Factual inaccuracies in Gorman's portrayal of Irish cancer services


Tommie Gorman last night told RTE viewers of his eight-year battle with cancer. Previously he expressed his views in an Irish Times interview. Dr John Crown takes issue with some of his assertions

As a long-time critic of our cancer services, I am cast uncomfortably as a defender of that system, and even more uncomfortably as an adversary of any cancer patient. However, Kathy Sheridan's recent article (Irish Times, December 31st) concerning Tommie Gorman's cancer treatment is so factually inaccurate, and the collective ad hominem attack on Irish cancer specialists so unwarranted and hurtful, as to necessitate a reply.

Let us first deal with the more glaring factual inaccuracies.

Interferon, the anti-cancer treatment which it was implied Mr Gorman had to seek extra-jurisdictionally, has been available in Ireland since 1985. I have been prescribing it to appropriate patients with endocrine and other tumours since my return to Ireland in 1993.

Highly expert cancer surgery, including surgery for intestinal and liver tumours, is also routinely available here. It is in fact availed of by many foreign patients. Did Mr Gorman see an Irish oncologist or liver surgeon before seeking a second opinion in a pub in Budapest?

Germany and France have, according to the article, first-class public systems without a tradition of private practice. Untrue. Both, especially Germany, have large private practice components to their health systems.

What about Sweden as cancer Valhalla? I'm afraid not. A medical oncology speciality does not exist there, because of a turf war waged by other specialists. Sweden has cancer survival rates, which although reasonable in comparison to those of other bureaucratised government systems, are inferior to those in the US.

The notion (alluded to by Mr Gorman) that money is not discussed in Sweden would cause loud guffaws in Gothenburg. They may not tell the patient that they will be charged, but they do have to tell them that treatments are not available due to "resource constraints". This type of rationing is the rule in socialised systems, eg, the UK, where women are still routinely denied breast cancer treatments such as herceptin and Taxotere, which have been shown to be life-prolonging.

In a particularly confusing allusion, Gorman wonders if the preponderance of North American, as opposed to European, training among Irish cancer specialists is responsible for greedy antisocial behaviour in Irish doctors, and by extension, for the poor state of our cancer services.

In point of fact, Irish students in the US train under medical academics (relatively poorly paid medical school employees), and not money-orientated private practitioners. My own antipathy to bureaucratised health systems came not from my American professors (mostly old school New Deal/Great Society liberals), but rather, from the frustrating experience of my first few years back in Ireland.

Secondly, as such training is with rare exceptions entirely funded from American sources, we owe the US a huge debt of gratitude for educating almost an entire generation of Irish cancer specialists (14 of our 17 medical oncologists) for free. Man for man and woman for woman, we now have the finest-trained cohort of cancer specialists in Europe bar none.

Why is it that young cancer specialists from all over the world (including Sweden and Germany) flock to the US for training? They do so for the same reason that wealthy Europeans with cancer go there for treatment - because American cancer research, care and survival are verifiably the best in the world. This fact sits uncomfortably with aficionados of bureaucratic health systems, but it is true. Despite all the alleged inequalities of the US system (in my experience, a far more equal system than ours), it provides such good care to such a high percentage of its population (probably 90 per cent), that America has the best cancer survivals of any nation in the world.

The article comes closest to the truth in decrying the lack of sub-specialised cancer units in Ireland. By careful juxtaposition, Mr Gorman implies that medical greed is the reason. This is pure cant.

The true reason is simple, but again unpalatable to all but the most committed bureau-sceptics. It has been the policy of successive governments, despite entreaties by myself and others, not to have such units.

In 1994, the community of Irish oncologists put forward a detailed set of proposals to the Department of Health suggesting that all cancer care should be concentrated in a small number of specialist centres, with appropriate outreach facilities.

Who said "no"? The Department of Health did, persisting rather with its plans to have non-comprehensive cancer treatment in every electoral crossroads.

THE two-tiered Irish health system is offensive, duplicative and inefficient. It has, however, provided us with an opportunity to see two different systems in operation. One is our mildly dysfunctional, quasi-socialised private system, and the other our appalling public system.

The way forward is not to bureaucratise the private system, but rather to democratise it, by making access to it equitable.

We need mandatory, occupationally based insurance, with a social security net for the unwaged, run within a strict regulatory framework provided by government. The system, which would need incentives for efficiency and quality, would be financed principally by not-for-profit, non-governmental agencies.

I wish Mr Gorman the very best of luck in his battle with cancer. I for one would also welcome his informed, professional influence in the ongoing battle to improve our still-unsatisfactory cancer services.

Dr John Crown is a consultant medical oncologist at St Vincent's Hospital in Dublin. Tommie Gorman told his story in a True Lives Special last night at 10.10pm on RTÉ 1