Respectful Insolence

The Cancer Blog goes woo

I used to like The Cancer Blog. I really did. It was one of the first medical blogs I discovered many months ago when I first dipped my toe into the blogosphere. Indeed, less than two months after I started blogging, one of The Cancer Blog’s bloggers then, Dr. Leonardo Faoro, even invited me to join him as one of its bloggers. Although as a new blogger I was very flattered by the attention and offer, I nonetheless reluctantly turned the offer down because at the time I didn’t know whether this whole blogging thing would work out and was afraid of being tied down and obligated to provide a minimal number of posts per week. Since then, I’m sorry to report that something’s happened to The Cancer Blog in the last 18 months, something I don’t like at all.

Sadly, The Cancer Blog has gone altie. Mixed among the more straightforward posts about cancer and evidence-based cancer therapy, increasingly there appears to be more and more credulous acceptance of pseudoscientific and spiritualistic woo.

I had first noticed this tendency several months ago. Since then, I’ve noticed more and more woo-filled posts. After a particularly credulous post about the quackery known as Reiki therapy back in January followed by a nearly as credulous post in April, I even quietly removed The Cancer Blog from my blogroll and considered writing a post like the present one, but I held off. Unfortunately, The Cancer Blog’s altie tendency got worse, with more examples of credulous acceptance of altie woo., not to mention a positive spin on the story of Abraham Cherrix, the 16-year-old boy with Hodgkin’s lymphoma who has almost certainly doomed himself by choosing quackery over conventional medicine. Still, somehow, I never bothered to post about it, whether it was because other things caught my attention or whether it was a reluctance to criticize a fellow medblog, one that still posted a fair amount of useful information. I even held my fire a couple of months ago, when, after I posted a polite but pointed comment expressing skepticism about one of the woo-filled posts, someone at the blog deleted my comment within a day after I posted it.

Then, over the weekend, I saw this article: Sun’s Soup: Herbal Remedy Saves Mother With Cancer:

As Dr. Alexander Sun watched his mother fighting lung cancer and suffering in pain, with chemotherapy failing to stop the progression of her cancer, he developed an herbal soup for her to drink that he thought might help. Three months later, surgeons removed a tumor and she lived cancer-free for another 17 years.

Ah, yes, an anecdote. Of course, I have to wonder why the surgeon thought it was worth operating on Dr. Sun’s mother if she did indeed have stage IV cancer. I wanted to know more; so I did some digging and found more information at, of all places, the NCCAM website, in minutes of a 1999 CAPCAM meeting:

Dr. Alexander Sun first used a combination of Chinese herbs and vegetables to treat the cancer of his mother, who was diagnosed in 1984 with non-small cell lung cancer. Despite chemotherapy and radiotherapy, the cancer grew and metastasized until it was graded as a Stage IV cancer and conventional medicine could not fight the disease. Dr. Sun, a native of Taiwan who is fluent in Chinese, found a copy of a Chinese traditional medical textbook, Chinese Medicinal Herbs, and studied it thoroughly. He learned where and how each herb grows, how to prepare it, what its properties are, whether it is toxic, and how it is used to treat disease. The book listed the right ways to use each herb, and Dr. Sun carefully analyzed all this information to prepare an herbal vegetable soup to boost his mother’s immune system and shrink her tumor. When the tumor was removed surgically in December 1985, the surgeon was impressed that although it was large, it was very well encapsulated, and that there was no cancer in the margins or lymph nodes. The surgeon told Dr. Sun he had never seen this kind of encapsulation in 30 years, and said there must be something about the Chinese herbal treatment that had led to this result. Dr. Sun reported that his mother is still free of cancer 14 years later.

Sound familiar? Yep, it’s a testimonial. Two issues come to mind here. First, if the tumor was so well encapsulated, perhaps it was a different, less aggressive sort of lung cancer. Another issue is that prolonged survival, even spontaneous remission, can occur in up to 0.5-1% of lung cancer patients, as I’ve discussed before. It’s possible that Dr. Sun’s soup was responsible for his mother’s survival, but it’s also possible that conventional medicine or even spontaneous remission was. It’s impossible to tell from this story.

