Beat the medical odds?

You don’t tug on Superman’s cape
You don’t spit into the wind
You don’t pull the mask off the ol’ Lone Ranger
And you don’t mess around with Jim

– Jim Croce

I love it when a commenter gives me blogging material.

Let’s face it. Blogging is a tough hobby. As much as I do love it so, sometimes I’m at a loss for blogging material. Some would argue that when that happens but not me. Why? Because the blogosphere will provide. At least, it has each and every time that I’ve ever run into difficulties. Of course, it’s even nicer when blogging material is delivered up to me right there in the comments when I’m in just the mood to take on the topic presented. Truly, blogging doesn’t get any better than this.

So let’s meet Harriet Denz-Penhey PhD, Research Associate Professor, Rural Clinical School, University of Western Australia, who showed up in the comments after a post in which I commented on a brilliant video from The Onion showing what some cancer quacks in effect fool patients into doing, namely denying that they have cancer. It was a brilliant bit of parody of “Secret”-like thinking, in essence taking the denial of a cancer patient and juxtaposing it in an overblown manner with his obviously ill appearance. True, the parody was a bit tasteless and uncomfortable to watch, but it hit very close to home. It also attracted the attention of Harriet:

People who eat an onion a day have been shown to reduce their risk of cancer by 50% in studies published in scientific peer reviewed journals.

Given that the biggest cancer quacks are oncologists you need to be careful in your sarcasm. There have been no studies which show that surgery contributes to improved survival (they have just assumed it does for a hundred years). Chemotherapy contributes only just over 2% to the five year survival rate and any contribution from radiotherapy can just as easily be explained by other scientific rationales.

Perhaps it is time to look at your own self delusion.

Unfortunately many just parrot anti-alternative therapy rhetoric without looking at the evidence. Properly prescribed and administered drugs in hospital are the third largest cause of death in the US and by the time you add in medical error, patient error, hospital contracted infections and other medical misadventure modern medicine just might be the highest cause of death in the western world.

Well isn’t that special?

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First off, I’d be very, very interested in the scientific studies that show that people who eat an onion away reduce their risk of cancer by 50%. That’s some claim! So I followed back to her websites. All I could find was this, which referenced this study. In reality, it was a retrospective study of people in Italy and Switzerland. There did appear to be an inverse correlation between onion intake and cancer. What that means, who knows? It’s only one study; it’s retrospective; and who knows if there’s a confounding factor. After all, people who eat a lot of onions may do other things that are healthy, such as eating more vegetables. After all, the only adjustments that were made were for age, sex, study center, education, body mass index, and energy intake, plus, depending on the cancer, alcohol intake, smoking, physical activity, parity, and family history of cancer at the same site. There are lots of confounders not covered.

Next, Harriet’s clam that there have been no studies that show that surgery prolongs survival is just plain wrong. We know that surgery prolongs survival in many cancers from multiple studies. Moreover, we know how long, which surgeries are more effective, and which types of tumors are and are not likely to be helped by surgery. As for Harriet’s claim about chemotherapy, I’ve dealth with it before on multiple occasions. Quacks like to abuse a dubious study that was custom made to minimize any findings of benefit due to chemotherapy. It’s an Australian study that she abuses here. This is a study that has been widely abused by anti-chemotherapy quackery supporters like Harriet.

It turns out that this is not such an impressive study. Certainly it is not the ringing slam dunk against chemotherapy that Harriet seems to think it is. Indeed, as I have pointed out before, this study appears almost intentionally designed to leave out the very types of cancers for which chemotherapy provides the most survival benefit. Also, it uses 5 year survival exclusively, completely neglecting that chemotherapy can prevent late relapses, and 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! Indeed, I think it’s worth repeating a criticism that was published in a letter about this study. After all, it’s been a year and a half since I’ve done it. I suspect that every several months I’ll have to point out the deficiencies in this study yet again, as people like Harriet keep bringing it up. In any case, here’s a letter to the editor laying out the deficiencies of this study:

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.

I’m willing to take bets regarding how long it will be before I have to take on this article again. Be that as it may, another thing that isn’t mentioned is that a lot of the chemotherapy in this article was given as adjuvant chemotherapy. That means the chemotherapy was not the primary therapy but rather given in addition to surgery. In those cases, the vast majority of the survival benefit is due to the surgery; chemotherapy is “icing on the cake.”

Of course, the bit about “medical errors,” I’ve addressed so recently in dealing with Dr. Dossey’s Three Musketeers of Woo that I don’t feel the need to reiterate.

Sadly, there’s so much more on Harriet’s two websites, so much so that I can only hit the “high points.” For instance, Harriet parrots the quack nostrum of “boosting the immune system” and blaming “toxins” for cancer. Boosting the immune system is, as has been explained here and elsewhere, a meaningless claim, and toxins, as I have said, are nothing more than a fancy “science-y”-sounding word for what, when you look at it closely, is nothing more than the modern day equivalent of miasmas or evil humors.

