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Here's a noteworthy twist on the news:...


Here's a noteworthy twist on the news: The World Health Organization (WHO) is praising the fact that worldwide consumption of morphine more than tripled during the 1980s, rising from 2,345 kilos in 1980 to 7,206 kilos in 1990.

Drug use is good news?

Yes, because morphine use is a good measure of the quality of life and death for the 51 million people who die of cancer each year. For many of these people, a point comes where the only medical treatment that can make much difference is any care that relieves pain and lends comfort to a patient's final days.

That point comes much sooner for cancer patients in the Third World, where a majority of cancer deaths -- 40 million a year -- occur.

Especially in rural areas, medical care can be primitive, and cancer is often detected after the point where traditional treatments can do any good.

Even when the disease is diagnosed early, chemotherapy and radiation may be unavailable or inaccessible.

It makes sense, then, for WHO to target cancer pain relief as a major public health goal. 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.

WHO is addressing the problem on two fronts: training health care providers in effective methods of relieving cancer pain and educating governments about the importance of focusing on pain relief.

The latter goal is especially important. One problem WHO faces is the bad name drugs have gotten because of drug abuse in affluent societies. Some developing countries have adopted tough drug laws that interfere with efforts to promote the legitimate medical use of effective pain relievers. However, health care workers find that morphine prescribed for cancer pain relief is not misused; its legitimate use is well understood by patients and caretakers alike.

Pain does not strike every cancer patient, but studies suggest that moderate to severe pain occurs in 30 percent to 40 percent of patients with early cancers and in anywhere from 45 percent to 100 percent of people with advanced cancers.

The importance of relieving pain for cancer patients has gotten shamefully short shrift in the developed world. But the neglect of pain has been all but universal in poor countries.

In part, that is due to attitudes that say, in effect, the pain must be God's will. But a larger share of the blame must go to a simple lack of education in pain relief and a shortage of medical supplies to make it possible.

As a result, while striking victories against cancer have been won in this country and elsewhere, for many of the disease's Third World victims, cancer is still a death sentence. Even worse, the disease condemns millions of people to prolonged pain -- and, thus, a death that is robbed of any dignity.

No wonder WHO considers unrelieved cancer pain one of the world's most pressing health problems.

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 rest of the world provide cancer patients with the chance to face death with some measure of dignity.

(Do you have a question about mortality for Sara Engram? You can write to her in care of Universal Press Syndicate, 4900 Main St., Kansas City, Mo. 64112. Questions of general interest will be addressed in future columns.)

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