The war on cancer: failure of therapy and research

A generally-held beliefby both the medical profession and the lay public is that therapeutic medicine greatly affects health. Providing more hospital beds, doctors and resources is viewed as the path to improve health. Therapeutic medicine is of much benefit to sick people. However, with the exception of several highly contagious infections, it has not reduced the incidence of disease. This generalization applies particularly to cancer. Despite this fact most ofthe expense and effort devoted to the management of cancer is directed towards early diagnosis (screening) and improved therapy. Evidence has steadily accrued that this strategy is essentially a failure: little impact has been made on the toll taken by the major cancers. The failure of therapy, coupled with the realization that the overwhelming majority of cancer is related to environmental, particularly lifestyle, factors, dictates that prevention should be our foremost aim. It follows, therefore, that cancer research should concentrate on those environmental factors which may cause or prevent cancer. Instead, most research looks at either the detailed mechanisms of cancer formation or else investigates new types of therapy. Medicine should admit its severe limitations in therapy and redirect itself. Using the fruits of an expanded research programme into such areas as diet and exercise, medicine should strive to apply this knowledge to cancer prevention

Towards a new system of health: the challenge of western disease

Over the last three decades, the concept of Western disease has become well established. Medicine has approached this group of diseases by searching for new cures but has achieved relatively little success. We argue that medicine should now accept the failure of this strategy and place a major emphasis on prevention. The key objective is to change the climate of opinion so that prevention is taken seriously by the general population. The chief activity should be a wide ranging public education campaign so as to persuade people to live a healthier lifestyle. Medicine will require restructuring in order to carry out this work. Medical education needs to be reformed so that medical students receive the necessary training. This must be done as part of an integrated approach in which government, industry and medical research all play a major role. Governments should use taxation and subsidies in areas such as food and tobacco so as to shift consumption patterns towards healthier products. Governments must also tighten laws on tobacco sales and advertising, support health education, and improve food labelling. Industry must be made far more responsive to the health needs of the population. This should be done both by public education, so as to alter demand, and by government action. Medical research should change its emphasis from studying the detailed mechanisms of disease ("complex research") to studying the role of lifestyle factors ("simple research")

A Tumour Syndrome Affecting Children in Tropical Africa

WITH the exception of leukamia, the vast majority of malignant tumours occurring in children consist of those developing in the central or autonomic nervous systems, the kidneys and the lymph glands (Campbell, Gainsford, Paterson and Steward, I96I). The metastases from these neoplasms are most frequently observed in the liver, the lungs and the skeleton, excluding the jaws. Among the rarest of sites in which malignant tumours have been recorded in children might be listed the ovaries, the thyroid, the salivary glands, the testes, the extra-dural space in the spine, the orbit, excluding the eye, and, above all, the jaws. Yet it is in these very sites that tumour deposits are frequently observed in the tumour syndrom