The quackery that is "naturopathic oncology"

With a bill to license naturopaths (HB 4531) wending its way through the Michigan legislature supported by supplement manufacturers, its current status being in consideration by the full House of Representatives, periodically I feel the need to provide ammunition to the bill’s opponents, because we need to protect the patients in the state of Michigan from the naturopathic quackery that would be unleashed if this bill were to be passed into law.

If there is one area that naturopaths have been invading with a vengeance and even gaining enough seeming legitimacy to propose what they risibly refer to as “evidence-based guidelines,” it’s oncology. Many are the times I’ve written about how much naturopaths, who use the abbreviation “ND” (which from my perspective means “not a doctors”) and have formed their own specialty of “naturopathic oncology,” signified by FABNO (which I like to refer to as, “FAB? NO!”) subject patients to. Not surprisingly, one organization that’s really embraced naturopathic oncology is the Cancer Treatment Centers of America, a for-profit hospital chain that’s made its name advertising the “integration” of quackery with real medicine, known as “integrative medicine.” Depressingly, the Society for Integrative Oncology (SIO), an organization supporting the integration of “complementary and alternative medicine” (CAM) modalities (i.e., quackery) with real oncology, seems to accept naturopathy as a valid specialty, as two naturopaths were among the authors of the aforementioned SIO guidelines for the integrative treatment of breast cancer. As I found out, their naivete is profound, as evidenced by the SIO’s surprised and indignant reaction to my dwelling on homeopathy in my critique of integrative oncology. The SIO responded by accusing me of dwelling on the modalities with the “weakest evidence bases” (like homeopathy), apparently unaware that naturopathic training includes a lot of homeopathy and the naturopathic licensing examination (the NPLEX) has a whole section on homeopathy, and that one of the naturopaths who wrote the SIO guidelines for breast cancer was running a clinical trial of homeopathy at the time. Heck, an ex-naturopath has even revealed a scary practice question for the exam. That’s not even counting what naturopathic oncologists say when they think no one’s listening and the quackery to which they subject their patients.

Naturopathic oncologists even brag about it. They’re proud of it, so much so that they’re more than happy to publish what they do, as they did in this article for Integrative Cancer Therapies entitled Breast Cancer Integrative Oncology Care and Its Costs. But wait. I bet you’re thinking, “But, Orac, integrative oncology and naturopathic oncology are not the same things.” Right you are! Two of the authors of this paper are FABNOs, and they declare in the abstract, “Naturopathic oncology in conjunction with conventional treatment is commonly referred to as integrative oncology (IO),” and state specifically that the purpose of this study is to “To describe the types of IO therapies prescribed to breast cancer patients by ND FABNO physicians.” So, yes, this paper is about naturopathic oncology more than “integrative” oncology. Sure, there’s a fair amount of overlap, but not all integrative oncology is naturopathic oncology, although all naturopathic oncology is integrative oncology; that is, if you accept the nomenclature, which I do not.

Nor do I accept this premise of the study:

Because of their training and their licensed scope of practice, ND, FABNO are among those able to offer comprehensive whole-person integrative cancer care. For this reason, IO clinics directed by ND, FABNOs are a source of high-quality data for describing these therapies and their costs and measuring clinical outcomes. IO clinics are a rich source of data for cost-effectiveness research. Such care consists of a whole-person-oriented approach, including a variety of evidence-based complementary and integrative medicine practices that include a diversity of nutrient and botanical natural products, diet and exercise plans, acupuncture, hyperthermia, and mind-body medicine. Many of these therapies are based on clinical evi- dence. Although cost and cost-benefit analyses of CAM and integrated health care have been conducted5, and CAM use among breast cancer patients described, neither IO care nor its costs as it is practiced in community settings has been well described. Description of IO medical services is a required step toward evaluating its impact on disease-free and overall survival in breast cancer as well as measuring its cost-effectiveness.

Of course, to measure cost-effectivness, there has to be effectiveness to be begin with. With the vast majority of naturopathic treatments, the evidence of efficacy is sketchy at best, usually nonexistent, or at worst contradictory to any claims of efficacy. In any case, there were 324 patients with breast cancer treated at one of six naturopathic oncology clinics in the Seattle area, who agreed to be enrolled in a five year observational outcomes study. Of course, given that there’s no control group and any outcomes observed would have to be compared to historical controls, this trial design virtually guarantees that naturopathy won’t be embarrassed by poor outcomes, mainly because it’s likely that women attracted would be a select group. Indeed, I note that only 3.7% of the participants had stage IV disease when they sought out naturopathic treatment, and only 9.9% were stage III. Thus, the vast majority of the subjects had early stage disease. In fairness, though, I do note that only 6.2% of the patients had stage 0 disease (ductal carcinoma in situ, or DCIS, which is premalignant and noninvasive), a lower percentage than at most cancer centers.