Now, I’ll give Dr. Sun a modicum of credit for trying to develop some scientific evidence for his soup, which apparently contains shitake mushroom, soybean, lentil bean, leek, mung bean, and other vegetables. But you’d think that after so many years, including a patent from 1995, in which the evidence presented to support the application consists primarily of four anecdotal case reports (one of whom died of aspiration of the soup), Dr. Sun would be able to come up with better evidence than what exists. Basically, there are nothing more than anecdotal reports and two published trials. The first one was a two-arm study. The first arm was mainly a trial designed to show that there was no toxicity in patients treated with conventional therapy plus or minus Sun’s soup. This arm reported that Sun’s soup had a positive effect in preventing weight loss and decline in performance status during the trial. The second arm was a survival study that reported improved median survival in lung cancer patients. The problems with this study are several, but the main flaws were: (1) sample sizes too small to make any real conclusions; (2) there was no standardization or even good reporting of the conventional therapies that trial patients received; and (3) the study was not randomized. Of the three, perhaps (3) was the worst flaw, because we have no way of knowing if there was a systematic difference between the two groups. Indeed, the patients in the experimental group were self-selected. Perhaps those who opted to take Sun’s soup were more highly motivated or had less systemic problems from their cancers, and it is noted that one patient in the control group received supportive care only. In such a small study, even one patient can make a difference in the results. Still, it was promising enough that even I’d agree it was worth doing another study.

One complicating factor is that Dr. Sun holds a patent on the soup and thus has a financial interest in it, having formed a company to produce his soup and sell a freeze-dried version as a supplement:

Complicating the debate is Dr. Sun’s status as holder of a patent for the SV soup. Since he has a financial stake in the outcome of the Phase III trial, there was much debate about the extent to which he should be involved. Many committee members said they believed his involvement was crucial.

I bring this up not because I think it’s a horrible thing that Dr. Sun holds such a patent (although, given how little evidence was provided in the application, it is rather disturbing that it’s possible to patent a therapy based on so little evidence of efficacy), but rather because alties are very quick to castigate trials by big pharma, in which the company has a financial stake in the outcome. You’d think they’d be equally skeptical of trials by folks like Dr. Sun, who similarly has a financial stake in the outcome of any trial of his soup. My view tends to be that, as long as the trial is conducted according to the most rigorous scientific standards, the claim of conflict of interest in these cases is almost always a red herring. But the key is that the studies have to be scientifically bulletproof.

Sadly, such was not the case with Dr. Sun’s followup study, another small pilot trial with several design flaws, including too few patients; the use of historical controls rather than a valid control group; no blinding of groups; again, no standardization of conventional therapy received; and the setting up of a control group after the case series. In essence, as the NIH concluded, the evidence neither shows nor rules out an effect from Dr. Sun’s concoction.

So why was I annoyed at The Cancer Blog‘s take on this? Here’s why:

The National Cancer Institute has documented information on the human clinical studies that were conducted, with additional information about Sun’s Soup. I found it interesting that they do not rule out the effectiveness of the soup, only that the data is too limited to make a conclusive statement regarding the soup. I understand Sun’s Soup is sold freeze-dried as a dietary supplement.

Can you say “credulity”? Sure, I knew you could.

Of course the existing evidence is inconclusive! The studies conducted were too small and flawed to be conclusive. The same can be said of any proposed therapy with such sketchy evidence. Any decent science or medical writer should know that. Science is always tentative in its conclusions, particularly when the evidence is that sketchy! The reason the NIH said that the data is too sketchy to make a conclusive statement is because the data is too sketchy to make a conclusive statement. Period. Why would the writer be surprised at that? Even I don’t rule out the possibility that the soup is a powerful cancer treatment, although I will admit that I doubt it’s anywhere near as effective as its advocates claim or even that it’s effective at all. However, like a good scientist, I reserve judgment until a halfway decent study is performed.

Maybe you think I’m being unfair, and I will concede that the above probably isn’t the most egregious example of woo infiltrating The Cancer Blog. It just happened to be the one that set me off, the most recent in a pattern. Here are some others, some of which are probably worse:

The Cancer Blog on Reiki (based on this puff piece):

An ancient form of Japanese healing being used in conjunction with modern medicine has shown remarkable results. Reiki is a holistic, natural, healing system that addresses the body, mind and spirit of a person. It uses life energy and pulls in positive energy. In a typical session a patient rests, yet is fully aware of their surroundings,and is encouraged to focus on the universal life energy flowing into their bodies. It is noted that reiki has helped with cardiovascular health, cancer, wound healing, fibromyalgia, and AIDS. Reiki is used in more than 50 major hospitals and clinics throughout the United States. As with anything there are skeptics, and simply need to be mentioned. Look only for a licensed practioner or Reiki Master when considering a Reiki treatment.

