Supporters of science-based medicine and keeping pseudoscience out of medicine have a few years to prepare for an onslaught of crappy studies “proving” the value of “integrative” oncology. No doubt at this point you’re wondering just what the heck Orac is talking about. I will tell you. It involves an institution we’ve encountered before and a naturopath we’ve met before, specifically the Ottawa Integrative Cancer Centre and Dugald Seely, ND (translation: Not a Doctor), FABNO (translation: Not an Oncologist). Somehow, Dugald Seely and his brother Andrew have somehow scored some sweet, sweet foundation cash for the purposes of doing...well, whatever passes for research in the world of naturopathy:
The pair will co-lead a major research project that will do what many have long asked for: provide hard data about whether naturopathic therapies such as acupuncture, massage, exercise and nutritional therapies combined with conventional medicine can help prolong or improve the lives of cancer patients.
The randomized control trials will study the use of integrative treatments for 300 esophageal, gastric and lung cancer patients who will undergo surgery. The 11-year study will take place in Ottawa, Kelowna, B.C., and Hamilton. Exactly which therapies will be offered to the patients in the clinical trials will be determined based on a consensus of which ones are the most evidence based and useful.
The grant that will fund the research — $3.85 million from a Canadian foundation that wants to remain anonymous — is the largest of its kind in the world, Seely says. The research, between the Ottawa Integrative Cancer Centre (which is an arm of the Canadian College of Naturopathic Medicine) and the Ottawa Hospital Research Institute, has the potential to change treatment for some cancer patients. It also represents a major step toward integrating more naturopathic treatments into conventional medicine using scientific rigour.
Nearly four million? To fund research in to woo? It’s a depressing thought, the main reason being that I can’t help but think of how much good that money might have done were it channeled into actual real research, rather than into the parody of research that constitutes most of what passes for “naturopathic research.” That’s well over two, perhaps even as many as three R01-level projects or even around 8 to 10 R21 preliminary grants. Heck, it’s on the order of a Stand Up 2 Cancer “Dream Team” grant. Of course, the big difference is that these two are anything but a “dream team”—well, that, and that, unlike the case for most foundation funding, we don’t know who is funding these research projects.
Normally, I like to emphasize that it is the science that is ultimately the most important, but that doesn’t mean that knowing the funding source is not important. Let’s just put it this way. If alternative medicine practitioners were to find out that a study about a drug was funded by the pharmaceutical company that makes the drug, they’d be outraged. If antivaccine activists were to discover that a vaccine study were funded by an unknown foundation, they’d be quite reasonably suspicious, particularly if the investigator were someone as provaccine as Paul Offit. So now we have two guys, one of whom is heavily into “integrative” oncology, receiving a grant from a foundation unwilling to reveal itself. In addition, as yet, we have no idea what the protocols will be or even very much detail on what the research will involve. This is in marked contrast to other foundations that fund research, such as SU2C or the Gates Foundation. Sure, any foundation can give money to whomever its leadership wants, and it can even request to remain anonymous if it wishes, but it does make you wonder...what does this foundation have to hide? Certainly there can’t be very many Canadian foundations out there with the resources to fund a nearly $4 million grant. It can’t be the Bravewell Consortium, which is based in California, or the Samueli Institute, which is located in Alexandria, VA, Corona del Mar, CA, and Frankfurt, Germany.
One wonders if there’s a new woo foundation in town. Actually, it would appear that there is, but we don’t know who it is yet other than that it is, apparently, Canadian.
The news reports and press releases I have read don’t say much about what this project is about. This news story says:
The project, called the Thoracic Peri-Operative Integrative Surgical Care Evaluation (Thoracic POISE), is divided into two parts.
First, it will use integrative care techniques to use on patients before and after surgery.
The second part includes a randomized controlled trial to evaluate the techniques and see if they reduce adverse events and improve survival.
This is similar to this press release:
"We have assembled an outstanding team of investigators that includes surgeons, oncologists, naturopathic doctors, PhD research specialists and a health economist," said Dugald Seely, project co-lead, Executive Director OICC, Director of Research CCNM, and affiliate investigator with the Ottawa Hospital Research Institute. "Lung cancer accounts for the highest incidence of cancer deaths in Canada and we know that more than half of all cancer patients use complementary therapies. This research will help determine when complementary care is appropriate and may potentially lead to enhanced standards of medical practice that can positively impact patients' lives."
