- Email: [email protected]
Mnemonic performances
Cancer survival
cancer care might be no worse in the UK than in the rest of Europe.
Sir—The medical and lay press have included many reports about the poor outcome of cancer treatment in the UK compared with Europe. I was therefore surprised at the difficulty I experienced in finding data to back this assertion for the most common form, lung cancer. I was directed to the Eurocare study, and especially to the research relating to lung-cancer survival across Europe.1 Survival data are reported from 44 populationbased registries across Europe, and survival rates in England and Scotland are about half that in many other countries, a situation blamed on variations in cancer care. Such comparisons are only valid if registration is complete in each country, or at least subject to the same biases. No information about these factors is given, but I suggest that systematic bias might be disorting the results (table). The UK and Denmark fare worst. The surveys used in the study covered differing proportions of patients in each country (acknowledged in the paper). Such differences need not matter if the population boundaries for the smaller registries are tightly defined, but small selective movement of participants might bias the results. The lowest survival rates are in countries with the oldest patients. Unless this age structure of the population of patients accurately reflects the age structure of the general population, these values must indicate systematic registration bias. Old age is not incompatible with successful lung cancer treatment, but comorbidity and operative risk increase with age. The histology results might have arisen because UK physicians are unable or unwilling to investigate their patients properly, but are more likely a reflection of a different mix of patients. Unless more substantial data become available, the lack of basic epidemiological principles evident here suggest that the UK government cancer strategy is built on sand, and
J B Cookson
Country
Scotland England Denmark Netherlands Germany France Spain Slovakia
% 5-year survival, men (in 1000s)
Numbers of patients surveyed (in 1000s)
6 7 6 12 9 12 12 12
20 77 15 2 2 2 4 10
Selected data from Eurocare study
THE LANCET • Vol 356 • November 4, 2000
University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE3 9QP, UK 1
Janssen-Heijnen MLG, Gatta G, Forman D, Capocaccia R, Coeberg JWW, and the EUROCARE Working Group. Variations in survival of patients with lung cancer in Europe 1985–1989. Eur J Cancer 1998; 34: 2191–96.
Mnemonic performances Sir—In your Sept 2 news item1 the method you describe to remember the 52 playing cards mimics that described by a brilliant promoter of such methods—Father Matteo Ricci (1552–1610). He spent most of his life as a Jesuit in China, where he taught (among other things) Chinese scholars how to improve their memory. Father Ricci wrote: “There are three ways to build up ‘palaces of memory’. By taking inspiration from real world, by a total intervention of buildings, or by combining both. For example, from a well known building, one will invent a door opening on new spaces, or an imaginary staircase leading to upper floors, which indeed does not exist. We must pair all that we want to remember with images, and classify these images so that they can wait quietly until we recall them”. Francesco Panigarola, who taught Matteo Ricci, could manipulate about 100 000 images. He explained: “Once everything is ready in your construction, you may enter and start. Turn right and go straight forward from that place. In the same manner we are used to start from the beginning up to the end when deciphering a calligraphy, everything is appropriately set up into the brain and all images are ready to make appear what we wish to remember. If you have to memorise a great quantity of images, then build up hundreds or thousands of buildings. If you need only a few of them, just build up a hall and divide it in four quarters . . .”.
Age distribution of population (%) 65–74 years
>75 years
38 39 38 36 29 29 35 27
28 30 24 21 21 17 18 15
Proportion confirmed by histology (%) 61 58 88 95 82 95 90 79
Much earlier, Quintilianus, a Roman philosoper, clearly described the same basic method: “The first idea must be, so to speak, attached to the hall, the second to the atrium, the others around the impluvii, et subsequent series of images to different bed-rooms, to the statues et various objects which adorn the house. When you need to recall the content of your memory, just walk along these places, starting from the first and asking them to release what has been entrusted . . .” These similarities raise two questions: whether visual stimuli (as opposed to other stimuli such as auditory, olfactory, and tactile) possess a specific power to trigger instantaneously long-term memory capabilities (although for some people, auditory stimuli might play the same part). Nadia Boulanger, a famous professor who insufflated her spirit in a master class of piano of worldwide reputation thought in terms of musical tones, which opens another area of associations and connotations; and whether specific capabilities are needed to improve one’s memory by such methods. But the methods work; Father Matteo Ricci’s teaching remains a remarkable example of how complex such a method can be. Christian Manuel 54 Rue Pergolèse, 75116 Paris, France (e-mail: [email protected]) 1
Spence JD. The memory palace of Matteo Ricci. New York: Elisabeth Sifton Books/Viking, 1983.
Zidovudine’s patent history Sir—P Chirac and colleagues (Aug 5, p 502)1 wrongly allege that most of the research that showed zidovudine’s effectiveness as an antiretroviral agent was done by the US National Institutes of Health. They also unfairly dismiss the United-Nationsled endeavour to accelerate access to care and treatment for HIV infection and AIDS in less-developed countries, in which GlaxoWellcome and four other major companies are partners. After the discovery of HIV in 1983, Burroughs Wellcome began a screening programme for compounds that would be effective against the virus. In November, 1984, zidovudine, first synthesised in 1964, was found to inhibit the replication of
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cancer care might be no worse in the UK than in the rest of Europe.
