Expanding INCTR's Membership
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Two of INCTR's faculty members Emma and Nicholas Seaford spent 9 months in East Africa last year, assisting INCTR with its studies on Burkitt lymphoma, which are yielding excellent results even in the midst of such poor circumstances. This is not a little due to the efforts of Nick and Emma, who worked with the local team in Lachor, Uganda. In this picture they are "on safari" checking up on some patients that we had not heard from recently. For accurate conclusions to be drawn from out studies, we need to make sure we know what has happened to every patient on one INCTR's implementation trials (well, almost everyone. Even in clinical trials performed in the very high income countries occasional patients are lost to follow up). Nick and Emma were struck by the kindness and gratitude of the people who insisted on giving them food and sometimes gifts. In several villlages, they came away with a couple of live chickens! But there are many on-going INCTR projects around the world, and the more fellows we have, and the more they are willing to do, the better will be the outcome of cancer therapy across the world. In addition, to a large degree. should our members wish to actively engage in fund-raising or specific projects, they will be working in their own country and expanding its capabilities.

Even the wealthy economies face a continually worsening situation, since although the overall number of deaths from cancer has begun a slow downward path, at least in the higher income countries, the increasing prevalence of cancer will create a greater demand for care, even after therapy is completed. Unfortunately, the numbers of nurses and doctors required in more developed countries is constantly rising, such that more and more trained health professionals are migrating from their own country, either before or after training as a health care provider, worsening the plight of all patients who need medical care in their own countries. One of INCTR's strategies, therefore, is to markedly increase the number of branches and members, in the hope that some, at least, will play an active role in addressing the cancer burden. They do not have to be care provides. People capable of raising funds, or working with governments (state or federal), professional societies and NGOs to improve the situation for cancer care, or those willing to donate to INCTR can make a big difference. Very often, the establishment of networks that meet informally - or formerly - such as at journal clubs, at the meetings of societies for specialists of one kind or another, benefits both the participants themselves and others in the country, since such meetings provide considerable incentive to keep up to date and discuss cases with fellow specialists or, in the case of cancer, a variety of specialists. These societies can also give training sessions at regular interval, keeping the hospital staff up to date and recruiting students to undertake medical training. Once again, INCTR members who can do many things to make the projects are successful

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. Finally, various NGO's with overlapping interests can work together and mutually benefit from working together.

In all professions continuing education is essential, but it is often difficult for full time practitioners to find the time to organize it. Thus, many meetings ensure that attendance is recorded, and benefits (e.g,. in the form of points obtained towards their continuing education). In Britain, doctors have to be re-certified at intervals - a good idea perhaps, and quite a bit more complicated than standard continuing education. But then, Britain had no official continuing education programs of any type until recently. The issue of continuing education is perhaps one of the more important ones that INCTR's members will take up, even if only in certain countries, but there are many other things that they can do to benefit their careers e.g., research. It is sad that with WHO insisting (and rightly so) that all research conforms to good clinical practice and few practicing doctors have experience - or even interest in the conduct of research. Bringing them "up to speed" in this area is important not only for the conduct of science within ongoing clinical care but for doctors to become more familiar with the language of science and to become more involved in the conduct of clinical studies at least. That, of course, is one of the functions that our programs already undertake, and the application of good ethical practice as required by all scientific studies including human subjects is a sine qua non to good science. Even if informal, working together and sharing knowledge and experience benefits everybody. We are constantly bombarded by information, yet the Institute of Medicine of the USA undertook a survey that showed that the average time for new information - the results of clinical studies with definite outcomes - to become a routine component of the treatment of patients is 17 years!!!! Are we all 17 years out of date?

INCTR members can also propose to INCTR - or undertake them themselves in the context of local or regional organizations, certain projects they think are important, or become a faculty member and be involved in upgrading teaching materials and tools - with INCTRs active involvement or merely advice. If they have the necessary skills, they can help train colleagues in countries where the resources are so poor that it may be impossible even to make a correct diagnosis. All of this benefits our members, since they are the better a health provider for it, and meet many like-minded people with the same values, and could reach a number where governments and profit-oriented centers must listen. And they will make many friends within the larger INCTR "Family." In the long term, the burden of cancer will continue to increase and must be met by approaches to ensure early diagnosis or prevention and many more doctors from less developed countries need to be trained in these skills. There is much to be done, and INCTR members could become a major new army to defeat the enemy, ideally, as per General Sun Tzu, before a major violent confrontation occurs. In the coming months we'll make it possible for your voice to be heard in various ways - we invite you to actively participate in this process of mobilizing a army that will fight to win, and not simply to exploit people when at their most vulnerable. An individual may be poor, but serving with a company of others, he or she is rich. And, depending upon the country, so much of the money spent is wasted - or even creates a worse situation, such as increasing cigarette sales. One thing is clear - no country has sufficient resources to win the battle by itself. There is much to be done and you can be a part of the action. JOIN INCTR NOW and join not only the the conversation, but the action!

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