Or:

In a feature story at NBC4, Jerilyn Ray-Shelley and her daughter, Megan, both cancer survivors, are using Reiki as part of their healing process. According to the news story, Megan Shelley, 27, of Silver Spring, started Reiki therapy after her mother recommended it. Four years ago, Megan was diagnosed with thyroid cancer. Several months later, her mother, Jerilyn learned she had endometrial cancer. “About a year ago, I started crying all the time,” Jerilyn said. “I just felt hopeless about life.” Jerilyn said Reiki helped lift her depression. Both women go to Washington Hospital Center for Reiki therapy.

Never mind that this “energy” cannot be detected or quantified and that there is no evidence that the “power” of Reiki is due to anything other than placebo or the power of suggestion. Never mind that these “Reiki masters” can’t even tell you what this energy is, and never mind that experiments designed to determine whether energy healers can detect human auras or energy fields have consistently yielded negative results.

The Cancer Blog also disparages scientists who try to study the role of spirituality in healing using scientific methods:

How do you measure the ethereal? In an earlier post, I quoted Dr. Richard Sloan, a professor of behavioral medicine at Columbia and author of a forthcoming book, Blind Faith: The Unholy Alliance of Religion and Medicine, who I believe summed it up best when he stated, “The problem with studying religion scientifically is that you do violence to the phenomenon by reducing it to basic elements that can be quantified, and that makes for bad science and bad religion.”

I think that Daniel Dennett would have something to say about that. Of course you can study religion scientifically, and, in the case of claims that spirituality or religion can help with cancer treatment, we are obligated as scientists to do so. It continues complaining about those pesky skeptics:

It doesn’t seem to keep those intent on attempting to measuring the immeasurable and attempting to prove in physical world scientific terms that spirituality can play a powerful role in health and healing. Of course it can. Spirituality is a path to profound healing for those who are spiritual in nature. But it does not exclude healing from those who do not follow a spiritual path. The truest power rests in the power of belief itself on an internal landscape of the mind and body.

The John Templeton Foundation announced it is funding a new study at Michigan State University exploring the role spirituality plays in the recovery from breast cancer. I think that it will not matter the results of the study — if it is positive it will reaffirm what the spiritual believe to be true and challenged by those who do not put much weight in the spiritual dimension of being. If it does not reveal a significant link between spirituality and healing, then the reverse dismissive rejection of the findings will be made.

Or how about this piece regarding the recent study that showed that intercessory prayer did not work in patients undergoing heart surgery:

The results of this study suggest prayer has no power to heal. But, I can quote an equal number of respected studies that show prayer does have the power to heal.

Of course, the writer of this piece, Dalene Entenmann, who seems to pen a lot of the altie stuff on the Cancer Blog, fails to mention a single study before continuing:

In addition, I can illuminate a central flaw in the study, just from reading the press on it. The flaw begins in defining healing and the true power of prayer.

The participants in the study who were asked to pray, were told they could pray in any way that suited them, but they were to include in the prayer, for a successful surgery with a quick, healthy recovery and no complications. Basically, prayer is not an exercise where Santa shows up and leaves all the presents you asked for under the tree. This predisposes the belief there is some central magical figure granting requests. Or, equally as misdirected, that we are all little Harry Potters, with the power to alter the course of an event by chanting a certain phrase. There are all kinds of healing. There is physical healing. There is emotional healing. There is healing of the mind. There is spiritual healing. Which means, at the start of this study, the researchers were on a course doomed to failure, if the results were based on specific wish granting of a single wish.

Apparently she doesn’t want to acknowledge that those who carried out this study were supported by the John Templeton Foundation, whose mission is to study spirituality but whose founder and members clearly believe in God and prayer.

The followup post is even worse:

Last week, I posted on the power behind the power of prayer regarding a study basically suggesting that prayer does not help people heal, and to make matters worse, prayer seems to inadvertently act with evil-eye power, making those prayed for suffer more difficult recovery than their counterparts who were not prayed for at all. But if prayer can have a negative affect on the health of someone prayed for, then it must have the power to heal too. Yes? Yes. As Nietzsche once pointed out, good and bad cannot, and do not, travel separately, as each is merely a side to a two-sided coin. So if the study is suggesting prayer does not have any power to heal, it cancels out its conclusions by suggesting that prayer does have the power to harm.

Of course, that’s a huge straw man. That’s not what the study found at all. What the study did find was that there was a trend towards more complications and worse outcomes that was not statistically significant in the group of patients who were prayed for and who knew they were being prayed for. The investigators’ explanation had nothing to do with invoking the power of prayer to do harm. Rather, they speculated that perhaps their result could have been due to patients who knew they were being prayed for fearing that they were in worse shape because people felt the need to pray for them. In the two groups who didn’t know whether or not they were being prayed for, there was no difference in complication rates.

