"CHEMOTHERAPY KILLS!!!!"
I've lost count of how many times I've come across brain-dead statements like the one above, often in all caps on websites resembling that of the Time Cube guy, quite frequently with more than one exclamation point, on the websites of "natural healers," purveyors of "alternative medicine." In fact, if you Google "chemotherapy doesn't work," "chemotherapy is poison," or "chemotherapy kills," you'll get thousands upon thousands of hits. In the case of "chemotherapy kills," Indeed, the top two autofill choices I get on Google for "chemotherapy kills" are "chemotherapy kills more than it saves" and "chemotherapy kills you."
Depressingly, the vast majority of the hits from these searches tend to be websites hostile to science-based medicine, such as Mercola.com, the website of "alternative medicine entrepreneur" Dr. Joe Mercola and NaturalNews.com, the website of Mike Adams. At the latter of these you will quickly will find cartoons like "Chemotherapy 'treatment,'" which likens the administration of chemotherapy to a Nazi death camp or The truth about chemotherapy and the cancer industry, which portrays patients going into a cancer center for screening and coming out in body bags while an armored car drives up to pick up the profits. As my final example, there's Chemotherapy Stickup, which portrays chemotherapy as sticking up and old woman and demanding, "Hand over your immune system, or I'll kill you." The article that accompanies the cartoon above even makes this astounding claim:
There is not a single cancer patient that has ever been cured by chemotherapy. Zero. They don't exist. Not a single documented case in the history of western medicine.
And why is that? Because conventional medicine operates from the false belief that there is no cure for cancer! Thus, anyone offering a cure (or assisting in the body's own natural reversal of the disease) is immediately dismissed as a quack. Meanwhile, the real quackery is found in the pushing of toxic chemotherapy chemicals that are injected into the bodies of patients and called "treatment" when they should really be called "torture." (Nancy Pelosi, by the way, was never briefed on the fact that chemotherapy is torture...)
When I first encountered that cartoon a few years ago, I was a bit surprised that even a total loon like Mike Adams would go so far as to make such an absolutist statement claiming that not a single person has ever been cured of cancer by chemotherapy in the entire history of "western medicine." All it would take is a single example to prove him wrong, like--oh, you know--Lance Armstrong, the patients cared for by my pediatric oncology colleagues, or the patients I saw during my training cured of anal cancer by the Nigro protocol. The Nigro protocol, by the way, consists of combined chemotherapy and radiation and is still the standard of care for anal cancer. That doesn't even count all the patients with leukemia or lymphoma cured primarily by chemotherapy.
Unfortunately, this attitude isn't just limited to cranks. There are legitimate scientists, even those who have published in magazines devoted to skepticism, who make very similar statements, although perhaps not quite as absolutist. Not quite, but close. For example, there's Reynold Spector, whom Mark Crislip and I took to task for his article earlier this year in Skeptical Inquirer entitled Seven Deadly Medical Hypotheses. One of his "seven deadly medical hypotheses" actually read thusly:
From a cancer patient population and public health perspective, cancer chemotherapy (chemo) has been a major medical advance.
In other words, to Dr. Spector, the very idea that chemotherapy is a notable advance in the treatment of cancer is not just wrong but a "deadly medical hypothesis." Of course, Dr. Spector's statement is not a hypothesis at all, deadly or otherwise, as what one means by a "major medical advance" is very subjective and the weasel words of "from a patient population and public health perspective" give Dr. Spector wiggle room, but it's very clear what his intent is. He doesn't think chemotherapy works very well, if at all, even as he admits:
However, it cannot be denied that there are a few populations for which chemotherapy is marvelously effective, as noted above, and must be used.
So which is it? If chemotherapy is marvelously effective, even in a few populations, then chemotherapy "works" when used properly.
In previous posts, such as If we can put a man on the moon, why can't we cure cancer? and When skepticism about medicine devolves into nihilism, I explored some of these questions. In the former article, I pointed out just how complex the problem is, with cancer being hundreds of different diseases and using the example of just how messed up the prostate cancer genome is to provide an idea of the magnitude of the problem. In the second article, I pointed out an example of a specific cancer for which advances in chemotherapy have made a meaningful difference in both survival and quality of life outcomes. What I haven't yet done is to look at the arguments cancer cranks use to try to convince people that chemotherapy doesn't work.
Attacking chemotherapy
Any rational assessment of the efficacy of chemotherapy must be forced to include an admission that chemotherapy is only rarely curative in solid malignancies, particularly advanced solid malignancies. Notable exceptions include testicular cancer (which is what Lance Armstrong was cured of) and anal cancer. In contrast, for hematological malignancies, such as leukemia and lymphoma, chemotherapy is usually the mainstay of therapy. However, not being curative doesn't mean that chemotherapy is useless anymore than the fact that beta blockers don't cure hypertension and metformin doesn't cure diabetes makes them "useless" drugs. Before we take a rational look at what chemotherapy can and can't do, let me just point out that there are three studies that are frequently used by cranks to try to argue that chemotherapy is useless.
The first one is easily dismissed, but you'll see it a lot anyway. It's frequently cited in articles with titles like 75% of MDs Refuse Chemotherapy Themselves and the claim will go something like this:
Several full-time scientists at the McGill Cancer Center sent to 118 doctors, all experts on lung cancer, a questionnaire to determine the level of trust they had in the therapies they were applying; they were asked to imagine that they themselves had contracted the disease and which of the six current experimental therapies they would choose. 79 doctors answered, 64 of them said that they would not consent to undergo any treatment containing cis-platinum - one of the common chemotherapy drugs they used - while 58 out of 79 believed that all the experimental therapies above were not accepted because of the ineffectiveness and the elevated level of toxicity of chemotherapy. (Source: Philip Day, "Cancer: Why we're still dying to know the truth", Credence Publications, 2000)
Wow! This sounds really damning, doesn't it? What hypocrites those oncologists are! Right?
It turns out that this survey is over 25 years old and was about a specific kind of chemotherapy, cisplatin for non-small cell lung cancer, which was a new therapy at the time and didn't have a lot of evidence for it. As Anaximperator describes, a followup survey was conducted in 1997 at a session on the National Comprehensive Cancer Network (NCCN) clinical practice guidelines. Participants were asked to respond to the same question regarding chemotherapy:
You are a 60-year-old oncologist with non-small-cell lung cancer, one liver metastasis, and bone metastases.
Your performance status is 1. Would you take chemotherapy? Yes or no?
The results? Let Anaximperator tell the tale:
The overall results of the 1997 follow-up survey show that 64.5% would now take chemotherapy - which is almost a doubling from 34% to 64.5% of those willing to have chemotherapy and radiotherapy and a quadrupling from 17% to 64.5% of those who would take chemotherapy alone.
Anaximperator adds:
The study from 1991, "Oncologists vary in their willingness to undertake anti-cancer therapies," pertains to many kinds of cancer and cancer stages, from early stage to terminal, as well as to experimental therapies. It shows percentages as high as 98% of doctors willing to undergo chemotherapy, while the remaining 2 % were uncertain, and none answered "definitely no" or "probably no" to chemotherapy.
Should another survey be conducted today, there's a good chance the results would be even higher in favour of chemotherapy, given that over the years chemotherapy has shown enhanced clinical benefit and less side effects.
Indeed. One should also note that this question was constructed such that the clinical presentation of the cancer was incurable. Participants were thus presented with a scenario in which they are diagnosed with stage IV metastatic disease, a situation where opting for palliative care rather than aggressive treatment often makes sense. To me this makes the results even more striking. Also, I know from personal experience that it is not true that oncologists tend to turn down chemotherapy, even for advanced disease. having known oncologists who developed various cancers and underwent standard-of-care chemotherapy. In the end, this particular ploy serves two purposes. First, it implies that oncologists are hypocrites who don't believe that the treatments they are giving patients are worthwhile. Second, it feeds into the conspiracy theories beloved of quacks with the implication that oncologists are hiding something about chemotherapy effectiveness. They're not.
My favorite example of the use of the next study beloved of anti-chemotherapy cranks is by Andreas Moritz, who describes himself as "a medical intuitive; a practitioner of Ayurveda, iridology, shiatsu, and vibrational medicine; a writer; and an artist." The article is entitled Can you trust chemotherapy to cure your cancer? and in it Moritz cites a study from Australia published in 2004:
An investigation by the Department of Radiation Oncology, Northern Sydney Cancer Centre, Australia, into the contribution of chemotherapy to 5-year survival in 22 major adult malignancies, showed startling results: The overall contribution of curative and adjuvant cytotoxic chemotherapy to 5-year survival in adults was estimated to be 2.3% in Australia and 2.1% in the USA." [Royal North Shore Hospital Clin Oncol (R Coll Radiol) 2005 Jun;17(4):294.]
The research covered data from the Cancer Registry in Australia and the Surveillance Epidemiology and End Results in the USA for the year 1998. The current 5-year relative adult survival rate for cancer in Australia is over 60%, and no less than that in the USA. By comparison, a mere 2.3% contribution of chemotherapy to cancer survival does not justify the massive expense involved and the tremendous suffering patients experience because of severe, toxic side effects resulting from this treatment. With a meager success rate of 2.3%, selling chemotherapy as a medical treatment (instead of a scam), is one of the greatest fraudulent acts ever committed. The average chemotherapy earns the medical establishment a whopping $300,000 to $1,000,000 each year, and has so far earned those who promote this pseudo-medication (poison) over 1 trillion dollars. It's no surprise that the medical establishment tries to keep this scam alive for as long as possible.
Here is the study to which Moritz refers and which is the origin of the claim that "chemotherapy only provides 2% benefit," a favorite talking point used by cancer quacks. I've seen it on websites ranging from Moritz's website to NaturalNews.com, to Mercola.com, to Whale.to (my favorite), to I forget how many others. Always it's the same thing, a variant of a statement claiming that chemotherapy only contributes 2% to five year survival in adult malignancies, followed by conspiracy-mongering of the sort above in which chemotherapy is portrayed as a huge scam designed to enrich big pharma. Indeed, so common is this particular favorite that I proclaim it "The 2% Gambit." It turns out that this is not such an impressive study. Indeed, it appears almost intentionally designed to have left out the very types of cancers for which chemotherapy provides the most benefit, and it uses 5 year survival exclusively, completely neglecting that in some common cancers (such as breast cancer) chemotherapy can prevent late relapses. There were also a lot of inconsistencies and omissions in that leukemias were not included, while leukemia is one type of cancer against which chemotherapy is most efficacious. Indeed, the very technique of lumping all newly diagnosed adult cancers together is guaranteed to obscure benefits of chemotherapy among subgroups by lumping in patients for whom chemotherapy is not even indicated. A letter to the editor listed these problems and several really egregious errors and omissions, too:
The authors omitted leukaemias, which they curiously justify in part by citing the fact that it is usually treated by clinical haematologists rather than medical oncologists. They also wrongly state that only intermediate and high-grade non-Hodgkin's lymphoma of large-B cell type can be cured with chemotherapy, and ignore T-cell lymphomas and the highly curable Burkitt's lymphoma. They neglect to mention the significant survival benefit achievable with high-dose chemotherapy and autologous stem-cell transplantation to treat newly-diagnosed multiple myeloma [4]. In ovarian cancer, they quote a survival benefit from chemotherapy of 11% at 5 years, based on a single randomised-controlled trial (RCT), in which chemotherapy was given in both arms [5]; however, subsequent trials have reported higher 5-year survival rates. In cancers such as myeloma and ovarian cancer, in which chemotherapy has been used long before our current era of well-designed RCTs, the lack of RCT comparing chemotherapy to best supportive care should not be misconstrued to dismiss or minimise any survival benefit. In head and neck cancer, the authors erroneously claim the benefit from chemotherapy given concomitantly with radiotherapy in a meta-analysis to be 4%, when 8% was in fact reported [6].
The authors do not address the important benefits from chemotherapy to treat advanced cancer. Many patients with cancers such as lung and colon present or relapse with advanced incurable disease. For these conditions, chemotherapy significantly improves median survival rates, and may also improve quality of life by reducing symptoms and complications of cancer.
Of course, those using this particular gambit almost invariably never include the criticism of this particular article. Another aspect of this particular study that always bothered me is that it appeared to lump patients undergoing adjuvant chemotherapy in with those undergoing chemotherapy for cure or palliation. Adjuvant chemotherapy is given after surgery in order to decrease the rate of recurrence, but the truly curative modality is the surgery itself. In early stage cancer, the absolute benefit of chemotherapy in terms of prolonging survival tends to be modest, often single digit percentages. Lumping adjuvant therapy in with other uses of chemotherapy again appears custom-designed to minimize the survival benefit due to chemotherapy observed.