Table 5 is the money table. It shows the types of treatments received by the subjects in the cohort who had at least two office visits. These included, predictably, a whole boatload of supplements, such as Coriolus, also known as Yun Zhi, Turkey tail, or Trametes versicolor, which an astonishing 62.7% of the patients received. I was unfamiliar with this particular herbal medicine. Basically, it’s a mushroom used in traditional Chinese medicine as a tonic. There are studies that suggest antitumor activity for some cancers, but the results in breast cancer have been unimpressive. The rest of the supplements included the usual suspects, such as melatonin, vitamin D3, digestive pancreatic enzymes, green tea, seaweed poultice, black cohosh, and many others. About 12.3% of patients received various injectables:

Of the 287 women described in Tables 4 to 6, 76 (26%) were prescribed some type of injectable therapy. Injectable IO therapies included subcutaneous injections of mistletoe (Viscum album) and a diversity of parenteral therapies that included vitamin B complex intramuscularly (12%), IV high-dose ascorbate (12%), IV artemisinin (7%), and IV nutrition and hydration (4%). Injectable therapies were used almost exclusively in stage 4 breast cancer patients (data not shown).

Other than hydration, the vast majority of these treatments range from quackery to unproven. Worse, they’re used for the patients who can’t be cured and would be expected to be most desperate. I’ve discussed high dose vitamin C/ascorbate on many occasions. It almost certainly doesn’t work for any cancer, and even if it does it requires incredibly high doses for incredibly underwhelming effects. As for nutrition, which is supposed to be the strong point of naturopaths, who castigate MDs every chance they get for supposedly not knowing much about nutrition and not emphasizing it enough in their treatments, this is what the naturopaths provided:

Whereas some patients (20%) were referred for nutritional counseling by a certified nutritionist, most received dietary advice from the IO physician within the visit. Dietary recommendations included increased green tea as a drink (24%), increased vegetables (17%), broth fast (16%), increased protein (13%), increased water (15%), reduced simple sugars (8%), increased fish (7%), and decreased mammalian fat (5%).

None of these are likely to be harmful, other than a broth fast, which is not a great idea for a cancer patient undergoing chemotherapy. Be that as it may, there were other recommendations that are less helpful, such as juice fasts, eliminating dairy, eliminating wheat, and the like. Of course, one can’t help but note that the 20% referred to nutritionists were almost certainly referred to woo nutritionists, as real nutritional counselors practicing evidence-based nutrition counseling are called dieticians.

In any case, the remainder of the modalities examined were of the “mind-body”variety, including massage, meditation, unspecified “mind-body” therapy, and qi gong, which aren’t likely to be harmful, but 6.8% were also referred for the quackery known as craniosacral therapy.

Now let’s look at the cost:

The direct costs of care include medical visits (naturopathic oncology consultation and mind-body medicine visits), procedures (acupuncture), and pharmacy. Pharmacy includes nutritional and botanical medicines administered orally, intravenously, subcutaneously, intramuscularly, or topically. Yearly cost for office visits ranged from $512/year to $1084/year. Stage 3 women had the most visits and the highest visit costs compared with women at other stages of breast cancer at diagnosis.

That doesn’t sound so bad. However, this does:

We asked the ND, FABNOs to describe an ideal core protocol for IO care for each stage and type of breast cancer. We then calculated the cost of IO pharmacy for 1 year of care for a stage 4 cancer patient. Table 8 presents an IO core therapy program for 1 year of treatment for a stage 4 breast cancer patient. Total cost of the medicines used in this treatment plan for 1 year is approximately $27137. Parenteral therapies were the most costly of IO treatments, and few stage 4 breast cancer patients completed such an idealized treatment. Total costs (visits and IO pharmacy and procedures) of 1 year of IO treatment for a women with progress- ing stage 4 breast cancer is approximately $31662/year. ND, FABNO visits cost approximately $4525/year (see Table 3). Office visits are reimbursed by medical insurance providers, including Medicaid but not Medicare.

