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