The second study frequently cited by cancer quacks as evidence that "chemotherapy doesn't work" is, not surprisingly, also cited by Moritz:
In 1990, the highly respected German epidemiologist, Dr. Ulrich Abel from the Tumor Clinic of the University of Heidelberg, conducted the most comprehensive investigation of every major clinical study on chemotherapy drugs ever done. Abel contacted 350 medical centers and asked them to send him anything they had ever published on chemotherapy. He also reviewed and analyzed thousands of scientific articles published in the most prestigious medical journals. It took Abel several years to collect and evaluate the data. Abel's epidemiological study, which was published on August 10, 1991 in The Lancet, should have alerted every doctor and cancer patient about the risks of one of the most common treatments used for cancer and other diseases. In his paper, Abel came to the conclusion that the overall success rate of chemotherapy was "appalling." According to this report, there was no scientific evidence available in any existing study to show that chemotherapy can "extend in any appreciable way the lives of patients suffering from the most common organic cancers."
As I pointed out in my first takedown of this claim, I looked for this study. In fact, I went to The Lancet's website and looked up the August 10, 1991 issue. I could find no study by Ulrich Abel or anything about chemotherapy other than this study on stroke after chemotherapy for testicular cancer. So I started searching PubMed more widely, and I found what appears to be the paper to which Moritz referred, only it wasn't published in 1991 but rather in 1992 and it wasn't published in The Lancet but rather in Biomedicine & Pharmacotherapy, a much lower tier journal. Somehow, through the magic of playing "telephone" over the Internet, this article has morphed from being in a lower tier journal to having been in The Lancet--even published on a specific date!
It turns out that the Dr. Abel's article is rather odd. It's not really a study, and it's definitely not a meta-analysis. Nor is it really a particularly good systematic review, given that the methodology of selecting papers isn't exactly transparent, and the larger "review" to which he refers readers appears to be in German and not readily available on the web, as far as I can tell. In the abstract, Dr. Abel states that "as a result of the analysis and the comments received from hundreds of oncologists in reply to a request for information, the following facts can be noted." More importantly, Dr. Abel was addressing a fairly limited situation that excludes two of the most effective uses of chemotherapy, as described in this English translation of a Der Spiegel article describing his work:
- Abel's verdict against the medicinal treatment of cancer is emphatically untrue for various kinds of lymph cancer, Hodgkin's disease, leukemias, sarcomas, and testicular cancers in the male. These kinds of malignancies can be cured by chemotherapy with a high degree of probability, especially in children -- an undisputed success. But these are, in any case, only a very small part of the new cases of cancer diagnosed every year.
- Abel's doubts are not directed against chemotherapy when it is used in support of a curative operation, in order to shrink the tumor beforehand; nor do they apply to chemotherapy used prophylactically after an operation, to prevent a relapse (as an adjuvant).
These are, of course, the two most effective uses of chemotherapy that there are. I'll grant critics that the types of tumors that can be cured with chemotherapy with a high degree of probability are a minority of tumors, but, contrary to what is implied in many uses of Dr. Abel's work, they are not insignificant. For example, leukemias and lymphomas (Hodgkins and non-Hodgkins) add up to almost 10% of newly diagnosed cancers every year, and they are cured primarily with chemotherapy. Sarcomas and testicular cancers are much less common, but add them in and the total exceeds 10%. A distinct minority, yes, but the fact that many of these cancers can be cured with chemotherapy puts the lie to statements like the one by Mike Adams quoted above, which, not surprisingly, is parroted in Andreas Moritz's little screed.
The second indication left out of Dr. Abel's analysis, adjuvant chemotherapy, can, depending on the circumstance and tumor, be highly effective. Admittedly in early stage breast cancer adjuvant chemotherapy adds on an absolute basis only low single digit percentages to five and ten year survivals, but in more locally advanced breast cancer, particularly so-called "triple negative" breast cancer, the benefit is much more substantial. For instance, using Adjuvant Online, it's possible to use the latest literature to estimate the benefit of chemotherapy in specific clinical situations. Here's an example of a hypothetical 40 year old woman with an estrogen receptor negative tumor measuring between 3 and 5 cm with 1-3 axillary lymph nodes positive for metastatic disease:
Note that standard chemotherapy increases this woman's chance of survival by 18% on an absolute basis and by 35% on a relative basis. Either way, the survival benefit is substantial. These are women who otherwise would have died but did not, thanks to chemotherapy. These women could be your mother, your wife, your sister, or even your daughter. The bottom line is that, even though I wasn't particularly impressed with his methodology, Dr. Abel was actually reasonably nuanced in his discussion in that he discussed overdiagnosis and stage migration as confounders that can make a treatment seem more effective than it is, as I myself have discussed many times on this blog, starting with this post.
Besides, few oncologists would disagree with this statement at the end of Dr. Abel's abstract, "With few exceptions, there is no good scientific basis for the application of chemotherapy in symptom-free patients with advanced epithelial malignancy." And, indeed, most oncologists do not recommend chemotherapy for patients with stage IV epithelial malignancies who are asymptomatic, because at that point all treatment is palliative, and you can't palliate symptoms that don't exist. That's why chemotherapy is, in most cases, reserved for when tumor progression leads to symptoms. Moreover, this study only examined epithelial malignancies. These are cancers for which surgery can be curative if the tumor has not metastasized. Since 1991, also, we have made significant advances in improving survival using chemotherapy. I've used the example of colorectal cancer before, where, thanks to newer and better chemotherapy regimens developed over the last couple of decades that have improved survival in patients with liver metastases from 6 months to close to two years.
The bottom line is that the "evidence" used by cranks and quacks to prove that "chemotherapy doesn't work" is most often based on intellectually dishonest tactics. They either misrepresent studies, as they frequently do with the McGill study claiming that oncologists won't use chemotherapy. True, thanks to the way these studies have been misrepresented over the years, many of these quacks probably honestly think they're accurately representing them, but that just goes to show how lazy they are about going back to the primary sources to back up their claims. As for the rest, the Australian study was custom-designed to minimize the apparent utility of chemotherapy, while Dr. Abel's study intentionally left out the types of situations where chemotherapy is most useful and looked at primarily advanced malignancies. In this latter case, there's nothing wrong with that approach; the problem comes when the quacks either intentionally or unintentionally fail to disclose that qualification, lose any hint at nuance, and use the results to imply that chemotherapy doesn't work for anything.
Framing the question
Considering the question of whether chemotherapy "works" or not is very similar to asking the question, "Why haven't we cured cancer yet?" The reason is that it's a question that's so vague as to be almost meaningless. Cancer is, as I have pointed out, hundreds of diseases, each driven by a plethora of different combinations of disruptions in cell growth control mechanisms. A more appropriate question is whether we've cured this cancer or that cancer, not whether we've cured cancer. Similarly, asking the question of whether chemotherapy "works" is similarly vague and meaningless. The real questions are (1) whether this specific chemotherapy regimen "works" for this cancer, although there are some examples that in aggregate we can make some conclusions about and (2) whether specific chemotherapy regimens can cure specific cancers. As noted above, even some "skeptics" of chemotherapy admit that chemotherapy can be "marvelously effective" for some cancers; the argument that usually follows is that the cancers for which chemotherapy is effective are so few as not to matter. The other issue is that few cancers are treated only with chemotherapy. Multidisciplinary and multimodality therapy are more the rule than the exception, particularly for solid malignancies and includes chemotherapy, radiation therapy, surgery, hormonal therapy, and a variety of other less common therapies.
What needs to be understood is that chemotherapy is very good for some things. For instance, it's very good for treating and curing leukemias and lymphomas. For certain cancers, such as breast and colorectal cancer, it's very good at decreasing the chance of relapse after curative surgery. When given before curative surgery, chemotherapy can also make organ-preserving surgery possible. Prominent examples include using neoadjuvant chemotherapy (chemotherapy before surgery) to shrink breast cancers so that they can be removed without mastectomy and shrinking rectal cancers so that sphincter-sparing surgery is possible (i.e., surgery that leaves the anal sphincter intact and thereby spares the patient having to have a permanent colostomy). For specific tumors, chemotherapy has also contributed to significant increases in survival, but it is not a panacea. For example, chemotherapy usually does little for pancreatic cancer, and metastatic melanoma laughs at most chemotherapy (although, fortunately there are newer agents coming into use that provide hope that this will no longer be the case). For all its uses and advantages in various clinical situations, in other situations chemotherapy doesn't work well. For example, chemotherapy alone is not very good at prolonging survival in advanced epithelial malignancies, and it's not at all unreasonable to ask whether oncologist, for whatever reason, overuse it in such patients, who are, for the most part, currently incurable.
This reasonable skepticism devolves into nihilism or crankery, however, when tactics such as those used by Mike Adams, Andreas Moritz, or, yes, even the esteemed Reynold Spector are used to "prove" that chemotherapy is "useless." Moreover, such "skepticism" completely dismisses as worthless survival benefits of a few months, which certainly aren't "worthless" to many patients. Such briefly lengthened survival times can mean the difference between seeing a child graduate from college or not, seeing a child get married or not, or seeing the birth of a grandchild or not. It must also be remembered that the measured improvements in survival due to chemotherapy are usually medians. Not uncommonly, buried in that median are "outliers" who derive a huge survival benefit from the chemotherapy and survive many more months than expected, sometimes many more years than expected. Moreover, it does patients no favor to try to use the observation that chemotherapy has at best relatively modest benefits in patients with advanced epithelial malignancies to try to imply that chemotherapy doesn't work for all patients. In particular, patients have to remember that just because chemotherapy doesn't do that well against advanced malignancies does not, as the quacks would have you believe, imply that "alternative medicine" can do better.
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@ Chris
I Was Guardian of the Poll at pharyngula. I lasted two years. I still guard polls that this great ape at pharyngula tried to fornicate.
However, captain blackbeard (Ed Brayton) banned me becuase he couldn't handle me or my name there.
Shows how little you know.
Following this storyline is sad. Following stupid trolls is even more sad. Doctor Dumb is annoying but how do we know he has not hijacked this electronic technician website like he did others? Camp Fema? Wellness Resources? Really? Methinks he uses other websites to be more annoying than usual.
You have extolled the virtues of chemo very well but not much mention of any alternative. Why not? Are there alternatives..? What about a vegan diet or an aklanine diet, the dangers of meat and animal protein and their well proven connection with the chronic conditions of affluence? What about the fact that chemo is an acid treating an acid and how this predisposes and conditions the body for future instances? No doubt chemo isnt all bad, also no doubt diet and lifestyle are not all bad.. What about preventative measures. Silence on any and all possible alternatives does seem to feed into what the so called quacks are saying. Dr Robert Morse of youtube fame says spontaneous remission is easily brought about.
Citations desperately needed for your baseless claims.
Hahahaha good one, thanks for the laugh.
"Dr Robert Morse of youtube fame says spontaneous remission is easily brought about."
Thanks for the reference to this healer, Dave. I've bookmarked the site for easy *reference*, as an alternative for cancer treatment....or weight loss.
http://healthy-happy-life.blogspot.com/2011/06/dr-robert-morse-on-fasti…
I'm so *impressed* with all those letters after *Dr.* Morse's name...he certainly is a heavy hitter.
The same lunatic quack naturopath iridologist Robert Morse said this:
WHO BELIEVES THIS CRAP?!!
Thank you for this article. It'll be a good reference to counteract those employing the "chemo is useless" ploy.
It is both wrong and repulsive when cranks argue that oncologists are eager to prescribe harsh chemotherapy regimens when there is no realistic benefit to be had. I would like to drag Mike Adams by his scaly tail into a typical Tumor Board meeting at our hospital, where cancer cases are presented and treatment proposals aired. Time and again, our oncologists will say that they would advise the patient that chemo is not indicated for them, because of efficacy (i.e. in late stage disease) and/or quality of life issues. Often it's the patients who want to do anything possible to extend life who insist on trying chemotherapy, not greedy oncologists seeking to line their pockets with Pharma loot.*
*speaking of which, there has been concerned and even angry discussion at our meetings recently about the shortage of mainline generic chemo drugs, which some big pharmaceutical firms have stopped making once the patents ran out and it was no longer deemed sufficiently profitable to manufacture them. I guess our docs haven't realized that they're betraying their Pharma Masters with such talk.