Naturopaths will say that chemotherapy costs more, and that much is true. The difference, however, is that chemotherapy is an effective adjuvant therapy for early stage breast cancer and for stage III, while it can, when judiciously used, be a good palliative treatment for stage IV breast cancer. Nothing in the list of intravenous treatments for breast cancer listed in Table 8 is proven, either as an adjuvant therapy or palliative therapy. Certainly nothing in Table 8 is curative.

So how does one justify spending $30,000 a year on intravenous therapies that do nothing? The funny thing about this article is that it doesn’t even try. It is simply an observational study, which reported what treatments were received by this cohort of 324 breast cancer patients and how much it cost. The naturopathic oncologists and other authors of the paper seem to have simply assumed that these treatments are worthwhile and effective. They do not question them. From my perspective, doing studies like this is totally putting the cart before the horse. Efficacy should be established first, and then utilization and cost are worth studying. In the world of naturopathic oncology, it doesn’t matter if the treatments being studied work or not. In fact, this study gives a falsely reassuring picture of just how quacky naturopathic oncology and naturopathy in general are. Remember, this studied only clinics affiliated with an academic medical center, which are the ones that are trying to be the most "respectable" and whose practitioners are under the delusion that they are evidence-based. As I've shown many times, if you go beyond these clinics, you'll rapidly find incredible quackery offered, such as IV ozone therapy, homeopathy, applied kinesiology (a favorite!) for food "allergy" or "sensitivity" testing, and more quackery than I can describe in even a 2,000 word post.

I’d just like to leave with a question and an answer. The question is: Who funded this study? The answer: The National Center for Complementary and Integrative Health. Yes, the NCCIH continues to waste taxpayer money on pointless studies like this.

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Yearly cost for office visits ranged from $512/year to $1084/year.

The lower end of that range would be 3-4 office visits, for patients who are undergoing active "treatment" for a chronic condition. Let's just say that my BS detector is giving me a signal here. What are they not including in the cost of an office visit? And do they really see the patients that infrequently?

By Eric Lund (not verified) on 01 Jun 2016 #permalink

IV artemisinin. Great. There is no better way to ecourage the evolution of resistant organisms than to misuse antimicrobials. I hope this is not used by quacks in areas where malaria is endemic,

By Michael Finfer, MD (not verified) on 01 Jun 2016 #permalink

Still incredibly ill-informed about IV vitamin C.
Figure 52-104 infusions per year at $200 each. I paid less for retail service to the MD's office for 62 gram infusions in a large US city. That's $10,400 - $20,800/yr high side.

Even terminal, horizontal patients are put on their feet, able to go out and enjoy the day.

But one big deal is with respect to histamine, HIF-1a, KRAS mutant patients. This fundamentally alters cancer patients production of VEGF-A without the toxicity of Avastin or similar.

It must be embarrassing when drs so openly fall behind, that civilians can do better at home than at the hospital.

My challenge for quacks who want to be taken seriously is always the same. Show me one example of a treatment that was used by your community of practitioners, which was tested, found to be wrong, and discarded.

No field of human endeavour is immune from error. I don't think anybody would seriously dispute that. So either you have examples of things that have been abandoned as incorrect, or you have no functional mechanism for distinguishing valid and invalid therapies.

Any system of treatment that has no objective mechanism for self-correction, will necessarily result in a positive-feedback loop. And positive feedback loops always drive to the extreme. If you have no robust mechanism for testing, evaluating and discarding treatments then it is not only likely but pretty much inevitable that you will end up using dangerous and ineffective treatments.

By Guy Chapman (not verified) on 01 Jun 2016 #permalink

@prn: IV vitamin C does not actually have any objectively demonstrable effect, so it doesn't really matter if the scammer is "only" bleeding the patient of ten thousand dollars (which is ten thousand dollars more than the annual cost of healthcare in my country, by the way) or a hundred thousand.

By Guy Chapman (not verified) on 01 Jun 2016 #permalink

@ Guy Chapman

So either you have examples of things that have been abandoned as incorrect, or you have no functional mechanism for distinguishing valid and invalid therapies.

I remember an article by homeopaths testing different speeds of succussion to activate some nostrum. Their results showed that the speed set by Hahnemann more than one century ago was the best.
It's possible that someone got it right the first time, or that the technology available at his time was sufficient to test different modalities and focus on the better one - although there is no trace of these tests, AFAIK.
Still, these results were very convenient.

By Helianthus (not verified) on 01 Jun 2016 #permalink

I remember an article by homeopaths testing different speeds of succussion to activate some nostrum. Their results showed that the speed set by Hahnemann more than one century ago was the best.

