The World Health Organization has some good news about drug use: World-wide consumption of morphine more than tripled during the 1980s, rising from 2,345 kilos in 1980 to 7,206 kilos in 1990.
That's good news? Yes, because it indicates that many more of the 51 million people who die of cancer each year are getting the only care that can make much difference -- relief from pain. This is especially important in developing countries, which record 40 million cancer deaths each year. In many cases, the disease is not diagnosed until it is so far advanced that little can be done even if adequate medical facilities are available.
But humane care for cancer patients goes beyond attempting to cure or delay the disease. Good medicine also demands that patients be kept comfortable -- and that means paying attention to pain. Studies suggest that moderate to severe pain occurs in 30 to 40 percent of patients with early cancers and in 45 to 100 percent of people with advanced cancers. Even so, fewer than one-quarter of 1 percent of the pages in standard oncology textbooks in this country deal with cancer pain.
Clearly, pain relief as an integral part of cancer treatment has gotten shamefully short shrift in the developed world. But the neglect of pain has been all but universal in poor countries. As a result, cancer has not only been a death sentence but, worse, it has also condemned millions of people in developing countries to prolonged pain -- and a death that is robbed of any dignity.
For these reasons, WHO has targeted cancer pain relief as a major public health problem. Because health care resources are so scarce in many parts of the world, pain relief will be the only realistic treatment for these people in the next few years. That lends added urgency to WHO's efforts to train Third World health care providers in cancer pain relief and to educate governments about the need for drug laws that do not prevent efforts to promote the legitimate medical use of effective pain relievers.
There is no humane reason to allow people to suffer unnecessary pain. And until developing countries can offer cancer patients more hope for treatment and recovery, there is a special burden on WHO and on developed countries to help the developing world provide cancer patients with the chance to face death with some measure of dignity.