Respectful Insolence

October is Breast Cancer Awareness Month, a fact that is hard to escape. It’s one of those things that I have mixed feelings about, particularly now that I’ve had a close relative, namely my mother-in-law, die of breast cancer less than two years ago. On the one hand, the attention that’s brought to the cause of breast cancer is helpful for spurring research and donations to support research, as well as promoting screening programs. On the other hand, I do now have a bit of understanding about “pink washing,” and some of the whole “pink thing” at times makes me uneasy. Be that as it may, one thing I can count on, unfortunately, is that October will be a magnet for breast cancer quackery and the promotion of dubious breast cancer treatments. As a skeptical blogger who happens to be a breast cancer surgeon, I find the breast cancer woo, ranging from just the dubious to pure quackery, coming at me fast and furious. Sadly (or maybe fortunately), there’s no way I can possibly deal with it all, but I can target particularly egregious examples.

Not surprisingly, that wretched hive of scum and quackery (yes, I know I use that term a lot now, but it fits so well), The Huffington Post, is in on the action. This time around, the breast cancer woo comes in the form of an article by Oprah’s favorite gynecologist, Dr. Christiane Northrup, who apparently has decided that she really, really likes breast thermography. I’ve actually been meaning to write about thermography, the dubious claims made for it with regard to breast cancer, and the even more dubious ways that it’s marketed to women. In retrospect, I can’t believe that I haven’t done so in detail yet. Well, now’s as good a time as any, and the target is Dr. Northrup’s post at HuffPo entitled The Best Breast Test: The Promise of Thermography.

You remember Dr. Northrup, don’t you? Not too long ago, blog bud Peter Lipson took her apart for parroting anti-vaccine views and even citing as one of her sources anti-vaccine activist Sherri Tenpenny. Other supporters of science-based medicine have also caught Dr. Northrup espousing anti-vaccine views and harshly criticized her for her promotion of “bioidentical hormones” and various dubious thyroid treatments. However, Dr. Northrup is perhaps most (in)famous for her advocating on The Oprah Winfrey Show the use of Qi Gong to direct qi to the vagina, there apparently to cure all manner of “female” ills and apparently to promote fantastic orgasms in the process. Even Oprah looked rather embarrassed in the video in which Dr. Northrup led her audience in directing all that qi goodness “down below.”

Dr. Northrup’s promotion of thermography was truly painful for me to read, and I consider it inexcusable that someone who claims to be an advocate of “women’s health” could write something that reveals such ignorance. But, then, I suppose I shouldn’t be surprised that she’d think espousing an unproven screening test is just hunky dory after her recent flirtation with anti-vaccine views. If it isn’t already complete, Dr. Northrup’s journey to the Dark Side just requires the final oath to the Sith Lord. You’ll see what I mean right from her very introduction:

Every year when Breast Cancer Awareness Month (October) comes around I am saddened and surprised that thermography hasn’t become more popular. Part of this is my mindset. I’d rather focus on breast health and ways to prevent breast cancer at the cellular level than put the emphasis on testing and retesting until you finally do find something to poke, prod, cut out, or radiate.

Let me take a moment to note the framing that Northrup uses. She’s all about “prevention,” or, at least, that’s what she wants you to think she’s all about. This is no doubt meant to be a stark contrast to us reductionistic, “Western,” “allopathic” physicians who, according to typical “alt-med” tropes, don’t give a rodent’s posterior about prevention but only care about, as Northrup so quaintly put it, “poking,” “prodding,” “cutting out,” and “irradiating.” The only alt-med trope Northrup left out of her attempt to don the mantle of prevention is “poisoning.” But what does it mean to “prevent breast cancer at the cellular level”? That’s just a scientifically empty and meaningless buzz phrase, especially coming from her.

How would thermography achieve “prevention at the cellular level”, anyway? Thermography is just another test. In intent the use of thermography is no different than mammography in that its advocates claim that thermography can find breast cancers at an early stage. Its advocates also use thermography in damned close to exactly the same way that we use mammography. They use the test on asymptomatic women periodically to try to detect cancer early. There’s zero “prevention” involved. Even if thermography worked as well as its proponents (like Dr. Northrup) claim, there would still be zero prevention involved. Northrup’s use of the term “prevent breast cancer at the cellular level” is as empty as her head is apparently of knowledge about breast cancer and as empty as her handwaving about thermography.

Yes, it’s nice-sounding but ultimately empty nonsense, but Dr. Northrup’s blather does echo many of the claims made for thermography. For instance, if you go to BreastThermography.com, a site that is clearly pro-thermography, you’ll find a whole bunch of similar claims, such as that thermography detects cancer earlier, that it can provide an “individualized breast cancer risk assessment,” that it’s better for younger women, and that it can detect “thermal signs of hormone effects” that can be used for breast cancer prevention. It ends up including the groundless recommendation that “every woman should include breast thermography as part of her regular breast heath care.” Pointing out that the “incidence of breast cancer is on the rise” (it isn’t, by the way, and hasn’t been for years; in fact, the incidence of breast cancer has been decreasing over the last decade), the website then makes the completely baseless recommendations that every woman should have a baseline scan at age 20 and then be scanned every three years between ages 20-30 and every year after age 30. On what do they base these recommendations? Who knows? The authors don’t say. I’ve written before about the science and controversy behind the guidelines for mammographic screening; that science is based on dozens of studies and decades of research. Some aspects of it may be controversial; there may be a lot of gray areas; but at least with mammography we know the parameters of the debate.

Not so thermography.

Thermography: The Data

What is thermography and how is it used to detect breast cancer? As its name implies, thermography measures differences in temperature. Most systems use infrared imaging to achieve these measurements. There’s nothing magical about it; the technology has been in use for various applications for decades. The rationale for applying thermography to the detection of breast cancer is that breast cancers tend to induce angiogenesis, which is nothing more than the ingrowth of new blood vessels into the tumor to supply its nutrient and oxygen needs. A tumor that can’t induce angiogenesis can’t grow beyond the diffusion limit in aqueous solution, which is less than 1 mm in diameter. These blood vessels result in additional blood flow, which results in additional heat. In addition, the metabolism of breast cancer cells tends to be faster than the surrounding tissue, and cancer is often associated with inflammation, two more reasons why the temperature of breast cancers might be higher than the surrounding normal breast tissue and therefore potentially imageable using infrared thermography.

Although thermography is scientifically plausible, unfortunately its reality has not lived up to its promise, Dr. Northrup’s claims notwithstanding. Let’s take a look at those claims:

I understand that mammography has been the gold standard for years. Doctors are the most familiar with this test, and many believe that a mammogram is the best test for detecting breast cancer early. But it’s not. Studies show that a thermogram identifies precancerous or cancerous cells earlier, produces unambiguous results (which cuts down on additional testing), and doesn’t hurt the body.

No, studies do not show anything of the sort, other than that thermography doesn’t hurt the body. In particular thermography does not produce unambiguous results–far from it! That’s a major part of its problem and a major part of the reason why thermography hasn’t caught on. It’s unreliable, and it doesn’t provide much in the way of anatomic information that allows a better localization of the breast cancers it does find. If you look at Dr. Northrup’s article that the most recent article she cites that directly addresses the use of thermography to detect breast cancer is from 1982. There are more recent reviews and studies, as you might expect, but, oddly enough, Dr. Northrup doesn’t cite them.

I wonder why.