I haven't read the article in question, but this sounds like the kind of study where one needs to be especially careful about investigator bias. If the patient knows he's getting an "experimental" rather than "traditional" homeopathic remedy, that could have an effect--and the only way a patient would know is if somebody running the trial told him which group he was in.

By Eric Lund (not verified) on 01 Jun 2016 #permalink

I've been hearing about the Turkey Tail mushroom ( and Shiitake and Miitake ) for cancer for a long time- in fact, even though I can't access it now, I have a 1990s tome about natural health that discusses that .
IIRC prn knows about these therapies.

By Denice Walter (not verified) on 01 Jun 2016 #permalink

That's MAITAKE

By Denice Walter (not verified) on 01 Jun 2016 #permalink

Can we pause for a sec and talk about that question Britt Hermes posted? That kid is not just in respiratory distress; that's pending arrest. 60 and gasping is bad, bad, bad. 60 respirations is an easy one to remember because that is tachy at any age; at 8 that's more than twice the normal range.

And he's working hard. 60 is not sustainable when it's effortless. With the cough and gasping this kid is quitting sooner than later.

Note that there's no mention of mental status which would be the first thing I would need to know for deciding treatment. Normally you don't want to agitate croup patients but I'd they're altered you need to get aggressive.

And lastly, remember this is a phone call. A PHONE CALL! Doesn't the Ezekiel story make more sense? Tannis did exactly what she was trained to. How is it that they have any success when they kill children in their test scenarios?

Sorry for the digression Orac. Pediatric emergencies were my thing so that really grinds my gears.

By capnkrunch (not verified) on 01 Jun 2016 #permalink

@Guy Chapman #4:

So either you have examples of things that have been abandoned as incorrect, or you have no functional mechanism for distinguishing valid and invalid therapies.

Or, option C: they do not care which of their "therapies" are valid or invalid, as long as they attract marks.

Guy@5
@prn: IV vitamin C does not actually have any objectively demonstrable effect,
You're just parroting and shouting an extraordinarily uninformed, dogmatic opinion.
At 1 gram per kg, infusion time is the primary delay, otherwise for redox effects, including toxins, the benefits can visibly start in minutes. Toxins, ROS, and excess histamine are being chemically neutralized rapidly as well as other processes occurring.

We've had to implement several of Klenner's uses, including a smaller, slower motion version of the caterpillar incident, and our results are consistent with his.

(which is ten thousand dollars more than the annual cost of healthcare in my country, by the way) or a hundred thousand.
If IV vitamin C were streamlined for administration, the IV costs might be under £25 by UK medical accounting. Of course, US prices are way inflated, largely controlled by supplies, restrictions, and lack of volume and competition.

Denice Walter@8
I’ve been hearing about the Turkey Tail mushroom ( and Shiitake and Miitake ) for cancer for a long time
The asians have scores of turkey tail papers for PSK and PSP. My data show some improvement in 5FU-LV chemo activity, and was key to stopping/slowing/reversing WBC erosion on chemo. At something like triple dose, both PSK and PSP, I was able to spike WBC from 5 to over 9. A lot of chemo patients get in trouble when their WBC goes below ~1.5 after a few times or months.

One Japanese paper had data suggesting that PSK had a targetable OS association with initial CEA level.

@prn #12 Deja-moo: the uncanny feeling that you've heard this bull before.

Yes, quackery shills always describe the reality-based view as uninformed and dogmatic. They also come up with equally unhinged guesses as to how much the NHS could save by spending money on quacks rather than evidence-based treatment. Guess what? None of that counts. What counts is systematic reviews of large scale clinical trials, plausible mechanisms of operation, and (importantly) the advocates of a treatment not being obviously charlatans.

By Guy Chapman (not verified) on 01 Jun 2016 #permalink

You’re just parroting and shouting an extraordinarily uninformed, dogmatic opinion.

I suggest you type the words "vitamin c" into the little box that appears at the upper right underneath the words "Search This Blog". That will allow you to read what Orac has posted on the subject in the past. You will find that in 2014 he commented on a paper that purported to show such an effect, and he was unimpressed by the evidence. He noted that very high concentrations of vitamin C (unrealistically high, in his opinion) were required to see any effect at all, and even then the effect was not terribly large. There were also issues with study design, something that happens with depressing regularity. The journal in which this study was published is a sister publication of one of the so-called "glamour mags": journals which have a reputation of pursuing impact factor at the expense of rigor. That by itself doesn't mean that this paper was wrong, but it's good reason to be skeptical, especially when the evidence presented is less than slam-dunk.

