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Cancer Medicine Quackery

Does chemotherapy work or not? The “2% gambit”

“CHEMOTHERAPY KILLS!!!!”

I’ve lost count of how many times I’ve come across brain-dead statements like the one above, often in all caps on websites resembling that of the Time Cube guy, quite frequently with more than one exclamation point, on the websites of “natural healers,” purveyors of “alternative medicine.” In fact, if you Google “chemotherapy doesn’t work,” “chemotherapy is poison,” or “chemotherapy kills,” you’ll get thousands upon thousands of hits. In the case of “chemotherapy kills,” Indeed, the top two autofill choices I get on Google for “chemotherapy kills” are “chemotherapy kills more than it saves” and “chemotherapy kills you.”

Depressingly, the vast majority of the hits from these searches tend to be websites hostile to science-based medicine, such as Mercola.com, the website of “alternative medicine entrepreneur” Dr. Joe Mercola and NaturalNews.com, the website of Mike Adams. At the latter of these you will quickly will find cartoons like “Chemotherapy ‘treatment,'” which likens the administration of chemotherapy to a Nazi death camp or The truth about chemotherapy and the cancer industry, which portrays patients going into a cancer center for screening and coming out in body bags while an armored car drives up to pick up the profits. As my final example, there’s Chemotherapy Stickup, which portrays chemotherapy as sticking up and old woman and demanding, “Hand over your immune system, or I’ll kill you.” The article that accompanies the cartoon above even makes this astounding claim:

There is not a single cancer patient that has ever been cured by chemotherapy. Zero. They don’t exist. Not a single documented case in the history of western medicine.

And why is that? Because conventional medicine operates from the false belief that there is no cure for cancer! Thus, anyone offering a cure (or assisting in the body’s own natural reversal of the disease) is immediately dismissed as a quack. Meanwhile, the real quackery is found in the pushing of toxic chemotherapy chemicals that are injected into the bodies of patients and called “treatment” when they should really be called “torture.” (Nancy Pelosi, by the way, was never briefed on the fact that chemotherapy is torture…)


When I first encountered that cartoon a few years ago, I was a bit surprised that even a total loon like Mike Adams would go so far as to make such an absolutist statement claiming that not a single person has ever been cured of cancer by chemotherapy in the entire history of “western medicine.” All it would take is a single example to prove him wrong, like–oh, you know–Lance Armstrong, the patients cared for by my pediatric oncology colleagues, or the patients I saw during my training cured of anal cancer by the Nigro protocol. The Nigro protocol, by the way, consists of combined chemotherapy and radiation and is still the standard of care for anal cancer. That doesn’t even count all the patients with leukemia or lymphoma cured primarily by chemotherapy.

Unfortunately, this attitude isn’t just limited to cranks. There are legitimate scientists, even those who have published in magazines devoted to skepticism, who make very similar statements, although perhaps not quite as absolutist. Not quite, but close. For example, there’s Reynold Spector, whom Mark Crislip and I took to task for his article earlier this year in Skeptical Inquirer entitled Seven Deadly Medical Hypotheses. One of his “seven deadly medical hypotheses” actually read thusly:

From a cancer patient population and public health perspective, cancer chemotherapy (chemo) has been a major medical advance.

In other words, to Dr. Spector, the very idea that chemotherapy is a notable advance in the treatment of cancer is not just wrong but a “deadly medical hypothesis.” Of course, Dr. Spector’s statement is not a hypothesis at all, deadly or otherwise, as what one means by a “major medical advance” is very subjective and the weasel words of “from a patient population and public health perspective” give Dr. Spector wiggle room, but it’s very clear what his intent is. He doesn’t think chemotherapy works very well, if at all, even as he admits:

However, it cannot be denied that there are a few populations for which chemotherapy is marvelously effective, as noted above, and must be used.

So which is it? If chemotherapy is marvelously effective, even in a few populations, then chemotherapy “works” when used properly.