I could go on (for instance, don’ t get me started on this post about fighting stress with six essential oils and aromatherapy), but hopefully this is enough to show why I no longer consider The Cancer Blog to be a reliable source of cancer information. In the year and a half since I first discovered it, it’s gone from a blog full of useful cancer information that was primarily evidence-based to a mixture of straightforward studies supplemented with a heaping helping of fluffy fuzzy altie woo, topped off with at least one writer who apparently has a tendency to delete comments expressing skepticism about her non-evidence-based speculations and assertions. It’s not that there isn’t still useful information at The Cancer Blog; there is, such as this post about mammography. It’s just that the evidence to woo ratio is becoming increasingly unfavorable.

It gives me no great pleasure to write this post. In fact, I’ve been debating for at least a couple of months whether I should do it or not, only deciding that the time had come over the weekend. Maybe in retrospect, it’s probably a good thing that I never took Dr. Faoro up up on his offer. The owners of The Cancer Blog would probably have ended up giving me the boot for laying down my characteristic Respectful Insolenceā„¢ about dubious treatments and my insistence on evidence-based medicine. Either that, or I would have had to leave in disgust to prevent my reputation from being sullied by association. Either way, I doubt it would have been pretty. On the other hand, maybe if I had said yes, I could have done something to stop the slide of The Cancer Blog deeper and deeper into woo–or at least provided a skeptical counterpoint for as long as possible.

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Comments

  1. #1 epador
    July 3, 2006

    It takes little to understand where this transformation began. $$$$ for advertising. Just look at the ads and “sponsored links.” No medical ethics here, nothing to see but simple business, move along…

  2. #2 Chris
    July 3, 2006

    A minor point: even if it were proved that the soup were effective fresh, wouldn’t they still need *another* study to prove that freeze-drying it doesn’t destroy its effectiveness, before marketing the freeze-dried version?

    I guess that only applies in a world where they are bound by ethical constraints, though. They don’t have much to fear from the laws against false or misleading advertising.

  3. #3 Hyperion
    July 3, 2006

    Nah, you’d have just become their Alan Colmes. That’s not a fun position for anyone.

    Oh, if you haven’t reached your recommended daily allowance of woo yet, there’s an interesting (and I use that term loosely) piece of secondary-woo (ie, falsely denigrating an accepted treatment so as to make altie treatments look more appealing) by El-Zein that was published in last December’s “Cancer Letters.” It’s an n=12 pretest-posttest study with no control group. I don’t know for certain whether it’s intentionally woo-ish or whether it’s just simple incompetence, not that there’s usually a difference, but it’s hard to conceive that any non-altie would construct a non-controlled pretest-posttest study and actually claim that it shows anything.

    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=16297714&dopt=Citation

    I’ve heard some reaction from the mental health advocacy communities, but not much so far from any oncologists (prolly because there’s not much there to debunk).

  4. #4 Sid Schwab
    July 3, 2006

    Orac, I really admire your continued well-reasoned and detailed responses to the credulous alties. I know from experience that such fervor comes from seeing patients seduced away from what you know could help them, to treatments that clearly won’t. I’ve seen it in my practice as well. The difference between me and you is that you have brought yourself, via this blog, into a position possibly to prevent it from happening to more people than just your own patients. That you continue your fight shows both a fury and optimism that are wholly admirable. The fury, I share. The optimism, not so much. I continue to sense an across-the-board trend away from science in this country; an ascendency of belief over reason. My hope is that it doesn’t take a majority to keep science moving forward: that as long as there is some sort of undefinable critical mass of skeptics and thinkers, progress will be made and even the credulous will benefit, even as they deny it. I hope. Keep it up.

  5. #5 ArtK
    July 3, 2006

    it is rather disturbing that it’s possible to patent a therapy based on so little evidence of efficacy

    There are many requirements on patents, but being functional is not one of them. Well, unless you’re trying for a perpetual motion machine that is, in which case USPTO may ask for a working model. I think that they issued quite a few worthless patents before they got wise on that topic. Perhaps we can lobby for a similar “snake oil” exception, requiring some proof of efficacy.

  6. #6 impatientpatient
    July 3, 2006

    Thank you- you are my hero and I really do think that you ought to do more of this.

    I also want to read that book on medicine and religion- fascinating stuff……

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