By Eric Lund (not verified) on 01 Jun 2016 #permalink

Of the 287 women described in Tables 4 to 6, 76 (26%) were prescribed some type of injectable therapy. Injectable IO therapies included subcutaneous injections of mistletoe (Viscum album)
Table five fails to mention mistletoe. What's up with that, Standish, Dowd, Sweet, Dale, Weaver, Osborne, Anderson?
Mistletoe injections are not approved for use in the US outside of clinical trials, yet NDs in Utah, California, Colorado, New York, Utah, Arizona, Vermont, and probably other states, advertise it as one of the possible therapies the ND may prescribe. If they are not reselling it, they teach patients how to obtain it illegally from Canada or Germany (its use is legal in both those countries).
I suppose either too few people have complained, or the FDA and the FTC have bigger fish to fry, but why do none of the naturopathic schools, 'professional' organizations, or naturopathic licensing boards sanction these NDs?

mho @16: Mistletoe! Right, because what I really want when I'm fighting an pernicious growth is injection with a plant that is a ... pernicious growth! Mistletoe is a parasite, and if it weren't so pretty in winter (giving it religious connections) then no one would let it grow.

By JustaTech (not verified) on 01 Jun 2016 #permalink

@Eric Lund
yep, b.s. about the $. One of the FABNOs directs clients to obtain $1200 worth of blood tests before their first visit. Legitimate tests, but they are largely irrelevant. Said FABNO also has them repeat many of the tests on a monthly basis, even for clients who are in remission.

"Mistletoe is a parasite, and if it weren’t so pretty in winter (giving it religious connections) then no one would let it grow."

An example of survival of the cutest?

For the record, Trametes versicolor (syn. Coriolus versicolor) and crude extracts thereof are far from the same thing as the purified Japanese drug, PSK (Polysaccharide Kureha) derived from the fungus. Crude extracts are legally available as dietary supplements, but PSK is not. Yet, among others, naturopaths commonly conflate the two. What's next? Crude extracts of Taxus brevifolia or T. baccata conflated with Taxol?

There is no reliable evidence to show that either a crude extract of the fungus, PSK, or PSP, another polysaccharide derived from the fungus, are effective against breast cancer. To suggest otherwise is unconscionable.

By Lighthorse (not verified) on 01 Jun 2016 #permalink

Eric Lund@15
Guy: @prn: IV vitamin C does not actually have any objectively demonstrable effect...
prn:You’re just parroting and shouting an extraordinarily uninformed, dogmatic opinion.

Eric, my comment in this exchange refers to treating acute viruses and toxins with IV C, not cancer which is far more lengthy and complex. MSM has sidelined a full tx where NNT-->1 for too long. Probably the simplest solution is to vote with our feet, our dollars and faint praise.

....and he was unimpressed by the evidence. He noted that very high concentrations of vitamin C (unrealistically high, in his opinion) were required to see any effect at all, and even then the effect was not terribly large....
MSM once again missing the boat. While C itself is a mild tumorcide, it's properties against histamine, HIF-1a, VEGFA are being more recognized as antimetastatic.

Increased tumorcidal performance is achieved with multiple adjunct modulations and even light chemo like oral 5FU drugs. We're increasingly unimpressed with MSM.

@ Guy #5: I disagree that it doesn't matter if the scammer is only getting $10K vs $100K since the treatment doesn't work.

It matters. It matters a lot. What I think this study Orac has discussed does is expose naturopathy for the financial fraud that it is. Orac is right when he says you study efficacy before you study cost. The study authors skipped that part, so what they have shown is cost without proof of benefit, a benefit they didn't show because other studies of these "treatments" have shown little to no benefit.

So if you're giving a patient treatments you know don't work, that's fraud.

The good news is, now that we know how much the fraud costs, since there is no demonstrable benefit, CMS will not classify these treatments as best practices under the ACA, and quacks will have a hard time getting Medicare to reimburse for them, which will give insurance companies leverage not to reimburse either.

mho @18
One of the FABNOs directs clients to obtain $1200 worth of blood tests before their first visit. Legitimate tests, but they are largely irrelevant. Said FABNO also has them repeat many of the tests on a monthly basis, even for clients who are in remission.
Do you have a link or a name that discusses the test details?