Another comment on the survey(s) of oncologists and whether they'd opt for chemo... one has to bear in mind that how someone responds when given a hypothetical scenario of almost certain death is often quite a bit different from when they are actually staring death right in the face for real.
I don't have data to support this, but my intuition tells me that people would be more likely to say they want a peaceful death when faced with the hypothetical, and in a real life-and-death scenario they would be somewhat more likely to roll the dice on even the slightest chance of a few more months or even weeks with their loved ones. This effect is probably less pronounced in oncologists, but I imagine it still exists. So these numbers may skew towards refusal anyway -- at least that's my data-less hypothesis :)
(To be clear, I'm not trying to characterize "fight it out" as the superior choice or anything... These decisions are soooo personal, that except in extreme cases, e.g. refusing treatment when chances of recovery are very good, I would not deign to question someone's decision at all, and clearly palliative care is often the "right" choice for many many people. Perhaps it is even the case that some who thought they would have chosen palliative care, but then faced with their imminent demise chose to fight as hard as they could, perhaps they "should" have chosen palliative care anyway, i.e. they would have been happier. I'm just saying that the imminent fear of death has a tendency to change people's decision-making -- for better or worse -- and that's all.)
In 1999 I was diagnosed with testicular cancer. Following removal of my left testicle, I was treated with 9 weeks of chemotherapy to shrink a tumor in my back. I continued to see the doctor for a couple years without any sign of it returning.
In January 2011, I was diagnosed with Merkel Cell Carcinoma. 30+ lymph nodes were removed from the left side of my neck and biopsies revealed that 3 were malignant. I had 18 chemo treatment ending July 21, and I have now completed 4 weeks of a scheduled 5 and a half week regimen of radiation. Only time will tell about the efficacy of chemo for Merkel Cell. But I'm convinced that it worked for my semanoma.
Because I read and listen to various anti-chemo screeds, I wonder how this type of propaganda affects the choices of real people with cancer who have to make decisions? And how this mis-information poisons their emotional life if they choose to follow the prescribed treatments.
Imagine if you will a person who is diagnosed and told that chemotherapy is important either as the primary therapy or as an adjuvant.How does the ramped up fear and conspiracy mongering ( inciting distrust of doctors), courtesy of Mssrs Adams et al, affect choice and dealing with the effects of the treatment? The entire scenario is frightening to begin with- being ill, uncertainty, needing treatment that may be painful- and the added nonsense spewed by idiots adds to the suffering, like bitter frosting on an already inedible cake.
Another reason for us to deconstruct and dis-ambiguate woo.
I was diagnosed with diffuse large B-cell lymphoma in June. I'm in the middle of my chemotherapy regimen, and scans indicate that I'm already very close to complete remission. Adams, Moritz, Spector and their ilk can go f**k themselves.
I'm so angry, I can't come up with any more coherent responses than that.
In a way, that's technically true, since for any single case there's no way to conclusively prove that chemotherapy was the cause of the cancer going away. You need to apply statistics to lots of cases to see if chemotherapy works.
Well, since each and every patient who has received chemotherapy eventually dies (of something, even if it is old age), a very simplistic and rigid person could draw the (mistaken) conclusion that chemotherapy has never "cured" anyone. This sort of statement says more about the speaker than the topic.
This demonstrates - once again - that going to Mike Adams or Joe Mercola for medical information is like asking your cat for investment advice.
Buy catnip futures.
Prometheus
My cat warned me about the financial crisis of 2008. I should've listened to him instead of getting him neutered.
@ Prometheus:
Right now, my cat already gives better health advice than any of the usual suspects- i.e. none.
Keeps mum on stocks, too.
@George
While I am overjoyed that your treatment appears to have been successful, I would caution you against using your own experience as evidence that something 'worked'. Just as anecdotes about chemo NOT working for someone with your disease profile wouldn't prove that chemo DOESN'T work, so too for the reverse case.
I wish you many long, happy, and cancer-free years.
By the same (lack of) statistical clarity employed by wooists to knock chemotherapy, one could say that homeopathy and vitamins kill at the same rate as chemotherapy. 100% of all users die. At least SBM makes the effort to look at the effectiveness of treatments. Adams, Null & Co would be out of business in a month if the crap they peddle were analyzed scientifically for efficacy.
Keep in mind that the govt's definition of "alternative medicine" definition includes the building blocks of life, namely nutrition, which "conventional" doctors don't even study.
The SBM crowd likes to make fun of homeopathy, but everything from nutrition to physical therapy is technically alt-med. If it's not a drug, they seem to think it's not medicine.
Come to think of it, that may be the problem with our health care system, we have come to define the practice of medicine as the prescribing of medication alone. In that case, it would make sense for doctors to go into joint practice with pharmacists, who know more about the actual medicines than the medicos.
However, it's nice to see somebody who, in taking apart some woo-woo arguments against chemo, actually admit chemo's limitations. How often do patients get this kind of information?
And considering how little of "standard" medical practice is actually tested by the gold standard of double-blind, placebo-controlled trials, I wonder SBM can even find a leg to stand on much of the time.
Just read the science articles of this newspaper for a year - time after time approved medical therapies are disproved and - if patients are lucky - disapproved.
Here's a great expostulation of the root cause: http://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-an…
Fascinating screenshot. Saved and bookmarked - in the event that I'm ever unlucky enough to be diagnosed with cancer, I'll mention it, because that's precisely the sort of question I could see myself asking.
No touchy-feely stuff, just "What are my options, and for each of those options, what's your best guess as to the probability of overall survival on 1- 2-, 5-, and 10-year timeframes, and is there any data that supports that guess? Even if the green bar is big, I promise not to sue you if my individual toss of the dart happens to land in the red part. Show me the numbers, and then we'll talk about whether the side effects are worth it."
(I'm not sure if that means I'll be a good patient or an annoying patient... probably depends on the doctor. To borrow a car analogy, some mechanics provide a cup of coffee and a free wash/wax, and some mechanics let you watch over their shoulder while they're wrist-deep in parts. Both types of shops do equally-sound mechanical work while keeping their customers happy.)
Sounds like Mike was just channeling Joey Goebbels
Bullshit.
For good reason.
Bullshit.
Bullshit
In appropriate circumstances, this is already happening.
AFIK, this is routine.
More bullshit. A lot of interventions can't be tested that way - surgery, for instance?
Yes, science progresses, while alt-med stays stuck in the remote past - as if that's a good thing.
@kilroy71
http://scienceblogs.com/insolence/2011/06/lies_damned_lies_andscience-b…
Hey, did anybody get an alt-med BINGO from Kilroy71's post? The squares didn't quite line up on my card, but boy did a lot of 'em get filled.
-- Steve
kilroy (#12) claims:
This is a musty old canard, a favorite of the "alt-med" apologists and is, of course, completely wrong.
"Nutrition" is taught in every medical school in the US, UK and EU. It may not always be labeled "nutrition", but it is taught in courses titled "biochemistry", "physiology", and the like.
What "kilroy", and others of his ilk, really mean is that medical schools - until very recently - haven't taught the eccentric, unsupported and often bizarre nutritional claims made by the "alt-med" crowd. You know, the ones about how eating the "right" foods will keep you from aging and how "nutrition" (usually some proprietary supplement) can "cure" cancer, heart disease, cataracts and enlarged prostates.
Unfortunately, the marketing directors of many medical schools have convinced the faculty to offer courses in phony "nutrition" and other "alt-med" practices, so kilroy's argument has a short shelf life. What will they claim next - that "conventional" doctors don't learn about "vital energy fields" in their physics classes?
Prometheus
>"Keep in mind that the govt's definition of "alternative medicine" definition includes the building blocks of life, namely nutrition, which "conventional" doctors don't even study.
The SBM crowd likes to make fun of homeopathy, but everything from nutrition to physical therapy is technically alt-med. If it's not a drug, they seem to think it's not medicine." -kilroy71
Wow! Funny then how my "conventional" doctor does talk to me about nutrition.
And did send me to physical therapy after I mentioned I had neck and back pain after an accident.
Of course, she didn't try to sell me "magic water" or "special diets" as a cure either.
> "And considering how little of "standard" medical practice is actually tested by the gold standard of double-blind, placebo-controlled trials, I wonder SBM can even find a leg to stand on much of the time." -kilroy71
Considering how Alt-med doesn't even use those trials because every time someone does, it proves the Alt-med to be just fraud, one wonders how Alt-med can even find a leg to stand on any of the time.
Kilroy's argument seems a bit like the following: Imagine a car manufacturer trying to sell people on the safety features of a new vehicle. When asked for tests showing the effectiveness of the features, the equivalent response was to a) call into question the idea of testing things, and b) insist that other manufacturers never put brakes on their vehicles.
Not only are some chemotherapies effective against some cancers, but the only case of a person being cured of HIV/AIDS was the result of chemotherapy.
Timothy Brown, an American living in Berlin, was diagnosed with HIV in 1995. In 2006, he was diagnosed with acute myeloid leukemia (AML), unrelated to his HIV. In 2007 and 2008 Brown underwent three grueling rounds of chemotherapy, two with raditation,followed by stem cell transplants from a compatible donor with a rare inherited mutation, called delta32, which prevents some strains of HIV from attaching to CD4 T-cells and thus confers immunity to those strains of the virus.
Both the chemotherapy and the transplants were intended to treat Tim Brown's AML, which is now in remission, but they also have cured him of HIV, by completely wiping out his immune system and T-cells that the virus attaches to, hides in, and replicates through. Since then, the most sensitive diagnostic tests available have not been able to detect in him any sign of HIV infection. He is considered to be the firstâand onlyâperson cured of HIV.
Unfortunately, this cure will not be an option for most people with HIV. Stem cell transplants, and the chemotherapy and radiation that precede them, are expensive and risky procedures with long-lasting negative effects. Given how effective and tolerable antiretrociral treatments for HIV are now for most people, stem cell transplants just aren't a practical approach. More crucially, delta32 mutations are very rare, occurring only in people of northern European descent, and only 1% of those. Very few people living with HIV would be able to find a delta32 donor who is compatible in terms of ABO blood type, human leukocyte antigen system (HLA), and other features.
I watched a good friend die by refusing "standard" cancer treatments, like chemotherapy and surgery, in favor of herbs and drinking colloidal silver, some 10 years ago. Her death was relatively swift, but fairly horrible. How can these people live with themselves?
@#21:
"On a huge pile of money with many beautiful ladies."
--Ranier Wolfcastle
In all fairness, not that I'm sure why I bother, chemotherapy cures few or no solid tumors. Lance Armstrong needed chemotherapy to survive, but he also needed surgery. For whatever reason, if you don't remove the primary, there's little chance of cure in testicular cancer. Only hematologic malignancies can truly be cured by chemotherapy alone. Within hematologic malignancies, though, cures are possible for ALL (95+% in childhood ALL), APL, (some) other types of AML, Hodgkin's, some non-Hodgkin's, and hairy cell leukemia. Treatment for CML is not curative, but it makes CML a truly chronic disease, like diabetes or hypertension. In fact, I'd rather have CML than diabetes, if I had to choose one: it's less likely to kill me through complications.
As for side effects, yeah, they can be nasty. But they aren't usually. The most common statement I've heard when seeing a patient after their first chemotherapy is some variant of "how underwhelming". They had it built up to a horrible thing in their minds and then...nothing. Maybe a little nausea. Maybe not. In any case, not the horrifying endless emesis of the pre-5HT days. No torture, nothing worth dying to avoid, just a boring and possibly mildly uncomfortable day.
The SBM crowd likes to make fun of homeopathy, but everything from nutrition to physical therapy is technically alt-med.
Umm...no. That is, yes, we like to make fun of homeopathy, at least until it gets dull and we want more challenging targets. But nutrition and physical therapy are very much parts of standard medicine. To give a few examples: the majority of hospitals have dieticians who round on patients and make recommendations for optimizing their nutritional status (both as inpatients and after discharge.) Nutrition and proper eating are the critical to the treatment of diabetes. And physical therapy (along with occupational and speech therapy) is a basic requirement in settings ranging from the ICU to outpatient. In short, I don't know where you even get the idea that nutrition and PT aren't part of standard medical care.
If it's not a drug, they seem to think it's not medicine.
Surgeons everywhere, including orac, will be stunned to hear this.
If it's not a drug, they seem to think it's not medicine.
Surgeons everywhere, including orac, will be stunned to hear this.
Radiotherapists likewise.
My mom has APML (acute promyelocytic leukemia).
