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John Crown: ‘I was a poster child for having a messed-up work-life balance when I was younger’

The campaigning oncologist has retired from the public health service and says he has given up advocating for reform of it, but he remains passionate about its potential

At 67, Prof John Crown still exudes the old intensity, energy and capacity to talk like a train. A two-hour interview produces a transcript about the size of a short book. He’s still a bit ornery, though a little more battle-weary and a lot more circumspect. In short, he’s pretty damn happy with his life.

When we last met eight years ago, Crown was 59, fulminating at the prospect of mandatory public service retirement, insisting he couldn’t afford to leave at 65. He had recently married Orla Murray, a civil servant, and had a baby son as well as three children from a previous marriage. Then the public service retirement age changed but he retired anyway. Which was surprising.

“I didn’t have to go at 66. Look, I’ll be blunt: I was a 66-year-old man with a then seven-year-old child. And I honestly felt I’d paid my dues in the public system ... it was becoming so difficult. You spend so much of your day apologising for beds which didn’t exist, for scans which weren’t done ... It did wear me out a bit. And the demographics tell you ... when you’re a man in your 60s with a child of seven, you’re aware of how much time you will have with that child. I want to try and do a bit more of it.”

Fortunately for his many adoring patients, Crown still runs a practice from St Vincent’s private hospital and keeps his hand in as an unpaid voluntary consultant in the public hospital, which enables him to continue his clinical and teaching research.

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He takes energy from his involvement with cancer research charities such as the Caroline Research Foundation, and the Cancer Clinical Research Trust, and his professional career was crowned a few weeks ago with the Outstanding Contribution to Cancer Medicine and Research Award from the Irish Association for Cancer Research (IACR), presented at a prestigious international conference in Dublin.

An entertaining suspicion that he has an eye on the presidency is swiftly crushed. He did mull the idea for about an hour way back in his Seanad days, when a few colleagues raised it, he says. It was an unlikely prospect anyway for a man who can’t not speak his mind.

Crown contests the notion that he was ever a tad cantankerous or lacked diplomacy in a necessarily collegial profession – but then concedes that yes, he might have taken after his beloved mother, Kathleen, “a woman of very strong opinions and a very strong personality”.

Kathleen was working as a nurse in New York, where John was born in 1957. His father – who had entered the United States as an illegal immigrant, using his brother’s papers – was a taxi driver who sustained near-life changing back injuries in an accident and opened a small shop with the settlement.

John was 10 when they returned to Ireland and Kathleen worked in Irish hospitals for decades before returning to New York in her 60s to nurse for another 10 years. She was there when her son returned to New York for his oncology training. She was his touchstone, an “extremely resourceful, very intelligent, very well-informed woman”.

So, “on the um, question of diplomacy”, he says, “there’s no doubt that whatever that tendency is, I certainly inherited from her”. That’s a mild concession that he left nothing unsaid about healthcare administrators and politicians across numerous platforms over the years in a small country where establishment medicine and politics are often intertwined.

There is a fearlessness about Crown that may be partly explained by the formative American rearing and training. His enduring love – and “reinvigorated fear” – for the country that largely shaped him raises a question whether he regretted coming back to Ireland. “Sometimes I think Ireland and me weren’t a good mix. I still think that but I don’t regret it because obviously one cannot regret one’s family, the children I wouldn’t have had. I love Ireland deeply ... I’ve lived here for 49 of my 67 years. I will die here.”

Politics remains a great love. In another life, he says wistfully, he would have found the right party and made it a full-time job

The fearlessness led him into politics and the NUI Seanad seat he occupied from 2011 to 2016, won on the manifesto of health and Seanad reform.

That left him pretty disillusioned but with “zero regrets – and funny enough, much more respect for the political process”. He even “slightly” regrets some of the attitude previously aimed at politicians; once inside he liked them as individuals a whole lot more than expected.

In the same candid way, Crown admits to “a seduction that comes with being close to power ... I didn’t have individual power, but at a very superficial, immature level it’s a buzz to be near the leaders of the country and to actually get to meet them and have a cup of coffee or a drink with them – or have some kind of a forum for perhaps expressing an opinion in a way that perhaps it might be taken on board.”

He had promised he wouldn’t run for the Seanad a second time unless it was reformed and, infamously, it wasn’t and hasn’t been. At a personal level, however, the Leinster House experience changed his life because he met Orla, his “lovely wife”, there.

But politics remains a great love. In another life, he says wistfully, he would have found the right party and made it a full-time job.

As a teenager Crown was heavily influenced by the Northern Ireland conflict, developing “a huge, huge respect for the moderates in the SDLP ... This is going to lose me a few friends, but I really hate the way that history is being rewritten now, that there was no alternative – which is wrong.” He is glad that things are settling there. But his “dread of extremism” has been “reinvigorated because of the way the world is going right now . . . I just fear what will happen to American democracy in the next four years.”

In Crown’s oncology life, it’s clear the IACR award was immensely fulfilling. He describes low times in research such as when five international trials on high-dose chemotherapy co-led from Dublin failed and ended with the crushing sense that nearly 10 years of his early research life had been spent in vain. So he feels “very honoured” by the award.

“There are high times and low times in research. My contributions are not in the realms of brilliant scientific research. I think probably my biggest contribution was helping to get formalised, organised nationwide clinical cancer research off the ground and to get high-quality cancer clinical trials into Ireland systematically.”

He repeatedly defers to research heroes such as Dr Dennis Slamon of UCLA, ‘godfather of all things Herceptin’. They met on a flight at a low point for Crown and Slamon gave him a personal four-hour booster session that led Crown to become a translational cancer researcher

That was harder than it sounds. Clinical research – involving patients for medical trials – was virtually absent in Ireland when Crown returned as a fiercely competitive, ambitious 37-year-old consultant to St Vincent’s in 1993, shaped by visionaries at the Mount Sinai Medical Centre in New York and, later, Memorial Sloan Kettering Cancer Centre, and determined to get a national clinical trials group up and running.