One aspect of thermography for breast cancer detection that its advocates almost always mention is that it is “FDA-approved” for the detection of breast cancer. That is true, but not in the way it is often implied. Yes, thermography is FDA-approved for the detection of breast cancer, but what they don’t tell you is that thermography is not approved alone for screening women for the detection of breast cancer. It’s approved to be used in conjunction with mammography. What thermography boosters usually fail to mention is that the reason why thermography fell out of favor 30 years ago was as a result of a study by Feig et al in 1977 that found thermograpy to come in dead last among existing screening modalities of the time for finding breast cancers. Mammography detected 78% of breast cancers. In contrast, thermography only detected 39%. This is not a stellar record. In a separate trial in the early 1970s, the Breast Cancer Detection Demonstration Project (BCDDP) planned to compare thermography, mammography and clinical examination. However, BCDDP investigators decided to drop thermography early in the project due to a high false positive rate and low sensitivity.

Of course, technology was a lot more primitive back then, both in its ability to detect temperature gradients and to produce images; it’s not at all surprising that thermography would not perform as well as mammography back then. Add to that the problems of bulky equipment, some of which required liquid nitrogen to work, and the lack of computational power in the 1970s to analyze images, and it’s not surprising that, compared to mammography, thermography never really caught on. Indeed, in a 1985 review, Moskowitz analyzed the data from the BCDDP trial. Of the 1,260 patients with more than one positive thermogram from 1973 to 1976, 1.9% subsequently developed breast cancer from 1977 to 1983. That finding was not statistically significantly different from the 1.3% of patients who developed cancer and never had a positive thermogram. His review of the literature also supported the dismal record of thermography for detecting breast cancer.

Ah, the thermography-philes say, but that was 30 years ago. What about now? Computing power has increased exponentionally since then, and newer thermal sensors can detect temperature differences of 0.08° C or even less. They might have a point. It is reasonble to ask: Has technology evolved to the point where the shortcomings of the original studies that buried thermography as a viable competitor to mammography for breast cancer screening no longer apply?

Maybe. Maybe not. That’s exactly the problem. Same as it ever was. As pointed out by Gregory Plotnikoff, M.D., M.T.S., and Carolyn Torkelson, M.D., M.S. in a 2009 commentary in Minnesota Medicine entitled Emerging Controversies in Breast Imaging: Is There a Place for Thermography?:

The biggest question concerns the efficacy of thermography to detect breast cancer. Despite various studies that suggest positive results for thermography, there has never been a major randomized controlled trial to determine baseline measurements of sensitivity and specificity. It is hard to imagine thermography being accepted by the conventional medical establishment without such data or evidence of cost-effectiveness.17 In addition to questions about the effectiveness of thermography, research needs to be conducted to determine the cost of using it for widespread cancer screening.18

Even naturopaths, at least relatively intellectually honest naturopaths, can’t recommend thermography. For example, wo naturopaths reviewing the thermography literature in 2009 in one of the most woo-friendly journals in existence, Integrative Cancer Therapies, were forced to conclude:

In light of developments in computer technology, and the maturation of the thermographic industry, additional research is required to confirm and/or continue to develop the potential of this technology to provide effective noninvasive early detection of breast cancer.

Even though the naturopaths tried very hard to spin the data into as favorable a view as possible, they just couldn’t bring themselves to recommend routine thermography. Meanwhile, virtually every reputable professional organization whose purview includes breast imaging and breast cancer does not recommend it. Here is a typical position statement, this time from cancer organizations in New Zealand.

That’s not to say that there aren’t “positive” trials of thermography. The problem is that they don’t rise to the level necessary to justify recommending thermography to all women, as many of these chiropractors and naturopaths are doing. There was a recent study of 92 women in 2008 that, using a technology called digital infrared thermal imaging (DITI), found a sensitivity of 96% and a specificity ranging between 12-44%, depending upon the setting of the machine. While this is promising, you can’t justify the widespread adoption of this technology on the basis of such a small clinical trial, however promising it might be.

There is also considerable opportunity for subjectivity in the interpretation of thermograms. This is because, in marked contrast to mammography, there aren’t any widely agreed-upon standards for the performance and interpretation of breast thermography. Plotnikoff and Torkelson described the state of the industry quite well, with one huge blind spot:

In its current state in the United States, thermography is a balkanized industry. Although thermography never took root in mainstream medicine, it has begun to flourish in alternative settings as a breast cancer detection service offered by some physicians, chiropractors, and naturopaths. In lieu of any industry or professional standards for thermography, a variety of practices and protocols have emerged among practitioners and equipment manufacturers. As one practitioner described it, the industry is in its “Wild West” days.19 This fragmented state weakens the credibility of the entire field because consumers have no way to distinguish credible from inferior thermographic techniques. As thermography emerges as an alternative screening tool, consumers are led to believe that it has been validated for efficacy and compared with mammography. This misconception could raise public-safety concerns.

The huge blind spot is the blithely amusing statement that the marketing of thermography as though it were validated as a breast cancer screening modality “could raise public-safety concerns.” Is that the understatement of the year, or what? My guess is that Plotnikoff and Torkelson have not been reading the ads for breast thermography on the web? These go far beyond simply claiming that thermography has been validated for efficacy and compared with mammography. They claim that thermography is superior to mammography while at the same time hyping fears of radiation and other harms, all exaggerated for effect, that mammography can allegedly cause.

The marketing of thermography by CAM practitioners

Thermography has become very popular among chiropractors, homeopaths, naturopaths, and a wide variety of “alternative practitioners.” I’ve always found this to be odd, given naturopaths’ belief that “natural” is better and the fact that many thermography machines are actually technologically more complex than a typical mammography machine. Then there’s the disturbing fact that many are the ads that claim that thermography is safer than mammography and that it can replace mammography for breast cancer screening, particularly for younger women. Typical of such marketing and propaganda is this article by Joe Mercola entitled Revolutionary and Safe Diagnostic Tool Detects Hidden Inflammation: Thermography as a means of marketing the test at Dr. Mercola’s Natural Health Center in the Chicago area:

In this ad, Mercola claims that mammograms cause breast cancer, that the compression used during mammography can lead to “a lethal spread of any existing malignant cells” (it can’t), and that thermograpy can identify inflammation that leads to cancer. This last claim leads to further claims that this “inflammation” can be treated–all using diet and Mercola’s plethora of supplements, of course–to prevent breast cancer. Mercola also claims that thermography is good for more than just breast cancer detection. If you believe Mercola, it can also detect a whole panoply of conditions, including arthritis, immune dysfunction, fibromyalgia, carpal tunnel syndrome, irritable bowel syndrome, diverticulitis, and Crohn’s disease.

Holy crap, is there anything thermography can’t do?

Apparently not, if we’re to believe Dr. Northrup, this is another thing breast thermography can do:

The most promising aspect of thermography is its ability to spot anomalies years before mammography. Using the same ten-year study data,2 researcher Dr. Getson adds, “Since thermal imaging detects changes at the cellular level, studies suggest that this test can detect activity eight to ten years before any other test. This makes it unique in that it affords us the opportunity to view changes before the actual formation of the tumor. Studies have shown that by the time a tumor has grown to sufficient size to be detectable by physical examination or mammography, it has in fact been growing for about seven years achieving more than twenty-five doublings of the malignant cell colony. At 90 days there are two cells, at one year there are16 cells, and at five years there are 1,048,576 cells–an amount that is still undetectable by a mammogram. (At 8 years, there are almost 4 billion cells.)”

Of course, even if this were true (and no evidence is presented to show that it is), as I’ve pointed out time and time again, ever earlier detection of cancer is not always a good thing because not all early lesions progress to become cancer. In other words, detecting breast cancer earlier is in general a good thing most of the time, but there clearly exists a point of diminishing returns and a point beyond which detection that is too early has the potential to cause harm. The very issue in the recent rethinking of recommendations for mammography (most recently discussed just two weeks ago) hasn’t been that mammography is not sensitive enough, but rather its potential to detect too many breast cancers that would never progress to endanger the life of the woman.