"This study is an innovative whole-person approach involving naturopathic medicine integrated with traditional care. It is more than a single intervention," said project co-lead Dr. Andrew Seely, an associate scientist at The Ottawa Hospital, director of research for its Division of Thoracic Surgery and an associate professor at the University of Ottawa. "By using a well-designed randomized controlled trial to assess multiple evidence-based interventions that are often found in real-life clinical practice, we hope to show that integrative cancer care improves two critical problems simultaneously, namely adverse events after surgery and long-term cancer outcomes."
One thing this press release tells me right here is that Seely and his brother must have spent considerable time putting this whole grant proposal together. Another thing it tells me is that the Seelys are using the old alt-med trope that this is “holistic” care, as though conventional primary care and oncology were not. Finally, there is a hint of how this clinical trial will be designed. Note how Seely emphasizes “multiple evidence-based interventions.” In other words, they’re going to throw a whole bunch of stuff against the wall and see what sticks.
Perhaps the best way to predict what the Seelys will do with this money from the unnamed Canadian foundation is to look at what they’ve done in the past, or at least what Dugald Seely has done in the past. We have a very good example from less than a year and a half ago, too. Basically, in this study Dugald Seely and colleagues carried out what they sold as a randomized clinical trial of adding naturopathic interventions to the “usual care” of patients with cardiovascular disease. It’s a study that advocates of “integrative medicine” jumped on as evidence that “integrating” naturopathic quackery with standard of care.
To recap, the study itself was fairly straightforward as randomized trials go. The subjects were all members of the Canadian Union of Postal Workers aged 25 to 65 years who were under the care of a primary care physician who could speak English and were competent to provide informed consent. The study took place at multiple sites, for a total of 246 subjects, 207 of whom completed the study. These subjects were randomized either to either “usual care” by their existing family physician alone or to “usual care” plus naturopathic care. Obviously, the study was not blinded. Rather was was a “pragmatic” trial, which means that pretty much anything goes for both arms. The idea was to compare “usual care” in the community to “usual care” plus naturopathy. I’ve noted time and time again that CAM and “integrative medicine” practitioners (particularly fans of acupuncture) love pragmatic trials to death because they are less rigorous than a true randomized clinical trial. In particular, they are very much prone to placebo effects and other confounders.
There’s a reason why pragmatic trials aren’t usually the first choice of trial design in determining whether an intervention works. The usual order is to do a rigorous randomized clinical trial, placebo controlled if possible, ideally double-blinded. That determines efficacy, which is how well the treatment works compared to placebo or standard of care. However, interventions that show a high degree of efficacy in clinical trials are often disappointing. That’s because, outside of the highly controlled environment of clinical trials in academic medical centers, treatments are used on people who might not have fit the inclusion criteria precisely, people who cover a wider range of severity of condition, and are often not administered according to the exact protocol used in the clinical trial. In other words, the messiness of real world usage intrudes. Enter the pragmatic trial, which are often not blinded and take place in an environment more like what happens in the community. Usually, the apparent effectiveness (and note that “effectiveness” refers to real world effectiveness rather than efficacy). Most of the time, effectiveness is less than efficacy. One time that is not true is for treatments that don’t have specific effects, that are placebo medicines. In the case of such medicines, pragmatic trials are far more likely to show an effect.
See why woo-meisters, particularly acupuncturists, love pragmatic trials so much.
The other thing that Seely did with the cardiovascular trial is something typical of what CAM advocates do: Rebrand, rebrand, rebrand. There were lots of interventions such as weight loss, aerobic and anaerobic exercise, diagphragmatic breathing, and dietary interventions similar to the Mediterranean and Portfolio diets. In other words, there was a lot there that wasn’t part of science-based medicine. True, there were also lots of supplements and less evidence-based interventions, but that’s one more example of how CAM practitioners love to “integrate” quackery with science-based medicine, the latter of which is rebranded as being somehow “alternative.” Cardiologist Dr. David Winchester wrote an awesome takedown of this rebranding:
The goal of this investigation seemed to be to test the hypothesis that naturopathic care is superior to usual care. While the authors have demonstrated that a generous investment in counseling is effective at reducing calculated CHD risk, they have not demonstrated any effect specifically attributable to naturopathic care. Dietary counseling, for example, appears to be effective regardless of the provider (reference originally published in 2005). (2) As a practicing cardiologist, I routinely "deliver diet and health promotion advice" to my patients and "emphasize this form of self- directed care". As noted in the accompanying editorial, (3) I would welcome the opportunity to spend an additional four hours in consultation with my high CHD risk patients and I suggest such an intervention would have been the appropriate control comparator.
