Another voice
From a medical correspondent
Auberon Waugh
Perhaps I should explain that I have no medical qualifications. Occasionally, in my own home, I announce that certain things are carcinogenic, or cancer-inducing, as, I imagine, most Englishmen do nowadays — television, baked beans, plastic shoes, paper napkins — but these announcements are more often inspired by intuition than by detailed research. When challenged for an authority, I usually say that I have read it in the Sunday Times or the Sunday Times colour magazine, confident that nobody will have read either.
But I did write a regular medical column for some time in a publication called British Medicine until it went bankrupt, owing me large sums of money. It was given away free to general practitioners, financed by drug advertisements, and seemed to be doing quite well until its enterprising owners faded away behind the cover of a 'shell' company. With this and similar experiences in mind, I sometimes worry for those of my colleagues who have signed wonderful contracts with Cavenham Communications, publishers of the disastrous Now! magazine. But the reason I mention my days on British Medicine now is for the insight they afforded into the world of pharmaceutical advertising. Every month whole pages were taken to advertise some new wonder-drug produced by one or other of the giant drug firms. Many, if not most, seemed to belong to the boom area of anti-depressants and most of these involved a new mix of more or less familiar ingredients, but the bewildering variety of new proprietary brands confirmed me in my own self-medication policy.
This is to prescribe aspirins in all cases of illness. In fact I honestly believe that there are few physiological or psychological conditions for which a judicious mixture of aspirin and gin (or, for those who prefer it, whisky) is not the best medication. This sounds like a hearty saloon bar joke, but I believe it to be sound advice. Serious illnesses should be taken more seriously, of course, and surgery is something quite different, but in a long experience of hospital life I cannot honestly say that medicine — with the exception of antibiotics — has ever done much good.
Aspirin has the further advantage that by causing indigestion, intestinal irritation, flatulence, constipation and other disagree able side-effects it offers no temptation to the hypochondriac or pill-guzzler. One takes it only if one is feeling ill. But these disagreeable side-effects do mean that any recommended course of self-medication is unsuitable for those suffering from peptic ulcers, whether of the stomach or duode num. Such people, if few others, might be justified in risking the new-fangled substitute called Paracetamol.
Until recently there was no medicine which even claimed to cure peptic ulcers, although surgical techniques had improved. Then, a few years ago, the international pharmaceuttical concern of Smith, Kline and French started marketing a new drug called cimetidine, under the brand name Tagamet, which claimed to reduce the stomach's production of acids. For once, it seemed to work. Many millions of sufferers from this distressing condition found that they were actually cured. I knew nothing more about this wonder-drug until last Sunday when one of the Sunday newspapers carried the photograph of a Tagamet label on its front page under the heading: 'This stomach drug could be dangerous.'
The caption, in large, bold type, ran as follows: 'Eleven million people use the revolutionary drug cimetidine (brand name TEiga met). But now some doctors are voicing fears that it could be linked to stomach cancer. Full story, page four.'
All of which might seem to confirm and justify my in-built scepticism about new wonder-drugs. But if one actually turns to page four and reads the full story, which is very long, one learns that these 'fears' are very tentative indeed. The 'leading British gastro-enterologist' whose report is the basis of the story reveals that he is still prescribing it forabout a quarter of his ulcer patients, if only for short periods, while the other consultant whose discovery of cancer in three patients led to these misgivings has concluded that cimetidine is an excellent drug if used prudently.
Which is not what anxious ulcer sufferers would have concluded if they had ready only a few paragraphs under the page four headline 'Doctors raise cancer fears over "wonder drug" used by millions.' (Apparently 11 million use the drug.) The reaction of most of them, I suspect, will be to pour the pills down the lavatory — standard five-week course costs £35 — and return to the agonies of their peptic ulcers, The technicalities of the matter (those bored by them may skip to the end of this paragraph) would appear to be that while cimetidine reduces stomach acid, as does surgical vagotomy, any low acid level carries with it a higher level of a carcinogenic substance called nitrosamine. In other words, it is the fact of being cured of one complaint which makes you prone to another.
Which might, again, be taken as reinforcement of my own prejudice against medicine as such: one should not tinker with natural processes. But the fact remain; that ulcers are painful and disagreeable things beyond the reach of gin and aspirin. and one would be insane to ignore any relief available unless it was proved to be harmful in itself. Not only is there no proof in this case, but elaborate and prolonged tests have tended to prove the opposite.
I have avoided the temptation to excoriate the newspaper or the journalist concerned (Mr John Maurice, of the Sunday Times ) because I do not really believe that either is to blame, so much as the popular appetite for which they are catering. The journalist, in particular, seems to have done a thorough job in dispensing the sensational claims of the headline. Anxiety about cancer hangs like a dirty cloud over all modern preoccupations, and it might be thought a cheap trick on an editor's part to pander to it, but I see such pandering as inevitable. It is only on this occasion, when the sensational treatment of some extraordinarily tentative findings may result in stomach pains and further anxiety for hundreds of thousands of people, that I feel we should declare a bad joke.
Cancer has always seemed to me a misfortune which may strike any of us at any time, rather than something we can usefully do anything about in advance. In recent history we have seen Thalidomide disfigure some 500 British babies, and an unknown number. of casualties from an antidepressant which was discovered too late to combine dangerously with Marmite, cheese and other homely fare; but I still feel we do better to trust our doctors rather than investigative journalists.
Like us, doctors make mistakes, but I suspect they are fewer. An illustration of this point comes from the article I have mentioned: 'Over the next three years, of the one million people treated with cimetidine alone, only about 3,000 (0.03 per cent) complained of side-effects, most of them minor.'
I wonder how many people noticed that Mr Maurice has misplaced his decimal point in that percentage. Not a very serious mistake. The sort of thing any of us might do. But if he had been writing a medical prescription, instead of a newspaper article, it might have had very serious consequences indeed. Even my own beloved aspirins might produce some nasty side-effects if I took 30 of them instead of three.
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