Jane McCredie: When religion and medicine collide

THE spectre of thalidomide looms large, despite its rehabilitation in recent years as a cancer treatment.

As you’d expect, patients taking the teratogenic drug are given detailed advice about contraceptive precautions — or at least they should be.

But what happens when this clinical imperative collides with the Catholic Church’s opposition to birth control?

The Sydney Morning Herald reported last week that doctors at Newcastle’s Calvary Mater Hospital had been forbidden from providing specific written contraceptive advice to patients participating in trials of the closely related drug, lenalidomide.

Instead, the newspaper said, the hospital provided a “statement of reproductive risks” that told women they must not become pregnant during treatment, but offered no information on how to avoid this.

Although it is run by a Catholic health care organisation, Calvary Mater is a public hospital and the main provider of cancer treatment in the Newcastle region.

When I contacted the hospital last week to check the accuracy of the information in the Herald report, I was sent a written statement that said its doctors provided comprehensive written and verbal information on the risks associated with trials. Women were advised to talk to their doctor as they must avoid pregnancy during cancer treatment, the statement said.

That would seem to indicate, as reported, that the hospital stops short of providing written specific contraceptive advice to participants in trials of a teratogenic drug.

Now, you might think most women know how to use contraception without the need for detailed written instructions but, as one doctor pointed out last week, patients who have just been diagnosed with cancer are likely to have a lot on their minds and may easily overlook verbal advice.

The recommended precautions for lenalidomide are also particularly stringent. The manufacturer advises women of childbearing potential to use two effective means of contraception simultaneously while taking the drug and for 4 weeks after cessation of treatment.

There is also a risk that the drug can pass into semen, so male patients are advised to use latex condoms over the same period, even if they have had a vasectomy.

It is hard to believe an Australian hospital would seek to prevent doctors from providing that information in written form to their patients, as is being alleged here.

Individuals are entitled to their opinions, but it seems to me an establishment that is given the status — and government funding — associated with being a public hospital does not have the right to impose views that are so at odds with general community attitudes.

And is an organisation that is apparently unwilling to provide contraceptive advice really the right place to conduct a trial of a teratogenic drug?

Jane McCredie is a Sydney-based science and medicine writer.

Posted 14 June 2011