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         Letters to the Editor
     To the Editor: I was pleased to read The Cancer Patient        1 Bottomley A. The cancer patient and quality of life. The
and Quality of Life, by Andrew Bottomley in the current               Oncologist 2002;7:120-125.
issue of The Oncologist (2002;7:2) [1]. Dr. Bottomley dis-          2 Wharton RH. Sleeping with the enemy: treatment of fatigue
cusses the importance and feasibility of incorporating qual-          in individuals with cancer. The Oncologist 2002;7:96-99.
ity-of-life (QOL) measures as an outcome variable for
cancer treatments. This issue also includes the Commen-
tary, Sleeping with the Enemy: Treating Fatigue in
Individuals with Cancer, by my husband, Robert H.                 TRUST FACTOR
Wharton, about the role that stimulant medication has                  To the Editor: I read your recent editorial “Trust
played in improving his and our family’s quality of life [2].     Factor” and wished to comment [1]. For many years, I

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As both a psychologist and the wife of someone with lung          worked within both a large pharmaceutical company and
cancer, it is exciting to see issues of QOL being increas-        later, within small biotech companies. I have no doubt that
ingly acknowledged in cancer research as well as treatment.       there are some biotech companies which, under the pres-
     It is a natural corollary from these two articles, as well   sure of Wall Street, will do some of the things alluded to in
as from what we know from the field of psychology, that           your article. However, your editorial fails to discriminate
not only should QOL be incorporated into research, but that       between the behavior of a few and the behavior of the
other factors known to impact QOL should be evaluated             much larger group of ethical and well behaved within the
and treated along with the medical treatments for cancer.         pharmaceutical industry.
     I would suggest a standard evaluation of HRQOL with               Many small biotech companies have no business doing
specific treatment recommendations for all patients at some       clinical trials, and many of them are nothing more than out-
point soon after diagnosis. For example, for people who feel      growths of university professors who suddenly find them-
socially isolated, support groups and other types of commu-       selves running a company. They have no idea how to organize
nity groups can be recommended. Depression should be              a clinical trial or what it takes or what the Food and Drug
actively considered for patients as well as their key family      Administration (FDA) or the medical community is seeking.
members. Further, full treatment options and plans should be           When I worked in a large pharmaceutical company, we
initiated as early as possible. Psychiatrists, psychologists,     actually had planners—people who got paid to do this—to
social workers, and peer support groups should be seamlessly      estimate the time from idea in head to Institutional Review
integrated with cancer centers for patients, their spouses, and   Board review to document gathering to first patient being
their children. I would suggest further that these services       treated, and so on. And, in turn, looking over their shoulders
should not only be available but their use should be discussed    were a group of compliance people who wanted everything
as a “normal” part of treatment for patients with cancer and      done according to the regulations. The counterbalance to
their families.                                                   “short cuts” was, therefore, quite great and not mentioned at
     Fortunately, my husband’s oncologist routinely addresses     all in your editorial.
QOL issues, and the cancer center where he receives treatment          For the vast majority of your readers, they do not dis-
also has resources available. Our family has benefited greatly    criminate between a small biotech company with a great
from these resources and, in spite of my husband’s progress-      deal of näiveté and the larger pharmaceutical companies
ing cancer, we have all been able to enjoy unexpectedly           who are quite sophisticated. I do not think that your reaction
remarkable QOL in the 2 years since his diagnosis.                fairly characterizes much of the pharmaceutical or biotech
                                                                  industry anymore than it would be fair to characterize the
Karen Levine Wharton, Ph.D.                                       recent events with Enron as being representative of the com-
Psychologist                                                      mercial world of oil, any more than the events with National
Instructor, Harvard University                                    Surgical Adjuvant Breast and Bowel Project (NSABP) sev-
e-mail:                                        eral years ago would characterize the cooperative group

The Oncologist 2002;7:383-384
384                                                                                                           Letters to the Editor

system. The errant behavior of one physician in Montreal         them. It manages their expectations when often those
did not bring down or undermine the trust of the cooperative     expectations are unrealistic from a lack of experience
group system.                                                    coupled with pressure from the financial gurus.
    In a similar sense, the errant behavior of a few should          Your editorial, while reflective of recent events with
not lead to a massive characterization of an industry that       ImClone and probably accurately reflecting some of your
has placed so many products in the hands of treating physi-      experiences with small companies, seems a bit harsh and
cians which otherwise would still be sitting in a laboratory.    unfairly characterizes an industry in which there are many
Therefore, your “trust factor” was and remains in place for      who do indeed follow the rules and who do so carefully.
the vast majority of those on the industry side just as the          Please do not create the illusion of a trust problem when
trust in the cooperative group system remains in place.          a few errant groups behave as suggested in your editorial.
    Many of your prescriptions for repair are already in place   The sum of the whole in terms of the partnership that exists
in most companies. The issue of fraud is why the FDA has         between industry and academia is greater than the individual
legions of inspectors to prevent such things from ever hap-      parts alone.
pening. To their credit, they do their own audits of the data
and source material. The issue of proper review is also in       Eric M. Bonnem
place in most companies.                                         Medical Oncology-Hematology

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    Rather than cast doubt on an entire industry, would it       Mt. Vernon, New Hampshire, USA
not be better to hand out a “contract of expectations” to        e-mail:
small companies who come in? Such a contract would
say something to the effect that this is the procedure and       REFERENCES
this is how long it takes etc., etc., and serve to educate         1 Chabner A. Trust factor. The Oncologist 2002;7:94-95.
                                 Trust Factor
                                Eric M. Bonnem
                           Oncologist 2002;7;383-384
                      DOI: 10.1634/theoncologist.7-4-383-a
                 This information is current as of April 20, 2010

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