The mortality rate in 1957, when it was first characterized, was 100%, generally within just two weeks of when symptoms were first observed in a patient. It's the most aggressive form of leukemia known.
In 1973, Bernard et al. demonstrated that APL leukemic cells
were relatively sensitive to chemotherapy (daunorubicin) that yielded a complete remission (CR) rate of 19 (55%) in 34 patients with APL.
Today, in 2011, with the addition of ATRA and ATO to daunorubicin, the 5 years survival rate is close to 95%.
Either there's something pretty crazy in the air that has magically increased a survival rate from 0% to 95% over the last 55 years or so, or chemo works.
It is true that "There is not a single cancer patient that has ever been cured by chemotherapy", and not in some hand-waving epidemiological sense, either. A cure in infectious disease leads to an undetectable level of the pathogen, and the absence of recurrence. A "cured" cancer patient, no matter how the cure is come by, will still have many foci of cancer cells within their body, many completely unrelated to the original cancer. And if they live long enough, eventually these foci will become malignant - it's evolution in action. A "cure" for cancer is basically a Whac-A-Mole game: how long can you continue to smack down each new neoplasm?
A "cured" cancer patient, no matter how the cure is come by, will still have many foci of cancer cells within their body, many completely unrelated to the original cancer. And if they live long enough, eventually these foci will become malignant - it's evolution in action.
Um, where are you getting this statement? There are plenty of people out there who have cancer, get treated, live 20 or 30 (or more) years, and die of something non-malignant many years later. It's true that curing one cancer doesn't prevent you from ever getting another cancer, but saying that (for example) your lymphoma isn't really cured because 10 years later you got a breast cancer is like saying that the strep throat you had as a kid wasn't really cured because you got a pneumonia when you were 70.
I have known more than 10 people who all died from cancer and all of them took chemo. That is a 100% failure rate. So, I have to say that NO it does not work.
Chemo ony targets cancer cells. It does not solve the problem as to how the cancer formed in the first place. So, if you do not get rid of the cause, then you will not solve the problem.
Giving a cancer patient chemo is like watching a building on fire and you only put out most of the fire and leave the rest alone. Eventually it will flare back up again.
To kill cancer, you have to start at the source - the immune system. Find out what started it and you will find out what stops it.
(not a) Doctor Smart:
The plural of anecdote is not data. And since you are an electronics technician, you have no idea on how the immune system works. It is a bit more complicated than a radio communications system.
"I have known more than 10 people who all died from cancer and all of them took chemo. That is a 100% failure rate. So, I have to say that NO it does not work."
Fortunately, scientists and oncologists do not consult with radio technicians when researching chemotherapeutic medicines or planning treatment for a cancer patient.
Smarty, why don't you "write up" your research and submit your study to a medical journal...instead of "bestowing" your knowledge here?
Well, I've always heard that people function as "naive scientists" or "naive psychologists" but this is the first time I've ever encountered a "naive statistician".
Hello, my brother's stalker. Nice to see you again. I'll tell my brother you have arrived. He loves to pick on you.
Use common sense. It works better than your mud to man theory of the universe. Common sense prevails all else. If ony our goverment knew that little fun fact.
Tell me, "Smart", if you needed to repair a radio, would you test to make sure that your repairs worked?
Except you and Medicien Man, along with "Televisionless Consersvative", all occupy the same body.
You, and all of the voices in your head, are idiots.
Oh great...just when we thought that the radio tech couldn't be "topped"...we can await the yahoo's learned brother. I'm just in the mood now to hear what the voodoo medicine man has to say.
lilady, there is no brother. They are all sock puppets of the same guy, an electronics technician working for a HAM radio equipment manufacturer in the Southern US. If he continues to be an idiot, I'll just post his webpage, the one that he has been known to link to in his one of his many 'nyms.
Stop being an idiot, Mr. JRH.
@ Chris: I know they are sock puppets...all of them.
Sorry for doubting you. We need a sarcasm tag.
My brother's stalker, Chris, is delusional. I have NEVER worked on a radio in all of my life. I work with electronics, but have never worked on a radio before.
I do, as a hobby, like to read about and learn about the medicinal uses of herbs and spices. While liberals use "medical" pot they tend to believe that pot is the only plant that has a "medical" use. Did you know that OAK tree leaves can be used in a poltice to stop bleeding and heal wounds? This was an old native american use, but our very own U.S. Special Forces Survival Handbook has a chapter on wilderness survival and injury/wound treatment in the wild. One such instance has this exact same native remedy. This special forces survival manual (I have several variations) lists numerous plants worth eating and making medicinal uses of. There is a slave right now that is used in the Armed forces for use on gunshot wounds and deep lacerations. It is called Oakin. You can buy a downgraded version of it in most any vitamin store or pharmacy worth its name. It uses OAK TREE leaves as part of its healing mechanism.
So, Chris, before you go off another tangent remember that some people do actually read more than phony peer reviewed nonsense.
I have done my homework. I have printed thousands of pages and have numerous books on medicinal uses of herbs and spices. Many of these uses are actually used in the U.S. Armed forces survival manuals. So, I guess now the Army is full of woo too?
If you are wondering what I would be doing with a United States Army Special Forces Wilderness Survival manual, the I guess you would get goosebumps (if you believe they exist) to learn I also have Special forces Escape and Evasion manuals and Special Forces Booby trap/homeade wilderness weapons manual as well as navigation/map reading manuals and other such interesting topics. It never hurts to be prepared for the future.
These manuals can be purchased through any gun vendor or gun show or such for less than $5 each. Some are better than others. The British SAS survival manual is okay for building shelters and staying alive under adverse weather condition in enemy territory, but the Special Forces guide to homeade weapons and killer traps is the best. Same stuff that Rambo used, only far less Hollywood and far more deadly. Most special forces training manuals cover medicinal plants for wilderness survival.
So, chris, you see, Pot is not the only "medicine" plant that is useful.
As far as cancer goes, the spice Tumeric has been shown in some cases to be otent cancer fighter, but also disturbes the metabloism of oxalate and can cause kidney stones is used for long periods of time. Vitamin C injections directly into the tumor has shown in a number of cases to cause tumor shrinkage. Vitamin D and Selenium both have been shown to decrease the risk of getting certain cancers in the first place.
Chris, do you know what White Willow bark is or what it does? Some dumb peer reviewed crap will not help you survive in the world. White Willow Bark is where Aspirin is derived from. It is a natural pain killer and blood thinner.
See, I know more than you think. You just think I sit around and figit with radios all day. I do not. You never told me what you do except stalking my brother and accusing me of working on radios. Maybe I could poke fun at your profession/delusion for a change.
@ Chris: What about "sylph"...sock puppet or drive-by poster?
I suspect that "sylph" did a paste up job and is clueless about the comparisons between successful curative treatments of cancer and another totally unrelated cancer...focusing on "foci" that will eventually become malignant and kill you. Of course Dianne did a commendable dissection of "sylph's" silly post.
@ Chris:
is pretty popular over at Pharyngula.
@ "Doctor Smart":
So tell us, in your expert opinion: what causes cancer to form? I was under the impression that it was primarily genetic mutations, which would require...what? Fixing the DNA in all of your cells?
Maybe the issue isn't that doctors haven't considered the problem of fixing the root cause(s); maybe the issue is that it's way more complicated than you seem to grasp.
Whoops, that's what I get for not previewing the comment first. The first sentence should read:
"< / snark> is pretty popular over at Pharyngula."
[Spaces added to prevent the faux tag from being eaten by the blog software again.]
...Dammit. Take three.
"[/snark] is pretty popular..."
Reading these "arguments", I was reminded of an engineering joke: "First they say it can't be done. Then you do it, and they complain it can't peel pineapples."
David N. Brown
Mesa, Arizona
Lycanthrope:
Huh? This is confusing, and is without merit without some kind of evidence. Like a link to the thread in question. By the way my surname starts with an "H" not an "M."
Doctor Smart/Medicien Man/I.M. Smart/Televisionless Conservative/JRH has been banned from other blogs. I doubt Mr. JRH would have lasted any time at Pharyngula due to insipid stupidity.
Chris:
My remark to you was regarding a "sarcasm tag" I've seen used at Pharyngula: [/snark]. I don't have a link to an example, sorry. But it wasn't about the popularity of you, me, or Doctor Smart at that blog, if that's what you thought I meant.
The first two times I tried to write that comment, I used the < and > marks, and for some reason the blog software edited the mock tag out, and I hadn't bothered to preview my comment to see if this would happen. So I ended up posting a sentence with no beginning, twice.
I have no idea what the bit about the spelling of your name is regarding; I made no reference to your surname, and I definitely spelled your given name correctly.
I hope that clears up the confusion.
@Dr Smart:
Giving a cancer patient chemo is like watching a building on fire and you only put out most of the fire and leave the rest alone. Eventually it will flare back up again.
If you know a way of directing the immune system so it will stop the fire coming back after chemo or radiotherapy or surgery have quelled the immediately life-threatening flames, then all you have to do is prove that it works in controlled trials, and a Nobel prize is yours!
This is what happens when I try to write anything at 1:30 AM...
Apparently you can't use the pointy brackets at all. They just won't show up. At least not to me - I'm assuming this is the case for everyone. Or am I just a complete inept?
What I originally tried to write:
(pointy open bracket) /snark (pointy close bracket)
What this produced:
(nothing)
What I eventually switched to:
[/snark]
What I tried to write in the first sentence of the second paragraph of my previous comment:
"...I used the marks (pointy open bracket) and (pointy close bracket)..."
Cripes. I apologize for all the helpless words I so cruelly minced here tonight. I wash my hands of the whole affair, and leave my comments as a testament to my facepalm-worthy stupidity and a warning to others to stay away from the pointy brackets.
@ Lycanthrope: Now, you are infringing on my territory ("Apparently you can't use the pointy brackets at all. They just won't show up. At least not to me - I'm assuming this is the case for everyone. Or am I just a complete inept?") How dare you!
Everyone knows I am the most "complete inept" on this site and I will fight anyone who disputes that I am also the undisputed queen of run-on sentences.
I learned "typing" (not keyboarding) (far) too many years ago in Junior High, on a manual typewriter...hence my heavy banging of the keys. It was a strict QWERTY keyboard with none of the computer keys. Further along during my stellar career in public health I used word processing on the ancient WANG computer, then used WordPerfect on the large desktop computer. I wouldn't even attempt brackets and Chris often has to do the "links" for the articles I cite.
I find it amusing that you even attempted the pointy brackets...it takes some of the heat off my "real" totally inept skills and lack of punctuation...I keep forget that the (.) is my friend...much to the bemusement of other posters here.
The > and < symbols surround real formatting tags in the comments, like italics. I would like to think the software strips anything that looks like a tag but isn't one it thinks is safe for our protection.
Mephistopheles O'Brien,
Only those in league with the Devil can get pointy brackets to appear in a comment like that ;-)
Thanks for this article. Chemotherapy and radiation therapy gave my cousin 8 more months to live before she died from an incurable brain tumor at age 14. This time wasn'tworthless to her or her family.
@Denice
Lance Armstrong did have surgery, but his testicular cancer recurred. The point is that there are a few solid tumors for which chemotherapy can actually treat stage IV disease successfully. Perhaps a better point to make would be that rarely does cancer treatment these days consist of a single modality. It's almost always multimodality and multidisciplinary. Expecting chemotherapy alone to cure any malignancy makes less sense than expecting surgery alone to cure any malignancy (surgery can, actually, but, depending on the tumor, combining it with chemotherapy and radiation greatly increases the chances of cure).
Something else that ticks me off in these discussions (though I'm sure this won't be a new observation to any of the regulars): the way alties always decry "reductionist Western medicine" for oversimplifying everything and not personalizing treatment. Bullshit. Seems to me that it's usually the CAM peddlers who claim "Cancer is always caused by this!" and "My woo can heal everyone!"
Until I started reading this blog, I never realized just how mind-bogglingly complicated cancer research really is. Sure, I knew that different cancers were treated differently, depending on type, stage, the patient's history, etc., but I couldn't see just how deep the rabbit hole goes, as it were. I knew that treatment protocols had come a long way, but I would still wonder idly, "But why don't we have a cure?" Now I get it.
So don't you dare tell me how those "evil allopaths" just don't get it, and how they only treat the symptoms. Those "evil allopaths", who I call "legitimate doctors", are the ones who are actually doing something about anything, while the alties have the luxury of sitting back and claiming they have all the answers, while never being held properly accountable as far as backing up their claims goes. Must be nice.
