of the Cancer Society, he saw what positional authority could provide. The organization had enough public trust and standing that when he called a health minister or senior official, there was a good chance they would answer.
But getting the phone answered was not the point. What happened next was the work.
“There’s really no point in having a leadership role if you don’t do something with it. Simply being on a board, being on a committee, being in a role is meaningless if you don’t do something with it.”
He is equally skeptical of leaders who need to dominate every room. One leadership lesson stayed with him from a friend in industry.
“If you’re a leader and you’re the smartest person in the room, then you’ve done a terrible job.”
For Jackson, good leadership means surrounding yourself with people who bring different strengths, perspectives and ideas. It means creating psychological safety, encouraging healthy debate, and allowing disagreement to improve the final decision.
“The exchange of ideas and challenge makes everyone better.”
Leadership also changes depending on the stage of an organization. A start-up phase requires one approach; a mature organization requires another. Common Sense Oncology, in its establishment phase, needed a different style from a long-standing global organization such as UICC.
But across all settings, one requirement stays constant.
“As a leader, you must behave with integrity and with respect for the people around you.”
Those words sound simple, but Jackson defines them practically.
“All that means is showing up when stuff’s tough.”
Trust, he adds, is fragile.
“Trust and respect are things that can take you a lifetime to build and a moment to destroy.”
The Cost of Doing It All
With a career spanning patient care, research, policy, advocacy and global cancer control, the obvious question is how Jackson protects his time and finds work-life balance.
He rejects the premise.
“I don’t really think there’s any such thing as work-life balance, actually. I think there’s work-life compromise.”
When his children were younger, he remembers being at work and feeling like he was not being a good enough father. Then he would go home, spend time with his children, and wonder whether he should be doing more for his patients.
“There was always this wee nagging voice in the back of my head going, you’re mucking something up, you’re stuffing something up.”
Eventually, he let go of the idea that life could be arranged into perfect harmony. There were trade-offs. He could write more papers if he spent more time at work. He could move to a larger center in a bigger country. But each option would cost something.
“That would mean that I wouldn’t get to live in paradise overlooking a local beach and walking my dog in the evening.”
For Jackson, the key is not eliminating compromise. It is making compromises that fit one’s values.
“Hopefully being a better doctor makes me a better human, and being a better dad makes me a better doctor too.”
It is another version of the same principle he brings to oncology: every decision has a cost, and values should be visible when those costs are weighed.
Not What You Want to Do. Who You Want to Be.
At the end of the conversation, Jackson’s advice to young oncologists is not about publications, titles, leadership roles or reaching “the top of the mountain.” It is about character.
“Spend your time thinking about not what you want to do, but who you want to be.”
He urges young clinicians to reflect on values and direction rather than rigid destinations. Goals can be useful, but they can also narrow a life too early. Direction, if rooted in values, leaves room for unexpected opportunities.
“If you are rigid about a destination where you’re going, then you’ll miss the extraordinary opportunity that you never expected that will unfold along the way.”
Oncology does not allow much illusion about time. It teaches clinicians, again and again, that life is fragile and that waiting for a future version of oneself can be a dangerous habit.
“You better make sure you’re doing what you value now, because you can’t be quite sure how many tomorrows there are.”
The Selfish Gene stayed with Jackson long after he first picked it up at 18. Decades later, the idea that seems to remain is a more human one: we may be shaped by many forces – biology, systems, geography, institutions, chance – but we still have a say in what we choose to change and who we choose to become.
“Be who you want to be now.”
For Jackson, oncology begins with being present beside suffering. It expands into systems when the same suffering repeats in predictable ways. It becomes advocacy when patients ask why the system is not delivering for people like them. It becomes leadership when a title is used for something beyond itself. And it becomes common sense when progress is measured not by how loudly it is announced, but by whether it helps patients live longer, live better, and spend time on what matters most.
“To help the people who you see every day have a fair chance, a fair go, a little bit longer with someone who they love.”
Written by Eliz Baloyan, MD, Editor at OncoDaily
Interview by Shushan Hovsepyan, MD, SVP of OncoDaily