Author’s reply to Dangoor and colleaguesBMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6508 (Published 05 December 2016) Cite this as: BMJ 2016;355:i6508
All rapid responses
The debate regarding “cancer drugs, survival and ethics” sparked considerable online interest (22 Rapid Response contributors, over 600 likes) but the diversity of opinion was not reflected in either of the printed versions of the BMJ of 12th Nov 2016 and 10th December. Wise’s initial polemic (1) was vigourously endorsed by Godlee’s biased accompanying editorial (2) entitled “too much chemotherapy” which concludes with “only then will cancer care serve patients rather than governments and industry”. Blimey.
The Association of Cancer Physicians (3) quickly offered a polite, conciliatory, perhaps almost meek, rebuttal (RR 12th Nov) which in the printed journal of 10th Dec was accompanied by Wise’s rather curt reply ( RR 19th Nov – “am I cynical ? Yes” ) and only one other comment.
The online contributions, however, were much more broad, both for or against, some nuanced, others more direct – “the oncologist’s role is to take our hand and help us across the inevitable threshold”. Is that even legal ?
But what added much more insight to the debate was the patient’s perspective provided contemporaneously by AA Gill, with his revelation in the Sunday Times of 21st Nov of his “malevolent, meaty malignancy”, for which he coined the phrase “the Full English of cancer”. His acclaimed, final essay (ST, 11th Dec) was about his cancer, his care, his chemotherapy, his choices. If oncologists are implored to always tell us the truth, Gill doesn’t have to be : “we say it (the NHS) is the envy of the world. It isn’t”. . . “We say it’s the best in the West. It’s not”.
He very clearly gave what Wise describes as genuinely informed consent to both first and second line chemotherapy, even in, or, of course, perhaps because of, his desperate situation. How does this chime with Godlee’s comment that “patients are being misled by over-enthusiastic accounts of chemotherapy’s effects”?
But let’s give Adrian Gill, who has subsequently sadly died, the final word. In his penultimate paragraph, he tells one of the nurses that
‘ it turns out the chemo isn’t working”. Her shoulders sag and her hand goes to her head. “F***, f***, that’s dreadful”. I think she might be crying’.
We all are.
John Lennon posited that “War is over, if we want it”. Let me assure Wise, Godlee et al, that when it comes to the so-called war on cancer, we want it ! And as soon as possible, please.
1. Wise P H Cancer drugs, survival and ethics. BMJ2016; 335:i5792
2. Godlee F Too much chemotherapy. BMJ 2016; 335:i6027
3. Dangoor A et al BMJ 2016;355:i6487
Competing interests: No competing interests