(End of rant, whew. Like I said, probably nothing here that hasn't been complained about a thousand times already, but I had to get that off my chest somehow.)
@ lilady:
Fear not - I shall defer to you, Your Maladroitness. :) And hey, I tend to whack the keys pretty hard myself, a practice I no doubt picked up from my dad, who probably learned on typewriters himself.
@ Turtle:
My condolences.
This. That's part of why chemotherapy is so important; every case is different, but there are bound to be lots of cases like your cousin's, where even if a cure is off the table, extending remaining lifespan even by a matter of months is a precious and worthwhile thing.
@ Orac:
I know.I don't think you got my gist- I should have said " anti -SBM screeds"- altho' chemo is their numero uno.
-btw- my cousin is in the same boat as Lance, since 1993! Also 2 friends in the multi-boat.
Just read the comments, and something I felt like adding about an earlier troll's comment:
Who cares what the government (through lobbyists) defines as "alternative"? We're a segment of the population that rejects such false dichotomies. There's no such thing as "alternative" medicine. The term is a marketing gimmick, based on cultural indoctrination, not on actual characteristics.
If you know a way of directing the immune system so it will stop the fire coming back after chemo or radiotherapy or surgery have quelled the immediately life-threatening flames, then all you have to do is prove that it works in controlled trials, and a Nobel prize is yours!
It's not as bad as that...Part of the way hematologic stem cell transplant works is "graft versus tumor", that is, the transplanted immune system can sometimes mop up residual tumor cells. And there's a new agent out for prostate cancer which is an immune system inducing agent. Not to mention the now old standby rituximab and other passive immunologic therapies. And the new retroviral therapy for CLL at Penn--though we don't know how well that will work yet. Mainstream medicine is definitely onto ways to tweak the immune system into recognizing and destroying tumors.
The problem is that virtually every immune therapy in existence works best when the tumor burden is quite small. No one's ever gotten a cure using immunotherapy alone when the tumor is large or arguably even grossly apparent. And some tumors are easier for the immune system to mop up than others. Finally, stimulating the immune system is not, as implied by the original poster, simple or risk free. People die of immune over reactions and morbidity with immunotherapy can be substantial. So I doubt that even when/if we ever optimize immunotherapy we'll be able to completely do away with surgery, radiotherapy, and "conventional" chemotherapy. (Or even targeted agents.)
Expecting chemotherapy alone to cure any malignancy makes less sense than expecting surgery alone to cure any malignancy (surgery can, actually, but, depending on the tumor, combining it with chemotherapy and radiation greatly increases the chances of cure).
I would quibble with this a little: if we believe cancer (at least some cancers, for example breast) is a systemic disease by the time it's detectible, then one could argue that in principle of all the available modalities only chemotherapy has the potential to cure as a single agent since the others are local treatments. I find it interesting that this isn't true, even when it appears that it should be. For example, a breast cancer where neoadjuvant chemotherapy was given and a CR obtained still requires mastectomy or at least local resection. Why is that? Cancer stem cells perhaps? Chemoradiation can be curative in some cases (i.e. head and neck cancers even when stage IVa/b) but again not chemotherapy alone. What does radiation do that chemo can't? It's an interesting problem-IMHO anyway.
To bring it back on topic, I think this illustrates the difference between SBM and "alternative medicine". In CAM failures like this would result in either patient blame (they didn't follow the diet well enough, didn't think positively enough, etc) or simply ignoring the failures and clinging to the rare anecdotal successes. In SBM, failures-and partial successes-are met with questions like, "Why did tamoxifen work in patient A but not patient B?" (Leading to the discovery of hormone receptors.) "Why did the cancer recur even though the surgery appeared to have got it all?" (Leading to the development of adjuvant therapy.) "Do we really need margins THAT wide?" (Leading to lumpectomy and modified radical mastectomy.) CAM never adapts and improves its therapies. SBM does.
Actually, we don't know that for sure. We continue to advocate local therapy because (1) we don't have solid evidence that it is safe not to perform surgery and (2) the pathologic examination of tissue is only a relatively small sampling of the tissue, particularly in the case of a mastectomy. Just because there is a pathological complete response does not necessarily mean that there aren't tumor deposits that were simply missed. To cover the entire specimen satisfactorily to be very sure that there are no remaining tumor deposits would not be practical, as it would take hundreds of sections and many hours of a pathologist's time just to do one patient.
As for margins, don't get me started on that. The question of what constitutes an "adequate" surgical margin is perhaps one of the least strongly science-based aspects of the surgical resection of cancer, with adherents every bit as dogmatic for various answers to the question as any clergy.
Every time I read some of these CAM websites, I wonder how many people get taken in by the nonsense. And, it is not just cancer that these "experts" discuss...although that has to be the most egregious of their assaults on medicine.
I have a friend who twenty odd years ago was diagnosed with a very aggressive type of breast cancer due to mutations in one of the BRCA genes. This woman had two young children and was 38 years old. She had several lumpectomies and underwent radiation and chemotherapy and had an elective oophorectomy Her sister also had breast cancer and then ovarian cancer and did not survive. About four years ago, cancer was found in the other breast...a totally different non-aggressive type; owing to her past history she underwent the same regimen again. She has just had elective mastectomy and reconstruction on both breasts, which for her were 12 hour procedures as the only donor sites for reconstruction are transplanted adipose tissue from her back. She views her surgeons and her oncologists who provided these life-saving procedures and treatments as heroes.
Another friend is undergoing treatment for multiple myeloma for which there is no cure, but the regimen of chemotherapy and occasional blood transfusions enabled her to see her son get married, enjoy the birth of her only two grandchildren and to go on a trip to Alaska with me, my hubby and two other friends in July.
Chemotherapeutic treatments have enabled my one friend to live out her live and to extend the life of my other friend.
As for margins, don't get me started on that. The question of what constitutes an "adequate" surgical margin is perhaps one of the least strongly science-based aspects of the surgical resection of cancer, with adherents every bit as dogmatic for various answers to the question as any clergy.
Ah, come on, get started. It'd make an interesting post. I'm not a surgeon, so I mostly just know the mastectomy versus lumpectomy/radiation trial and am not at all up on the data/controversy in general. But if there is little strong evidence for a given margin, isn't that a good opportunity to run a clinical trial? Maybe we're taking too much tissue. Or not enough. Either way, surely more information would be better.
I've heard the argument made that neo-adjuvant therapy might actually result in worse outcomes in breast cancer than surgery and adjuvant. I'm not sure how good the data is-I've drifted into hematology and haven't kept up with solid tumors the way I should. OTOH, a friend of mine got some very promising looking outcomes with pre-op chemoradiotherapy so maybe breast will join head and neck in being a non-surgical disease soon. Needs some randomized trials though.
Limited sampling is a problem in defining true CR. Maybe we need to use more PCR: extract the RNA and look for definitive mutations, if known, or tissue that shouldn't be there (i.e. cytokeretin bearing tissue in lymph nodes.) That would be less pathologist time intensive, though more prone to false positives.
Ok, why did my last comment go into moderation? Drat. I can't remember if I mentioned T@xol by name or not...
A guard against poll crashing. Wow. Talk about stupid. The whole point of poll crashing is that it demonstrates the worthlessness of your typical online poll. They're unscientific, especially since the people who take the poll are often people from within a specific target audience of the host. When PZ sends people like us to crash the poll, he's undoing that, as well as showing that results can change wildly depending on who is made aware of it.
Oh, and every troll claims that every banner can't handle their truth, even if they were demonstrably violating rules of conduct. I spent a year dealing with a racist troll who said I couldn't handle the truth while constantly throwing up straw men. He apparently couldn't handle the fact that I had an opinion he didn't provide for me.
If you are wondering what I would be doing with a United States Army Special Forces Wilderness Survival manual....
Why would anybody wonder about that? It's common as dirt among 14-year-olds who've discovered the Loompanics catalog and blowhard Internet tough guys.
Lycanthrope:
It does a little bit, it is a bit befuddling. I figured if you were being sarcastic you thought that my last name was "Mooney."
I don't comment often at Pharyngula, and in both places it is just "Chris." Though the *&^%#! registry software that I stumbled with at freethoughtblog would not let me use any uppercase letters.
Chris:
Ah, I get it now! Nope, although I do enjoy the sarcasm, I was just making a statement that time. Simple misunderstanding, all because of some disappearing pointy brackets.
Curse those disappearing pointy brackets!
Continued insipid stupidity from Mr. JRH, who was banned from several blogs while pretending to know medicine (sock puppet names include: Doctor Smart, I.M. Smart, Medicine Man, Medicien Man, and my personal favorite, Televisionless Conservative). This is how he actually describes himself on his own website:
Which explains why he does not understand what websites selling herbal preparations are not scientific evidence, that internet polls are worthless, and why he should not be taken seriously. To be charitable I would not say he is entirely stupid, but he is undereducated and does not realize that fact. He is a classic case of Dunning-Kruger syndrome.
To be charitable I would not say he is entirely stupid, but he is undereducated and does not realize that fact.
He apparently also doesn't realize that "ham" isn't an acronym. And, really, after seven years he still hasn't gotten to General class?
Who are we to say, that the sock puppets' religious affiliation, education and work experience don't leave him/them well-qualified to discuss medicine? Not residing in Northern Mississippi, I simply don't know if he/they is/are regarded as the town intellectual(s) and the "go-to guy(s)" for advice about medicine. If I ever actually purchase a "ham radio" and find myself residing in Northern Mississippi (shudders), the radio technician with the AAS degree, would be my "go-to guy".
(no attempt at pointy brackets)...but you get my opinion on the trolls' medical opinions.
ok. You officially lost me. What is all of the sudden ham radio mississippi AAS degree talk all about? Are you people trying to refer to me?
Better question. What kind of mushrooms and you been slurping?
And people call me crazy.
North Mississippi? I am in wisconsin. Speaking of medicine, you people must be using some of your "medical" pot while you write.
lilady, please do not characterize an entire state on the actions of one person. Actually the University of Mississippi did ask Blaylock to stop using them as an endorsement (especially since he got the name of their medical school wrong). It is also one of the two states that does not allow philosophical exemption to vaccination.
I apologize to everyone who lives in Northern Mississippi. I based my opinion on just one inhabitant of the area. I forgot that Mississippi and West Virginia are the only two states that only permit exemptions for medical reasons, documented by a licensed physician.
I still think Smarty is crazy (and scary too) for his "theories" about disease, "natural" cures of disease and for his bunker mentality reading material.
Okay, he may have moved to Wisconsin, but he is still an electronics technician. He still knows nothing about medicine and cancer.
Okay, he may have moved to Wisconsin, but he is still an electronics technician.
This would call into question the identification as KE5BMP, unless somebody failed to tell the FCC.
Narad, there is a possibility that the silly person who claims to be "Doctor Smart" is not Mr. JRH. Perhaps he agrees with that particular electronics technician because he is also an electronics technician.
Or he pretends to live in Wisconsin because he realized how foolish it was to post his own webite.
Yes, Dr. Smart is a tech...he must have been taking too many of his "curative substances" because he cannot remember his prior posting(s).
Further up on the link Chris provided was this scatological rant:
40
Well, if it isn't my personal little turd stalker Chris. What took you so long to come on to me this time?
What is a fart, but the lonely cry of an imprisoned turd?
I fail at everything and am very proud of it. Thank you very much.
I may be bad at trolling, but I am excellent at turd farming. Wanna play?
I bet chris is one of those annoying turd burgler people.
turd burgler
buy turd burgler mugs, tshirts and magnets
When you are taking a crap in a public restroom and someone tries to come into your stall, even though its locked they try forcing their way in because they dont know you are there
Chris my url will explain your curious obsession with my turds.
Posted by: Doctor Smart | August 11, 2010 11:07 PM
Five minutes ago when I viewed this posted and clicked on his url, I found 3,000 pictures of actual turds in toilet bowls, cartoons about turds and girlie pictures taken in a public toilet...mysteriously gone now. What a disgusting vile troll.
Short and sweet,
I didn't read all the comments, but I'm an electronic tech, and dont' want to be stereotyped. So a quick analogy for you all.
"Abstaining from science, is equivalant to the Palin's abstaining from sex."
Except,guido, you don't try to pontificate on cancer, nor brag that you can provide a cure for any ailment:
Hopefully, you know better than to play pretend healer.
If the "technician" class is equivalent to my Canadian "basic" license, it is easy to get. When I wrote my exam, the other person taking the exam (successfully) looked to be about 10 - 12 years old.
VE6TDB - There is no intelligent life on 2 metres.
