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Cancer Medicine Skepticism/critical thinking

James Randi speaks about chemotherapy

People fear chemotherapy.

Some of this fear is not unreasonable, but a lot of it is a vestige of older days, when chemotherapy was much more unpleasant and even at times horrific. However, contrary to the old alt-med trope of chemotherapy as “pure poison” that makes you sicker than cancer, advances in chemotherapy and supportive management that minimizes nausea and other side effects have made chemotherapy easier to bear for many people. Last year, James Randi underwent surgery and chemotherapy for what sounds like colorectal cancer, although he refers to it as “intestinal” cancer. Be that as it may, what he has to say is very, very important, namely that chemotherapy is not as horrible as it used to be, that it no longer can be assumed to make you sick as a dog, that it can be usually handled reasonably well, and that, if you need it, you should not fear it to the point of rejecting it:

Randi is off chemotherapy now and doing well, thanks to modern, science-based medicine. May The Amazing One live many more years, and I hope you’ll all join me in wishing him well.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

38 replies on “James Randi speaks about chemotherapy”

Yes, he must have been praying to Mary MacKillop and had a piece of her cloth pinned to him. There’s no other explanation. Her 3rd miracle. Praise Jebus.

Good on ya Randi. Keep on Trucking.

Shouldn’t we be clear that oncology chemo has become a lot more kindler and gentler — even cudley — as opposed to hematology chemo which is still pretty damn toxic much of the time? I’m speaking as someone 14 years out from an auto BMT who also took care of acute leukemics as a resident not too long ago.

Chemo has made big leaps forward since the 70s when my grandmother was on it. even since the 90s it’s improved dramatically. I hope they keep improving the stuff, but I’ll tell you — if it meant the choice between death and being sick, I’ll take being sick. I’m not sure I agree with Randi on the Happy Camper thing. An irascible, annoying complainer might do as well as an upbeat jovial fellow.

Great outcome for Randi, but some people still have horrible experiences on chemo. A friend recently treated for breast cancer ended up in hospital for extremely low red blood count and associated symptoms during her treatment. Don’t know the details, but she was quite miserable.

I have to admit, I don’t consider James Randi to have much credibility on anything outside of conjuring tricks these days. He has demonstrated that he really is ignorant about a lot of science, and that does not change just because I agree with his message.

I am happy that his chemo treatments went well, and I hope he recovers well and continues to lead a healthy life. However, his personal testimonial on this matter does not mean much.

When a patient starts chemo, he or she is given a long list of things that could happen ranging from hair loss to multiple organ failure and death. Depending on the type of chemo, they may be told that they may experience heart failure, kidney damage, loss of function in their nerves, infection, anemia, bleeding, lung scarring, and the always popular GI side effects such as nausea, vomiting, diarrhea (or constipation severe enough to require manual disimpaction) and mucositis. Oh, did I mention the risk of anaphylaxis, weird rashes, and bleeding that come particularly with the newer agents? And “chemo brain”, that’s always fun.

So, people hear (or read) all this and, sensibly, get scared stiff and convinced that they will be in the ICU as soon as the IV is started. But the truth is, although all sorts of nasty things CAN happen during chemotherapy, they don’t happen to the vast majority of patients. Most patients will have a massively underwhelming experience during chemotherapy. Maybe a little nausea. Maybe some hair loss. Maybe not even that. For some high grade tumors, chemo may be a downright pleasant experience because the tumor shrinks. A patient once told me that, for all the buildup about nausea, he went home after CHOP and ate the largest meal he’d eaten in weeks…because he felt so much better afterwards (probably placebo, but still, it gives you an idea of the range of experience.)

So, yeah, chemo can be handled in most cases. It will probably be unpleasant (probably no more so or even less so than surgery or radiation), but not overwhelmingly so in most cases.

So, yeah, chemo can be handled in most cases. It will probably be unpleasant (probably no more so or even less so than surgery or radiation), but not overwhelmingly so in most cases.

I agree with Dianne completely, and just will add that James Randi’s testimonial does not change any of it, regardless of which way it would go.

Orac, didn’t you recently post a piece about the impropriety of putting any significance personal testimonies in medicine? What am I missing here? How is this any different?

I agree with several above–Randi’s experience is just one example and just an anecdote. I also agree with those who mentioned the improvements in chemo in recent times and that is much more pertinent as it represents a much wider experience–of science and of patients.

