Reviews

The Enemy Within is an hour-long film presented by Vivienne Parry – it tells the story of the human fight against cancer over the last 50 years.

Contributors include the great and the good of cancer research – Professors Robert Weinberg and Umberto Veronesi, Lord Ara Darzi, Professor David Nathan, Professor Brian Druker and many more. Equally, there are contributions from a number of patients, including Karen Lord, a survivor of childhood leukaemia, Julian Tutty, one of many patients who benefited from the development of Gleevec, and Bobbie Ariaudo, who eventually succumbed to pancreatic cancer.

In chronicling the fight against cancer, it describes any number of important events – be that the debate surrounding combination versus sequential, single agent chemotherapy, the provision of palliative care or the realisation that a conservative surgical approach, as opposed to radical mastectomy, might be equally beneficial and less disfiguring for patients with breast cancer.

It also focuses on achievements further afield that have helped improve survival rates for many cancers – the vast technological advances that have led to the development of CT, MR and PET imaging, the sequencing of the human genome and the realisation that environmental exposures (smoking, alcohol, obesity and sunbeds) are significant causative factors that need to be addressed. In doing so, it tells a calm and sober story of human endeavour.

The power of the human story, the story of those who have succumbed to cancer and those who have survived, feels sanitised – devoid of the emotion that might invigorate this short film

Whilst the film also acknowledges the role of survivors, politics and ‘people power’, you sense that the nod to these groups is simply that – a nod. The power of the human story, the story of those who have succumbed to cancer and those who have survived, feels sanitised – devoid of the emotion that might invigorate this short film. Moreover, you can’t help but feel that it glosses over many of the challenges that remain – the failure to diagnose and treat virulent cancers, especially pancreatic and thoracic disease, the inadequacy of treatment in the non-industrialised world, and the considerable costs arising from non-adherence.

This is a non-commercial, editorially independent piece, supported by Cancer Research UK and funded by an educational grant from Roche. The filmmakers set out to educate and inform those who are affected by cancer. Whether they have achieved that is questionable, as the focus and language is largely directed towards the medical fraternity. However, in a little over an hour, this film provides a high level overview of what has been achieved in 50 years, which will be enjoyed by many a clinician.

Gawande distinguishes between errors of ignorance and efforts of ineptitude – the most common and relevant in today’s medical world being the latter. He explains that the high pressured and intense environment that is prevalent in the medical world means mistakes are inevitable.

He borrowed a concept from the aviation industry: the checklist, similar to the checklists used by pilots before take-off, and applied it to medicine. He then argues that implementing checklists that walk surgeons through procedures actively prevents mistakes. Good checklists and clear communication amongst the team can significantly reduce errors.

I encourage every doctor to read this well-crafted and fascinating book – it will change the way you think

For those among the medical profession who are sceptical about using checklists, or are interested in how the WHO operative checklist came about, I suggest you read this book, as it is powerful enough to make you rethink your ideas.

I’ve found myself using examples of Gawande’s book to inform my operating staff of the origins of the checklist, while stressing its importance to us all.

Surgeon or paediatrician, GP or psychiatrist – I encourage every doctor to read this well-crafted and fascinating book – it will change the way you think.