Sir—The medical and lay press have included many reports about the poor outcome of cancer treatment in the UK compared with Europe. I was therefore surprised at the difficulty I experienced in finding data to back this assertion for the most common form, lung cancer. I was directed to the Eurocare study, and especially to the research relating to lung-cancer survival across Europe.1 Survival data are reported from 44 populationbased registries across Europe, and survival rates in England and Scotland are about half that in many other countries, a situation blamed on variations in cancer care. Such comparisons are only valid if registration is complete in each country, or at least subject to the same biases. No information about these factors is given, but I suggest that systematic bias might be disorting the results (table). The UK and Denmark fare worst. The surveys used in the study covered differing proportions of patients in each country (acknowledged in the paper). Such differences need not matter if the population boundaries for the smaller registries are tightly defined, but small selective movement of participants might bias the results. The lowest survival rates are in countries with the oldest patients. Unless this age structure of the population of patients accurately reflects the age structure of the general population, these values must indicate systematic registration bias. Old age is not incompatible with successful lung cancer treatment, but comorbidity and operative risk increase with age. The histology results might have arisen because UK physicians are unable or unwilling to investigate their patients properly, but are more likely a reflection of a different mix of patients. Unless more substantial data become available, the lack of basic epidemiological principles evident here suggest that the UK government cancer strategy is built on sand, and
J B Cookson
Country
Scotland England Denmark Netherlands Germany France Spain Slovakia
% 5-year survival, men (in 1000s)
Numbers of patients surveyed (in 1000s)
6 7 6 12 9 12 12 12
20 77 15 2 2 2 4 10
Selected data from Eurocare study
THE LANCET • Vol 356 • November 4, 2000
University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE3 9QP, UK 1
Janssen-Heijnen MLG, Gatta G, Forman D, Capocaccia R, Coeberg JWW, and the EUROCARE Working Group. Variations in survival of patients with lung cancer in Europe 1985–1989. Eur J Cancer 1998; 34: 2191–96.
Mnemonic performances Sir—In your Sept 2 news item1 the method you describe to remember the 52 playing cards mimics that described by a brilliant promoter of such methods—Father Matteo Ricci (1552–1610). He spent most of his life as a Jesuit in China, where he taught (among other things) Chinese scholars how to improve their memory. Father Ricci wrote: “There are three ways to build up ‘palaces of memory’. By taking inspiration from real world, by a total intervention of buildings, or by combining both. For example, from a well known building, one will invent a door opening on new spaces, or an imaginary staircase leading to upper floors, which indeed does not exist. We must pair all that we want to remember with images, and classify these images so that they can wait quietly until we recall them”. Francesco Panigarola, who taught Matteo Ricci, could manipulate about 100 000 images. He explained: “Once everything is ready in your construction, you may enter and start. Turn right and go straight forward from that place. In the same manner we are used to start from the beginning up to the end when deciphering a calligraphy, everything is appropriately set up into the brain and all images are ready to make appear what we wish to remember. If you have to memorise a great quantity of images, then build up hundreds or thousands of buildings. If you need only a few of them, just build up a hall and divide it in four quarters . . .”.
Age distribution of population (%) 65–74 years
>75 years
38 39 38 36 29 29 35 27
28 30 24 21 21 17 18 15
Proportion confirmed by histology (%) 61 58 88 95 82 95 90 79
Much earlier, Quintilianus, a Roman philosoper, clearly described the same basic method: “The first idea must be, so to speak, attached to the hall, the second to the atrium, the others around the impluvii, et subsequent series of images to different bed-rooms, to the statues et various objects which adorn the house. When you need to recall the content of your memory, just walk along these places, starting from the first and asking them to release what has been entrusted . . .” These similarities raise two questions: whether visual stimuli (as opposed to other stimuli such as auditory, olfactory, and tactile) possess a specific power to trigger instantaneously long-term memory capabilities (although for some people, auditory stimuli might play the same part). Nadia Boulanger, a famous professor who insufflated her spirit in a master class of piano of worldwide reputation thought in terms of musical tones, which opens another area of associations and connotations; and whether specific capabilities are needed to improve one’s memory by such methods. But the methods work; Father Matteo Ricci’s teaching remains a remarkable example of how complex such a method can be. Christian Manuel 54 Rue Pergolèse, 75116 Paris, France (e-mail: [email protected]) 1
Spence JD. The memory palace of Matteo Ricci. New York: Elisabeth Sifton Books/Viking, 1983.
Zidovudine’s patent history Sir—P Chirac and colleagues (Aug 5, p 502)1 wrongly allege that most of the research that showed zidovudine’s effectiveness as an antiretroviral agent was done by the US National Institutes of Health. They also unfairly dismiss the United-Nationsled endeavour to accelerate access to care and treatment for HIV infection and AIDS in less-developed countries, in which GlaxoWellcome and four other major companies are partners. After the discovery of HIV in 1983, Burroughs Wellcome began a screening programme for compounds that would be effective against the virus. In November, 1984, zidovudine, first synthesised in 1964, was found to inhibit the replication of
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