Cancer is an extremely complicated disease. There are at least 8 totally different methods of treating cancer, many of which are given in combinations. It is a disease for which there is generally one chance of beating and if that one chance is not successful, often there is no second chance. That is because cells grow geometrically and become an untreatable size quickly as well as many treatments preclude the opportunity of using them or other treatments at a later time. These facts coupled with the fact that all physicians are human beings and have the faults and weaknesses of all human beings make a second opinion in cancer vital.
We’re spending billions of dollars to research new drugs and methods to treat cancer. We’re trying to prevent cancer and make earlier detection possible. Why not attack easily and simply the single weak link, the human element in initial diagnosis. What are some of the problems. First of all, very rarely is a cancer discovered initially by an oncologist. It is their family practitioner, dentist, urologist, gynecologist, etc. These doctors are not thoroughly trained in treating cancer. They may be kindhearted and say, “Let’s watch it and see what happens in six months.” They may be having financial problems so they want to do the treatments themselves, even though they are inexperienced. They may be magnanimous and send them to their golfing buddy down the hall. The patient fools around receiving inadequate, insufficient or incorrect treatments allowing the cancer to grow to a point where it is untreatable.
When we started a free multidisciplinary second opinion panel in Kansas City in 1980, our doctors saw 3 to 4 patients per panel. We felt that one out of four patients presenting had their life saved. But that was not the greatest benefit! We felt the greatest benefit was that after a year or two, no longer was a newly diagnosed cancer patient in Kansas City told they were terminal. The doctor may have said he had never seen a case like this successfully treated but he would make some phone calls and see what could done. The idea of not destroying hope because the panel had proved him wrong so many times caused him to change his practice of medicine. When I present the idea of mandatory second opinions to Dr. John Mendelsohn, past president of M. D. Anderson, his comment was that it would raise the entire level of cancer medicine.
A top medical oncologist stated that he had never treated a cancer patient without a second opinion from someone other than an associate of his. This was for four reasons:
- Cancer is a very serious disease that grows geometrically. If it is not treated properly the first time there is often no second chance.
- He is human and could make a mistake
- Someone else could see something that he doesn’t see.
- Someone else could know something that he doesn’t know.
I am not fighting for what treatments a patient receives or from whom. All I care about is that the patient is entitled to make an informed decision knowing all the honest facts. Being told that nothing can be done, that surgery is required tomorrow or take these pills and come back in 90 days is not making an informed decision.
There are numerous ways to accomplish making second opinions mandatory: by law, by action of medical associations, by insurance companies requiring second opinions prior to treatment, by publicity about what can happen when second opinions are not obtained. Or by grass roots effort to change public opinion. We know that such grass roots efforts can be tremendously effective. Witness the success of campaigns for 2nd hand smoke, designated driver, anti-litter, no smoking on airlines and recycling.
Our Foundation’s board of directors has determined to start and fund a national drive to educate the public about the need for mandatory second opinions in cancer diagnosis prior to treatment. We plan a national publicity campaign. You will see ads on television and on billboards. You will hear our campaign on radio and on talk shows. Our campaign will emphasize that no cancer patient should be intimidated into automatically accepting the first diagnosis and treatment recommendation. Instead, second opinions will become the accepted standard procedure. We are going to make it happen. I would like to invite you to join us in this most worthwhile effort. We’re going to make it happen. Your participation will make our goal happen easier and faster.