Let’s put it this way. Even if everything Northrup says or cites is absolutely accurate and thermography can detect inflammatory states that lead to cancer several years before mammography, that would not necessarily save even a single life but would have the potential to cause even more harm through overdiagnosis and overtreatment, particularly given that as many as one in five mammographically detected breast cancers might never progress–and some might even regress. Indeed, like MRI, the widespread adoption of thermography without adequate validation could easily lead to an increased number of mastectomies, and detecting such lesions five to ten years earlier could easily exacerbate the problem of overdiagnosis and overtreatment. It might also lead to the perfect situation for CAM practitioners. They could find breast “lesions” with thermography; prescribe “treatments” in the form of dietary manipulations, supplements, or whatever; watch the lesions either disappear spontaneously or not progress; and then claim credit for having “cured” or “stopped the progression of” the cancer. Even if the cancer progresses to where it requires surgical removal and other treatment, the quack can claim credit for having detected it “before mammography.”

If you want evidence that Dr. Northrup has truly gone completely woo, look no further than this next passage:

As with anything, I suggest you let your inner guidance help you in all decisions about your health. If you feel it’s best to get an annual mammogram, then by all means continue with them. Just be aware of the drawbacks and risks associated with the test. One helpful way to assess your risk for breast cancer–which in turn can help you decide how often you want to have mammograms–is to use the National Cancer Institute’s Breast Cancer Risk Assessment Tool, available online at www.cancer.gov/bcrisktool. After you answer seven simple questions, it calculates both your risk of getting invasive breast cancer in the next five years as well as your lifetime risk, and it compares each to the risk for the average U.S. woman of the same age and race or ethnicity.

You would be surprised by how many women tell me their doctors make them feel guilty for not having a mammogram. Women who just know they have healthy breasts. Don’t be intimidated if you prefer to forgo annual mammography.

If Dr. Northrup truly tells her patients that it’s medically acceptable for them to forego mammograms and use thermography instead for their routine screening for breast cancer, she is guilty of gross malpractice, in my opinion. If she doesn’t tell her patients that but writes articles like her HuffPo excretion, she’s guilty of hypocrisy. Her statements are scientifically unjustified, profoundly unethical, and potentially dangerous to patients. Pure ridiculousness doesn’t even come close to describing them. Many are the women whom I’ve met who “just knew” they were fine until their family persuaded them to undergo mammography, which then found real, invasive cancers. I don’t have much faith in anyone’s “inner guidance” with regard to asymptomatic disease. In essence, Northrup is urging women to base their health care decisions on intuition rather than science.

The bottom line

The sad thing is that thermography is a technology that has some degree of scientific plausibility. It just hasn’t been validated as a diagnostic modality to detect breast cancer yet. The studies from 30 years ago showed it to be markedly inferior to mammography for this purpose, the claims of naturopaths, chiropractors, and various other quacks notwithstanding. While it’s true that advances in technology and computing power might have brought thermography to a point where it might be a useful adjunct to current imaging techniques, large randomized clinical trials have not been done to define its sensitivity and specificity and determine its utility when added to routine mammographic screening. Until that is done, thermography can’t be considered to be a scientifically acceptable screening modality. In addition, thermography doesn’t provide any information that breast MRI can’t provide–and provide better. MRI measures in essence the same thing that thermography does (blood flow, which is what the heat maps that thermography produces are surrogates for) and adds to it detailed anatomic information that can guide biopsy and excision. That’s something thermography can’t do.

Currently, my take is that thermography might be useful as an adjunct to mammography. Indeed, I’ll make a confession. Back when I worked at The Cancer Institute of New Jersey, I became involved with a project that was testing a thermography-like machine. (I can’t say more than that about it.) A startup company was testing its new device to determine if the combination of mammography plus this technique could improve the sensitivity and specificity of breast cancer detection. I don’t know what ever became of the company or the device, but I still view thermography basically the same way now as I did then. It’s a test that might be useful as an adjunct to mammographic screening.

In order to determine whether thermography is useful as an adjunct to other imaging techniques, however, its proponents need to do the proper scientific validation and clinical testing first, which haven’t been done yet and will require large clinical trials. Until that testing is done, thermography should not be offered to women outside of a clinical trial, its FDA approval decades ago notwithstanding, and it should never be offered to women in lieu of mammography to detect breast cancer. Science does not support the former indication, although I have to concede that it might one day. More importantly, science most definitely does not support the use of thermography instead of mammography, a use that I doubt any clinical trial is likely ever to support because clinical equipoise demands that thermography be added to mammography in any clinical trial, not tested instead of mammography.

The ironic and sad thing about thermography is that it isn’t quackery in and of itself. Rather, it’s the way it’s marketed and used that is quackery. The concept of breast thermography is based on a reasonable and scientifically plausible idea, namely that tumors produce more angiogenesis, which leads to more blood flow, which leads to more heat that can be detected as “hot spots” that stand out from the surrounding normal breast tissue. Unfortunately, Dr. Northrup is buying into the highly dubious promotion of thermography and has even coupled it with a condescending appeal to “women’s intuition.” (You know, if I were a woman, I’d be highly insulted by Dr. Northrup’s nonsense.) Unfortunately, the suffocating embrace of quacks around thermography contributes to the unsavory reputation the technique currently has in the medical community and continues to hinder its development in mainstream scientific medicine. On the other hand, maybe the quacks like it that way. If mainstream medicine were ever to validate thermography scientifically, then it would become science-based medicine, and the quacks can’t have that. It’s too profitable to market the test through fear and misinformation. There’s gold in that thar machine if you don’t care about science, don’t understand breast cancer biology, and have no scruples.

Comments

  1. #1 Paul Browne
    October 13, 2010

    Thanks Orac, a very thorough post indeed.

    If quacks are very adept at co-opting medical science when it suits them, and then of course misrepresenting it, their real forte lies in presenting their “advice” in a way that would make even the most hard-hearted pharmaceutical industry salesperson blush.

  2. #2 Denice Walter
    October 13, 2010

    More “October Revolution” : “Why Can’t It Be Called Breast Cancer Prevention Month?” ( Mike Adams, NaturalNews; 10/12/10). Mikey lauds the nutritional defense against cancer ( Where, oh where have I heard *that* before?) and rails at EBM and Pharma, which of course, suppress women and encourage “slavery”… More and more, I’m visualizing this guy (in my mind’s eye) as an aging, stoned, and deranged surfer or skateboarder who has found Religion and is now preaching to the masses.Except that his religion is about selling stuff.

  3. #3 Chris
    October 13, 2010

    Your friend Bob Sears has a post up with the Headline “Warning: Don’t Mix Flu shots with other vaccines”
    http://www.huffingtonpost.com/dr-bob-sears/flu-shot-safety-not-teste_b_749287.html

  4. #4 Paul
    October 13, 2010

    Some years ago I was intrigued by the writings of the late John Gofman, who claimed that mammography was the main cause of breast cancer. More recent studies must, I’m sure, refute Gofman’s claims. Is there any definitive source of information on this?

  5. #5 Lynn Fraley, RN, DrPH
    October 13, 2010

    Such a rant. Competition hurts, sometimes. Well, the very good news is that women can choose for themselves what they want to do re scanning. Women can also self refer to breast thermography. Like any scan, due diligence is suggested. Isn’t it nice to know that great technology exists and is provided by practitioners who suggest real preventive measures?

    Dr. Northrup, you remain my heroine! Write on.

  6. #6 Matthew Cline
    October 13, 2010

    Since thermal imaging detects changes at the cellular level,

    What does that mean? That thermal imaging devices have cellular size resolution? Or merely that they detect heat, and heat is generated by individual cells?

