The more of us who behave like that the more impossible it becomes to find out which treatments work
Posted in General on 20. Jul, 2010
The more of us who behave like that the more impossible it becomes to find out which treatments work. And yet for a doctor to withhold his opinion in order to coerce you into a trial seems to me to verge on the unethical, where scientific ends justify the dubious means.The reason we need trials is that cancer treatment is an absurd lottery anyway, with doctors up and down the country doing quite different things. Armed with this reassuring advice, I returned to my own doctor, refused the trial and requested the treatment I wanted This was, I am afraid, anti- social behaviour. I gleaned from him the general view that tamoxifen was a pretty good bet and radiotherapy in my case was probably not necessary. Once it was chopped out, I was offered another randomised trial.
I would be allocated tamoxifen, tamoxifen and radiotherapy, just radiotherapy or nothing. I was sure my distinguished specialist had a hunch which treatment he thought best. He might not prove it scientifically, but he must have an idea and I demanded the benefit of his experience He would not give it. At this point, any patient wonders whether the imperatives of science are interfering with the doctor’s imperative to do the best possible for his patient.So I went for a second opinion from a specialist not engaged in this trial. Secretly, they ganged together and pooled all the pills so that they could all get at least some of the AZT The trial was wrecked. Random trials make a lottery of life, but then unscientifically proven medicine is anyway a lottery.Later I did develop breast cancer. In the early days of AZT in America, a group of Aids patients were offered AZT only if they entered a double blind trial.
When they realised half of them were getting sugar pills, they rebelled. First, the doctor had to persuade me that tamoxifen looked like a good bet. It might have some side-effects, but early indications suggested it also might prevent cancer.Now that is a clear choice. But when the doctor goes on to say: “Ah, but I’m not offering tamoxifen. I’m offering a randomised trial, so neither you nor I will know if you are getting it or a sugar pill,” then that is deeply disturbing. You screw up your nerve to accept a treatment – then you don’t know if you are getting it or not. Are you having side- effects or is it imaginary? I said no, and I had nothing.
(This may have been a mistake, but how am I to know?)I am not alone. They want the transplant, not the chemotherapy, because they’ve read about it as a successful treatment. The same is happening with prostate cancer trials – men are demanding to have the cancer removed and are refusing a random trial that might select them to have no treatment at all. They are insisting on surgery even though for older men, operating may be much more dangerous than the cancer.Doctors’ powers of persuasion are considerable. If a doctor recommends one or other course of action, the patient would probably accept it.