ERV has a post on a cancer treatment that uses highly modifed HIV-1 (AIDS) viruses.
http://scienceblogs.com/erv/2011/09/what_do_you_get_when_you_cross.php#…
@ Militant Agnostic:
I Think Orac mentioned this procedure that took place at the University of Pennsylvania Medical Center. I also recall hearing about the modification of the HIV virus for treatment of CLL (on a TV show?) a few months ago.
There are several other sites on the internet that discuss this treatment at U-Penn and there were three patients who underwent the treatment. The study was reported in the NEJM this past spring and at that time, one year after treatment, 2 of the 3 patients were in complete remission...the 3rd patient had a 70 % reduction in leukemia cells. I tried to locate an abstract on PubMed, but couldn't locate it.
ERV has a post up about scientists and laypeople being separated by a common language. In that case, she was talking about vaccine response, but one wonders if something similar is not happening here as well. Ive known several people who have been told by their oncologists that you never cure cancer, that the oncologists consider your case a success if you live long enough to die of something else. Its been relayed enough to suggest it is something of a meme amoung oncologists. In a sense, it seems reasonable, there is always a chance of recurrence, so in that sense, even someone who has exhibited no symptoms for 10 years is not "cured", because there is still a chance of recurrence. On the other hand, to a layperson, "not being cured" suggests continuing symptoms and affliction, not just a constanly decreasing chance of recurrence.
On the other hand, this seems to be a decreasing trend (in my very unscientific view.) Ive known a couple of people recently who were declared "cured" by their doctors. In both cases, they were "cured" surgically. In both cases, there is still ongoing followup, and I could see a patient might question why do they need an annual cat-scan if they are cured? Such questioning could have been the original reason for the earlier meme.
There are folks like myself who don't argue with the efficacy of some chmeo regimens. But what the cancer people do is that they, it appears, based upon my personal observations, tell patients that THEY cannot cure, that their disease is incurable. They never mention the therapies of Drs. Revici, Burzynski or Gerson.
I have seen chemo cure tumors of family and friends. I have also seen people suffer and never look into any alternatives because they are called quackery. For any physician to not give all the alternatives to a patient is unethical.
To sum up, some chemo works, and some very well. But giving chemo to someone with a large, fast moving brain tumor is just cruel. However, just looking into the anti-neoplastin therapy of Dr. Burzynski would clearly show that it works for many people. And IT IS a chemo therapy, just not one that one of the major drug companies produce.
Yet he was sued, threatened and called a quack, and still, my friend who has metastatic bone, liver and pancreatic cancer has NOT been referred to him but is told that the only therapies available are the ones that Sloan Kettering uses.
Additionally, if someone say 25 years ago wanted to use arsenic therapy for leukemia, they would have been told it was quackery. You see, many people have to die being given placebos and many wealthy administrators and paper pushers have to be convinced before I or anyone I love can use any therapy that is somehow not approved by my insurance company.
THAT is the big complaint. ALL therapies should be discussed with someone who is ill, not just the ones administered by the caregiver.
Eric M. Sanders
Eric M. Sanders:
Possibly because they don't work. Mr. Sanders, go to the upper left hand side of this page. Plug in the name of anyone of the three listed into the search box.
Oh, very funny. Forty years ago someone proposed cyanide to cure cancer, except they called it laetrile. There was a clinical trial, but it was ended early because instead of getting better the subjects started to show signs of cyanide poisoning. Yet, even though it was a spectacular failure there are folks who sell it as a "cure for cancer."
I am not sure you understand the point.
Arsenic is used today, now, for the treatment of leukemia.
It is used by Sloan Kettering, today. Look it up on Google.
Go and find the book, "A Cancer Therapy, 50 Case Studies."
Dr. Gerson cured the wife of the President of Mexico. He was a few votes short of having his therapy approved and paid for for all Americans by our Congress in about 1954. It was stepped on by the AMA.
You cannot simply refer me to a link that calls someone a quack and expect that to stop my inquiry, Chris. I have been doing research for over 30 years, and yes laetril is garbage but that does not mean anything unapproved is garbage.
It's up to you what you do for yourself and family and friends. But to shut out something because some web site or trade organization says you should is not going to help anyone. Be fair, look up the two things I listed above.
I don't think you understand research. You are new here, so I am pointing out where those persons have been discussed. It is not merely calling them "quacks." I suggest you spend some time actually reading the articles.
And since you are a newbie, I shall tell you something that is often used here:
The plural of anecdotes is not data.
... and this includes the fifty case studies.
Ah, and another bit of advice: when we ask for data we mean real science. Not books, not websites and not your own personal stories. Just list the journal, date and title of the paper from the medical literature index, www.pubmed.gov.
Chemotherapy definitely isn't useless, but, well, it is poison. Orally taken Temodar comes in a bag labeled as a biohazard and it's been shown to cause leukemia when taken in high doses over long periods of time. It has a warning label that says caregivers should not handle it without gloves. They're also pumping me full of so much radiation it'd normally be a monstrous crime... except that I have brain cancer.
Sure the radiation is dangerous. Sure the Temodar leaves me weak. It really sucks putting up with either, never mind both concurrently, but it also sucks having brain cancer.
As for whether or not cancer can be cured, that's a matter of semantics. Sure, it's possible to cure it. It's impossible to KNOW that you've cured it. In order to cure cancer, you need to make sure every last cancer cell is dead, and there's currently no real way to do that.
So Mr. Sanders, you tell me that Dr. Gerson cured the wife of the President of Mexico? Prove it. If you can, I might have to head south for the winter.
@ ERIC M. SANDERS:
A book written by Gerson...which you use as your resource, which touts Gerson's "cancer cures"...does not constitute a peer reviewed journal's reporting of cancer treatments.
From Wikipedia "Max Gerson"
Gerson described his approach in the book A Cancer Therapy: Results of 50 Cases. However, when Gerson's claims were independently evaluated by the National Cancer Institute (NCI), it was found that Gerson's records lacked the basic information necessary to systematically evaluate his claims. The NCI concluded that Gerson's data showed no benefit from his treatment.[1] The therapy is considered scientifically unsupported and potentially hazardous.[2][3]
I suggest that you use your Google research skills and view the entire Wikipedia article and also look at footnotes (2) (3) for the National Cancer Institute and Sloan Kettering Cancer Institute review of Gerson's "cancer cures".
That's all fair. I did not take the time to read the entire thing.
I would only add that 50 cases should be enough at least for anecdotal evidence. I do not comprehend why anyone should have to die in order to prove any treatment's efficacy. We each have our own individual chemistry and genetic dark matter, as you know.
I am a court reporter, not a medical specialist. I have done many, many malpractice cases and my interface with medicine is in the judicial realm. I know how much crap doctors get and how much pressure they are under to perform miracles.
I just cannot comprehend how a system arose where people, like my mother-in-law had to die because they are given placebos in place of potentially life saving agents.
Additionally, just as medical folks seem to be flummoxed by the niceties of the legal system, from my experience, we in the legal system do not demand that all divorces be filed in court. People are free to work out things on their own.
Settlement is always encouraged.
But it seems that once a person enters a physician's office or hospital, even for a check up, they have to bare their ass in a special robe and waive their rights to question what their medical provider is doing. In other words, everything is mandatory. You get a tumor, we tell you your staging, no argument, we tell you the medicine, no argument and we give you the prognosis. You WILL comply and no argument.
That's just my perception but I know it is shared by many.
@Eric Sanders:
That's just my (strawman) but I know it is shared by (people who haven't examined real evidence).
FTFY.
Mr. Sanders:
Which is still not data! Especially if it is biased in a form of a book trying to get more people to go to Gerson's clinic in Mexico.
We only have your statement of events. Who said she was given placebos, something that is frowned upon in modern medicine? What lifesaving agents was she denied? Where is the scientific evidence they would work?
If you read more of this blog, you will learn there is a vast difference between legal evidence and scientific evidence. Especially in regard to the Autism Omnibus cases (use search box on this page).
Go to your local library and find the book Emperor of All Maladies. This will explain how incredibly complex the vast numbers of diseases that are labeled "cancer." Here is a hint in this cartoon.
Eric: if that's your perception, maybe you need better doctors, or a friend or relative to go with you and help you ask questions and take notes. (People who have been shocked by bad news tend not to remember well, even if the doctor carefully describes the situation and says "we can do A, B, C, or nothing at all. Here are the benefits and risks of each."
Also, malpractice cases will give you a skewed view of medicine, because if the doctor does things right and the outcome is good, you don't see them. You see the ones where doctors make mistakes; the ones where there are two or three choices, all plausible, and the one made doesn't come out well; and the ones where, even with good care, the patient dies or doesn't regain function.
If you judged ordinary people on the basis of court cases, you could conclude that nobody at all is capable of driving a car safely. Next door in family court, on that basis, you might decide that most relationships end badly, and that divorced parents cannot get alone even well enough to raise children. The cases where the parents meet in front of the police station to hand off custody on a carefully prepared schedule are more visible than the ones where the mother calmly puts the child on an airplane to spend the summer with her father in another state.
@ ERIC M. SANDERS:
"I would only add that 50 cases should be enough at least for anecdotal evidence. I do not comprehend why anyone should have to die in order to prove any treatment's efficacy. We each have our own individual chemistry and genetic dark matter, as you know."
Our "individual chemistry" is known in medicine as "electrolytes" which have very narrow parameters for sustaining of life. "Genetic dark matter" is known in medicine as the complete mapping of the human genome..which is the same in every human being...although each of us may have some benign or some serious mutations/deletions of some of those genes.
"I am a court reporter, not a medical specialist. I have done many, many malpractice cases and my interface with medicine is in the judicial realm."
My secretary who transcribed doctors and nurses notes is a clerical worker...not in the medical realm and not able to practice as a public health clinician and not able to offer opinions about the competence of doctors or nurses.
You are not in "the legal system" but merely a court stenographer, with absolutely no ability to judge the merits of a medical malpractice case and absolutely no ability to judge the competence of a physician.
Eric M. Sanders (#90):
Eric M. Sanders (#94):
Not to "pile on" Mr. Sanders, but what he describes as "research" is simply reading - and quite obviously not very critically - books and websites that confirm his pre-formed (and uninformed) beliefs on the topic of chemotherapy.
I don't say this to embarrass or humiliate Mr. Sanders but to point out that many in the non-scientific community think that "research" consists of reading books, articles and - FSM forfend! - Internet websites about a subject. This is the high-school/middle-school/undergraduate term paper definition of "research", so their confusion is understandable, since most of them stopped taking "science" classes in college - if not earlier.
Actual research, Mr. Sanders, involves forming and testing a hypothesis by experimentation and observation. Using your "Google-Fu" is not research.
Mr. Sanders continues:
I'll grant the bare ass - can't stand those exam gowns. As for the idea that people "...waive their rights to question what their medical provider is doing.", that fails to conform to my personal experiences, or those of my friends and family members. If anything, my doctors - and those of people I know - give too much information and are too eager to involve the patient in the medical decision-making. On numerous occasions, I have had to ask doctors "Which option would you choose, if you were in my situation?".
I think that someone who is not an oncologist or pathologist would be a fool to argue about the staging of cancer or the prognosis - few people have the knowledge needed to participate in that part of the medical assessment. As for the medical options (which Mr. Sanders abbreviates "medicine"), there are always options, including the option to do nothing.
That said, I also know that there are times and situations when there aren't a lot of options or where all of the options are equally poor. And sometimes people in those situations hear only part of what is being said before they "shut down" and stop listening. Still, there is no compulsion (except in the rare case of a minor child whose parents refuse clearly life-saving treatments) and "argument" ("discussion", for those who can remain civil) is not only tolerated, it is expected.
I'll be charitable and suggest that Mr. Sanders' experience as a court reporter has given him a very skewed view of medicine, as seen through the filter of malpractice cases.
Trying to understand what happens in any part of society based mainly on what you see in a courtroom is going to give a terribly lopsided view. Imagine what you might think of automobile drivers based solely on Traffic Court. Or how basing your opinion of human interactions on the procedings of Criminal Court might give you a false perception of what happens in our cities and towns.
Prometheus
They never mention the therapies of Drs. Revici, Burzynski or Gerson.
The key thing about these people is that they follow quite different, incompatible paradigms. If Burzynski were sincere about anti-neoplastin then he would be calling Gerson a lying fraud, and vice versa.
Instead they are all the best of mates and mentor one another, much in the way that other specialities of conmen respect one another's professional abilities.