Furthermore, I have concern about the evidence base used to determine which lifestyle interventions would be used. It would appear from the appendix that abstinence from coffee was encouraged. The available literature published prior to the trial registration, however, demonstrated an association between moderate coffee use and both a reduced risk of diabetes (4) and no increase in risk of CHD. (5) Conversely, the evidence cited demonstrating clinical benefit for some of the recommended supplements is sparse or no evidence is provided (cinnamon, pomegranate juice, lutein, etc.).
Now do you see what I mean when I say I expect a whole lot of other trials like this, beginning a few years from now? That’s what this anonymous “foundation” expects; otherwise it wouldn’t have picked Seely. Four million dollars can buy a lot of that.
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Ah, crikies. The local cancer center runs a huge charity bike ride every summer to fund actual scientific research into cancer; thousands of participants and volunteers manage to scrape up, oh, maybe $3 mil in a good year.
With that in mind stories like this are rather discouraging.
I'm all for private groups funding woo.
Lots better than wasting our tax dollars on it (hello, NSCCAM).
GAH!!! All that money .... wasted. It boggles the mind. But, as stated above, better that a private group funds it than my tax dollars.
SelenaWolf
A portion of it probably is our tax dollars since the money going into this formation was probably deducted from personal or corporate taxable income. I suspect the CEO of Canadian Natural Resources Ltd. is behind this - a couple of years ago a foundation of his was found to be doing an ethically dodgy and scientifically dubious study that involved giving homeless people huge doses of supplements while providing them with free dental care.
"The pair will co-lead a major research project that will do what many have long asked for: provide hard data about whether naturopathic therapies such as acupuncture, massage, exercise and nutritional therapies combined with conventional medicine can help prolong or improve the lives of cancer patients."
That paragraph strikes me as particularly ominous, because they are trying to make it sound like this is novel research that has never been done, as compared to what it really is: attempt 3,095 at legitimizing CAM. Their omission of the reality that there is already hard data on the subject implies to me an intentional sleight of hand...
Well... The say they will be assessing if "Integrative Oncology" can improve the lives of cancer patients. About the only benefit I can see from all their modalities is they get to talk with a very nice naturaopath and the massage is relaxing!
a couple of years ago a foundation of his was found to be doing an ethically dodgy and scientifically dubious study
What makes this more disturbing is the impression I'm getting that the funding and venues for this study have been designed to avoid such minor details as an IRB, which would normally put the kibosh on anything unethical that might be funded by government grants, funded by a mainstream foundation, or conducted at one or more mainstream research institutes.
As for the study locations: The host institution is based in Ottawa. The other two sites are Hamilton, which is close to the US border (Niagara Falls area) and therefore might get some alt-med tourists, and Kelowna, a resort town in the mountains of British Columbia--I don't know if Kelowna is a hotbed of woo, but I've known some other mountain resort towns to fit that description.
Oh, and the plans are for this study to take 11 years. I would like to have the kind of job security that comes with an 11-year grant--my FTE salary plus benefits and overhead would use about half of this grant, leaving plenty of money for research activities.
Since when is talking to a patient about diet "naturopathic?" My doc (My APN, actually) gets on my case every time I see her about my crappy eating habits.
Four million for self indulgent BS.
I had to stop working, and most everything else due to a chronic disease for which there's no effective treatment. CDC does not break it out separately; the entire bucket it resides in has a budget of
$5M.
There are about 1M in the USA who have this or a related disease; research is so sparse, and CDCs interest (or disdain) is such that it tossed in a general category with vaguely similar disorders.
So, since massage, exercise and nutritional therapies have always been part of "conventional medicine," this is really a multi-million dollar "major research project" into acupuncture.
Which has been repeatedly shown to be no better than placebo...
... And placebo is the name given to sham treatment that doesn't have any physical effect on the person receiving it.
Hey, sounds like they got one sure fire winner! "Did you like that?"Yes, that was nice, thank you."
