Respectful Insolence

I got home from work rather late last night; so for once I’ll spare you my typical Orac-ian level of logorrhea today. Yes, I know how much the ravening hordes of my fans thirst for every bit of wisdom that flows from my keyboard to Seed Magazine’s servers and from there to the world, but fear not. I didn’t say I wouldn’t quench that thirst. I just won’t be taking as long as usual. Maybe a couple of quickies instead of the epic post.

My vastly inflated sense of self-importance, bloated beyond all reasonable sense of scale, aside, if there’s one thing I’ve taken an interest in and written about since the very beginning of this blog, it’s cancer testimonials, specifically “alternative medicine” testimonials that purport to show that this woo or that cured a cancer that is incurable by any treatment available to science- and evidence-based medicine. Often, it turns out that the patient actually used lots of conventional therapy and then turned to woo. In the case of breast cancer, even if the patient did turn to woo right away, a typical story is that the breast tumor was completely excised surgically during a biopsy. Unfortunately, what most people don’t know is that in a large proportion of cases, surgical excision can be curative. Radiation is merely the icing on the cake that decreases the chance of a local recurrence where the tumor was excised, and chemotherapy does the same for the rest of the body, decreasing the chance of a recurrence as metastatic disease. Nothing heals like surgical steel, as they say.

Still, the woo is often strong with breast cancer. Sometimes a patient doesn’t even undergo surgery. Sometimes the “tumor” seemingly disappears. Like this:

I have been fortunate to be able to pass along some of your wisdom to many of my family members. Most notably my mother Maria. Without your insight she might very well not be with us now. She was once told by her doctor that she should go in for a biopsy for a lump in her breast. I persuaded her to wait and I coached her on a daily basis using the knowledge I have gained from reading your books, watching yours and Shelley’s DVD’s, youtube videos, ect. Three months later her doctor could not find the lump in the breast anymore and canceled the planned biopsy!

http://www.phmiracleliving.com/p-253-the-ph-miracle-for-cancer.aspx

I have attended Anthony Robbins’ “Unleash the Power Within Weekend” where Tony or one of his facilitators teaches your health approach. That Monday, Joseph McClendon III ( he won the motorcycle on “American Chopper”) talked about how he helped his mother overcome diagnosed cancer, and how she lived many many years beyond what her doctors had told her. I believed him that day and I wished that I could help someone in the same way.

Notice something about this story. There is no diagnosis. The man writing this testimonial assumes that his mother’s “tumor” must be cancer. He doesn’t come right out and say it, but the implication is clear. Unfortunately, there is no tissue diagnosis. Although it’s sometimes possible to be very sure that a breast mass is cancer just by physical examination alone, even in such cases a tissue diagnosis is required. On occasion, for example, I have been wrong about a mass that I was sure just had to be a cancer. In any case, this “tumor” might have been anything. It is true that it might have been cancer, but it’s far more likely that it wasn’t. Palpable breast masses can range from nothing but fibroglandular breast tissue to benign lesions such as fibroadenomas to frank cancers. Again, a tissue diagnosis is absolutely required before one can say that this “tumor” was a cancer that would endanger his mother’s life.

This man assumes that this “tumor” was endangering his mother’s life and that Dr. Young’s pH quackery made it go away and saved her life, but even the most cursory glance at his story makes it obvious to anyone with a little knowledge about breast cancer that no such claim can be made. After all, there are all sorts of masses in the breast that can grow, shrink, or even disappear. I myself have on occasion scheduled women for surgery to biopsy a palpable abnormality and had the surgery somehow be delayed for a month or two–or even three–at which point I could no longer find the mass that I had felt before. It generally happens once every couple of years. Indeed, that’s the very reason that a good breast surgeon always makes sure to examine the patient in the holding area before surgery before taking a woman back to the operating room to biopsy a mass that as felt. It’s a real bummer to take a patient back to the O.R. and be unable to find the mass that you were planning on biopsying. It’s bad form. Most of the time when this happens, it’s usually either a small fibroadenoma or glandular tissue associated with fibrocystic change, which can sometimes form lumps that are definitely concerning.

Another line of evidence is that it’s not uncommon to see benign-appearing masses on mammogram or ultrasound and document their regression in subsequent studies months or even years later. Heck, there is even evidence that as many as 20% of frank breast cancers may regress. Personally, I don’t believe the number is quite that high, for reasons that I explained when discussing the study that suggested a high number of spontaneous regressions, but I do believe that spontaneous regressions occur. They generally have nothing to do with the woo du jour that a woman is trying in order to get rid of them. Again, as with so many things in medicine, well designed clinical trials are required to sort out a treatment effect from the random noise of lesions that grow, remain stable, or regress.