While I greatly admire Randi for his efforts to get the anti-woo movement going, I think his best days are gone, but I wish him all the best and am happy to hear he is doing well.

The problem with anecdotes is that while an anecdote can prove something possible, it can’t prove how likely it is. So, Randi’s experience demonstrates that it is possible for someone to come through chemotherapy thinking, eh, no big deal, but it says nothing about how likely someone is to have that impression. Maybe Randi is an outlier. Maybe he’s typical. Maybe he’s typical of patients undergoing chemo for colon cancer (if that’s what he has) but not of patients undergoing cancer for, say, acute leukemia.

Nonetheless, anecodotes have power and while I agree with everyone’s concerns about using Randi’s experience to “prove” that chemo is tolerable, I’m also glad that he made this video to counter some of the alt-med scare stories.

Nonetheless, anecodotes have power and while I agree with everyone’s concerns about using Randi’s experience to “prove” that chemo is tolerable, I’m also glad that he made this video to counter some of the alt-med scare stories.

My reason for jumping on this is because Orac has been outspoken about the misuse of testimonials.

@Pablo-

“…Orac has been outspoken about the misuse of testimonials.”

Really? That will come in handy soon.

My husband will start radiation and chemotherapy on Jan 22.
I will make sure he sees Mr. Randi’s video of Jan 10.
Am rooting for the “all clear PED Scan” for Mr. Randi and hope to report the same for the love-of-my life in about 10 weeks.

Dianne, you left extravasation off the list.

For those who don’t know, this is when a vesicant drug inadvertently leaks out of the vein and into the surrounding tissue. In my case, the tissue was destroyed all the way down to the bone and I had to have a chunk of my arm surgically removed. No, the tissue does not grow back. The disfigurement is permanent.

Being told it’s a rare complication isn’t much comfort when you’re the one it happens to.

I always hesitate to bring this up because it’s easy to write off my experience as being an outlier. But I think it’s naive to blather away about how benign chemotherapy is nowadays; these are still some damn serious drugs, so let’s not kid ourselves here.

Out of curiosity, was anyone here saying that chemotherapeutic agents aren’t “damn serious drugs”? No. Even Randi referred to them as nasty “chemicals” in the video.

Of course, “chemotherapy” is a hugely broad term. There are chemotherapy agents that are highly toxic, and there are chemotherapeutic agents that aren’t nearly as bad and are even given orally as pills. The stereotype of chemotherapy is of nasty drugs always given IV, but that doesn’t encompass the full range of chemotherapies by any stretch of the imagination.

I venture that many of the current chemo agents are probably even more “nasty” than those that have been used in the past, at least in their cancer cell killing ability. The biggest difference would be the improvement in their selectivity. If you are using an agent that kills everything in its path, cancer, hair, stomach lining, toe nails, and Aunt Hilda, then you are going to have to tip-toe more lightly. However, if you using something designed to by-pass the toe nails and Aunt Hilda, you can be more aggressive. If it is only looking for cancer cells, then it can be a nuclear weapon as far as anyone cares.

That’s what you want in a chemo agent. One that targets the cancerous cells only, with as much fire power as it can bring. We haven’t achieved that type of perfect selectivity yet, but have made a lot of progress in many respects.

That’s what you want in a chemo agent. One that targets the cancerous cells only, with as much fire power as it can bring. We haven’t achieved that type of perfect selectivity yet, but have made a lot of progress in many respects.

Given how very, very like normal cells cancer cells can be, perfect selectivity is probably a dream. However, progress definitely occurs. Consider the difference in side effect profile between imatinib and interferon alpha or bone marrow transplant (current and past methods of treating CML.)

In the past, survival in cancer has been so lousy that all the focus has been on finding a treatment-any treatment-that is even vaguely effective. Now, thanks to a better understanding of how cancer works and enough effective treatment to be able to at least start thinking about other things than just “can it kill cancer” we’re getting a little past that. Not where anyone would like it to be yet, but better than 30 years ago. Or even 5 or 10.

I think Randi is suffering at the hands of all these grotesque skeptic monsters who can just accept the simple message of a cancer sufferer.

It’s a positive message: hey, it doesn’t have to be all bad folks. We know much about the placebo effect, the power of expectation and suggestion.

Randi is just balancing out all the chemo-scare-talk with some positive words — planting seeds in people’s minds to approach their own treatment from a pro-active, non-fear-based position.

He was candid and honest about what chemo is and isn’t, and about his own experience.