In previous posts, such as If we can put a man on the moon, why can’t we cure cancer? and When skepticism about medicine devolves into nihilism, I explored some of these questions. In the former article, I pointed out just how complex the problem is, with cancer being hundreds of different diseases and using the example of just how messed up the prostate cancer genome is to provide an idea of the magnitude of the problem. In the second article, I pointed out an example of a specific cancer for which advances in chemotherapy have made a meaningful difference in both survival and quality of life outcomes. What I haven’t yet done is to look at the arguments cancer cranks use to try to convince people that chemotherapy doesn’t work.

Attacking chemotherapy

Any rational assessment of the efficacy of chemotherapy must be forced to include an admission that chemotherapy is only rarely curative in solid malignancies, particularly advanced solid malignancies. Notable exceptions include testicular cancer (which is what Lance Armstrong was cured of) and anal cancer. In contrast, for hematological malignancies, such as leukemia and lymphoma, chemotherapy is usually the mainstay of therapy. However, not being curative doesn’t mean that chemotherapy is useless anymore than the fact that beta blockers don’t cure hypertension and metformin doesn’t cure diabetes makes them “useless” drugs. Before we take a rational look at what chemotherapy can and can’t do, let me just point out that there are three studies that are frequently used by cranks to try to argue that chemotherapy is useless.

The first one is easily dismissed, but you’ll see it a lot anyway. It’s frequently cited in articles with titles like 75% of MDs Refuse Chemotherapy Themselves and the claim will go something like this:

Several full-time scientists at the McGill Cancer Center sent to 118 doctors, all experts on lung cancer, a questionnaire to determine the level of trust they had in the therapies they were applying; they were asked to imagine that they themselves had contracted the disease and which of the six current experimental therapies they would choose. 79 doctors answered, 64 of them said that they would not consent to undergo any treatment containing cis-platinum – one of the common chemotherapy drugs they used – while 58 out of 79 believed that all the experimental therapies above were not accepted because of the ineffectiveness and the elevated level of toxicity of chemotherapy. (Source: Philip Day, “Cancer: Why we’re still dying to know the truth”, Credence Publications, 2000)

Wow! This sounds really damning, doesn’t it? What hypocrites those oncologists are! Right?

Wrong.

It turns out that this survey is over 25 years old and was about a specific kind of chemotherapy, cisplatin for non-small cell lung cancer, which was a new therapy at the time and didn’t have a lot of evidence for it. As Anaximperator describes, a followup survey was conducted in 1997 at a session on the National Comprehensive Cancer Network (NCCN) clinical practice guidelines. Participants were asked to respond to the same question regarding chemotherapy:

You are a 60-year-old oncologist with non-small-cell lung cancer, one liver metastasis, and bone metastases.

Your performance status is 1. Would you take chemotherapy? Yes or no?

The results? Let Anaximperator tell the tale:

The overall results of the 1997 follow-up survey show that 64.5% would now take chemotherapy – which is almost a doubling from 34% to 64.5% of those willing to have chemotherapy and radiotherapy and a quadrupling from 17% to 64.5% of those who would take chemotherapy alone.

Anaximperator adds:

The study from 1991, “Oncologists vary in their willingness to undertake anti-cancer therapies,” pertains to many kinds of cancer and cancer stages, from early stage to terminal, as well as to experimental therapies. It shows percentages as high as 98% of doctors willing to undergo chemotherapy, while the remaining 2 % were uncertain, and none answered “definitely no” or “probably no” to chemotherapy.

Should another survey be conducted today, there’s a good chance the results would be even higher in favour of chemotherapy, given that over the years chemotherapy has shown enhanced clinical benefit and less side effects.

