Respectful Insolence

It never seems to end, does it?

I’m talking about the hype and questionable practices revolving around dichloroacetate (DCA), the small molecule chemotherapeutic agent that targets the Warburg effect, in essence normalizing the metabolism of tumor cells and thereby inhibiting their growth. (See here and here for more details.) A report by Evangelos Michelakis at the University of Alberta in Cancer Cell in January reported strong antitumor activity against a wide variety of tumors in rat tumor models resulted in a phenomenon ballooning out of control in a way that he could never have imagined. Even though DCA has never been tested in humans against cancer (although it has been tested against specific metabolic diseases), desperate cancer patients are seeking DCA from bootleg sources. This hysteria, even though there had not yet been any evidence that DCA had any antitumor activity in humans, was fueled mainly by the mystique applied to DCA because (1) it’s a small molecule, orally available drug; (2) a novel and interesting mechanism of activity; and, in my mind most importantly, (3) big pharma was not very interested in funding clinical trials to test it against cancer because the drug itself was not patented, leading to a lot of Internet and blogospheric hype about the “cure for cancer” being “suppressed” or “ignored’ by big pharma. I’ve written about this extensively since January, most recently about a week ago, and I had hoped to leave the topic alone for a while.

Then on Friday there was a new development. I managed to restrain myself from writing about it for the entire Memorial Day weekend, but that’s about all I can manage.

This time around, believe it or not, I won’t be primarily writing about The DCA Site, the website run by a pesticide dealer named Jim Tassano, who hired a chemist to make up some home brew DCA and sell it from his other website BuyDCA.com to dying cancer patients. Many of these patients populate forums of TheDCASite.com and tell stories that are either wishful thinking, tell tales of side effects, or border on downright quackery in which patients are told that they must “alkalinize their blood” to make DCA work. Unfortunately, I will be discussing a couple of other “entrepreneurs” who’ve decided to enter the DCA fray:

EDMONTON – A private cancer centre in Toronto is selling itself as the first in Canada to prescribe a possibly poisonous chemical to patients, even though the compound hasn’t been tested on humans and hasn’t been approved by Health Canada.

In February, wife-and-husband team Drs. Humaira and Akbar Khan heard how a University of Alberta researcher used dichloroacetate (DCA) to successfully shrink tumours in rats without damaging healthy cells. Last month, they offered the water-soluble powder to cancer patients in Ontario who have exhausted all other treatments.

They did so despite dire warnings from Edmonton’s Dr. Evangelos Michelakis that the chemical can be toxic and can cause imbalance, finger numbness and nerve damage.

“I agree with the warnings,” said Humaira Khan, a public health epidemiologist who focuses on research in Toronto’s Medicor Cancer Centres. The clinic opened one year ago and charges patients about $150 for one week’s supply of DCA.

“But at the end of the day, it comes down to patients’ rights. It comes to the patient’s choice. That was the philosophy and the motivation because patients come to us and say, ‘We know the risks. We understand it hasn’t been studied. I don’t have much to lose.’ ”

Khan said it’s better for her clinic to supervise patients instead of having them self-medicate, as hundreds around the world are doing after hearing about Michelakis’s research, published in the prestigious academic journal Cancer Cell.

And why do Drs. Khan and Khan want to do this? Why, they’re humanitarians, of course:

The paper sparked worldwide frenzy, with patients buying questionable DCA from unproven sources and reporting their outcomes in Internet chat rooms.

“We felt we needed to do it,” Khan said.

Her husband, a family physician with 13 years experience in palliative and cancer care, is the clinic’s medical director. “It didn’t seem ethically right to say no,” he said. “At the end of the day, even if we’ve saved one life, it’s worth it.”

“Didn’t seem ethically right to say no?” How about more like “didn’t seem financially right to say no”? And, of course, the Khans have, as all alternative medical practitioners do, testimonials:

One woman in her 70s, who almost died from chemotherapy, had a four-centimetre tumour on her shoulder that has disappeared.

One man could walk again after taking a strong dose of DCA. His nausea and severe pain also disappeared, even after he had to go off the treatment when he suffered side-effects. Some patients reported memory loss, stomach upset or tremors in their arms.

“Most of our patients have benefited from it,” Humaira Khan said.

“It’s hard to say how much of a benefit, but they are palliative patients and pretty much had nothing else to go on, so DCA has prolonged their life and given them a better quality of life. That gives us a lot of confidence.”