  7. #7 Chris
    October 13, 2010

    Ms. Fraley, is that all you have? A week attempt at a version of the Pharma Shill Gambit?

    OK, you have funny letters behind your name, answer this question: How does the thermography measure anything but the surface temperature? How good would it be from a tumor a couple of centimeters inside a breast?

    Show us the actual papers showing it was effective for deep tumors.

  8. #8 Birger Johansson
    October 13, 2010

    Since breast cancer is hard to detect among more benign lumps, maybe you could use a multiple scan in terahertz, infra-red and other frequences, and superimpose them with X-ray images.
    Also, progress in designing “metamaterials” will probably improve the images of ultrasound by an order of magnitude.

    Since cancerous tissue must have *some* differences from ordinary tissue, you could throw different imaging technologies on it, integrate the images, and then use a pattern-recognition algorithm to indicate the most likely cancerous objects on the image.
    — — — —
    BTW, this week a Swedish study indicate that -contrary to other surveys- there IS a benefit of breast cancer screening among women in the 40-49 year age bracket. Researchers from Umeå have performed the countrywide SCRY-study -the largest of its kind in the world: http://www.justnews.com/health/25213808/detail.html

  9. #9 Vicki
    October 13, 2010

    Being able to choose is not always good, or even meaningful. For a real choice, at a minimum I need good information. “You don’t have to have a mammogram, you can give us money, and we’ll give you some pictures that don’t mean anything, but it won’t hurt.” How is that better for a woman than not having a mammogram, but saving her money and staying home? A really bad test is worse than useless: false negatives can mean ignoring symptoms or not getting a more useful test, and false positives can lead to stress or unnecessary treatment.

    If “competition” is actually useful, it has to mean more than the right to lie to people about health and safety in order to make money from them.

  10. #10 momkat
    October 13, 2010

    Why is it that every time I see “Huffington”, I initially interpret is as “Hufflepuff”?

  11. #11 Pablo
    October 13, 2010

    Such a rant. Competition hurts, sometimes.

    What competition?

    Orac is a friggin surgeon! He’s not a radiologist or mammographer. In fact, he is no friend of mammographers because he has supported reduced usage of mammmography as a screening tool because it appears to be ineffectual.

    Why should he be opposed to thermography – IF IT WORKS? He would still be in their having to remove the stupid tumor, albeit a smaller one, and would still be recommending that it be treated with radiation. Thermography is a diagnostic tool, not a treatment. Why would a surgical oncologist care whether the tumor was detected with whatever technique, assuming that it actually detects cancer?

    I have to say, if all you have is conspiracy theories, then you don’t have much. But jeez, what if all you have are stupid conspiracy theories that don’t even make any sense in the first place? That’s the bottom of the barrel as far as criticism can get.

  12. #12 Calli Arcale
    October 13, 2010

    Lynn Fraley:

    You purport to be a registered nurse. This means you have a college education and postgraduate medical education and extensive medical training. Surely, then, you understand the difference between “screening” and “prevention”. Your hero is claiming that thermography can prevent cancer, but it clearly can’t, any more than mammography or MRI can. It is a screening technique, not a prevention method, and as such the best it can do is to detect cancer early enough to treat it.

    It is not prevention that Northrup is recommending, even though she states that it is.

    It’s unclear how she claims it can detect cancer at the cellular level, since the whole concept of breast thermography deals with large groups of cells in the process of angiogenesis. You appear to be familiar with Dr Northrup’s work, and you are a health care professional. I’m curious what your take on that is. How can angiogenesis be detected at the cellular level by temperature readings alone?

    I’m also curious what your position is on the relative accuracy rates of mammography, breast MRI, and thermography. The data quoted by Orac above show that while thermography really can detect some tumors, the accuracy rate is much worse than mammography. It misses more tumors, and claims more false positives. How, then, can you describe this outdated technology as “great technology”, much less as a “prevention measure”?

  13. #13 René Najera
    October 13, 2010

    Do not, under any circumstances, do a Google search for “directing qi to the vagina”. Either hilarity will ensue, if you’re home… Or you’ll get an e-mail from the IT department.

  14. #14 Pablo
    October 13, 2010

    Since cancerous tissue must have *some* differences from ordinary tissue, you could throw different imaging technologies on it, integrate the images, and then use a pattern-recognition algorithm to indicate the most likely cancerous objects on the image.

    Why bother? We already have MRI, which can do this.

    It’s bloody expensive, of course, and therefore is a serious waste as a screening procedure, but it can be done.

  15. #15 triskelethecat
    October 13, 2010

    @Calli Arcale: Ms Fraley (who, according to a speaker agency that she is listed with) has a BSN from Wayne State University in Michigan, a MS (field not listed) from UCLA and a PhD from UC Berkeley. I don’t know if she is a practicing nurse or just a public speaker, but she seems to post comments on a lot of posts that have to do with mammography. Her website link seems to be inactive so I can’t see what kind of woo she promotes on it. However, she IS in California, and since she approves of Dr Northrup, I think she’s also a woo fan.

    However, it is rather embarrassing, as a RN with a degree from another Michigan university (waves pennant at Orac), for another RN to ignore that Dr Northrup is claiming thermography can prevent breast cancer. If she doesn’t know the difference between prevention, screening, and diagnostics then her public health doctorate, at least, should be repealed.

    (I think I need to borrow Orac’s brown paper bag, or the Dr Doom mask for a while…)

  16. #16 triskelethecat
    October 13, 2010

    Weird…just typed a long comment that was held for approval. I didn’t think I used any spam filter words…and there were no links in it.

    MI Dawn

  17. #17 Orac
    October 13, 2010

    BTW, this week a Swedish study indicate that -contrary to other surveys- there IS a benefit of breast cancer screening among women in the 40-49 year age bracket. Researchers from Umeå have performed the countrywide SCRY-study -the largest of its kind in the world: http://www.justnews.com/health/25213808/detail.html

    Already wrote about it:

    http://scienceblogs.com/insolence/2010/10/better_late_than_never_the_swedish_mammo.php

  18. #18 Orac
    October 13, 2010

    Well, the very good news is that women can choose for themselves what they want to do re scanning. Women can also self refer to breast thermography. Like any scan, due diligence is suggested.

    In other words, caveat emptor (let the buyer beware!), eh? Great attitude to take regarding medical tests promoted by quacks.

    Isn’t it nice to know that great technology exists and is provided by practitioners who suggest real preventive measures?

    It would be if (1) that technology had been validated to do what these “practitioners” claim it can do (thermography has not) and (2) if the measures these “practitioners” recommend to “prevent breast cancer” were scientifically shown to be “real preventative measures” (they’re not).

    Nice defense of quackery, though.

  19. #19 Oracle
    October 13, 2010

    What are these guys new to the game or what?! Don’t the know they can buy the hard evidence that we SBM’ers want through ghost writing and funding the FDA?! Geez… amateurs at the profit making game.

  20. #20 Pablo
    October 13, 2010

    What are these guys new to the game or what?! Don’t the know they can buy the hard evidence that we SBM’ers want through ghost writing and funding the FDA?!

    Didn’t you know? Companies that make thermography instruments are being suppressed by Big Instrument, who won’t touch it because heat is not patentable, whereas high energy radiation is.

    Or something like that.

  21. #21 Chris
    October 13, 2010

    The variation of the Pharma Shill Gambit by the ever morphing troll is also very old, and stupid.

  22. #22 Denice Walter
    October 13, 2010

    (Rhetorical question) Why does Dr. Mercola post an enlargable image of his Illinois State *license* prominently on his website? If you click the image , you’ll get “Why Trust Me?”….

  23. #23 Matthew Cline
    October 13, 2010

    @Pablo:

    What competition?