Indeed. One should also note that this question was constructed such that the clinical presentation of the cancer was incurable. Participants were thus presented with a scenario in which they are diagnosed with stage IV metastatic disease, a situation where opting for palliative care rather than aggressive treatment often makes sense. To me this makes the results even more striking. Also, I know from personal experience that it is not true that oncologists tend to turn down chemotherapy, even for advanced disease. having known oncologists who developed various cancers and underwent standard-of-care chemotherapy. In the end, this particular ploy serves two purposes. First, it implies that oncologists are hypocrites who don’t believe that the treatments they are giving patients are worthwhile. Second, it feeds into the conspiracy theories beloved of quacks with the implication that oncologists are hiding something about chemotherapy effectiveness. They’re not.

My favorite example of the use of the next study beloved of anti-chemotherapy cranks is by Andreas Moritz, who describes himself as “a medical intuitive; a practitioner of Ayurveda, iridology, shiatsu, and vibrational medicine; a writer; and an artist.” The article is entitled Can you trust chemotherapy to cure your cancer? and in it Moritz cites a study from Australia published in 2004:

An investigation by the Department of Radiation Oncology, Northern Sydney Cancer Centre, Australia, into the contribution of chemotherapy to 5-year survival in 22 major adult malignancies, showed startling results: The overall contribution of curative and adjuvant cytotoxic chemotherapy to 5-year survival in adults was estimated to be 2.3% in Australia and 2.1% in the USA.” [Royal North Shore Hospital Clin Oncol (R Coll Radiol) 2005 Jun;17(4):294.]

The research covered data from the Cancer Registry in Australia and the Surveillance Epidemiology and End Results in the USA for the year 1998. The current 5-year relative adult survival rate for cancer in Australia is over 60%, and no less than that in the USA. By comparison, a mere 2.3% contribution of chemotherapy to cancer survival does not justify the massive expense involved and the tremendous suffering patients experience because of severe, toxic side effects resulting from this treatment. With a meager success rate of 2.3%, selling chemotherapy as a medical treatment (instead of a scam), is one of the greatest fraudulent acts ever committed. The average chemotherapy earns the medical establishment a whopping $300,000 to $1,000,000 each year, and has so far earned those who promote this pseudo-medication (poison) over 1 trillion dollars. It’s no surprise that the medical establishment tries to keep this scam alive for as long as possible.

Here is the study to which Moritz refers and which is the origin of the claim that “chemotherapy only provides 2% benefit,” a favorite talking point used by cancer quacks. I’ve seen it on websites ranging from Moritz’s website to NaturalNews.com, to Mercola.com, to Whale.to (my favorite), to I forget how many others. Always it’s the same thing, a variant of a statement claiming that chemotherapy only contributes 2% to five year survival in adult malignancies, followed by conspiracy-mongering of the sort above in which chemotherapy is portrayed as a huge scam designed to enrich big pharma. Indeed, so common is this particular favorite that I proclaim it “The 2% Gambit.” It turns out that this is not such an impressive study. Indeed, it appears almost intentionally designed to have left out the very types of cancers for which chemotherapy provides the most benefit, and it uses 5 year survival exclusively, completely neglecting that in some common cancers (such as breast cancer) chemotherapy can prevent late relapses. There were also a lot of inconsistencies and omissions in that leukemias were not included, while leukemia is one type of cancer against which chemotherapy is most efficacious. Indeed, the very technique of lumping all newly diagnosed adult cancers together is guaranteed to obscure benefits of chemotherapy among subgroups by lumping in patients for whom chemotherapy is not even indicated. A letter to the editor listed these problems and several really egregious errors and omissions, too:

The authors omitted leukaemias, which they curiously justify in part by citing the fact that it is usually treated by clinical haematologists rather than medical oncologists. They also wrongly state that only intermediate and high-grade non-Hodgkin’s lymphoma of large-B cell type can be cured with chemotherapy, and ignore T-cell lymphomas and the highly curable Burkitt’s lymphoma. They neglect to mention the significant survival benefit achievable with high-dose chemotherapy and autologous stem-cell transplantation to treat newly-diagnosed multiple myeloma [4]. In ovarian cancer, they quote a survival benefit from chemotherapy of 11% at 5 years, based on a single randomised-controlled trial (RCT), in which chemotherapy was given in both arms [5]; however, subsequent trials have reported higher 5-year survival rates. In cancers such as myeloma and ovarian cancer, in which chemotherapy has been used long before our current era of well-designed RCTs, the lack of RCT comparing chemotherapy to best supportive care should not be misconstrued to dismiss or minimise any survival benefit. In head and neck cancer, the authors erroneously claim the benefit from chemotherapy given concomitantly with radiotherapy in a meta-analysis to be 4%, when 8% was in fact reported [6].