I’d be very interested in knowing exactly on what evidence they base this claim that DCA has prolonged the lives of patients. For one thing, it’s only been four months since DCA hit the blogosphere, and that’s not long enough to determine whether DCA actually extends patient survival, even in a well-designed clinical trial. In the unsupervised experimentation that’s going on right now, determining if DCA has actually prolonged the life of a cancer patient is virtually impossible in such a short period of time. It may even be close to impossible in any amount of time, because determination of survival requires comparison of patients taking DCA to a control group, plus enough time for differences in survival due to the drug to manifest themselves. Unless DCA is truly a miracle drug, which, alas, it is not (as I’ve documented below), such differences will not manifest themselves in the two or three months since Jim Tassano, for instance, started selling his home brew DCA. In any event, neither of the Drs. Khan are oncologists. Dr. Akbar Khan is a family practitioner who is clearly lacks the training to be prescribing chemotherapy and monitoring the progress of cancer patients. Yes, he does have experience in the palliative care of terminally ill cancer patients, but he doesn’t appear to have any experience in administering chemotherapeutics. His wife, Dr. Humaira Khan, is a physician with an MPH who’s primarily an epidemiologist. The clinic also employs a naturopath, a physiotherapist, a counselor, a massage therapist, a dietitian, and a pharmacist, among others, but apparently not a single oncologist.

Despite the lack of oncologists, this clinic, Medicor, this clinic actually offers the antiangiogenic drug Avastin™. They also offer a whole lot of woo, such as high dose vitamin C therapy, among others. They also offer a test called ChemoFit, which supposedly tests the tumor cells of cancer patients and informs them which chemotherapy will and won’t work. Using in vitro measurements of tumor cell response to chemotherapy is a line of research that has been fraught with problems and is far less useful than Medicor would have you believe. Indeed, I find it telling that, on the ChemFit website, several peer-reviewed papers supposedly supporting the efficacy of using in vitro tumor assay-guided therapy, but none that I could find in a search of PubMed supporting the use of the ChemoFit test itself. I have to say, I’d want some strong, specific evidence about the ChemoFit test itself and its ability to predict the chemosensitivity or chemoresistance of a patient’s tumor before I would consider actually using it to guide therapy, especially since the test is not cheap, costing $2,500, and, contrary to claims by the Khans, it is not “standard practice south of the border.”

But maybe Medicor really is being reasonable about DCA therapy. Let’s see what it has to say about DCA:

Medicor believes that is essential for clinical trials to be conducted with DCA as a cancer treatment. However, we are aware of many patients who are currently self-medicating with DCA, or are being treated with DCA under naturopathic care alone. Medicor is committed to helping cancer patients who request DCA treatment to receive it in the safest possible way.

We respect the patient’s right to choose their treatment once they know all the potential risks and benefits. All of our DCA patients understand that DCA is not yet scientifically proven as a cancer treatment.

There it is, not unexpectedly, the old “health freedom” gambit, beloved of purveyors of dubious “alternative therapies” and, apparently, just as useful to doctors selling an unproven drug outside the confines of a clinical trial. Of course, if they really are collecting hard data on patients taking an experimental anticancer chemotherapeutic, it could be argued that they are doing clinical research. If that’s the case, then, i wonder, are they getting valid informed consent from these patients? Do they have a valid protocol that could produce actual useful information about whether DCA has an anticancer effect against specific cancers? If they do, then why should they be able to do this sort of research without oversight by an IRB, or whatever Canada’s equivalent is? None of the employees of Medicor appears to have any relevant experience in running cancer clinical trials; given that, their supervision is probably only marginally better than the lack of supervision going on at The DCA Site.

Perhaps it’s just the nasty advocate in evidence-based medicine in me, but am I so off base to suspect that this is nothing more than a case of some alternative medicine “entrepreneurs” seeing an opportunity to make a buck and going after it? After all, when Medicor opened a year ago, it was custom-designed to provide “personalized care” (a.k.a. woo) to cancer patients who can pay for it:

A clinic set to open today is offering what its operators call a private-medicine first in Canada — intensive care, counseling and portable electronic health records specifically for fee-paying cancer patients.

The physician couple behind Medicor Cancer say they will provide the kind of comprehensive aid in dealing with the disease and the health care system that many cancer patients cannot get now.
Clients will have to pay at least $2,500, but the physicians say any medically necessary services will be charged to the medicare system, as legally required.

It is the latest twist in the growing field of private health care, and the Ontario government says it will watch the clinic closely to ensure it abides by the law.

The doctors opening Medicor say they would be happy to see the province pay for the sort of services they will offer. In the meantime, patients have a right to pay for them, they argue.

“If I’m sick and I want something, I don’t want the government to tell me what I can spend my money on,” said Dr. Humaira Kahn, a public-health physician and Medicor president. “If it’s my life or the life of someone I love, I want to be able to control what treatment I want, where I want it, whether I pay for it or not.”