    Orac is a friggin surgeon! He’s not a radiologist or mammographer. In fact, he is no friend of mammographers because he has supported reduced usage of mammmography as a screening tool because it appears to be ineffectual.

    Well, if thermographs really were preventative as some claim, rather than only being screening devices, it would reduce the number of patients that Orac sees.

  24. #24 Cedric Katesby
    October 13, 2010

    Warning.
    Off-topic.
    Apologies all round:

    :(

    Orac, please call James Randi now.
    It’s happened again.
    The whole global warming denialism zombie thing has reared it’s ugly head.

    The latest article on the JREF website is a plug for the on-line Reason Magazine.

    This is bad.

    Reason Magazine is a platform of libertarian climate denialism.
    I don’t care about their political views but I do care about the climate denialism part.

    Our friends at Reason magazine have a cruise on the horizon! We would like to invite interested skeptics to join Reason’s all-star cast of investigative journalists, policy wonks, and assorted warriors for freethinking and free markets for a week at sea. It’s Reason’s first-ever seven-day cruise!

    When you click the link at the bottom and go to the Reason magazine website itself, you get this precious piece of wisdom as they advertize the very same cruise….

    Of course, there’s more to this cruise than just lazing on decks. You’ll hobnob with some of the most incisive writers and thinkers in America (…) Science Correspondent Ronald Bailey who can explain why the Florida coast we are sailing from will still be there a century from now no matter what global warming activists tell you.

    Type in “global warming” on their web-site and you get a host of articles poo-pooing global warming in general. Pretty much every single prominent climate denier out there gets a favourable mention at one time or another courtesy of Reason.com.

    These people are science deniers. Their political ideology is skewing whatever critical thinking skills they may or may not have.

    They are no friends of the JREF.

    Please, please, please say something. Bring this to somebody’s attention.
    Please.

    (I’ve posted this same plea at Phil Plait’s blog. I just hope somebody will do something. This is so disgraceful.)

  25. #25 Chris
    October 13, 2010

    Sometimes I like to change hands because it feels different…kind of like I’m dating 2 women. Yes, I’m a stud (at least that’s what the girls tell me)…one’s name is Palmela Handerson. Still looking to name the other…any suggestions? She was Orac for a while, but I like to change it up. Sorry…gotta run…I hear Palmela! Hubba-hubba.

  26. #26 JMD
    October 13, 2010

    OMG that article was way too long. Would have loved to helped you edit it with the same message in half the length. My eyes are so tired now.

  27. #27 superdave
    October 13, 2010

    Am I the only one who gets the feeling that alt med people only promote thermography because mainstream doctors don’t? IE that it is pure contrarinism? The technology isn’t really woo, what other reasons could there be?

  28. #28 aj
    October 13, 2010

    Money. Yesterday i saw a patient who paid $250 for a thermogram. She’s 42, mom and 2 sisters with breast cancer. She was told that thermography can pick up cancer 10 years before mammograms. Insurance does not pay for thermograms, it’s cash-on-the-barrelhead.

  29. #29 pj
    October 13, 2010

    ya, i hear ya, aj!

    check this out:

    “The drug Tarceva, which costs about $3,500 a month, was approved as a treatment for pancreatic cancer because it improved survival by 12 days.” http://www.nytimes.com/2009/09/02/health/research/02cancerdrug.html?_r=3

    $250 seems like chiclets compared to $3500/month doesn’t it?

  30. #30 Chris
    October 13, 2010

    aj, if your patient has two sisters with breast cancer, wouldn’t she be a candidate for a genetic BRCA1/BRCA2 test?

    (which are also pricey)

  31. #31 Chrissy
    October 13, 2010

    chris, if your arms have 2 hands, would they be considered lovers?

  32. #32 Chris
    October 13, 2010

    pj, points like that were covered here.

  33. #33 aj
    October 13, 2010

    I suggested BRCA testing. She refused. She said the “docs” that did her thermogram told her it was unnecessary. She plans to continue thermography because it doesn’t involve radiation. She is college-educated, but has totally bought into:

    “Well, the very good news is that women can choose for themselves what they want to do re scanning. Women can also self refer to breast thermography. Like any scan, due diligence is suggested. Isn’t it nice to know that great technology exists and is provided by practitioners who suggest real preventive measures?”
    I’m hoping i can convince her otherwise over the next few visits.

  34. #34 Calli Arcale
    October 13, 2010

    pj, paying the $250 will not prevent getting pancreatic cancer and perhaps being a candidate for a $3500/month treatment, no matter how good the thermography really is, because the thermography is intended to detect *breast* cancer, not pancreatic cancer. Pancreatic cancer is a bad one; it’s nearly always fatal and the treatments are poor to nonexistant, unlike breast cancer where surgery alone is often curative and there are a range of effective treatment options for many cases.

    Actually, Orac was discussing the problems with hideously expensive cancer treatments not too long ago, though he was discussing Avastin, not Tarceva. It’s definitely a challenge, and one which spotlights the big ethical question behind health care reform: at some point, treatment really *does* become too expensive to justify spending money on it, and how do you determine that point in a way which is fair and ethical in a big health-care system?

  35. #35 pj
    October 13, 2010

    chris, you live in a delusion. orac concludes:

    “With more research, I can only hope that science will soon be able to tell us which women with breast cancer are most likely to benefit the most from Avastin.”

    he who pays the piper calls the tune. pharma influence for FDA drug approval is bought and paid for…how do you think avastin was approved?

    wake up and smell the toilet (then wash your hands).

  36. #36 Chris
    October 13, 2010

    Calli Arcale:

    Actually, Orac was discussing the problems with hideously expensive cancer treatments not too long ago, though he was discussing Avastin, not Tarceva.

    Never mind. It looks like pj is one of those who is not here for discussion, especially with the Pharma Shill Gambit (why can’t these guys think of something original?). Don’t bother with him/her.

  37. #37 pj
    October 13, 2010

    Chris, do you wash your hands after?

  38. #38 Calli Arcale
    October 13, 2010

    Maybe so, Chris, but the ethical question of these really expensive drugs (and frankly, at $3500/month, it’s not even near the top of the price chart) is still an interesting one, and we’re gonna be seeing more of it soon, I’m sure. People talk about rationing, but it’s going to happen. It is happening. It has to happen. All we can do is try to make it fair and ethical. Which was Orac’s point in that other thread.

    With Avastin, it’s obvious it shouldn’t be given to all women, because a lot of women obviously don’t get much out of it. There are probably some women for whom the benefit will justify the cost, but without knowing that, how can we justify giving it to all of them? You spend your money where it will make the most difference, but you can’t make those choices without information.

    And then, of course, comes the really ugly question — how much is a month worth?

    (BTW, pj, why harp on the frailties of the FDA approval process? There is a great deal more to use in deciding how to use a drug than just whether or not it has been FDA approved. Case in point: I believe thermography is FDA approved. Doesn’t mean it’s the best choice in a majority of cases.)

  39. #39 pj
    October 13, 2010

    because chris likes to masturbate

  40. #40 Vicki
    October 13, 2010

    So, the morphing troll is against safe sex, too?

  41. #41 Orac
    October 13, 2010

    Oh goody. The Canadian sockpuppet has found a couple of new identities. How boring.

  42. #42 pj
    October 13, 2010

    vicki, i’m masturbating to you as we speak…

  43. #43 Chris
    October 13, 2010

    Sad, so sad. It cannot formulate a cogent argument, so it resorts to the taunts of ten year old playground bullies. Which were not effective when then, and definitely not now.

  44. #44 Chrissl
    October 13, 2010

    To a lay person, it might very well appear that thermography has significant benefits.

    First, it doesn’t involve any scary radiation (since many people “know” that all radiation is bad and scary and inevitably causes damage).