Hard data; low bar; start out with a lot of positives like that .
Profit!
Oh, man woo has crept so far into even formerly well respected medical institutions. Because my father died from pancreatic cancer I frequent a couple of forums dedicated to it. One of the latest hot woo-ful cures is bitter melon juice and pills. Doing a search looking for information to refute that I came across about a dozen sites that a run be well known medical schools and hospitals. http://www.bidmc.org/YourHealth/Holistic-Health/Herbs-and-Supplements.a… is just one of them.
this chaps my buns. With public health spending being slashed at the local, state, and federal level coupled with the most severe shortage of grants for research in recent memory (according to many of my friends in academia) $4M to study total crap. As Orac points out there are a lot of worthy projects that could be funded with that money. A lot. Instead we're going to toss it down the drain on a study to look at essentially everything that can be dreamed up, with probably hundreds of endpoints measured. In the end, after some truly spectacularly twisted statistical tap dancing, one or two end points (maybe more depending on how many they measure) will barely reach statistical significance (and no hard endpoints like death mind you) to be trumpeted across the internet for all time as 'proof' that the entire concept is valid. Even though many interventions won't have made a difference at all, they will all still need to be used. For proof look at TACT (I don't know how that got approved) and the endpoint that diabetics just barely squeaked out a statistically significant improvement. This result is now touted as absolute proof the entire concept is valid and we should chelate everyone! I bang my head on my desk in sheer frustration.
There might be a potential bright side to this.
Naturopaths seem to do a lot of 'common sense' stuff that is not "alternative" in concept: "massage, exercise and nutritional therapies." Dr. Winchester writes. "I would welcome the opportunity to spend an additional four hours in consultation with my high CHD risk patients and I suggest such an intervention would have been the appropriate control comparator."
Boom-shakala. What this suggests is that Dr. Winchester doesn't get that four hours now. Annecdotally, my PCP MD always gave me little talks about changing my diet and exercise, and I'd respond (usually to myself) "How?" Not as in what changes to make. But as "You're not telling me anything I don't know, and haven't known for a long time. I just don't have a psychological mechanisms to get myself to make these lifestyle changes." The MD says "east better and exercise more." It's kind of like the MD saying "Quit smoking." It's easier said than done.
Dr. Winchester: "the authors have demonstrated that a generous investment in counseling is effective at reducing calculated CHD risk." Which to these layman's ears sounds like another no-brainer. The question then is, what sort of counseling are 'conventional medicine' patients getting now?
Assume for sake of argument 'usual + naturopathic' bests 'usual' alone. Two not-mutually-exclusive hypotheses:
1) Natuopaths might be more effective at getting patients to change diet and exercise habits do to something they do that has nothing to do with woo. Maybe they just put more emphasis on lifestyle change, couch it in different ways, have some 'tricks of the trade' that result in better compliance.
2) Maybe, as Winchester suggests, it's just time. Who in their right mind would imagine 'usual + naturopathic' vs 'usual' is a fair comparison? The first group is receiving many more care hours than the second. Again it seem a no-brainer to guess they'd do better. Thus, the study has NO CONTROL AT ALL FOR TIME. Apples to apples would be 'usual + naturopathic' vs. 'usual + more usual'.
So there's two not-mutually-exclusive complementary hypothesis about conventional practitioners:
1) They're not particularly skilled at getting patients to actually make the lifestyle changes they suggest.
2) They work within institutional frames that deny them the opportunity to give lifestyle issues the attention they feel it deserves.
So (still in for-sake-of-argument land) what are we really talking about here? NOT difference in body-mechanism concept between 'usual' and 'naturopathy' but in application. And if the #2 hypotheses were shown to have the more profound effect (as I'd guess they would) what we're talking about is what Heath Insurance allows, not what doctors think is best.
I submit that's the crux of the issue. As an institution dominated by insurance provider dictates, SBM is inhibited from doing the things naturopaths get to do if they are covered by 'insurance in addition to usual'. And by training and habit, too many 'usual' docs are OK with this. They think the admonition to 'eat better and exercise' ought to be enough to get patients to actually do those things. (Here I hope Shay and I are sharing a bitter little laugh.)