There were just three other medical oncologists in the country at the time, “wonderful men who did phenomenal work, with little spare time for clinical research, although they all managed to do some”. Within 10 years the Irish Co-operative Oncology Research Group, set up by Crown and Prof John Armstrong, had enrolled more than 6,000 Irish patients on clinical trials. In practice, that meant new drugs were getting to Irish patients far more quickly.

In the mid-1990s, Crown put his first patient under a Herceptin trial in Ireland, still referred to as a “wonder drug” in breast cancer treatment. Back then, he says (diplomatically), there was a suspicion of oncology, not only that it might gobble up all the health resources but with a cultural outlook that palliative care might be kinder;

“There was a certain amount of finger-wagging along the lines of – ‘We should take a more holistic approach to treating patients with cancer and not be, you know, trying to torture them with cancer drugs.’”

Prestigious international co-authorship credentials were missed as a result – and still rankle – but Crown counts the benefits in hundreds of extra jobs in the pharma sector and the involvement of leading international experts in trials that brought cutting-edge treatment to Irish patients.

“It was a great, great success. I’m very proud of that. I think probably if I was to look back from my deathbed at some stage and say, what’s the thing you’re most professionally proud of – obviously, I hope I’ve given the best care I could to many, many, many patients – in terms of research accomplishments, that would be the big one, that we got that ball rolling in Ireland in a big way.”

He repeatedly defers to research heroes such as Dr Dennis Slamon of UCLA, “godfather of all things Herceptin”. They met on a flight at a low point for Crown, and Slamon gave him a personal four-hour booster session that led Crown to become a translational cancer researcher, ie operating at the crossroads of lab and clinical research. He also singles out Prof Martin Clynes, the “underappreciated visionary” emeritus professor in biotechnology at DCU, who nominated him for the chair of translational cancer at DCU. Without him, says Crown, he wouldn’t have received the award.

His excitement about immunotherapy – harnessing the immune system to treat cancer – is palpable because of what it means in major advances in the treatment of widespread melanoma, kidney cancer, bladder cancer, a subgroup of patients with secondary bowel cancer, and – to much surprise – some modest but worthwhile improvement in lung cancer.

One irony is that immune cell treatments tend to work best in nastier cancers with lots of mutations, such as the lung cancer type caused by cigarette smoking. But many patients with non-smoking-induced lung cancers can get years of disease control with tablets that target specific mutations.

“I’ve done a lot of research, as has Prof Janice Walsh [a consultant medical oncologist specialising in breast cancer at St Vincent’s] in recent years with a group of drugs which have been shown to have quite prominent activity in areas such as melanomas and oestrogen receptor-positive breast cancers.”

But the urgency of “early diagnosis” crops up repeatedly and there are developments here too. Keep an eye on blood tests, he says. “It’s known that cancer cells can shed DNA into the bloodstream, but with increasingly sophisticated molecular analysis you can take a little bit of blood from somebody and it’ll tell you that they may have a cancer cell floating around ... So I would say, watch this space.”

It’s a cliche but if you ask everybody from movie producers to sportspeople, from leading doctors and researchers and business people, the one thing they always say is: ‘I wish I’d given it a bit more family time.’ I wish I’d done that a bit more

—  Prof John Crown

Crown’s views on the health system are well-documented, most recently about the continuing differential access to new drugs between the private and public systems. He has no faith in what he terms the Sláintecare “heresy” and the suggestion that the “handful” of private patients are the cause of all the problems in the public system is “panacea thinking on steroids”.

As for the new public-only consultant contracts, he imparts what he calls a “great analogy someone made ... Imagine there’s a bar, which is a lounge and public bar. And in the bar, the barmen are paid per hour. And in the lounge, the barmen are paid per drink served. Where are you going to get a drink faster? ... The reality is, for some specialties, getting paid a large fixed salary without any particular policing on what’s happening to your waiting list is not that bad a deal.”

Still, he doesn’t blame consultants either, who work very hard, he says. “Of course there are bad apples in every barrel, but I don’t know of any waiting list in Ireland where it’s a result of consultants refusing to work.” Look instead at access to operating theatres, to scanners and how whole wards can be closed down for “urgent redecoration”.

The universal healthcare model is already there; it’s the VHI, he says. It’s very similar to the tried and trusted German system and 40 per cent of the population are already members.

“I despair,” he says suddenly. “This may well be the last time I’m quoted on advocacy for reform of the public health service because I’ve given up on it.”

That’s unlikely.

At a personal level, Crown is loving the life with Orla and James, nearly nine, and his three older children. He proudly lists off their accomplishments: Katie works in broadcasting and TV production, Jack recently opened a lively bar called the Motel No Tell in New York’s Lower East Side, and Mia is a nurse.

“I love it, I love it, I love it,” he says, though sheepishly concedes the contradictions. “I was like your poster child for having a messed-up work-life balance when I was younger. I’m um, trying not to repeat the mistakes second time round.”

He has advice.

“It’s a cliche, but if you ask everybody from movie producers to sportspeople, from leading doctors and researchers and business people, the one thing they always say is: ‘I wish I’d given it a bit more family time.’ I wish I’d done that a bit more.”

So would he have dropped a few things?

“I would have ... I adore all four of my children and I like to think I was the best father I could be to them under the circumstances. But yeah, I think a good general rule to anybody starting off, especially somebody who’s intoxicated with the smell of young professional success and thinking ‘I’m really gonna change everything’ – that’s great. Absolutely. Try and change everything. But definitely keep an eye on the family relationships and on your children as well. Do that. Definitely.”