    Second, it sounds like it produces significantly more positives (i.e. more anomalies are detected). This is seen as a Good Thing, especially since if you follow the woo-practitioner’s recommended regimen (whatever it is) many of the “hot spots” go away.

    Of course, the reason many of them “go away” is that they were never incipient cancers in the first place. But with something as scary as cancer, it’s easy to believe that possible overtreatment (especially if it’s YOUR body) is 1000% better than possible undertreatment, especially since we’ve all heard the stories that go “if only it had been detected earlier…”

    I get the impression that people are very ready to believe that all positive tests are real. The existence of false positives doesn’t seem to enter their minds. I know I’ve seen my own health practitioners lean heavily on making sure I understand that possibility, which leads me to think that many patients indeed don’t understand it.

  45. #45 Oracle
    October 13, 2010

    Hi from Canada, Orac! Woowoo, eh!

  46. #46 Peebs
    October 13, 2010

    An interesting article from the JREF regarding RN’s and woo.

    http://www.randi.org/site/index.php/swift-blog/1085-problems-with-nursing.html

  47. #47 Vicki
    October 13, 2010

    It’s always nice to be appreciated for my mind, pj.

  48. #48 Andrew
    October 13, 2010

    Cedric: Research articles by Ronald Bailey, who is Reason’s scientific editor. He’s not a denialist. Not in the least bit. Not sure how you’re thinking this, unless you’re allowing a personal distaste for libertarian political thought to cloud…well, reason.

  49. #49 Michele
    October 13, 2010

    I’m with you triskelthecat. I want that Dr. Doom mask. People like Lynn Fraley make me embarrassed to admith that I’m a nurse.

  50. #50 Michele
    October 13, 2010

    Ugg, should preview. That would be ADMIT.

  51. #51 Birger Johansson
    October 13, 2010

    @ 17: Sorry, my bad :(

    BTW, the strength of HuffPo is the political commentary, but I agree that the editors have uncritically bought into alt med (a k a fraud) and are spreading it around. I suppose this is part of the zeitgeist for the demograpics the site is aimed at. Pity.

  52. #52 Nikki
    October 13, 2010

    Extremely well-written! I actually read the whole thing, which I rarely do.

    Thanks for the info.

  53. #53 Cedric Katesby
    October 13, 2010

    @Andrew

    Cedric: Research articles by Ronald Bailey, who is Reason’s scientific editor. He’s not a denialist. Not in the least bit. Not sure how you’re thinking this…

    Didn’t mention Ronald Bailey.

    I said that Reason Magazine is a platform of libertarian climate denialism.
    I stand by this claim.
    It’s really easy to verify.
    Go to their site.
    There’s not a single prominent climate denier nut-job that Reason.com doesn’t like.

    Here’s a list of the latest articles published by Reason.com connected to the subject of global warming…
    How many can you find that don’t aid and abet climate denialism in some way or form?
    Check out the titles.
    Read the actual content.

    Reason.com has not embraced modern science.
    They’ve just adopted a very, VERY slightly more nuanced fallback position.
    It’s the same ol’ same ol’ denialism with a dash of lipstick.

    (Oh no, we don’t deny climate change over here.
    We just think it’s too hard to do anything about and, hey, we love warm weather.)

    In all their articles, AGW somehow (mysteriously) always manages to look bad.

    A few examples culled from their latest articles:

    “..architectural blueprints in the United Arab Emirates are best regarded not as structures that will actually be built but as a regional subgenre of science fiction.”

    “The case for anthropogenic warming might indeed become airtight one day.”

    “None of the suggestions address the IPCC’s fundamental problem: It has every incentive—financial and otherwise—to buttress the global warming orthodoxy and none to challenge it.”

    “That Californians believe a statewide global warming policy will make a serious dent in global warming is a measure of our inflated sense of our own importance.”

    “Yet even in the heyday of the consensus on global warming there was never this kind of certainty. The ClimateGate scandal—in which prominent climatologists were caught manipulating data to exaggerate the observed warming—has significantly weakened this consensus.”

    “Reason’s Ronald Bailey summarized the findings as follows: “All right, people. Move along. Nothing to see here.
    Since its release, many critics have begun attacking the credibility of the committee charged with investigating the scandal.
    (…)
    The solution to global warming may very well be worse than the problem itself and, considering the stakes, the public needs to feel confident that climate scientists are acting in an open, transparent, and accountable manner. In this regard, the Russell report leaves much to be desired.”

    Ecetera, ecetera, ecetera…
    It never stops.

    The JREF should have absolutely nothing to do with these climate deniers.
    It’s disgraceful.

  54. #54 Orac
    October 13, 2010

    @Cedric

    So why don’t you e-mail D. J. Grothe if you feel so strongly about it? He’s fairly responsive and definitely reasonable in most things. (One exception is that he has a tendency to accept anti-aging woo that disturbs me a bit.) You could also leave a comment after the post at JREF. Why go off topic here in a post that has nothing to do with this?

  55. #55 Adam C.
    October 13, 2010

    I could see a way of testing it against Mammography without violating clinical equipoise: do both tests for all women in the study sequentially on the same day (or thereabouts). Ideally, one would have the operator *not* evaluate, but have that done afterwards, or by someone in an isolated room. Keep the testers blinded to the result of the other test.

    Note findings, and follow up anything that comes up in either of them, blinding as to which treatment(s) found the anomoly.

  56. #56 Adam C.
    October 13, 2010

    I could see a way of testing it against Mammography without violating clinical equipoise: do both tests for all women in the study sequentially on the same day (or thereabouts). Ideally, one would have the operator *not* evaluate, but have that done afterwards, or by someone in an isolated room. Keep the testers blinded to the result of the other test.

    Note findings, and follow up anything that comes up in either of them, blinding as to which treatment(s) found the anomoly.

  57. #57 Cedric Katesby
    October 13, 2010

    So why don’t you e-mail D. J. Grothe if you feel so strongly about it?

    I called the JREF directly to let them know how disappointed I am with them. I hope they do the right thing.

    You could also leave a comment after the post at JREF.

    Unfortunatly, no. Not on that particular post.

    Why go off topic here in a post that has nothing to do with this?

    I’m sorry about going off-topic.
    I should have perhaps sent you an email instead but I rushed ahead and posted here.

    I can understand that you don’t want to have off-topic posts but…surely it’s a big thing that another huge turd has been dropped on the blogosphere?

    Criticise me for going off-topic.
    Fine.
    Fair enough.
    I hope you will accept my apology.
    I also hope that you will consider doing something about this.
    Please.

    This is the JREF.
    They are supposed to be the good guys.

  58. #58 Jenny
    October 14, 2010

    I don’t know who to trust. Here’s what I mean:

    http://www.youtube.com/watch?v=kOW8LNU2hFE&feature=channel

  59. #59 Chris
    October 14, 2010

    Jenny, neither thermograpjs nor mammograms are pharmaceutical drugs. Did you fail to read the article?

  60. #60 Jenny
    October 14, 2010

    Chris, I’m sorry if I upset you.

    I stumbled upon this blog after wanting to know more about breast cancer therapy. After my research (Avastin recall, the youtube video, etc.) and having read this article, I am now stumped as to who to believe in terms of treatment options.

    Again, forgive me if I didn’t convey that. I’m suffering.

  61. #61 Chris
    October 14, 2010

    How does pointing out that you were barking up the wrong tree translate to “upset”? Are you having problems reading words?

    If you wish to read more on Avastin see this.

    If you are “suffering”, I would suggest that you delegate reading duties to someone else. Because it seems you are now having trouble with basic vocabulary.