You cannot simply refer me to a link that calls someone a quack
We call Burzynski a fraud because he has been convicted for fraud.
I believe lilady is getting snippy. I have a bachelors degree from SUNY in communications and I am quite well read.
Yes, I have a job that job does not require making legal decisions and/or judgements. That does not mean I'm blind or deaf. I spent 4.5 years working in Bronx Family Court under Rudy Giuliani. I have seen a few things in my days. But I am not an issue. Really, the issue is cancer patients' rights to have access to any therapy they wish, especially when they are told they are near death.
Lilady betrays the writer's belief that only those who have graduated medical school can or should comment on medicine. All opinions are valid as opinions. The issue/s are not me, or my qualification to draw a conclusion or have an opinion.
I hate having to waste space in my defense, but my comment about malpractice was in defense of physicians. I have seen many, many, including my own dentist sued for no good reason. Obviously, many of you are defensive, and for good reason.
But sticking to the point at hand, I am not sure how trying to get patients to come to a clinic in Mexico is any different than Sloan Kettering putting on radio ads continuously in NPR, "The best cancer care anywhere." How is that different? It is not.
The use of bacteriological phages, hyperthermic treatment and many other treatments that don't cost some insurance company hundreds of thousands of dollars and don't fatten some pharmaceutical company's shareholder's portfolio are always under attack. Yet irradiating old folks who might just as well live another few years with no treatment is considered SOP.
Those of us who can read, see and listen are not fools simply because we did not attend medical school. In another uneducated, slobbish iteration I spent many years as a volunteer firefighter and assisted in highway traumas and other situations where individuals were in extremis.
I cannot count the amount of times physicians interceded in rescues of individuals with C-spine injuries and insisted on moving them before a KED could be installed. I watched with my own Bachelor educated eyes as a man with an obvious broken neck went into convulsions as a physician, who stated that his specialty was an OB-GYN, grabbed the crash victim by the head and turned it to face him so he could ask him assessment questions.
Luckily the police officer on scene saw the event, and made sure not to include the names of the first responders on his report.
But as I have stated repeatedly, I and any other citizen have a right to pursue any and all treatment we choose, at our own risk. Further, the constant attack on anything that doesn't involve 5FU or a lead apron or their equivalents is getting tiresome.
When treatments work, bravo! And many times they do.
But to require a citation for every opinion and to discount personal observation or opinion makes it quite clear to me
there is a double standard being perpetrated here. This is not 1962, when the safe thalidomide was given to my classmates who ended up with claws for hands.
This is a time of renaissance where those who work with PET Scans and MRIs need to learn to work with those who use less expensive, and perhaps not double blind tested methodologies. The point should be the patients quality and quantity of life, not whose right.
Re. claimed cure rates for the Gerson therapy, according to the Executive Vice President of the Gerson Institute:
SANDERS reminds me that a troll popped up in a RI thread to proselytise for Burzynski's therapy a few weeks ago, and invented an imaginary friend who had been cruelly deprived of access to it.
http://scienceblogs.com/insolence/2011/08/rip_david_servan-schreiber.ph…
There's a useful examination of Gerson's 50 cases here.
@100
I believe Gerson's definition of "cured" was - the patient left the clinic alive and survived long enough for their check to clear.
Estimate? Feelings?
They may as well use a downsing rod, or a ouja board.
What about some real data, I don't know, like checking if the patients are still alive 5 years later?
Well, someone is reading this blog, deleting some comments and allowing others in.
That is not free expression. Damn, even if I'm wrong about something or totally misguided, to delete my response to comment 98 just shows that someone is really enjoying censoring this thread.
And yes, I used my real name because I have balls. Orchids. Testes and using my real name shows that I have integrity.
I guess this will be deleted too, but then again, I am only a clerical worker.
Eric M. Sanders. Cleric
Well, someone is reading this blog, deleting some comments and allowing others in.
There is an automated moderation queue that one can trigger. So perhaps you and your real ballsy orchidy testes could wait a bit before pitching a crying fit.
Mr. Sanders, I have had comments with one URL link held up for moderation for over a day. The blog owner has this thing called "a life" and is not attached to the internets.
Hey, I thought clerics were patient and forgiving. Well, that goes that stereotype of religious clergy. ;-)
Eric - at least get your facts straight. Thalidomide was never approved for use in the United States (a great example of the system working) and was only harmful to the fetus, not to the person taking the drug (i.e. your classmates would have been fine).
@ Cleric: Is this your response to my comment at #98 above?
After your anecdotal commentary about chemotherapy, you took on another persona; that of a trial attorney. Yes I agree with you that you have balls, orchids, testes. I'm not questioning your abilities as a court stenographer, but rather your claim that you are "in the legal system"...medical transcribers are not doctors nor are court transcribers "in the legal system". Might I suggest a career change for you to get the education to become a part of the medical system or a part of the legal system.
I see you closed your posting with Eric M. Sanders.Cleric ...is this the "Cleric" you mean?:
The cleric is one of the standard playable character class in the Dungeons & Dragons fantasy role-playing game.[1] In the game, clerics are versatile figures, both capable in combat and skilled in the use of divine magic. Clerics are powerful healers due to the large number of healing and curative magics available to them. With divinely-granted abilities over life or death, they are also able to repel or control undead creatures. Whether the cleric repels or controls undead is dependent on its alignment. It is the only class to be in every version of Dungeons & Dragons without a name change.
This is not 1962, when the safe thalidomide was given to my classmates who ended up with claws for hands.
I think Mr SANDERS will find that thalidomide was completely withdrawn in 1961. And "given to his classmates"? Really?
All opinions are valid as opinions.
This doesn't mean anything.
@ Lawrence:
Thalidomide was never approved for use in the United States
Doctors still had test samples and were giving it to patients who clamoured loudly enough. So there were a few US cases of phocomelia.
(a great example of the system working)
OT, but Dr Kelsey (who blocked it for sale) is still going strong, aged 97. She retired in 2005 -- for the second time -- at 90.
"And yes, I used my real name because I have balls. Orchids. Testes and using my real name shows that I have integrity."
You have integrity, yet you just used a genderised reference to insult and demean people you've never met over something that is of little consequence in the context (and which is actually more in line with online culture than using your real name is) and which has no relation to the discussion, except in your head.
Why, if it was possible to tell which of the several hundred people with your real name is the real you, I'm sure we'd all be in awe at the size of your gonads.
Eric,
The difference is that many of the treatments that are used in Mexican clinics have been tested and found not to work, with others not having been properly tested at all. Those used by Sloan-Kettering have been tested in different cancers and found to work, at least to some extent. You might want to take a look at this article about alternative cancer treatments, which does mention Drs. Revici, Burzynski and Gerson.
By the way, I have good reasons not to use use my real name in these sorts of discussions. A man who knew my real name and home address once threatened to beat me to death with a baseball bat and set fire to my home because he disagreed with some things I had written on-line. Since then I have used a pseudonym. I am not prepared to put my family at risk just to prove I have cojones.
Mr. Sanders:
Really? You need to actually show the evidence for that kind of statement.
Evidence and opinion are two different things.
You should do a bit better research. I'd suggest you find out why Dr. Frances Kelsey was given the President's Award for Distinguished Federal Civilian Service from President John F. Kennedy in 1962.
And you really need to read the book The Emperor of All Maladies.
Why, if it was possible to tell which of the several hundred people with your real name is the real you, I'm sure we'd all be in awe at the size of your gonads.
Ah, but there's only one spelling his name in ALL CAPS.
Chris @116 or thereabouts pending insertion of Eric's much vaunted moderated post.
@ Cleric: I use a "nym" because like Krebiozen I have been threatened after I wrote newspaper articles under my "real name", about institutional warehousing of the developmentally disabled and testified at public hearings on behalf of the disabled. And, my ten year old daughter received a vicious threatening telephone call due to my advocacy activities. I have also been threatened by a troll and his sock puppet on this blog.
It is interesting that you brought up the subject of Thalidomide and its teratogenic effects when used for its sedative effects by pregnant women. Thalidomide is now used as first line therapy for treatment of multiple myeloma:
Thalidomide was first tested in humans as a single agent for the treatment of multiple myeloma in 1996 due to its antiangiogenic activity. The New England Journal of Medicine published the full study in 1999.[46] Since then, many studies have shown that thalidomide, in combination with dexamethasone, has increased the survival of multiple myeloma patients. The combination of thalidomide and dexamethasone, often in combination with melphalan, is now one of the most common regimens for patients with newly diagnosed multiple myeloma, with an improved response rate of up to 60-70%. (Wikipedia and various other sites)
You really need to consider a career change...and stay away from alternative/complementary medicine pseudoscience sites.
Mr SANDERS's mother-in-law died in the placebo arm of a trial; he has a "friend who has metastatic bone, liver and pancreatic cancer"; and class-mates (plural!) with "claws for hands" from thalidomide.* He has terrible luck. Or some version of Munchausen syndrome.
* The number of ectrodactyly cases in the US -- resulting from thalidomide -- can be probably counted on the fingers of one hand. One with ectrodactyly.
Mr Sanders:
You misunderstand, and if you think all opinions are equally valid, then perhaps I can see why you misunderstand. Lilady is not saying that nobody's entitled to an opinion without a degree; she's saying that the opinion is worth a hell of a lot more if the person expressing the opinion has the appropriate background. If you have a messed-up hard drive and three people give you an opinion, which one are you most likely to listen to? The house painter? The lawyer? Or the PC computer technician? They are all entitled to opinions, and they may all have opinions which are actually correct, but your odds are much better with the PC tech.
Are you saying that this is all about money? You have something of a point; at some level it's all about money. But it's the other way around. Insurers would rather not pay lots of money for no use. This is why, if you get hail damage to your house, you may have to argue with the insurance company to get the siding replaced all the way around (so it matches) rather than just on the side that was facing the storm (so it's fixed but looks ugly). Medical insurance is more constrained by law, but it follows similar principles. They don't want to pay for anything they don't need to -- it is NOT in their interest to fatten pharmaceutical company's shareholders' portfolios. Yeah, individuals within the insurer may hold pharma stock, but they'll be looking for new employment (and possibly finding new work stamping out license plates) if they're caught making insurance decisions based on their own stock holdings. Remember, insurers have shareholder portfolios too.
And while we're at it, what do you think of the likes of Gerson and the others if it's all about money? Do you think they are somehow immune from diverting people into their therapies to fatten their own portfolios?
How does that tell us anything at all about the validity of unproven cancer therapies? A doctor screwed up with possibly fatal results in a trauma situation. That has nothing to do with cancer. Do you think Gerson or Burzynski can't screw up like the OB-GYN? And while we're at it, didn't you just say that all opinions are valid? Well, I don't see how that OB-GYN's opinion was valid, if he didn't handle the patient appropriately.
No double-standard whatsoever. The citations aren't used to judge whehter or not your opinion is your opinion. It's to judge whether or not we should believe your claims. You want us to question medical orthodoxy; that's good! But you seem to be very reluctant to let us question *you*, or various alternative cancer treatment promoters. Why should we doubt chemotherapy, for instance, which has undergone extensive trials, but trust Gerson implicitly, when all he's really got is anecdotes?
Um . . . okay. Thalidomide given to people in 1962 didn't give them claws for hands. It gave their *babies* claws for hands. Perhaps you mean thalidomide given to their mothers? I wonder what country you live in, since in 1962, thalidomide was not approved by the FDA. In fact, it was the FDA's investigation into the application for approval in the US which ultimately lead to the big scandal about its teratogenic effects. I wonder -- you speak of these people as if you know actual thalidomide babies. As if you had classmates who had the severely malformed limbs characteristic of thalidomide during the relevant stage of pregnancy. Do you really, or are you speaking more generally and without the personal, first-hand knowledge you are implying?
Mr Sanders, I have a comment in moderation now. I'm sure that, like your earlier post, it will show up once Orac has a chance to approve it. See? No conspiracy against you. It's just the anti-spam software.
SANDERS:
if someone say 25 years ago wanted to use arsenic therapy for leukemia, they would have been told it was quackery.
This turns out to be about as untrue as it is possible to be. When some Chinese researchers reported 19 years ago (say) that old-fashioned arsenic therapy worked well against a form of leukemia, they were not told it was quackery (after all, arsenic therapy had been around since the 1930s); they were told "Great! We're going to try it too!"
Your last line gives you away:
"In particular, patients have to remember that just because chemotherapy doesn't do that well against advanced malignancies does not, as the quacks would have you believe, imply that "alternative medicine" can do better."
