3 AUGUST 1985, Page 18

Unnecessary cuts

Sir: Christopher Hitchens wonders whether President Reagan and his advisers 'knowingly put off a needed operation because they thought it would spoil the chances of a second term?' (20 July). Maybe — but was the operation needed? Hitchens has listened to surgeons who argue that if a malignancy is detected in its first stage, and removed, the patient has a 90 per cent chance of survival. Agreed: but the evidence strongly suggests that he would have the same chance if the malig- nancy was not removed. 'We all have cancer at 48,' Sir Heneage Ogilvie told his colleagues nearly 30 years ago. 'What is the force which keeps it under check?' Much more is known, now, about the force — the auto-immune system's protective mechan- ism; and it has come to be recognised that most malignancies, like warts and polyps, are dealt with effectively without the need for intervention. Any radiologist or physt- can in the business could tell Hitchens that there is no hard proof, from controlled trials, that early detection saves lives, because surgeons have always declined to have a control group who are not operated upon. As a recent survey in the Brinsh Medical Journal has shown, many of them even refuse to accept the evidence of such trials when it shows operations to be unnecessary — as in the case of mastec- tomy. Until surgeons submit to the same discipline as physicians, testing remedies, and learning to obey the evidence which the tests provide, we will not know wheth- er it would have helped Reagan if the polyp had been removed 14 months ago.

Brian Inglis

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