The authors do not address the important benefits from chemotherapy to treat advanced cancer. Many patients with cancers such as lung and colon present or relapse with advanced incurable disease. For these conditions, chemotherapy significantly improves median survival rates, and may also improve quality of life by reducing symptoms and complications of cancer.

Of course, those using this particular gambit almost invariably never include the criticism of this particular article. Another aspect of this particular study that always bothered me is that it appeared to lump patients undergoing adjuvant chemotherapy in with those undergoing chemotherapy for cure or palliation. Adjuvant chemotherapy is given after surgery in order to decrease the rate of recurrence, but the truly curative modality is the surgery itself. In early stage cancer, the absolute benefit of chemotherapy in terms of prolonging survival tends to be modest, often single digit percentages. Lumping adjuvant therapy in with other uses of chemotherapy again appears custom-designed to minimize the survival benefit due to chemotherapy observed.

The second study frequently cited by cancer quacks as evidence that “chemotherapy doesn’t work” is, not surprisingly, also cited by Moritz:

In 1990, the highly respected German epidemiologist, Dr. Ulrich Abel from the Tumor Clinic of the University of Heidelberg, conducted the most comprehensive investigation of every major clinical study on chemotherapy drugs ever done. Abel contacted 350 medical centers and asked them to send him anything they had ever published on chemotherapy. He also reviewed and analyzed thousands of scientific articles published in the most prestigious medical journals. It took Abel several years to collect and evaluate the data. Abel’s epidemiological study, which was published on August 10, 1991 in The Lancet, should have alerted every doctor and cancer patient about the risks of one of the most common treatments used for cancer and other diseases. In his paper, Abel came to the conclusion that the overall success rate of chemotherapy was “appalling.” According to this report, there was no scientific evidence available in any existing study to show that chemotherapy can “extend in any appreciable way the lives of patients suffering from the most common organic cancers.”

As I pointed out in my first takedown of this claim, I looked for this study. In fact, I went to The Lancet‘s website and looked up the August 10, 1991 issue. I could find no study by Ulrich Abel or anything about chemotherapy other than this study on stroke after chemotherapy for testicular cancer. So I started searching PubMed more widely, and I found what appears to be the paper to which Moritz referred, only it wasn’t published in 1991 but rather in 1992 and it wasn’t published in The Lancet but rather in Biomedicine & Pharmacotherapy, a much lower tier journal. Somehow, through the magic of playing “telephone” over the Internet, this article has morphed from being in a lower tier journal to having been in The Lancet–even published on a specific date!

It turns out that the Dr. Abel’s article is rather odd. It’s not really a study, and it’s definitely not a meta-analysis. Nor is it really a particularly good systematic review, given that the methodology of selecting papers isn’t exactly transparent, and the larger “review” to which he refers readers appears to be in German and not readily available on the web, as far as I can tell. In the abstract, Dr. Abel states that “as a result of the analysis and the comments received from hundreds of oncologists in reply to a request for information, the following facts can be noted.” More importantly, Dr. Abel was addressing a fairly limited situation that excludes two of the most effective uses of chemotherapy, as described in this English translation of a Der Spiegel article describing his work:

  • Abel’s verdict against the medicinal treatment of cancer is emphatically untrue for various kinds of lymph cancer, Hodgkin’s disease, leukemias, sarcomas, and testicular cancers in the male. These kinds of malignancies can be cured by chemotherapy with a high degree of probability, especially in children — an undisputed success. But these are, in any case, only a very small part of the new cases of cancer diagnosed every year.
  • Abel’s doubts are not directed against chemotherapy when it is used in support of a curative operation, in order to shrink the tumor beforehand; nor do they apply to chemotherapy used prophylactically after an operation, to prevent a relapse (as an adjuvant).