Really, why should my MD or Shay's ARPN or Dr. Winchester be expected to do more than admonish? They're medical doctors, not trained counselors or clinical psychologists. So let's say the questions becomes: What is the best SBM-compatible method to get patients to actually make lifestyle changes that will improve their long term health, what kind of professionals should implement such a program, and how do we pay for it?
From my observation, pretty much every conventional health provider has embraced some sort of 'wellness' thing aimed in that direction, and they're all pretty much worthless. Hey, we'll send you a newsletter every quarter reminding you to eat better and get more exercise! Hey, we have a one-hour seminar where our wellness expert will give you a pep talk on the benefits of eating better and exercise that you can sign-up for if you really really want to, if it fits you're schedule, and if we have a place open. Great! All my issues are solved!
In contrast, you go to a naturopath, get the same pep-talk but tailored to you as a specific person, and the kindly ND schedules a two-week follow-up to see how you're doing with that, and as a properly socialized patient you keep that appointment, and the next two-week follow-up after that... Might that not be just enough positive reinforcement to get some results in terms of changing your behavior? Might not SBM compatible counseling do even better at lower cost with the same allocation of patient and provider time?
What would a functioning wellness program look like? Why are diet plans with support groups left to the private sector where the nutrition part can twisted by faddism, and the marketers get to profit from branded over-priced prepared meals? Why isn't something akin to Weight Watchers covered by insurance, administered by medical centers, and food prescriptions separated from profiteering? Why can't the same thing be done with exercise? Why can't the med center provide regularly scheduled support groups AND sessions where group members can do their cardio together: hall-walking, laps in the pool, whatever? Wouldn't it even be cost effective for the insurance companies in terms of reduced treatment costs for heart disease and Type II diabetes if the med center created a gym space with treadmills and elliipticals with Netflix players, or whatever else helps folks want to do their cardio? The assumptions would be:
1) Patients aren't left to their own individual devices, but gathered into mutually-supporting and reinforcing groups (a shocking but perhaps inviting concept in the Internet age: doing something social with real human beings in meatspace!)
2) This is prescribed by the physician, more of a "you have to" than "maybe you should". It's tracked in the patients' medical records, and progress monitored by less-expensive and more specifically trained professionals than an MD. Maybe 'Wellness Assistants' combining the fields of dieticians and exercise therapists, but with less training than those professions as the 'WA' wouldn't be responsible for devising the diet and exercise plans, just checking in on the implementation and progress: taking BP, checking blood sugar, keeping charts, whatever — a specialized RN basically.
I know next to nothing about health care costs, so I'm sincerely asking those who know more: Would something like this be cheaper, similar, or way more expensive than covering naturopathy if the proper institutional mechanisms were in place?
So here's the bright side. As Eric notes, the Seelys have set themselves up for a lucrative long-term scam. They're not promising conclusions until 2025. We can guess how this will go: periodic preliminary reports all conditionally enthusiastic about 'usual + naturopathy', and a final conclusion that yes!, 'u + n'
"positively impact patients’ lives" because they feel better about themselves, but no "long-term cancer outcomes." don't show statistically significant "improved survival" because, well, cancer cells don't really care that much about what you eat or how strong your cardio-vascular system is. Of course, the data will probably be tortured and spun to put as much lipstick on that pig as possible, but it will probably be inescapable anyway. Why should the Seelys care? Their money will already be in the bank.
What I'm thinking is that this 11 year timetable, and the pub being generated around the study now, is a great opportunity for SBM docs to form a posse and cut the banditos off at the pass. Organize a coalition, get funding for a study of something along the lines of my suggestions above over 3-5 years, do the science right, and PROVE to the insurance companies and regulators that 'usual + practical enactment programs of usual' produces better outcomes than either 'usual alone' or 'u + n' at lower costs. Expand the scope beyond cancer to heart disease and Type II. Make the economic argument to the people controlling the purse strings that this provides way more bang-for-the-buck than naturopathy. Really, it all comes down to what Insurance will pay for. Right now, they pay for a lot of CAM, and don't pay for the kinds of SBM-compatible things I suggested above. Show them the alternative will save them money and that could change the whole ball-game. Bye-bye naturopaths. You cost too much and don't do enough for what we're paying you. Hello, wellness assistant, you cost-efficient little angel!
If I'm off base here, please explain why...
