ANSWERS TO AN ONCOLOGIST
From The Cancer Chronicles #30
© Dec. 1995 by Ralph W. Moss, Ph.D.
In October, the Granary Market, a big store in Pacific Grove, CA, printed an interview with Ralph W. Moss, PhD, editor of this newsletter, on his book, "Questioning Chemotherapy." This appeared in their newsletter," Granary News." The interview was also included in the delivery of about 40,000 copies of the local newspaper in Salinas and on the Monterey Peninsula. Among the many responses was an angry letter from two doctors at the local comprehensive cancer center. The editor of Granary News asked for our response:
Thank you for sending me the correspondence you have had with oncologist Grant Swanson, M.D. and bioethicist Dr. Roger Shiffman of your local comprehensive cancer center. You ask for my comments.
Essentially, in their remarks on the interview in "Granary News," the doctors accuse me of two things:
1) They state that I engage in "generalized simplifications" and "manipulations of complex data" and that my comments are "an exercise in dishonesty."
2) They also claim that several dozen of their patients were caused "personal pain and anxiety" by the interview. This they state "has added another level of fear" to the patients¹ struggles. They accuse us both of being responsible for "the pain our patients have suffered." These are serious charges indeed!
As to the first charge, most nonfiction books are indeed based upon a strict process of selection. The reader asks the writer to manipulate complex data, then simplify and generalize, so that thousands of facts can be brought into a manageable scope. That is precisely what I tried to do in "Questioning Chemotherapy," which is based on over 400 studies which are in turn culled from thousands. I am proud that most readers I have spoken to have found it to be both tightly reasoned and well-documented. If the doctors want to suggest positive studies on chemotherapy that they feel were omitted from my work I would gladly receive these and, if appropriate, make changes to future editions of the book.
I think it is abundantly clear that the interview in Granary News is intended as a short precis of a factually detailed book. It seems silly to attack such an interview as "simplified," when that is exactly what short interviews are supposed to be. But anyone who questions the conclusions that are succinctly summarized in the interview is free to consult the much fuller treatment of the topic presented in the book.
In fact, I would have thought the doctors would have wanted to examine the source of the opinions they were criticizing rather than just contenting themselves with a small, and necessarily simplified summary. There is no sign that they have done so‹perhaps they are just too busy treating patients to concern themselves with fundamental criticisms of their field.
In "Questioning Chemotherapy," as in the interview, I made it a point to include in a very prominent place many of the favorable findings on the life-prolonging effects of cytotoxic chemotherapy--when I could find them. I sincerely did not want to be "negativist" as the doctors put it but was in fact conscious of my responsibility not to mislead patients into possibly rejecting a treatment (such as for acute lymphocytic leukemia or Hodgkin¹s disease) that might possibly be of real benefit to them.
On the other hand, I felt an equal duty to inform patients and their loved ones when over 40 years of research have not revealed any significant life-prolonging effects from this type of treatment. Sadly, that still includes many common kinds of cancer. No glib talk about slow but steady progress will change that reality for hundreds of thousands of patients.
Drs. Swanson and Shiffman fail to cite any concrete examples of error in either the interview or my book. They deign to "argue the specifics of the interview" with you. Unwilling to sweat the details, they slip into the easiest form of argument--name calling. By calling me "dishonest" they dispense with having to confront the disturbing fact that a person of good will (who might also care about the welfare of cancer patients!) could study their profession and find it deficient.
I can assure you this is not the first ad hominem attack I have experienced in this field, nor is it likely to be the last. As I wrote in "Questioning Chemotherapy," "people generally resort to personal attacks when they sense that their arguments are weak or fatally flawed. Chemotherapists cannot help but suspect that their field rests on a bed of sand. They try to distract attention from this fact by launching personal attacks against those who point out the problems."
The doctors main grievance, however, seems to be that "several dozen" of their patients were distressed and caused personal pain by your printing this interview. Assuming that this account of patient distress is true, the question still remains whether patients should be told when a treatment they are about to receive is not likely to work--when it is likely to cause significant toxicity, cost a great deal of money, and in the end not extend their life?
As I see it, the question that Drs. Swanson and Shiffman have to answer is an old one: Should cancer patients be told the truth--or should they be soft soaped for their own benefit? I personally think that over the years we have had more than enough medical paternalism, and that patients need and deserve the truth so that they can make informed decisions. That is my conception of "medical ethics."
I would also like to ask the doctors, Don¹t you think that 150 years ago patients were equally pained and upset when the 'negativists' of that time criticized bloodletting and the constant dosing with mercurous poisons? Don¹t you think the critics of that day were treated with the same kind of disdain, and subjected to the same kind of personal invective as you now engage in?
The cases are not that dissimilar. I am convinced that some forms of chemotherapy will eventually be viewed as a kind of bloodletting of the twentieth century.
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