“Is it fair that the system forces mediocrity on every citizen?” asked her husband, Dr. Akbar Kahn, the clinic’s medical director and a family physician.

Medicor will not provide actual cancer treatment such as chemotherapy, radiation or surgery.

More “health freedom” blather. You know, whenever you hear someone providing non-evidence-based treatments start invoking “health freedom,” it’s a pretty good indication that you should run, not walk out of their office, because almost invariably what they really want is freedom from accountability and the freedom from oversight. In any case, it appears that the Khans have changed their minds about actually treating cancer or providing chemotherapy. After all, Avastin is a chemotherapeutic agent. DCA is a chemotherapeutic agent, and an experimental one at that. In fact, one has to wonder, if the Khans aren’t providing any real anticancer therapy to patients, what exactly are they doing that’s worth $2,500 up front and a $1,200 monthly fee. Certainly a visit with a family practitioner, naturopath, and various other CAM practitioners, plus a PDA on which they can carry their personal medical record seems a bit thin gruel to be charging this sort of money for. True, they claim that patients can see them through the Canadian medicare system, but state in their brochure that their fee-based services are intimately related to their medicare-covered services to the point that “doctors can’t separate them.”

I have to wonder if perhaps the alternative medicine business isn’t working out quite as well as hoped, given how little service Medicor appears to provide for a rather significant fee. Maybe the Khans needed a new angle to attract patients. Thanks to DCA, apparently they’ve found it. Dr. Khan could do more for his patients going back to the palliative care that he used to provide before he thought of Medicore and especially before he decided to jump on the DCA bandwagon.

All Orac posts on DCA:

  1. In which my words will be misinterpreted as “proof” that I am a “pharma shill”
  2. Will donations fund dichloroacetate (DCA) clinical trials?
  3. Too fast to label others as “conspiracy-mongers”?
  4. Dichloroacetate: One more time…
  5. Laying the cluestick on DaveScot over dichloroacetate (DCA) and cancer
  6. A couple of more cluesticks on dichloroacetate (DCA) and cancer
  7. Where to buy dichloroacetate (DCA)? Dichloroacetate suppliers, even?
  8. An uninformative “experiment” on dichloroacetate
  9. Slumming around The DCA Site (TheDCASite.com), appalled at what I’m finding
  10. Slumming around The DCA Site (TheDCASite.com), the finale (for now)
  11. It’s nice to be noticed
  12. The deadly deviousness of the cancer cell, or how dichloroacetate (DCA) might fail
  13. The dichloroacetate (DCA) self-medication phenomenon hits the mainstream media
  14. Dichloroacetate (DCA) and cancer: Magical thinking versus Tumor Biology 101
  15. Checking in with The DCA Site
  16. Dichloroacetate and The DCA Site: A low bar for “success”
  17. Dichloroacetate (DCA): A scientist’s worst nightmare?
  18. Dichloroacetate and The DCA Site: A low bar for “success” (part 2)
  19. “Clinical research” on dichloroacetate by TheDCASite.com: A travesty of science
  20. A family practitioner and epidemiologist are prescribing dichloracetate (DCA) in Canada
  21. An “arrogant medico” makes one last comment on dichloroacetate (DCA)

Posts by fellow ScienceBlogger Abel Pharmboy:

  1. The dichloroacetate (DCA) cancer kerfuffle
  2. Where to buy dichloroacetate…
  3. Local look at dichloroacetate (DCA) hysteria
  4. Edmonton pharmacist asked to stop selling dichloroacetate (DCA)
  5. Four days, four dichloroacetate (DCA) newspaper articles
  6. Perversion of good science
  7. CBC’s ‘The Current’ on dichloroacetate (DCA)

Comments

  1. #1 S. Rivlin
    May 29, 2007

    I have a suggestion for the Khans, place your Medicor clinic at the Creation Museum!

  2. #2 Willis
    May 29, 2007

    Here’s an article by Professor Pedersen who is in the biochemistry department at Johns Hopkins – he’s one of the people working on 3-bromopyruvate. You will have to pay for the whole article. This is an introductory article for an issue of Journal of Bioenergetics and Biomembranes discussing mitochondria-focused cancer treatments. He mentions dichloroacetate along with some others. I think it would make an interesting topic for your blog. From the tenor of the article, it seems to me that Pedersen is frustrated with the focus on signal transduction at the expense of cancer energetics/metabolism.

    I understand the need for clinical trials, but if someone points to a deeper understanding of what is going on inside the cancer cell, and they have a treatment based on that understanding, I for one would not expect to have to make do with whatever is on offer while we wait for years for clinical trials (obviously they’re needed, but I would expect trials for drugs based on new understandings of cancer to be expedited).

    http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17404823

  3. #3 TheBrummell
    May 29, 2007

    I wonder if all this DCA woo is having some kind of negative effect on the research of Dr. Evangelos Michelakis and others.

