It's great news to hear that the B.C. Cancer Agency has devoted a researcher to creating various treatments using the mutations found in the tumours of individual patients.
Dr. Brad Nelson, from the agency's Deeley Research Centre in Victoria, visited Prince George last Friday to explain the status of his work, as well as the protocol. He hopes to start clinical trials in two years, with the oversight of Health Canada and a research ethics board. This is not just paperwork or a procedural obstacle. Peer review is an essential part of the safe practice of modern science, particularly for medical researchers dealing with human subjects. Transparency and ethical conduct are as essential as properly quantifying the data.
This is particularly important because Nelson's research bears similarities with the treatments Dr. Suresh Katakkar was trying on terminally-ill patients during his time as chief oncologist with the B.C. Cancer Agency of the North. Katakkar resigned in June 2012 after the B.C. Cancer Agency suspended him, pending an investigation into his treatment practices. The cancer agency has strict practice guidelines and treatments outside of those guidelines must go to a special emergency committee, that can meet and approve courses of action in 48 hours or less. Katakkar refused to seek approval on at least one occasion because he said it would have taken too long to prepare a submission to the committee.
Katakkar may have earned the praise of his patients and their families but it is the 21st century in Prince George, not the 19th. Doctors are not free to experiment on their own patients and give people false hope that a miracle cure is just around the corner, nor should they be.
It is frustrating and heartbreaking for families to watch loved ones suffer and die from cancer. Their emotional vulnerability, however, makes them easy prey for a doctor - well-intentioned or not - to cross a line and try something on a wing and a prayer. The cancer agency's emergency committee is there to allow innovative treatments if there is evidence those treatments could work but it is also there to protect patients from overzealous doctors and doctors from overzealous patients. Desperation to do the right thing and save lives is always admirable but the intentions don't always justify the actions.
Some may find Nelson's work validates Katakkar's unauthorized treatments but that couldn't be further from the truth. Modern medicine and study happens in an ethical context and Nelson, by conducting his research within that framework, is showing a deep respect for today's cancer patients and families but also the countless others to come in the future until a cure is found to this horrible disease. Their treatment should be the best practices modern medicine can offer and shouldn't veer off into wild guesses and hunches from the gut to counter the feelings of helplessness that come as cancer claims another loved one.
Doctors are keenly aware of the harm they can do to their patients, not just from sins of omission and error but also from making the cure worse than the disease. Surgery, drugs and radiation are all forms of cancer treatment that can just as easily kill patients as save them, when used at the wrong time or in the wrong measure. Doctors like Nelson are working to give other doctors the means to wield these powerful treatment tools with precision, so that the disease is eradicated, not the patient.
For some, the approach of Nelson and the B.C. Cancer Agency may be too slow and cautious. Better that, however, than individual doctors playing god and refusing to answer to their colleagues on what's best for all patients.