These are, of course, the two most effective uses of chemotherapy that there are. I’ll grant critics that the types of tumors that can be cured with chemotherapy with a high degree of probability are a minority of tumors, but, contrary to what is implied in many uses of Dr. Abel’s work, they are not insignificant. For example, leukemias and lymphomas (Hodgkins and non-Hodgkins) add up to almost 10% of newly diagnosed cancers every year, and they are cured primarily with chemotherapy. Sarcomas and testicular cancers are much less common, but add them in and the total exceeds 10%. A distinct minority, yes, but the fact that many of these cancers can be cured with chemotherapy puts the lie to statements like the one by Mike Adams quoted above, which, not surprisingly, is parroted in Andreas Moritz’s little screed.

The second indication left out of Dr. Abel’s analysis, adjuvant chemotherapy, can, depending on the circumstance and tumor, be highly effective. Admittedly in early stage breast cancer adjuvant chemotherapy adds on an absolute basis only low single digit percentages to five and ten year survivals, but in more locally advanced breast cancer, particularly so-called “triple negative” breast cancer, the benefit is much more substantial. For instance, using Adjuvant Online, it’s possible to use the latest literature to estimate the benefit of chemotherapy in specific clinical situations. Here’s an example of a hypothetical 40 year old woman with an estrogen receptor negative tumor measuring between 3 and 5 cm with 1-3 axillary lymph nodes positive for metastatic disease:

View image

Note that standard chemotherapy increases this woman’s chance of survival by 18% on an absolute basis and by 35% on a relative basis. Either way, the survival benefit is substantial. These are women who otherwise would have died but did not, thanks to chemotherapy. These women could be your mother, your wife, your sister, or even your daughter. The bottom line is that, even though I wasn’t particularly impressed with his methodology, Dr. Abel was actually reasonably nuanced in his discussion in that he discussed overdiagnosis and stage migration as confounders that can make a treatment seem more effective than it is, as I myself have discussed many times on this blog, starting with this post.

Besides, few oncologists would disagree with this statement at the end of Dr. Abel’s abstract, “With few exceptions, there is no good scientific basis for the application of chemotherapy in symptom-free patients with advanced epithelial malignancy.” And, indeed, most oncologists do not recommend chemotherapy for patients with stage IV epithelial malignancies who are asymptomatic, because at that point all treatment is palliative, and you can’t palliate symptoms that don’t exist. That’s why chemotherapy is, in most cases, reserved for when tumor progression leads to symptoms. Moreover, this study only examined epithelial malignancies. These are cancers for which surgery can be curative if the tumor has not metastasized. Since 1991, also, we have made significant advances in improving survival using chemotherapy. I’ve used the example of colorectal cancer before, where, thanks to newer and better chemotherapy regimens developed over the last couple of decades that have improved survival in patients with liver metastases from 6 months to close to two years.

The bottom line is that the “evidence” used by cranks and quacks to prove that “chemotherapy doesn’t work” is most often based on intellectually dishonest tactics. They either misrepresent studies, as they frequently do with the McGill study claiming that oncologists won’t use chemotherapy. True, thanks to the way these studies have been misrepresented over the years, many of these quacks probably honestly think they’re accurately representing them, but that just goes to show how lazy they are about going back to the primary sources to back up their claims. As for the rest, the Australian study was custom-designed to minimize the apparent utility of chemotherapy, while Dr. Abel’s study intentionally left out the types of situations where chemotherapy is most useful and looked at primarily advanced malignancies. In this latter case, there’s nothing wrong with that approach; the problem comes when the quacks either intentionally or unintentionally fail to disclose that qualification, lose any hint at nuance, and use the results to imply that chemotherapy doesn’t work for anything.

