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MEDICAL research will suffer if the proposals contained in the recent
White Paper on Britain’s National Health Service become reality, a leading
cancer specialist has warned. John Smyth, scientific chairman of the Fifth
European Conference on Clinical Oncology, held in London earlier this week,
said: ‘Our NHS has been a phenomenally good resource for doing research.
If you dismantle that, research will certainly suffer.’

Smyth said that if hospitals opted out of the NHS, as the White Paper
proposed, the spirit of collaboration that existed at present would disappear
in the atmosphere of competition. ‘We don’t want competition,’ he said,
‘In cancer research, we need collaboration.’

When doctors want to do a clinical trial, Smyth said, they often need
to recruit several hundred patients who would be treated in comparable ways.
At present it is fairly easy to get doctors to agree on a uniform approach
to the treatment of a particular disease, in order to assess it scientifically,
because money does not dictate the day-to-day management of the patients,
Smyth said. ‘But we do not want a financial disincentive (to collaboration),’
he added.

Michael Peckham, deputy chairman of the Imperial Cancer Research Fund,
added that doctors often refer patients with common but serious conditions
to a specialist centre for treatment. A centre that carried out top-rated
research, however, would be likely to be more expensive, so hospitals trying
to economise might send their patients elsewhere.

Treatment, too, could suffer. Smyth pointed out that until recently,
the standard treatment for breast cancer was a mastectomy (surgical removal
of the breast). In Edinburgh, where Smyth is professor of medical oncology,
doctors now work very hard to save the breast, using a combination of treatments,
he said. His department has a range of staff, including dieticians, psychologists
and occupational therapists. Delivering such a combination of therapies
and support services requires skill and expertise, Smyth said, ‘and you
can’t provide that in every small hospital’.

Smyth thinks it immoral for doctors not to refer patients with rare
cancers, including childhood cancers, to specialist centres. Tumours can
become resistant to the highly toxic anticancer drugs if doctors fail to
prescribe high enough doses, perhaps because they are unfamiliar with the
methods of treatment. The proposals for the NHS are unlikely to affect the
numbers of patients with rare diseases referred to specialist centres, because
it is relatively cheap to treat them.

But what happens, he asks, when many people suffering a common disease
(such as breast cancer, which affects one in every 10 or 12 women) cannot
attend a specialist centre? ‘Are you going to accept that some people are
not going to get to specialist centres, or are you going to provide money
to give this treatment to all women?’