Unfortunately, this is about the most dishonest kind of “alternative” medicine testimonial for cancer because the woman almost certainly didn’t have cancer. Three quarters of such lesions–or even more–are not malignant. Unfortunately, many women don’t realize this and are easily convinced that any lump is cancer even without a tissue diagnosis. Don’t get me wrong. By no means am I suggesting that such lesions do not need to be biopsied. They do. But using such a story as “evidence” that Dr. Young’s pH woo eliminates breast cancer proves nothing at all. I don’t know which possibility is worse: that Dr. Young is so clueless that he doesn’t realize this or so dishonest that he doesn’t care.

Comments

  1. #1 Militant Agnostic
    January 21, 2009

    But some guy who won a motorcycle says it works. What have you ever won, Orac? Why should we listen to you?

    I think that has to be the worst argument from celebrity ever.

  2. #2 D. C. Sessions
    January 21, 2009

    Medicine is, for good reason, conservative regarding risk.

    Example: this weekend, we apparently had a special going on head injuries. Except for one tree strike I believe that they were all examined and released.

    Does that prove that all the standard cautions regarding closed-head injuries are unnecessary? That we can skip the whole backboard/transport thing? That we don’t need to worry about subdural haematomas? Using AltThink that would appear to be the case.

  3. #3 MikeMa
    January 21, 2009

    So 15 minutes of fame is as good as medical school? Cool. I am going to get a powerball ticket on my way home. Win tonight, cure cancer tomorrow.

  4. #4 Dan G.
    January 21, 2009

    “I coached her on a daily basis using the knowledge I have gained from…… watching youtube videos, ect.”

    We don need no stinkin doctors, we got Youtube.

  5. #5 Militant Agnostic
    January 21, 2009

    So 15 minutes of fame is as good as medical school? Cool. I am going to get a powerball ticket on my way home. Win tonight, cure cancer tomorrow.

    In the unlikey event that you win, we will hold you to that promise:)

  6. #6 Dangerous Bacon
    January 21, 2009

    If you don’t normalize the pH, the toxins won’t come out. This form of disease is known as a “woonosis”.

    I would never go to a surgeon who called himself the “American Chopper”.

  7. #7 DLC
    January 21, 2009

    Pardon my ignorance, but I seem to recall reading somewhere that some of these lumps or lesions in the breast do sometimes shrink away more or less on their own ?
    Perhaps I’m mis-remembering.
    Still. if you have a suspicious mass in there, isn’t it for the better to have a biopsy ? I mean, it may just be a lesion, but if it isn’t ?
    What worries me is that this fellow’s mother may decide that hoping/praying/meditating/sticking pins in vodoo dolls will cure her if another such event happens.

  8. #8 Joseph C.
    January 21, 2009

    What worries me is that this fellow’s mother may decide that hoping/praying/meditating/sticking pins in vodoo dolls will cure her if another such event happens.

    Don’t forget beating a voodoo doll with a hammer (Tong Ren).

  9. #9 bigjohn756
    January 21, 2009

    Dear Doctor:

    I thought I had cancer. I diligently followed your excellent program and now I don’t think I have cancer.

    It’s a miracle! Bless you, sir.

    Yours truly,

    Joe the Sucker

  10. #10 Doctor
    January 21, 2009

    Dear Joe:

    Please find enclosed my standard invoice for miracles.
    Prompt payment intitles you to a 10% discount on my weight control miracle.

    Yours truly,

    Doctor

  11. #11 bigjohn756
    January 21, 2009

    Dear Doctor:

    Thank you so much. I will use my 10% discount to buy a carton of cigarettes.

    Yours truly,

    Joe the Sucker

  12. #12 Andrew Dodds
    January 22, 2009

    I think that YouTube videos have offically descended to the rank of ‘worst form of evidence ever’. Written testimonials may be bad, but at least you can re-read them and look for references. Videos are straight propaganda. They are also a fave of 9/11 nutcases, given that many of their claims are subject to disproof by basic physics, so non-written arguments suit them.

  13. #13 DrCogSci
    January 22, 2009

    Oh I don’t know. Edward Current’s youtube videos are excellent evidence for the existence of God, for one thing.

  14. #14 The Perky Skeptic
    January 22, 2009

    So, a PhD from the University of YouTube is worth even less than a PhD from the University of Google?

  15. #15 Owen
    January 22, 2009

    Of course – at least the U of G requires the ability to read, even though actual comprehension seems to be restricted to the Honors program…

  16. #16 Andrew Dodds
    January 23, 2009

    TPS – I’d put it below a BA from the University Of My Mate Down The Pub Reckons.

    (This is possibly due to my annoyance with 9/11 troofers who, when clearly cornered into arguing with newtonian mechanics, switch to the ‘Just watch this video, la la la I’m not listening to you’ gambit.)

  17. #17 Chris
    August 2, 2009

    Spam troll is a bit blue and curt this time. No, not porn blue, the blue one turns when ingesting silver. Not to malign the troll, it could not even finish the sentence.

  18. #18 Orac
    August 2, 2009

    Spammer nuked.

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