big pharma and small mercies

The chemotherapy room in the Royal Jubilee Hospital in Victoria is a clean, quiet place, where patients sit drowsing, reading, or listening to their MP3 players in reclining chairs, as the plastic sacks of drug solutions drip into their veins.

The chemotherapy room in the Royal Jubilee Hospital in Victoria is a clean, quiet place, where patients sit drowsing, reading, or listening to their MP3 players in reclining chairs, as the plastic sacks of drug solutions drip into their veins.

Conversations are generally hushed, and from time to time a restrained alarm chime sounds, as an IV bag comes empty, or a patient’s wait and recovery time comes to an end.

I recently passed a couple of hours there, for the second time, in the company of a relative, who is undergoing a course of treatment there. I have since talked with her about how the experience has proven to be much different than she and I imagined on our first visit to the Cancer Centre back in May of this year.

“It certainly isn’t easy or any fun,” she told me, “but it isn’t nearly as painful and traumatic as I thought it was going to be. I think more people should know that, so they aren’t as afraid as I was when they see this place for the first time.”

It is in the service of that wish that I am writing about this experience here, now. My basic message being that medical technology in dealing with cancer (or at least some forms of it) is now much more humane than the general public imagines.

To begin with, though, it has to be acknowledged that cancer is a vastly variegated disease, and the effectiveness and humaneness of its treatment inherently varies enormously from case to case.

Chemotherapy, for instance, is not a one-size-fits all enterprise; the drugs or drug combinations used differ very significantly from one case to the next, as so the responses of various patients to those drugs.

In my relative’s case, for instance, her first four rounds of treatment – which patients with similar treatment regimens typically find the toughest – went by comparatively easily, with only some saltiness in the mouth and some fatigue as the predominant reactions.

Her current course of treatment (I was there for her second installment of this second phase of therapy) has so far proven to be more difficult for her, with mouth cankers, bone pain, nausea, loss of appetite, and very extreme fatigue – so much so, that at one point she ended up shredding a house plant out of sheer frustration with her inability to get out and do anything.

Her response to the second go-round of that drug, however, was notably milder in the course of my stay with her, as the doctors modified the nature and duration of palliative follow-up medication to make life a little easier for her.

The experience has hardly been a walk in the park (though she did, in fact, manage to take a therapeutic walk in a park or two, over the time of my stay), but nothing like the horrors of vomiting and agony and weight loss we had both had in mind as the pending future when we first went to tour the centre.

As the nurse at her first chemo-injection pointed out, people’s image of chemotherapy has largely been shaped but well-meaning but hyper-dramatic and out-of-date Hollywood presentations of its effects.

This nurse had more than 20 years of experience in chemotherapy wards, and had actually been involved in the early trials of the anti-nausea drug my relative was about to be prescribed – a drug, she said, that had a huge effect on reducing the misery level of a great majority of the patients she had dealt with since then.

The trial of the drug, she said, had proven to be so overwhelmingly positive – patients getting the real drug were pretty much universally faring better than patients on the placebo version in the blind trial – that it became an ethical problem not to give everyone the same relief, and the blind trial had to be scrapped.

All very good news, of course, and what she said certainly turned out to be true in the case of my relative – though the other side of the positive equation is the ongoing extremely high price for that particular medication, even after all these years of large-scale production and sale.

You would have to be overwhelmingly naive to believe that the products of the big pharmaceutical enterprises are always so effective, or that the medical establishment is always so thoroughly governed by concern for patients’ interests above its own.

Big pharma is notoriously unregulated and unsupervised, and a domain of high-risk, main-chance artists in a super-competitive but hugely profitable enterprise.

Nor can the medical establishment itself be inherently trusted to seriously investigate methods of treatment or prevention of disease that run counter to its own interest and business case.

But only a hardened cynic would try to deny that good work is being done – though perhaps by bad people, and for bad reasons – by way of small mercies to the ill; and only an utter ingrate would deprecate the professionalism and humaneness of the floor staff at places like the Cancer Centre of the Royal Jubilee Hospital, without whom mercy would not exist at all.

Rick Steele is a technology junkie who lives in Whitehorse.