Few reading this journal in 2000 will live to see the next century; death for all is inevitable. There should be an increased focus on how we die. As great advances have been made in reducing cardiovascular mortality, the relative importance of cancer will increase.

Chemotherapy can cure certain cancers. Unfortunately, in advanced cancers chemotherapy often merely delays the inevitable, sometimes only for a few weeks. In that short time the patient may have to endure unpleasant adverse effects. Chemotherapy aims to destroy all dividing cells, in the hope that normal cells will recover faster than cancer cells.

Patients are poisoned to the edge of their existence and products such as G-CSF allow us to push them even closer to the precipice. Some patients will fall because of their treatment rather than the disease.

The ability to destroy abnormal cells while sparing normal tissues has a strong appeal. Although it is still in its infancy, immunotherapy could be the way forward. There have been attempts to put the theory into practice, but there is a need to find antigens which are more specific for tumour cells.

I hope that by the end of the next century, we will be able to use the body's own immune system to fight cancer. This would allow us to consign aggressive chemotherapy to the list of twentieth century treatments, which already seem medieval.

J. S. Dowden