There is a private, family-based, alternative medicine organization. I read something about it. I believe the wife was treated for cancer using alt-med. I think they fund a school or research chair at a university Alberta. I seem to recollect Calgary. I will see if I can track down the reference.
I believe I was thinking of these folks:
http://www.hecht.org/
Almost half their funding goes to CAM. I don't know if they have $4 million to throw around. They do fund the $250,000 Dr. Rogers prize, but it is awarded only every 2 years.
Ten years ago the Templeton Foundation donated a few million bucks to enable a double-blind trial to test the power of wishful thinking to help with illness. Prayer, in other words.
The trial found that such wishful thinking had no effect except a negative one when subjects knew they were being prayed for. Possibly because of extra stess due to interpreting their illness to be more serious than they had thought - serious enough to warrant prayer.
The integration of other kinds of wishful-thinking modalities with scientific practices is unlikely to add significantly to the scientific clinical benefits. A double-blind trial would be able to demonstrate this.
What a pleasant surprise it will be if this study turns out to be that. Not that a null result would deter the true integrative believers. They would be sure to say that more research is required. It's not about science, after all. It's all about wishful thinking.
sadmar, one "tool" NDs use is guilt. The patient has to make all kinds of promises up front to "take responsibility" and then gets a load of guilt laid on if they aren't/can't measure up. And, then, the financial commitment a pt. makes is also significant and, I suspect influences compliance.
This seems more diatribe against *even trying* integrated therapies than constructive criticism. Continually not trying biological treatments is misguided and does cancer patients a disservice.
Even now, scientific, biologically based integrative therapies can help push "standard medicine" far beyond its current limits in metastatic cancer. Integrative treatments can hit similar targets and pathways without the toxicity, or cost. Further, they can hit many more targets at a time, because conventional therapies are typically limited by patients plugging up and coming unglued with more than 2-3 chemo drugs at a time.
e.g. why suffer the catastrophic side effects of some mTor inhibitors for $10,000-$20,000 per month, if you might get 50-110% of the good with a bottle of quercetin added to the stack and have still have $1000s left over after integratively hitting 10 other targets with other goodies, too?
Please note, I've dealt with multiple inoperable extrahepatic sites with about two dozen distant mets, from the start, with bad biomarkers at multiples of the upper range limit and an R2 resection in the peritoneum.
Partly by making mets operable, partly by doing way off-standard chemos with "nutrients". It sure wasn't just 900 mg 5FU content/m2/week that did the job - alone that might be more like fertilizer.
My experiments have now run over a year past 100% extinction according to modern papers, eg. see (Gallinger, 2013). And before you say it, it isn't spontaneous remission either. It's more like wrestling with pythons that got you down several times when you slip the slightest amount, but were each relieved with a head shot.
PRN, I noticed you linked to a real science paper but not to any peer based literature of your own. Can we all assume that like all magic based practitioners your proof is your word alone and based on nothing but anecdote? Certainly anyone who pushes quercetin as a valid treatment cannot be trusted. 96% of ingested quercetin is excreted unchanged within 72 hours. It is worthless but must bring you a pretty penny from desperate cancer patients.
Sorry, prn, I didn't see anything in the paper you linked to about quercetin or any of the typical naturopathic therapies like homeopathy, nutritional changes, acupuncture, reflexology or whatever.
What it did discuss was using liver resection, i.e. surgery, in addition to chemotherapy for patients who had colorectal cancer that had metastasized to the liver.
What seemed to be multidisciplinary about it was getting colorectal oncologists to work with thoracic surgeons to evaluate which patients might be suitable for liver resection, either before chemotherapy or possibly after chemo had some success in reducing the size of the metastases.
Try to at least link to a paper that discusses the treatment you are advocating.
Also, it was performed by Cancer Care Ontario, which is in Toronto, as well as the University of Toronto.
Ottawa, where Seely's little group works, is 449 km away.
The 2013 paper merely includes references to patient groups with the most dismal colorectal survivorship at 0% at 5 yrs and *well under*, giving datable tx and time frames to the stats. The dismal ones that were a waste of effort. Those particular dismal stat groups compare with what I have to work with at the individual level.
The quercetin comment was simply that there are natural, targetable inhibitors, with low toxicity and cost, among many. Not going to argue is too, is not, just establishing my point of view for the unwashed newbies here.
...must bring you a pretty penny from desperate cancer patients.