For a high risk, borderline stage III likely to recur the first 2 yrs, $1200 per month is an investment if it alters the odds or detects a recur sooner. An unresectable recur in CRC likely means $50-60,0000 per month in billed costs, plus social costs (e.g. jobs and young kids) and death.

If the test series streamlines with a learning curve, areas of application are defined, or costs are reduced with volume or competition, then I call that progress.

Lighthorse@20
For the record, Trametes versicolor (syn. Coriolus versicolor) and crude extracts thereof are far from the same thing as the purified Japanese drug, PSK (Polysaccharide Kureha) derived from the fungus. Crude extracts are legally available as dietary supplements, but PSK is not. Yet, among others, naturopaths commonly conflate the two.
PSK in Japan can have a common source for a supplement sold in the US. Sometimes fiber products are imported from multiple sources, graded, and sold as different lines of supplements

prn: if the tests don't have anything to do with a recurrence of cancer, then it is NOT money well spent.

Pancea@26 I'd like to see the specific tests myself. I have found NCCN and ASCO guidelines insufficient for my purposes, so I am curious there. Also I have a friend that gets a different set of tests from an ND that I'd like to see the differences there too.

@prn #25: That doesn't mean anyone is taking PSK in the clinical doses used in Japan in supplements sold in the US.

By Lighthorse (not verified) on 02 Jun 2016 #permalink

Here's an example of the kind of conflation of PSK and Trametes versicolor that I mentioned in my earlier post. It's one of the worst studies on breast cancer that I have ever seen. Guess who was behind it? None other than Leanna Standish, ND, PhD, LAc at that illustrious bastion of bull, Bastyr University. Moreover, to call T. versicolor a "mushroom" is just plain wrong for the simple reason that it lacks a fleshy cap.

Follow the hype and you will find the product used in the study is made in the U.S. and promoted by the manufacturer in direct regard to breast cancer. WARNING: the video may cause certain viewers to become upset.

By Lighthorse (not verified) on 02 Jun 2016 #permalink

ADDENDUM to #29: Contrary to the simplistic description of <A HREF="Standish et al, PSK or "Krestin" is not a mere "hot water" extract of the inedible wood-rotting fungus T. versicolor.

By Lighthorse (not verified) on 02 Jun 2016 #permalink

Yes, I'd like to know more, and please do post the list of what the ND you know orders. I have no medical training, so I'm not 100% sure of myself here and I'm quite curious about them. I asked about a few of these tests and googled others, but I didn't want to waste much of my physician's time on naturopathic baloney. I'm somewhat familiar with a number of the tests, although neither my primary or my onc. orders them routinely--for example we check thyroid about once a year. A friend asked her nurse practitioner, who laughed, and then got mad and took a copy to share with her colleagues.
Ferritin and copper are the first two that come to mind. Yes, ferritin might have something to do with fatigue, but if RBC is in normal range, why would a ferritin test be called for, particularly if the ND had not seen the client or taken a history yet? And why do serrum copper and ceruloplasmin? Give patients something else to worry about, that the naturopath can claim to fix, again--typical. I'm not a doctor--but testing for copper? What's she going to do, recommend--chelation? Yes, there're some mouse studies about copper and cancer, but this is so typically ND--experiment on patients.
Homocysteine?--again, without having a history? He4 plus a CA-125? CA-125 is a better marker, and without even knowing if the CA-125 is a good predictor for that patient, why order it in advance?--its a $300+ test. Why get it monthly? HgA1c--I asked my oncologist, and he said the tests he does make the hgA1c unnecessary. And again, monthly? C-reactive protein isn't even done routinely for heart patients, is it? Is an “anti-inflammatory diet” (that nds love) meaningful for cancer patients, or anyone else? Isn't the gene mutation that a G6pd reveals very uncommon?, but then, you need that if you're going to sell IV vitamin C, don't you?

TPO antibodies, antithroglobulin, TSH, T3 and T4? As far as I know, another naturopath gambit is sub-clinical thyroid disease. All those tests are on top of the tests an actual oncologist would d, and (cbc, magnesium, phosphorus, white blood cell, RBC, various sed rate tests that I don't have in front of me) And there are a few others that I may have copied incorrectly and don't recognize. -d-dimer, Pal-1. vegf. (is vegf a rountine test now? Lets see what I forgot...insulin, Ig1, fibrinogen.
The $1200 was using the price list from one of those online discount labs, so I don't know if the prices are accurate, I'd guess normally they cost more.