Framing the question

Considering the question of whether chemotherapy “works” or not is very similar to asking the question, “Why haven’t we cured cancer yet?” The reason is that it’s a question that’s so vague as to be almost meaningless. Cancer is, as I have pointed out, hundreds of diseases, each driven by a plethora of different combinations of disruptions in cell growth control mechanisms. A more appropriate question is whether we’ve cured this cancer or that cancer, not whether we’ve cured cancer. Similarly, asking the question of whether chemotherapy “works” is similarly vague and meaningless. The real questions are (1) whether this specific chemotherapy regimen “works” for this cancer, although there are some examples that in aggregate we can make some conclusions about and (2) whether specific chemotherapy regimens can cure specific cancers. As noted above, even some “skeptics” of chemotherapy admit that chemotherapy can be “marvelously effective” for some cancers; the argument that usually follows is that the cancers for which chemotherapy is effective are so few as not to matter. The other issue is that few cancers are treated only with chemotherapy. Multidisciplinary and multimodality therapy are more the rule than the exception, particularly for solid malignancies and includes chemotherapy, radiation therapy, surgery, hormonal therapy, and a variety of other less common therapies.

What needs to be understood is that chemotherapy is very good for some things. For instance, it’s very good for treating and curing leukemias and lymphomas. For certain cancers, such as breast and colorectal cancer, it’s very good at decreasing the chance of relapse after curative surgery. When given before curative surgery, chemotherapy can also make organ-preserving surgery possible. Prominent examples include using neoadjuvant chemotherapy (chemotherapy before surgery) to shrink breast cancers so that they can be removed without mastectomy and shrinking rectal cancers so that sphincter-sparing surgery is possible (i.e., surgery that leaves the anal sphincter intact and thereby spares the patient having to have a permanent colostomy). For specific tumors, chemotherapy has also contributed to significant increases in survival, but it is not a panacea. For example, chemotherapy usually does little for pancreatic cancer, and metastatic melanoma laughs at most chemotherapy (although, fortunately there are newer agents coming into use that provide hope that this will no longer be the case). For all its uses and advantages in various clinical situations, in other situations chemotherapy doesn’t work well. For example, chemotherapy alone is not very good at prolonging survival in advanced epithelial malignancies, and it’s not at all unreasonable to ask whether oncologist, for whatever reason, overuse it in such patients, who are, for the most part, currently incurable.

This reasonable skepticism devolves into nihilism or crankery, however, when tactics such as those used by Mike Adams, Andreas Moritz, or, yes, even the esteemed Reynold Spector are used to “prove” that chemotherapy is “useless.” Moreover, such “skepticism” completely dismisses as worthless survival benefits of a few months, which certainly aren’t “worthless” to many patients. Such briefly lengthened survival times can mean the difference between seeing a child graduate from college or not, seeing a child get married or not, or seeing the birth of a grandchild or not. It must also be remembered that the measured improvements in survival due to chemotherapy are usually medians. Not uncommonly, buried in that median are “outliers” who derive a huge survival benefit from the chemotherapy and survive many more months than expected, sometimes many more years than expected. Moreover, it does patients no favor to try to use the observation that chemotherapy has at best relatively modest benefits in patients with advanced epithelial malignancies to try to imply that chemotherapy doesn’t work for all patients. In particular, patients have to remember that just because chemotherapy doesn’t do that well against advanced malignancies does not, as the quacks would have you believe, imply that “alternative medicine” can do better.

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]

149 replies on “Does chemotherapy work or not? The “2% gambit””

Thank you for this article. It’ll be a good reference to counteract those employing the “chemo is useless” ploy.