Um, **not getting chemotherapy at all** is better in that case. It's not a comparison with "alternative medicine" it's a comparison with "not getting chemotherapy." This speaks a lot about you.
I have to wonder what you think of Ralph Moss' rather exhaustive twenty year history of studying whether chemo and radiation work, not all the half-wits and straw men studies you yourself knock down. It isn't pretty or encouraging re: chemo's success. Also, your very long debunking doesn't once mention what money has to do with the whole process of chemo, which is the gigantic elephant in the room. It's a literal cash machine to all parties in the food chain, and where's there money, there's tremendous disinformation and bafflegab.
Anecdotally, my sister's brain surgeon, one of the best in Canada, removed my sister's life threatening tumor and when pressed as to whether she should do radiation as the oncologist reflexively ordered, said "I wouldn't." Hmm. This propelled me to study extensively the science behind radiation for her tumor. To my surprise, *there wasn't/isn't any*. They just do radiation BECAUSE.
If anything, your very long-winded and smug "takedown" of chemotherapy is hardly that. It simply illustrates that chemo is good for very few forms of cancer, which is hardly "success." If you applied the same rigor to chemo as a new therapy today, would you want it, given its ENORMOUS side effects you hardly bother to mention?
Again I would love to hear what you say about Ralph Moss, as he would be the more logical choice for a "takedown" given his vast expertise on the subject.
Orac mentions Moss here.
In case you have not read the bit in the upper left of this page (near the search box), Orac is a surgical oncologist, and he has written lots of articles on cancer.
Where did you research radiation therapy? Could you share some of the papers from PubMed where radiation is conducted "just because"?
@Carl
Be very careful what you wish for. You might get it one day.
Orac mentions Moss here.
OMFSM that is hilarious. Especially the bit wehre Moss tells us that Hahnemann proved by self-experiment that homeopathic platinum will cure all ovarian problems, because metallic platinum was injurious to his own ovaries:
And then when Rosenberg et al. in the late-1960s noticed that the platinum compound cis-platin disrupted DNA division in E. coli and suggested trying it against cancers, they were really plagiarising the idea from Hahnemann (much as everyone who uses organic chemistry is plagiarising Hahnemann's work with charcoal). How duplicitous!
Someone is being duplicitous in this story, anyway.
Orac, you said: "Be very careful what you wish for. You might get it one day."
What does that mean???
This is the delicious hypocrisy of people who defend chemotherapy, that somehow alternative stuff, of which there are zillions of therapies with varying efficacy, the vast majority of which are both under-or-not-at-all studied by Science, are all assembled under the same "bullshit!" headline and assailed as money-making opportunities for snake oil salesman, while institutionalized "treatments" such as chemotherapy, which is incredibly profitable and has dozens and dozens of horrible "side effects" (hardly "side"), *and* has a success rate that anyone with a brain would call miserable, is somehow more virtuous and "sensible." It's truly laughable.
The available "science" on chemotherapy's efficacy is both tragic and appalling, especially when thoughtful people like yourself, so deep inside the cavern of Rene Descarte's man-as-machine paradigm, write screeds defending this miserable success rate as even barely acceptable, never mind desirable. How dare sensible people question a batting average that would would be savaged by people like you if it's name was "iridology" or, I don't know, "bloodletting" (get the irony?).
What really galls me, is the false equivalency of how a chemotherapy treatment that absolutely ravages a person down to their core is somehow acceptable, but when someone takes a perfectly useless homeopathic remedy, it's hugely alarming and even dangerous and must be stopped.
I believe in Science, why don't you? Science tells us chemo is a miserable failure by any measure. Is it so irrational to search for alternatives, especially when what the house is offering is so incredibly toxic to human life? Who's the dummy?
This is one of the more frustrating blogs I have read. Battle lines and crude comments. Chemo, like any medical tool has its place. But, the bashing of so-called "alties" is childish. Yes. There are false claims in CAM. And there have been false claims(hopes)from conventionalists. But, CAM which NIH admits is (too) broad to well define is also Integrative Medicine - conventional medicine embracing prospective randomized clincal trials (RCTs) along with evidence based CAM practices.
The massive movement into anti-aging internal medicine (20,000 MDs/DOs) is for a reason. Frustration with medical practices that refuse to accept another possiblity without RCTs.
We all know that free radicals do not really exist. Wait! The once refuted hypothesis of the 1950s is now embraced. Or perhaps we can chuckle at the silly notion that a bacterium may cause gastric ulcers. Absurd! Wait. It is now known to be true.
Yes. There is enough absurdity to go around. I prefer to look for evidence that something may actually work. And I no longer accept that Only the RCT must be used. The humble endogenous anti-oxidant with a lifespan of a trillionth of a second is far more complex in how it operates than the chemo agent. To believe that both can be studied in the same manner may be a bit naive.
Using "medical weapons" to slow or stop a diagnosed cancer is fine. Finding more ways to treat a cancer or better yet, prevent are best. Together they create healthcare not just sickcare.
Do you think the all the negative talk about Chemo, and modern medicine's approach might have something to do with the way the NCI handled Dr. Gonzalez's 2000 clinical trial in treating cancer? Why didn't the NCI follow proper protocol and select patients that actually could be treated by Dr Gonzalez's alternative method? Also why was the principal investigator at Columbia, who's supposed to be completely neutral, even part of the study since he had helped develop a chemo regimen that was being used against the alternative method? The NCI should be ashamed of themselves. They couldn't even participate in a study that may help some people live, and provide answers to this deadly disease.
"For example, chemotherapy usually does little for pancreatic cancer, and metastatic melanoma laughs at most chemotherapy (although, fortunately there are newer agents coming into use that provide hope that this will no longer be the case)."
I've a friend recently diagnosed with pancreatic cancer. Any pointers to studies on these newer agents would be greatly appreciated.
@Dwight: the "newer agents" are for melanoma, not pancreatic cancer, unfortunately. Pancreatic cancer is still not very treatable.
Do you know about this study: http://pancreatic.peoplebeatingcancer.org/article/improved-survival-met…
Clutching at straws here, but trying to avoid the junk. Thanks for your help.
@ Dwight: I found the study you are referring to at the:
NEJM (Free Preview) May 12, 2011 FOLFIRINOX Versus Gemcitabine for Metastatic Pancreatic Cancer
Here is part of the abstract...the rest of the article is behind a pay wall:
Results
The median overall survival was 11.1 months in the FOLFIRINOX group as compared with 6.8 months in the gemcitabine group (hazard ratio for death, 0.57; 95% confidence interval [CI], 0.45 to 0.73; P<0.001). Median progression-free survival was 6.4 months in the FOLFIRINOX group and 3.3 months in the gemcitabine group (hazard ratio for disease progression, 0.47; 95% CI, 0.37 to 0.59; P<0.001). The objective response rate was 31.6% in the FOLFIRINOX group versus 9.4% in the gemcitabine group (P<0.001). More adverse events were noted in the FOLFIRINOX group; 5.4% of patients in this group had febrile neutropenia. At 6 months, 31% of the patients in the FOLFIRINOX group had a definitive degradation of the quality of life versus 66% in the gemcitabine group (hazard ratio, 0.47; 95% CI, 0.30 to 0.70; P<0.001).
Conclusions
As compared with gemcitabine, FOLFIRINOX was associated with a survival advantage and had increased toxicity. FOLFIRINOX is an option for the treatment of patients with metastatic pancreatic cancer and good performance status. (Funded by the French government and others; ClinicalTrials.gov number, NCT00112658.)
It seems that in this one study median survival time was increased by 4.3 months and there were more adverse effects with Folfirinox, but according to this study degradation of quality was notably higher in the Gemcitabine study group at 6 months.
The link that you provided has a lot of "alternative" treatments, but you spotted this study amongst the woo.
I'm so sorry for you and your close friend who is dealing with this devastating disease.
@lilady: Thanks for your help and understanding.
I really have to laugh at the posts saying that the supposed quacks who have claimed chemo doesn't work are doing it so they can 'sit on a pile of money'. Are you aware of the multi-billion dollar industry that IS chemo? My mom was an oncology nurse, so believe me...I know all about it. And despite the fact that more patients who receive it than don't die anyway, from either their cancer or the chemo...no one questions this. My half-sister was diagnosed with breast cancer. She had surgery. She had chemo...for months on end. Her hair fell out. Her immune system failed. The cancer spread to her bones and eventually her brain, despite receiving chemo, numerous times and fighting for five long years with disintegrating quality of life to the point of being bedridden... she died anyway. The industry made hundreds of thousands of dollars off her fight and eventual death. I have known numerous same kind of situations. Chemo is useful in a small handful of cancers....that's it. The rest? People would be better off having surgery and then building up their bodies with alternative treatment, nutrition and other ways to prevent their tumors for coming back or growing. As for quality of life and the prolonging of life...sorry, but I've never met one chemo patient who was dying despite treatment who was in better condition than someone who was doing alternative and dying despite their treatment. In fact, some on alternative means are up and around just a day or two before they die! Quality of life right up til the last day. Conversely, most chemo patients die wasted away and incoherent in a hospital bed. (Read: more $$ for the industry.) Quality of life is better than quantity any day...and for those raging about the 'quacks' and money...like this author says, that few months might mean the difference between seeing a child born, get married or graduate. And the chemo/insurance industries are more than happy to rake in tens of thousands in order to help make that happen! An alternative 'quack' might recommend foods, a few bottles of supplements and vitamins that cost maybe a few hundred. Both patients still die...one has quality of life right up to the end, the other has hair loss, weakness, organ failure and almost no quality of life at the end. So who profits and who gave the person better survival? Does this mean chemo has zero use? No...it's useful for a small handful of cancers. Fine. Use it for those...leave the rest alone and utilize some of the myriad other treatments that give quality of life while enhancing survival.
So you honestly think Chemo is curing cancer?
Really? Get a life people! IT'S ALL ABOUT THE MONEY!
The last I checked chemo wasn't curing cancer. End of
story.
@meghan
And why did you decide to post your whiny little fact-free screed at a 4 month old post, idiot?
Meaghan...I suggest you read the article, before commenting here.
BTW, I don't see any information to back up your ranting post. Am I missing something?
I read an editorial in the Australian Prescriber some time ago - http://www.australianprescriber.com/magazine/29/1/2/3/ - that the contribution of chemotherapy to the survival of cancer patients is less than 3%.
My niece was just diagnosed with Liver Cancer a month or two ago. After the Chemo and radiation she was told that the Cancer was in remission. Two weeks ago she got severe head ack and went in to the doctor. The doctor said that she had a Brain tumor. She went to a city doctor that said that he seen no brain Cancer. Few days later he said well, there is a small cancer there. Then cancers in her spine. She is being bairred Monday. All that the chemo and radiation did was make her last days full of suffering. Western medicine sucks! The FDA is NOT our friend and we are not even close in our treatment. There has been a cure since 1900, but too much research money would go away. Multi- trillions of Pharma money would go away! Ask Henry Hoxley, Royal Rife, Edguar Cacey, nurse Casey. Get real people! The USA is #37 in medical care with Japan #1, even Cuba has better care. I have first hand experience. Cancer is population control. Are you next? Yes, I am mad as hell!
Witch - please read the original post.
Mr Gleason:
A couple of comments. First, Japan uses pretty much the same methods for cancer diagnosis and treatment as the US. So do all the other countries with better health care outcomes.
Second, I question whether your niece would, in the space of "a month or two" be diagnosed with liver cancer, given radiation and chemo and then told that she was "in remission". That seems awfully fast.
That does sound like an odd story, TBruce. I think most chemo treatments last many months; if a doctor ever told me my cancer was in remission after only a month, I'd be very suspicious that I was being conned. (And yes, there are doctors who will lie about you being in remission in order to keep you coming back to them; several of these odious folks have been discussed on this very blog.)
Mention of Cayce**, Hoxsey** and Rife should be enough to warn us that we're looking at woo via Time Travel- moving through the swirling mists of decades past into an earlier century when our ancestors lived - and probably made their own soap and ate rock-hard biscuits from tins- not a place I'd like to visit. ( My ancestors probably *sold* the soap and biscuits to poor trusting souls).
Unfortunately, I know an advocate of Cayce ( un-believable, isn't it?) who gave me a book about him- which I read: he was called "the Sleeping Prophet": following a consultation with a person who was ill, he slept on it and dreamt stuff up- which he then would prescribe as remedies for the problem. Then there's all sorts of flabbergasting confabulation about souls, re-incarnation and Atlantis.You can't make stuff like this up- although Cayce did.
** mis-spelled above.