  62. #62 Chris
    October 14, 2010

    I should say I am sorry for your illness, and I really am. But that does not excuse you from failing to read the article, or even using the handy dandy search box on the upper left hand side of this page.

    Now, the question is… would you be as accommodating to the fact that I have an adult child who had seizures from an actual disease? Or is it only important if it was assumed to be from a vaccine? Think very carefully before you answer.

  63. #63 Jenny
    October 14, 2010

    I’m not sure what you’re trying to say. I was just hoping someone could help me and comment on who I should believe. The video and this article gives such conflicting views.

    I won’t bother you any longer. Good bye.

    Also, I’m sorry to hear about your child.

  64. #64 Calli Arcale
    October 14, 2010

    We’ve had a lot of content spammers here lately and there was already an attempt to derail this thread earlier; that’s made people a little edgy. I’m sorry you bore the brunt of it.

    Who should you believe? My suggestion is to find a good oncologist, and if you’re not sure if he/she is on the level, get a second opinion. Don’t go off what you find on the Internet, especially YouTube. Get a professional who is experienced in the field and can apply the vast body of research to your specific case.

  65. #65 Calli Arcale
    October 14, 2010

    Oh, and you should be able to ask about the oncologist’s amount training, time he/she has spent in this specific field, and so forth. If you have breast cancer, seek an oncologist who specializes in breast cancer. (Orac’s one, though as a surgical oncologist, you’d probably see someone like him second.)

    Regarding the video, it’s quite true that the pharmaceutical companies push their products very heavily, and will try to present this products in the best possible light. They’re businesses; you need to expect that they will do this. It’s not honest, but it’s what businesses do. They’re not evil; they’re on a slippery slope, and you need to take things with a grain of salt when you listen to them.

    One big problem occurred in the 1990s under the guise of patient choice — the FDA’s power was weakened, and its workforce was reduced. People didn’t trust the FDA, so it was easy for the lobbyists to get Congress and the White House, in a big bipartisan effort, to make it easier for alternative remedies to compete with pharmaceuticals. The big problem there is that the lobbyists behind it were largely the pharmaceutical companies themselves. It made it even easier to mislead the public and mislead physicians. Twenty years ago, you didn’t see TV ads for drugs. Now you see TV ads for orthopedic implants, which is frankly insane, IMHO.

    There have been some recent efforts to improve the situation. You could look for an oncologist whose clinic/hospital has a policy forbidding receiving gifts from pharmaceutical reps. That might help. You can also ask for references and look up the actual research. PubMed is a great tool for that (click on my name for the link). It’s terribly dry, of course, because these are scientific papers. But it’s where you can find the actual data. Unfortunately, the weakening of regulation means an increase in caveat emptor — buyer beware.

    One red flag did pop up for me in the video. She suggests at one point that it’s the drug companies responsible for causing Scientology to be considered a cult, as a way of discrediting critics of psychoactive drugs. While it’s true that Scientologists oppose the use of psychoactive drugs, it’s certainly not just pharma propaganda that makes people call them a cult. It really *is* a cult, and a dangerous one at that. I hope she does not believe that psychoactive drugs never have a place, because they definitely do. There are definitely cases where the benefits outweigh the risks.

  66. #66 Chris
    October 14, 2010

    Jenny:

    I’m not sure what you’re trying to say. I was just hoping someone could help me and comment on who I should believe.

    So posting a video of a woman ranting is asking for help? You only prefaced it with a short cryptic message, how were we supposed to know, as Calli Arcale remarked, one of the many spammers and off topic trolls that were infesting this blog yesterday?

    I would suggest you stop getting advice from youtube videos, and perhaps discuss your problems with your doctor.

  67. #67 Chris
    October 14, 2010

    This is probably a good time for this reminder:

    Do not seek any kind of medical advice from strangers on the internet.

  68. #68 Jenny
    October 14, 2010

    Thanks, Calli.

    Chris, the woman on the video was not ranting. She was just discussing her experience as a drug rep.

    After watching the video and hearing about how some drug reps are trained to outright lie to doctors about their products, however, I’m not so sure how accurate the info is that doctors are then offering.

  69. #69 Chris
    October 14, 2010

    Big deal. It is part of reality. What you can do is to go to the Medline Drug Information and learn about them yourself. You can also talk to a trained pharmacist.

    The way you are ranting it sounds like:

    1) Test procedures are pharmaceutical products

    2) Pharmaceutical companies are bad, therefore their products are bad.

    This is the type of thinking that makes people with Type 1 Diabetes get off their insulin, with dire results… or people with heart issues like hypertrophic cardiomyopathy go off of their beta-blockers. The latter being what my son did, and we don’t know how much more his mitral valve is damaged.

    Now go whine somewhere else.

  70. #70 Chris
    October 14, 2010
  71. #71 CanadianChick
    October 14, 2010

    I’m confused. Orac is an oncology surgeon, specializing in breast cancer.

    Earlier detection does not constitute competition for him unless he prices his surgeries by tumour weight.

    And if he, and other EBM practioners were as mercenary as claimed by the woo-peddlers you’d think that the profession would be DELIGHTED to see teeny tiny tumours detected (even if they might not result in actual cancer) because that would mean more surgery and therefore more money.

    But no – what a conundrum! Orac and his colleagues actually appear to be concerned about the overall health of their patients. Recommending AGAINST unnecssary surgery or treatment as part of their service? That’s not very mercenary or heartless. Youd almost think they were motivated by something other than money – oh wait! They are.

    Wish I could say the same for the woo-peddlers.

    As a woman, I’d love it if thermography became the gold standard instead of mammography. Sounds like it would be less uncomfortable. But unless a TONNE of research is done in the next few years, I’ll be scheduling my first mammogram for my 50th birthday.

  72. #72 Calli Arcale
    October 14, 2010

    Jenny — there are no guarantees. Absolutely anybody anytime could be lying to you, or, in good faith, giving you information that happens to be wrong because they themselves were misled. This is a fact of life.

    Your best bet is still to look for experienced oncologists. I’ve been on the inside a bit, coming from a medical family, and it is astonishing what the drug reps will do. In my industry it’d potentially be criminal. But just because they can mislead physicians doesn’t mean you should ignore all physicians. After all, the drug companies aren’t just working that way. Now that they can advertise direct to the public, and now that more and more hospitals and clinics are banning them, they’re working on the patients themselves. That makes it harder to trust things on the Internet, because you never know what’s real and what’s a viral ad campaign.

    So I’d still go with the oncologists, and if you can, try to find one with a solid academic reputation from a facility that bans gifts from pharma reps. Multiple opinions aren’t a bad idea, and you should always be able to ask where they got their information, and then look up their references on PubMed. Doctors aren’t unaware of this problem; though many are still naive as to the extent of it, an increasing number are fighting back.

  73. #73 Josh Koenig
    October 15, 2010

    Question: while there haven’t been high-quality randomized/blind studies to prove the value, have such studies cast doubt, or is it more than they haven’t been done.

    I appreciate skepticism, but this article indulges in cultural arguments and guilt by association. This leads as flamebait, while concluding:

    The ironic and sad thing about thermography is that it isn’t quackery in and of itself. Rather, it’s the way it’s marketed and used that is quackery.

    If the point is, “this is an unproven (though possibly useful) technique that’s being oversold” that’s one argument. But the thrust of the article is different. I don’t know how responsible that is. Is this really true:

    … the suffocating embrace of quacks around thermography contributes to the unsavory reputation the technique currently has in the medical community and continues to hinder its development in mainstream scientific medicine.

    Or is that just prejudice? One could argue that in cases where the basis is principally sound, mainstream interest — however “unscientific” in its character — might help rather than hinder the development of emerging new treatments.

  74. #74 Lawrence
    October 15, 2010

    Except in cases where this is being peddled as a “cure-all” outside of all other conventional treatments, and people start to die.

