DOI: 10.1097/01.COT.0000294333.34462.38

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Issn Print: 0276-2234

Publication Date: 2005/09/10


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‘Simone's OncOpinion’ on Influential Books (July 10 Issue)

Arvin S. Glicksman

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Excerpt

I noted with interest the inclusion in the column on influential books William Osler's Aequanimitas. This is indeed a worthy text by a man who contributed significantly to the development of medical education in the United States and England. There is, however, one essay that was not mentioned in the article, information that has importance for us because of a potential negative impact on patient care.
I refer to the essay, “The Fixed Period,” in which Osler talks of two fixed ideas: the first, the comparative uselessness of men over age 40; and the second, his even stronger feeling about those over age 60 and the incalculable benefit it would be “if as a matter of course, men stopped work at this age.”
He then refers to Anthony Trollope's book The Fixed Period, in which there is “an admirable scheme of a college into which at 60, men retire for a year of contemplation before a peaceful departure by chloroform.”
While we may find this amusing now, 100 years after Osler's lecture (delivered at Johns Hopkins), pervasive thinking of this nature can produce an age discrimination associated with cancer treatment. More people are living a healthy and useful life beyond the age of 60, and 60% of cancer occurs in people over age 60.
A third of men reaching 65 will attain an age of 90, and 44% of women will reach this age. We need to impress this upon our fellow oncologists, our residents, and trainees so that treatment will be provided to all patients based upon performance status and an assessment of the severity of co-morbidities, not the patients' chronological age.
I am sure that in 2005, Osler would not be maintaining an “Aequanimitas” on age discrimination in cancer treatment.
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