No. They [CAM txs] save me a pretty penny from ignorant drs and costly, low efficacy suppliers. My particular experiment greatly exceeds their corresponding [sub]class performance on QOL and OS, at this point well beyond conventional medicine's 2nd-3rd deviation for conventional treatment up to the early Avastin/Erbitux era. Still winning outright on QOL, $, and probably slugging it out at 2nd deviation for those spending $2m conventional on multiple surgeries and lines of treatment even today, and still living miserably and dying much sooner.
So, prn,
how many of those you have treated with quercetin had stage 4 colorectal cancer that had metastasized to the liver?
How many of those are still alive 5 years after the diagnosis of the metastisis?
sadmar @15: you're right on 2 counts: "usual +nd" vs "usual " isn't fair, and that PCPs aren't necessarily positioned to provide the counciling needed form some of the lifestyle and behavior changes.
Specifically on the healthy diet front, what you need is a dietician. They can spend more time discussing diet (since that's what they do) and (hopefully) provide lots of specifics (rather than "eath healthy").
On other fronts, what a patient might need is physical therapy, an exercise trainer and a good old mind-therapist. But 5 separate people, and the stigma about therapy, and potentially problems with insurance, make all of that difficult. It is asking a lot of a person to make all of those separate appointments. When an ND might claim to do it all on a few sessions at one office.
So what we really need isn't "integrative medicine", it is to integrate our existing evidenced-based providers. Some health organizations do this (Group Health, Kaiser, for example), but it is still very rare.
Personalization favors n=1. The quercetin mentioned is not "a treatment" per se, it is simply an example of one natural inhibitor that some would dismiss out of hand. I buy many inhibitors, some are generic drugs with unapproved uses in the US and some are "natural" compounds.
I am very interested in personalization, biometrically stratified extraordinary performances e.g. "where no man has, gone lived, before", unfettered access to materials and technology, and closely analyzed case/phase I/II level results similar to what pharma research does in inhouse with unpublished data and details.
Tunnel vision here focuses on mushed together, large scale tests like for expensive new drug approvals that exclude or distrain competition. Such limited answers, decades late and trillions of dollars short, may be the death of us all.
"gone" was supposed to struck out with the line through it.
Dealing with very fatal situations and improved performance, the previous extinction point for best available techology and standard deviations are more useful. For example, de novo treated survivor dies at 37 months is a lot better than last survivor monotonically died at 19 months with SD=4.1 months. But both have 0% 5 yr survival. The median isn't the message, and neither is one size fits all.
@prn,
n=1 is the point in Flatland. It is unique, but has no connection to any other point and nothing to compare itself to.
So, doing something different for each individual means you have no way of knowing which component or components of your treatment help or hurt.
Since there is variation in the response of different individuals to the same treatment, you need a useful number of individuals receiving it with follow-up to assess the results.
Then, you can calculate an average an a standard deviation.
With only one individual for the same treatment, you have no average or SD. You only have a point and nothing to compare it to so that you can say if it's good or bad, the result of your treatment or just a lucky patient.
And, since you couldn't answer my simple question, I'm inclined to think you're not even collecting those follow-up numbers.
prn has a very obscure way of communicating, but prior comments indicate that s/he is treating him/herself and not others. prn is not, as I understand it, profiting off sick people but is a cancer patient attempting to survive and has, so far, done well. As others have pointed out though, we don't know which if any of the various things s/he has tried actually made a difference.
Not favors it; but perhaps requires it.
Of course, the downside is that n= 1 prevents you from deriving any conclusion at all on the efficacy of the intervention that single subject received.
Better for that first survivor, surely, but in no way suggestive that the reason he survived for 37 months was because of whatever personalized treatment he received. There's certainly no reason to presume that in the absence of that treatment he would also have died at around 19 months after diagnosis.
Thanks for the clarification, LW.
It's been a while since I had read something from prn, so I had forgotten some of the background.
SE: re Classical stats on a single data set.
There is a long discussion about combining prior knowledge, various tissue work, multiple biomarkers, scans, biopsies and well behaved multipoint, piecewise co-linear data to yield some treatment insights. But I am not really into it this week.
JGC: Even EBM recognizes unusual survival for particular state, with no other recognized causal event or process, as a degree of evidence.
I avoid some kinds of personal information, not even yes/no/maybe.