Harriet’s is basically garden variety woo for the most part. However, she distinguishes herself with some seriously despicable rhetoric:

Remember that the person who got cancer, became ill because of who they were and what they were doing. To become a person who has recovered from cancer means they will need to change some of who they are and what they are doing. These changes will be reflected in the physiological processes of the body, including how well the immune system functions.

Gaaaaahhh! Not this crap again!

Let me repeat this very slowly. Although there are some modifiable lifestyle risk factors that contribute to cancer, in the vast majority of cases it is not the fault of the person with cancer that they got cancer in the first place. One of the only exceptions I can think of is long term heavy smokers. Even in that case I realize just how addictive nicotine is and how hard it is for smokers to quit and therefore see nothing productive in blaming them for their cancer.

That’s not even the most pernicious part of Harriet’s statement. What I find most despicable is how she says that cancer patients became ill because of who they were. What the hell does that mean? Does that mean my mother-in-law developed a rare form of triple negative breast cancer, which killed her within two years of diagnosis (and the first anniversary of whose death is fast approaching) died because of who she was? Screw you, Harriet!

I apologize. Not to Harriet, but to my other readers. I’ll calm down now. But if there’s one aspect of “alternative” medicine that pisses me off more than other, it’s the “blame the victim” subtext to so much of it. If you get sick, it’s not because you were unlucky, or because some nasty pathogen managed to bypass your body’s physical and immune defenses, or because one of your cells went haywire and grew into a cancer. Oh, no. It’s because you didn’t eat the right foods, do enough or the right kind of exercises, take the right supplements, do the right meditations, or make yourself into the disease-invulnerable superman or superwoman that so much of alt-med claims you can be. (Think Bill Maher’s idiotic claims.) In other words, if you get sick, it’s your own damned fault! In fact, if you go to the extreme, believing in The Secret for instance, when you’re told that you can bring good things to yourself by your own thoughts and wishes, the unspoken converse to woo-ful concept is that, if bad things are happening to you, you must be bringing them upon yourself somehow. Harriet’s statement is in that vein.

I guess all those thousands of dead in Haiti wanted that earthquake to happen the other day.

Harriet is also–of course!–selling a book entitled Beat The Medical Odds: Stories Of Unexpected Recovery. It actually has an interesting idea at its core, namely this:

I wanted to do some research into miracles where every doctor would be surprised by the recovery. Research into what I had, chronic fatigue syndrome, wouldn’t work because many doctors thought that was a psychiatric problem and anyone could get better if they only “sorted themselves out.”

So I looked to explore what it was that people who should have died (but didn’t) had in common. I wanted to study people who had miraculous recoveries…

So after a lot of talking with doctors I came up with an idea they had to accept. I would research people who had less than a 10% chance of survival given their diagnosis and treatment. I would look for those who did “better than expected.”

That was much easier to sell to the doctors. I was then able to put together a proposal for the research, apply for and receive funding to do it and get Ethics Committee approval to do it.

It’s actually a rather interesting idea, if you strip it of the woo and try to apply actual science to the question. So, naturally, I did what I always do when I see research claims by someone who apparently holds a real academic medical position. I searched Pubmed. Apparently Dr. Denz-Penhey has published 15 papers in the last 17 years. Not bad. However, they’re pretty much all about medical school education in a rural clinical school. There’s nothing there about cancer or terminal illness. Yes, I knew what the answer to my question would be before I searched PubMed, but hope springs eternal. I had really hoped that Harriet had actually published the results of her “study” in the peer-reviewed literature.

No such luck.

Instead, she wrote a book to sell to desperate patients, who hope that there’s something in there that could make them one of these outlier patients. It’s not even a real book, too. Rather, it’s a downloadable book and doesn’t appear to be available other than as a PDF, with this claim:

Yes Harriet! I need to know what suvivors did to beat the medical odds when they had a terminal condition!

I understand that by placing my secure order today, I will be getting instant access to the amazing secrets of suvivors.

I will have valid hope because if it is possible for one person with a terminal condition to go into remission it is possible for another person to do so.

I will know what the survivors did and what was important to them and will be able to choose whether to do something similar to improve my own quality of life.

Unfortunately, there’s a problem with hoping to be an outlier patient, and that’s that outliers are outliers because their situation and how they do are not relevant to the vast majority of people–including you. Yes, there’s an off chance you might be one of those people if you ever developed terminal cancer, but the odds are so much against it that suggesting that we know how to increase the odds that a patient will be one of those rare survivors are a cruel lie and false hope.

And that’s what Harriet is peddling.

It may well be worthwhile to study such outliers scientifically. Finding them may be difficult, but I can see how a rigorous examination of unlikely cancer survivors might provide information that would help us understand cancer biology. Unfortunately, that doesn’t seem to be what Harriet is doing. My guess is that she’s just interviewing them with a heapin’ helpin’ of confirmation bias to identify factors that she already believes in. Even if she’s not, why did she publish her “study” results in an online book that she’s hawking on her website, rather than in a peer-reviewed medical journal?