What or who is behind “Prime Oncology”?

The organization “Prime Oncology” has surfaced recently, purporting to provide professional education to oncologists.

With offices in the USA and in Europe and a surfeit of conferences, it is obviously well funded, but strangely very little can be found on the Internet about just <i>how</i>. Interestingly, the company is able to secure leading members of the profession to speak in its seminars and conferences. It claims to be “independent”, but independent of just what is unclear.

I have written to both offices to seek more information, but to date, there has been no reply forthcoming.

It is likely that Prime Oncology is funded by pharmaceutical companies. The lack of disclosure is worrying.

Be wary.

The drug industry has no choice but to creep towards transparency in the United States, with Eli Lilly and Merck planning to declare the payments it makes to doctors and consultants, but it’s a uphill battle all the way.

To please no one

Marc Weide reflects in the Guardian on the run-up to his mother’s (Mdm. Weide-Boelkes) scheduled appointment for assisted suicide, or voluntary euthanasia (the former term is preferred by myself). The article is poignant and mixed with black humour.

‘I’m going to die on Monday at 6.15pm’

5.30pm: Dad is bent over the toilet bowl with a brush in his hand and a scowl on his face. I walk up to him. “Shall I give you a hand?” Dad begins to snigger, abandoning any attempt to make sense of the situation. We stand shoulder to shoulder with our backs to Mum, who paces around the landing with a newly fitted catheter in her hand. The catheter has been put in by nurse Marianne to enable our GP, who will be with us in half an hour, to give Mum a lethal injection. But instead of having a moment of peace with us, as Marianne suggested, Mum demands that we clean the toilets. Both upstairs and downstairs.

My brother, Maarten, is sitting on the edge of the bath, staring out of the bathroom window.

“Imagine,” he mutters. “Her last hour, spent like this.”

This is the Netherlands, where voluntary euthanasia is permitted, as well as physician-assisted suicide. This is the day my mother has chosen to die, and the toilets need to be spotless.

Mr. Weide proceeds to describe the surreal weeks between the diagnosis and Mdm. Weide-Boelkes’s death. I wonder whether the behaviour that Mr. Weide found so troubling in his mother was the result of brain metastases, rather than merely dysfunctional coping mechanisms. This could explain the nocturnal vacuuming, which is incidentally a common presentation of mania. Palliative cranial irradiation may have gone some way in alleviating the nausea, vomiting and seizures that troubled and robbed her of her sense of security.

Apart from that detached clinical observation, I have nothing but sympathy for Mr. Weide and Mdm. Weide-Boelkes. As an oncologist who cares for patients with terminal cancer, I can appreciate how difficult the situation can be. Each person must face his or her own inevitable mortality eventually, and this process can be very stressful for families. Not all families are equipped or have evolved a dynamic to cope.

Finally, that the obsessive house-cleaning was a diversionary tactic to turn attention to the external, material world rather than the self is obvious. Who really was the target?

“To please no one will I prescribe a deadly drug nor give advice which may cause his death..”

An anachronism today, but Hippocrates has never been faulted with lack of clarity.

A prison of our own making

I remember the last time I met Mdm Lee clearly. She was crying in my clinic, but refusing admission for her paroxysmal vomiting and headaches. I knew her symptoms were due to brain metastases arising from her breast cancer. This malignancy had already eaten away one breast, leaving behind raw and weeping chest wall.