    I know nothing about the researcher, but it sounds like he’s alarmed at all the weird woo attention generated by his research. I doubt he welcomes this attention. His motivations for getting into cancer research are presumably some mix of scientific curiosity and medical altruism (plus, of course, a dash of happy egoism at the prospect of becoming a significant pioneer in an important field). I don’t think the actions of a few woos will dissuade him or other serious researchers from continuing to look for and test therapies for illnesses.

    But, I wonder if there are any graduate student researchers out there, who have seen the stupidity of the media frenzy and might divert their efforts to less populist causes? I know I don’t want my publications associated with such stupidity; I’d rather be completely ignored by the foolish fringe than either lauded or condemned by them.

  4. #4 Nat
    May 29, 2007

    Dear Orac

    Looks like it’s my turn to be embarrassed by an alleged professional colleague.

    How can complete a masters degree in public health epidemiology and then think that anecdotes are perfectly acceptable evidence?

    The shame. The shame.

  5. #5 Abel Pharmboy
    May 29, 2007

    Excellent investigation of the Khans and their practices. I was particularly taken by your comment (emphasis mine):

    You know, whenever you hear someone providing non-evidence-based treatments start invoking “health freedom,” it’s a pretty good indication that you should run, not walk out of their office, because almost invariably what they really want is freedom from accountability and the freedom from oversight.

  6. #6 khan
    May 29, 2007

    This is your regular poster ‘khan’ assuring you that I be not them.

  7. #7 Dale Biden
    May 30, 2007

    The oncologists and drug companies want us to wait 15 years for a treatment like dibromopyruvate or dichloroacetate, fact is, they stop glycolysis in some cancers, and a half a million Americans are sent home to die, they are walking dead from the time they get their 30 day death sentence after being butchered and poisoned and the damn radiation, which one study says may actually kick start the cancer stem cells. Stop being cowards, when there is no hope for your patients, use the research, use multiple compounds to kill the cancer stem cells and the daughter cells. Shame on you doctor. Physician, heal thyself, and forget about the mansion payment and the liability insurance,and the yacht payment, and the Proche, and the mistress, and the 3 x wives alimony and

  8. #8 Jud
    May 30, 2007

    Willis said: “I would expect trials for drugs based on new understandings of cancer to be expedited.”

    I’m a layperson, so I don’t have answers, but I do have questions: Is the way that DCA’s supposed to work in fact based on a “new” understanding of cancer? Is this understanding “newer” than the research behind other drugs currently in trial? And why should trials based on new information be expedited? Shouldn’t it be trials of drugs that are judged, on the basis of available information, to have the best chance of success? If not, why not?

  9. #9 Interrobang
    May 31, 2007

    This clinic sounds like it may be operating in contravention of the Canada Health Act. Of course, that doesn’t mean a hill of beans if Do-Nothing Dalton McGuinty’s government doesn’t get off its collective asses and actually, oh, say, enforce the Act… *mutter grump*

    The “private clinic” is not the issue here; there are tons of private clinics here. The intimation of “private, for-profit clinic” bothers me, and if they’ve so much as stuck one toe over that line, I want them shut down with extreme prejudice and media fanfare. I’ve had about damn enough with the laissez-faire right-wing governments here looking the other way while con artists undermine the Canada Health Act, one minor violation at a time. Eventually, we’re going to wind up with a de facto two-tier system, and that contravenes the Act, as well as rubbing my fur seriously the wrong way… It’s too dangerous a precedent for my liking.

  10. #10 Ken Anderson
    July 23, 2007

    I have a question to all of you who think DCA should not be administered without a trail. If you were a terminal patient and your conventional doctor tells you that you have anywhere between 4 weeks to 12 weeks before the tumour in your throat chokes you to death, and another less known doctor tells you that there is some hope. What would you do?

    Now, assuming that you quite humanely took up the hopeful option and outlived those conventional life spans statistics. Who would be the biggest gainer. I suppose it is only You.

    For heaven’s sake stop talking about implementing outdated and absurd laws and rules. If you cannot help a cancer patient, atleast don’t hurt. If DCA does not work the way its expected, bad for all of us. However, if it does – I think we will all see some major firing in the pharma black hole.

  11. #11 Manfred wendt
    August 6, 2007

    I read your report with interest. The being castle effect of the aneroben fermentation is well-known and understandable me. I read also all reports over dosage and side effects. Only one problem I have, as get I DCA.

    Yours sincerely

    Manfred Wendt

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