    A few lawsuits should have a very deleterious effect on the development of this technology – even if there is something to it.

  75. #75 Todd W.
    October 15, 2010

    @Josh

    The problem that Orac is trying to highlight is not simply use of thermography, but the promotion of thermography in place of mammography in the absence of any evidence that it is at least as effective.

    Due to the lack of any evidence that it is an effective screening tool by itself, it should only be used in the context of a clinical trial. Even there, it should still be used in conjunction with a validated screening tool, like mammography, in order to treat the subjects ethically.

    The problem that Orac highlights is that thermography is being promoted and used outside of clinical trials as a substitute for mammography. This has potential problems: a) it can lead to women missing the detection of tumors, thereby leading to poorer outcomes or b) it can lead to “detection” of supposed tumors that will not progress, caused undue stress and potential needless expenditure of time, money and undergoing needless procedures.

    Frankly, you missed the point of his article.

  76. #76 Calli Arcale
    October 15, 2010

    Josh: studies of thermography have been done; it is actually an FDA-approved device, and you have to do studies to get that approval. It does work. But the studies show that the accuracy is significantly inferior to mammography — too many false positives and false negatives. (This is why the FDA approved it for us in conjunction with mammography, not alone.) Orac actually linked to a few studies in his post.

    My two cents? Mammography gets the best bang for the buck, and the radiation risk is not really all that big. You also don’t have to spend as long with your boobs hanging out, and as a woman, that has a certain appeal.

    More pertinent to Orac’s concerns is that thermography’s benefits are being wildly overstated. The basic premise of thermography is that a successful tumor relies on angiogenesis — building its own blood supply. That increased blood flow should be detectable by its thermal signature — it should be slightly warmer than the surrounding tissue. (This is also the basic premise of breast MRI.) The challenge is that this isn’t the only thing that can affect the temperature of a body tissue. But the premise is reasonable, and thermal imaging is accurate enough to detect that change in temperature.

    Some of these practitioners are saying it is more than that. Northrup claims it can detect cancer “at the cellular level”, which is, frankly, poppycock. Not only is there no evidence it does this, I don’t think it’s reasonable to suppose it even can, since that would mean measuring the heat of a specific cell, and that would be beyond the device’s capability. We’re not just talking resolution here either — tumors are three-dimensional, but the heat signature is basically flat. You simply can’t resolve a cell from a stack of a hundred of them seen from above the stack; they eclipse one another. She also claims it can prevent cancer, but the whole premise of the device is to detect established tumors. Furthermore, it’s being sold as superior to mammography, when the data shows the opposite, and that’s misleading.

  77. #77 Pablo
    October 15, 2010

    Hey, a little semi-on-topic.

    I saw on Dr Oz yesterday that he discussed the question of diagnosing breast cancer too early based on difficult-to-interpret mammography. They addressed the cost of having to do biopsies with negative results.

    In the end, however, I was a little bothered by the direction of how to address it, which turned into “be sure to use a radiologist who has enough experience interpreting these things,” which I don’t think really addresses the problem. It’s not that radiologists are incompetent at interpreting the imaging, it’s that we don’t have enough discriminators available, even for experts, to distinguish the problems from the benign. Even when the biopsies indicate they are pre-cancerous, that doesn’t mean these things detected so very early on will actually develop into something that will ultimately need treatment.

    OTOH, they did do a great job of distinguishing SCREENING results from diagnostics.

  78. #78 Scott
    October 15, 2010

    @ Pablo:

    Was that discussion about addressing it in the context of what individual women should do today, or what the medical profession should be doing to improve the situation? If the former, then it sounds entirely reasonable, as there’s not much else to be done until the science has progressed. If the latter, yeah, kinda silly.

  79. #79 Tom
    October 18, 2010

    Did anyone else catch Mercola’s endorsement of tanning beds for vitamin D deficiency? What next? Smoking as a weight-loss strategy?

  80. #80 Kathi
    October 20, 2010

    Thank you, Orac. Once again, you’ve nailed it.

  81. #81 Kathi
    October 20, 2010

    My only quibble with this post is that it’s not only the Pink Koolaid drinkers who apply the ‘slash/burn/poison’ language to cancer treatment. Unfortunately, like it or not, it is apt to a degree. But I don’t think any of us who have been treated for cancer or any of us who treat patients with cancer would argue against less invasive, more accurate & effective treatment protocols, which would cause fewer long- and late-term side effects. I do, however, object when people like Dr. Northrup, who don’t know excrement from shinola about surviving or treating cancer, toss that language about as if it demonstrates their empathy & wisdom on the subject.

  82. #82 Webbie
    October 21, 2010

    Thank you for “leading” me to this article Kathi. My mother, the Mother of CAM, has foregone annual mammography, probably based on Dr. Northrup’s recommendations among others. She is a highly intelligent and well educated woman, especially in the CAM field. She would naturally be attracted by thermography. And, after viewing the results of her first one, including its correlations to some long term problems resulting from injury, I was pretty impressed. But still can’t find it in my heart (or head) to endorse her decision.

    I have sent her this article in the hope that I can equally impress upon her the need for both. Tho cost is prohibitive and she does not have traditional insurance, considering the last two years of my life, I think it’s worth every dime to use these methods in conjunction, not necessarily negating either at this point. I don’t know if thermography would have helped me. I know my mammogram did. Too bad I can’t turn back the clock and compare the results of both methods for myelf.

    Like most CAM, the funding is not there for large scale studies. But maybe, if we can convince enough of us to go both routes, comparative analysis can be compiled over time creating a compelling enough picture for grant purposes or whatever it takes to get the ball rolling. (Think Nurse’s Study.)

    Thank you, Orac, for, as Kathi mentioned, nailing it. We don’t know enough yet, which is acceptable. The marketing before the research is not. It is not often that I find an author who can make this distinction. I find you to be far more credible than others who feel they must utterly denigrate their less preferred method, on both sides. And your clearly cited references make it much easier on us lay folk trying to separated the threads in this tangled twine of treatment/prevention/screening options. (No, Dr Northrup, they are NOT all three the same thing!)

  83. #83 Webbie
    October 21, 2010

    Thank you for “leading” me to this article Kathi. My mother, the Mother of CAM, has foregone annual mammography, probably based on Dr. Northrup’s recommendations among others. She is a highly intelligent and well educated woman, especially in the CAM field. She would naturally be attracted by thermography. And, after viewing the results of her first one, including its correlations to some long term problems resulting from injury, I was pretty impressed. But still can’t find it in my heart (or head) to endorse her decision.

    I have sent her this article in the hope that I can equally impress upon her the need for both. Tho cost is prohibitive and she does not have traditional insurance, considering the last two years of my life, I think it’s worth every dime to use these methods in conjunction, not necessarily negating either at this point. I don’t know if thermography would have helped me. I know my mammogram did. Too bad I can’t turn back the clock and compare the results of both methods for myelf.

    Like most CAM, the funding is not there for large scale studies. But maybe, if we can convince enough of us to go both routes, comparative analysis can be compiled over time creating a compelling enough picture for grant purposes or whatever it takes to get the ball rolling. (Think Nurse’s Study.)

    Thank you, Orac, for, as Kathi mentioned, nailing it. We don’t know enough yet, which is acceptable. The marketing before the research is not. It is not often that I find an author who can make this distinction. I find you to be far more credible than others who feel they must utterly denigrate their less preferred method, on both sides. And your clearly cited references make it much easier on us lay folk trying to separate the threads in this tangled twine of treatment/prevention/screening options. (No, Dr Northrup, they are NOT all three the same thing! Heat detection would NOT have stopped my cancer from growing thank you very much!)

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