Sir, – The article "Researchers argue case for creating a better environment for clinical drug trials" (November 21st) surveys the state of drug trials in Ireland. Many of these involve cancer drugs. A recent British Medical Journal editorial, "Too much chemotherapy" (November 10th), and an associated article claim that an almost 20 per cent improved five-year survival rate of cancer patients over the past 40 years owes little to chemotherapy (other than for a very limited number of cancers) but to earlier diagnosis and treatment of regional and localised cancers rather than chemotherapeutic attacks on cancers that have spread beyond their site of origin. The editorial states that "Unjustified enthusiasm for cancer drug treatments comes at huge cost, financial and personal (including treatment-related deaths and reduced quality of life)", and, it can be added, little or no survival benefit.
The recruitment of patients into cancer drug trials, often industry funded or carried out by commercial research organisations, involve information, consent and ethical issues of the highest complexity.
Waiting lists of inordinate length for cancer diagnosis and treatment prevailing in this country must surely contribute to our relatively poor outcomes among developed countries. – Yours, etc,
DERMOT WALSH,
Dublin 4.