D dimer? We use that to test for coagulation disorders, specifically to rule in or out pulmonary embolism, DVT or DIC.

If a patient is in remission, there is no clinical indication to test for that unless they are symptomatic.

It’s one of the worst studies on breast cancer that I have ever seen.

It's from Hindawi. I'm sure you can find something even worse.

By herr doktor bimler (not verified) on 02 Jun 2016 #permalink

From Lighthouse's link:

one-way ANOVAs with Turkey post hoc multiple comparison

FFS.

It’s one of the worst studies on breast cancer that I have ever seen.

I grant you, collecting three heterogeneous cases and calling them a "cohort" is hard to beat.

By herr doktor bimler (not verified) on 02 Jun 2016 #permalink

Thanks panacea. Any info for me on the other tests?
See what I mean?-legit. sounding tests--not so quacky as live-blood analysis--but inappropriate and therefore unnecessary. This Nd, and all of them I suppose, launches into a full-on gish gallop about these, and her clients are dazzled and think she has such a wealth of information that they can't get anywhere else. Never mind that they haven't a clue what it means...

Well, and I should clarify that we wouldn't do a d dimer for a cancer patient in remission unless they had s/s of DVT, PE or DIC, not if there was a question the cancer was coming back. Sorry if that wasn't clear.

I'm a nurse educator, not a physician, and I don't work in oncology (my first job was on a med surg/oncology floor but that was 30 years ago) so I'm not familiar with every one of the tests you mentioned. I wrote about the D dimer because that one stunned me so much.

TSH, T3 and T4 is a thyroid panel. TSH is Thyroid stimulating hormone, T3 (triiodythyrone), and T4 (thyroxine). The thyroid is a gland in your neck that produces hormones that play an important role in metabolism, oxygen consumption of cells, and calcium regulation (through production of calcitonin). That's way over simplified btw. Usually if the TSH is high, the thyroid is hypothyroid, and the correction for that is adding iodine to the diet (which is why we add it to salt because it doesn't take much). Hyperthyroidism is a cause of Graves Disease.

The only reason to do a thyroid panel is to check thyroid function. But if someone was treated for thyroid cancer, part of the treatment is to remove the thyroid, to my knowledge they take out the whole thing and it doesn't grow back. Patients have to be on life long Synthroid and calcium supplements. So doing that test at all, much less monthly, is completely unnecessary and expensive.

There are some people who have a normal thyroid panel but still have a thyroid disease, but they are rare and there is a more sensitive test for that but I can't remember what it is. It's not tracked monthly, and it should be diagnosed by an endocrinologist not a naturopathic quack.

HgA1C measures blood glucose consumption over the 120 day life cycle of a RBC. Totally unnecessary to do monthly.

C reactive protein is an inflammation marker. It's more sensitive than the erythromycin sedimentation rate (sed rate). In people with cardiovascular disease, it indicates risk and possible indication for statins. There's been some study of risk relative to colon cancer, but that's fairly new and I don't know much about it. But it wouldn't need to be done monthly.

Yeah, you can test to see how much insulin is in the blood, but we control it by measuring the blood glucose. Knowing what the insulin level is is only useful in some limited diagnostic instances, like when trying to decide to switch a Type II diabetic from an oral med to insulin. But since that decision can be made with less expensive tests based on clinical judgement of the physician (and we have tons of literature on how to do this, so doctors have a good grasp of what they're doing) there is no need to do this test for most patients and again, it tells us nothing on a monthly basis.

Fibrinogen only tells us something about how the coagulation system is working. A doctor would only order it for someone who is having bleeding issues that are difficult to control. I don't see what it has to do with cancer, nor that it would be useful on a monthly basis.

Ig1, I guess that means testing the immunoglobulins (IgA, IgG, IgE and IgM) antibodies. It's a measure of our immune systems, or part of it (our acquired immunity, ironically this is the part of our immune system vaccines stimulate). Again, unless the patient is having a problem with recurrent infection I don't see a need to test for it, certainly not monthly.

Most of the others I'm unfamiliar with. I'm sure some of the physicians here can correct any errors I've made or elaborate further if needed.

Oh yes. All those tests. You have to understand that naturopathis are constantly seeking ways to justify their experimentation on people. If they can make some correlation to a marker, all the better. Let's see. Thyroid function, because without it, how would the body make T cells? But C-reactive protein and cancer? Last time I checked up on the subject, which was about 5 years ago, I came away unimpressed. CRP levels were often elevated in people with excessive body fat around the waist, whether they healthy or not. CRP is a non-specific marker associated with inflammation, but not an inflammatory substance itself. But hey! The more tests you do, the more likely you are to come up with some correlation or other to justify your beliefs, experiments on people, and your bill!

