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Marcus M. Reidenberg, MD
The New York Hospital-Cornell Medical Center New York, NY

JAMA. 1996;275(11):835.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—Drs Jadad and Browman¹ review literature to evaluate the effectiveness of the World Health Organization (WHO) analgesic ladder approach to treating cancer pain. They state, "Unless there are controlled studies, it would be difficult to know whether the WHO ladder has really improved the management of cancer pain." They ignore the real worldwide issue of "improved" compared to what?

This WHO program had as its major goal making opioid analgesics available to everyone in the world suffering from pain from advanced cancer. The ladder approach was to facilitate the acceptance of opioid use in these patients since historically opioid use was condemned by medical authorities "if it [could] possibly be avoided,"² and surveys have found inadequate use of opioids to treat cancer pain (references cited in reference 1). One should assess the success of the ladder concept by learning what fraction of dying cancer patients . . . [Full Text PDF of this Article]

Footnotes
Edited by Margaret A. Winker, MD, Senior Editor, and Phil B. Fontanarosa, MD, Senior Editor.

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