He is NOT saying to ignore science or medicine in favour of anecdotes. He’s just encouraging people not to be scared of medicine.

You guys can only review something from one frame of reference now. The skeptic glasses.

I’m glad I’ve moved on from the skeptic blogosphere. It’s a boring symphony with only one note.

As a cancer survivor, Harriet made me more nauseous than chemo ever did….. can’t say chemo was a walk in the park, but at its worst for me was kind of like a bad flu…for me, the prednisone withdrawal included in the protocol was the worst part.

Given how very, very like normal cells cancer cells can be, perfect selectivity is probably a dream.

Once again, though, the fact that “cancer” is not a monolithic disease means some can be target more selectively than others, fortunately. In fact, CML was the first thing that came to my mind, too.

So while “perfect selectivity for every form of cancer” is undoubtedly a dream, I don’t think it is out of the realm of possibility for at least some forms, and it can always be improved.

Modern science is wonderful. My “general advice” I give to young people (on the last day of class, for example) is to never fail to appreciate how much you DO actually know. There is always still a lot to learn, but that doesn’t mean what we currently know is not very impressive.

My dad was diagnosed with liver cancer in the late 1990s (adenocarcinoma). After the agony my mother went through with her late diagnosed liver cancer a few years before this (she was dead a couple of weeks after diagnosis and never had chemo), I was convinced that he was going to suffer horribly, too. But he insisted that he never felt much pain, and that he was just immensely tired all the time. And when he went through chemo, he insisted that he didn’t experience nausea afterwards.

The cancer didn’t kill him — he died of a heart attack in his sleep less than a year later — but I’m still surprised that liver cancer could present so differently in two different people, especially after I spoke with his doctor who said that my dad was a pretty typical patient for that kind of cancer. It’s highly likely, though, that my mother had some other kind of cancer and it metastasized to her liver.

I’m glad to hear Randi made it through his chemo without too much difficulty – hurray! He is Amazing, and I hope he stays around for many more years. At least long enough so he can learn about the science behind the global warming consensus!

are you people ignorant or delutional or both?chemo will kill you.do the reserch its toxic drugs that kill the good cells along with the bad,wake up

Wow. And we are just supposed to take your word for it? Did you even bother reading what was written or watch the video?

are you people ignorant or delutional or both?

We aren’t homeopaths, so I guess we’re not delutional (sic).

I am suppose to start chemo next week. After reading this webpage, I am not sure if I should do it. It increases my changes by 10% that the cancer will not return. How long does it take to feel good again after the chemo treatments?? I don’t mind missing a breast, but I don’t want to go through this drug and then be sick for the rest of my life. For you that have had bad side effects; are you glad you went through with the chemo?? I want to hear more from those that have gone through it. Thank you for your information.

Did you actually watch the video? From subsequent interviews with James Randi, it seems he is doing fine and has no real lasting side effects.

You might want to read the comments a bit closer. And perhaps talk to your health care providers.

You got me Chris. No, I haven’t watched the video yet. I will do that and I do talk to my health care providers. They say chemo is important. I have a special breast cancer which is called triple negative. This type of cancer doesn’t respond to hormonal therapy and chemo is the only thing that could help. I am still researching and reading because this is happening so fast.

Best wishes to you.

Also remember each person is different, so what happened to them may not happen to you. Though from the above comments I see that chemotherapy has improved over the years, the most improvement are in the treatments for the side effects.

Good luck with your research and treatment.

Delighted to see the sceptic herd culling itself…tasting it’s own medicine… If only they could convince themselves that chemo is a great prophylaxis…

If only they could convince themselves that chemo is a great prophylaxis…

How is chemo preventative? Are you suggesting that even people without cancer take chemo, much like how people with certain heart conditions take prophylactic antibiotics before dental procedures?

Oh, I get it. GoodFellow thinks that chemo is poison and that The Amazing Randi will kill himself by taking it. He seems to hope that other people in the “sceptic herd” will decide to undergo chemotherapy and thus kill themselves. This will provide him some benefit and/or amusement.
Very witty, GoodFellow.
I can only point out that Mr. Randi appeared at DragonCon last month so isn’t dead 6 months after this message (and thus the herd has not been culled).

As I understand it, some chemo is prophylactic, administered after surgery (which can in many cases be curative in and of itself) to reduce the chance of recurrence. But not a person who has never been diagnosed with a particular cancer, as far as I know.

Someone probably slipped homeopathic remedies into his medicine, that’s probably why he’s so much better now!

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