By Lighthorse (not verified) on 03 Jun 2016 #permalink

Well, except that T cells form in the bone marrow (like all blood components) and populate the thymus (not the thyroid) to differentiate into the various types of T cells.

But I can see how a quack could confuse the two. ;)

The extra blood tests typically reflect the environment of cancer (e.g. inflammation sources increasing cytokine levels) and nonspecific markers that become more useful in advanced cancer.

I've seen a lot of friends and acquaintances blindsided by misdiagnosis (early or missed stage 4's dx'd as 2 o3) and missed recurs, and die sooner. Belated dx means they missed their last windows of curative tx.

Assiduous tracking of extra bloodwork means fewer surprises and a better handle on what's going on. The naturopaths are also attempting to modify the molecular environment of any residual cancer cells, keep them quiescent if possible and improve immune performance (leucocytes full of ascorbae, lower inflammation, etc) .

D-dimer can be used for prediction of CRC mortality or and nonspecific detection of recurs, or even tx. Some papers:

Preoperative plasma D-dimer predicts 1-year survival in colorectal cancer patients with absence of VTE

Elevated D-dimers are also a marker of underlying malignancy and increased mortality in the absence of venous thromboembolism.

Systematic review- D-dimer to predict recurrent disease after stopping anticoagulant therapy for unprovoked VTE.

Oy. Where to begin.

First of all, NONE of the articles you have cited have anything to do with detecting a remission of cancer, which is what the original discussion was about.

The first two articles are about research that is suggestive that a positive D Dimer is correlated with a poor prognosis in colon cancer in patients who do not have a VTE, but it doesn't tell you anything of use beyond that. There is no reason to "assiduously" track this blood work, certainly not on a monthly basis. Just what is a practitioner supposed to do with these results? Your first article only indicates a lower 1 year survival rate than the negative D dimer group. It doesn't change the course of treatment though, and there's nothing to indicate a recurrance of cancer, only a correlation of outcomes.

What needs to be done with this research is to determine WHY an elevated D dimer results in worse outcomes for those who have a negative D dimer; what is it about the coagulation cascade that is at play here, why, and through what mechanism. THEN we can start thinking about how to use this result clinically.

Your third article is completely irrelevant as it has nothing to do with cancer.

This is just taking research and using as an excuse to over treat for billing purposes.

prn, are you just googling papers and posting them without checking content or were you hoping we wouldn't check? Seriously, that is some of the laziest cherry-picking I've ever seen.

As Panacea said, the third paper is on the recurrence of venous thromboembolism not cancer. This is why I generally choose not to engage people like you and Keith Bell. It takes so little effort to google a handful of papers that superficially support you and much more effort to show otherwise.

That said I couldn't resist here because it was such a nice demonstration of your intellectually dishonest methods. And this is the best way to counter the Gish.

By capnkrunch (not verified) on 04 Jun 2016 #permalink

I turn off the killfile for a bit only to find that prn has adopted the majestic plural? Lesson learned.

Narad
I turn off the killfile for a bit only to find that prn has adopted the majestic plural?
Not sure where the the royal "we" is here, Narad. If I say "we" , that's my family or some part.

capnkrunch
Yeah, there were a bunch of new papers. Read two more (I worked on this area 5 yrs ago). I meant to grab a few correlated studies then ran out of time, and had to hurry off too quick.

Sloth. I'm assuming "the Gish"" is Duane Gish?

Panacea@
There is no reason to “assiduously” track [D-dimer] certainly not on a monthly basis
I don't. CEA works well, so DD is low priority, annually, right now. If I were an advanced CRC patient with low CEA values at dx, I would consider DD instead.

Assiduous tracking of extra bloodwork means fewer surprises and a better handle on what’s going on.

I 'm tracking several cheap markers including CEA "at base frequency" (10-65 days depending on circumstances). CA199 costs me money though. Some bloodwork I get ca every 4-5 mo. I can't arrange d-dime for the LEF price of $60, so it's annually.

...using as an excuse to over treat for billing purposes.
You realize that I'm on the buy side and not the sell side?
And no, I didn't get from an ND.

Yep, You guys are really on your toes. Mine, too.