It is both wrong and repulsive when cranks argue that oncologists are eager to prescribe harsh chemotherapy regimens when there is no realistic benefit to be had. I would like to drag Mike Adams by his scaly tail into a typical Tumor Board meeting at our hospital, where cancer cases are presented and treatment proposals aired. Time and again, our oncologists will say that they would advise the patient that chemo is not indicated for them, because of efficacy (i.e. in late stage disease) and/or quality of life issues. Often it’s the patients who want to do anything possible to extend life who insist on trying chemotherapy, not greedy oncologists seeking to line their pockets with Pharma loot.*

*speaking of which, there has been concerned and even angry discussion at our meetings recently about the shortage of mainline generic chemo drugs, which some big pharmaceutical firms have stopped making once the patents ran out and it was no longer deemed sufficiently profitable to manufacture them. I guess our docs haven’t realized that they’re betraying their Pharma Masters with such talk.

Another comment on the survey(s) of oncologists and whether they’d opt for chemo… one has to bear in mind that how someone responds when given a hypothetical scenario of almost certain death is often quite a bit different from when they are actually staring death right in the face for real.

I don’t have data to support this, but my intuition tells me that people would be more likely to say they want a peaceful death when faced with the hypothetical, and in a real life-and-death scenario they would be somewhat more likely to roll the dice on even the slightest chance of a few more months or even weeks with their loved ones. This effect is probably less pronounced in oncologists, but I imagine it still exists. So these numbers may skew towards refusal anyway — at least that’s my data-less hypothesis 🙂

(To be clear, I’m not trying to characterize “fight it out” as the superior choice or anything… These decisions are soooo personal, that except in extreme cases, e.g. refusing treatment when chances of recovery are very good, I would not deign to question someone’s decision at all, and clearly palliative care is often the “right” choice for many many people. Perhaps it is even the case that some who thought they would have chosen palliative care, but then faced with their imminent demise chose to fight as hard as they could, perhaps they “should” have chosen palliative care anyway, i.e. they would have been happier. I’m just saying that the imminent fear of death has a tendency to change people’s decision-making — for better or worse — and that’s all.)

In 1999 I was diagnosed with testicular cancer. Following removal of my left testicle, I was treated with 9 weeks of chemotherapy to shrink a tumor in my back. I continued to see the doctor for a couple years without any sign of it returning.

In January 2011, I was diagnosed with Merkel Cell Carcinoma. 30+ lymph nodes were removed from the left side of my neck and biopsies revealed that 3 were malignant. I had 18 chemo treatment ending July 21, and I have now completed 4 weeks of a scheduled 5 and a half week regimen of radiation. Only time will tell about the efficacy of chemo for Merkel Cell. But I’m convinced that it worked for my semanoma.

Because I read and listen to various anti-chemo screeds, I wonder how this type of propaganda affects the choices of real people with cancer who have to make decisions? And how this mis-information poisons their emotional life if they choose to follow the prescribed treatments.

Imagine if you will a person who is diagnosed and told that chemotherapy is important either as the primary therapy or as an adjuvant.How does the ramped up fear and conspiracy mongering ( inciting distrust of doctors), courtesy of Mssrs Adams et al, affect choice and dealing with the effects of the treatment? The entire scenario is frightening to begin with- being ill, uncertainty, needing treatment that may be painful- and the added nonsense spewed by idiots adds to the suffering, like bitter frosting on an already inedible cake.

Another reason for us to deconstruct and dis-ambiguate woo.

I was diagnosed with diffuse large B-cell lymphoma in June. I’m in the middle of my chemotherapy regimen, and scans indicate that I’m already very close to complete remission. Adams, Moritz, Spector and their ilk can go f**k themselves.

I’m so angry, I can’t come up with any more coherent responses than that.

Not a single documented case in the history of western medicine.

In a way, that’s technically true, since for any single case there’s no way to conclusively prove that chemotherapy was the cause of the cancer going away. You need to apply statistics to lots of cases to see if chemotherapy works.

“There is not a single cancer patient that has ever been cured by chemotherapy. Zero. They don’t exist. Not a single documented case in the history of western medicine.”

Well, since each and every patient who has received chemotherapy eventually dies (of something, even if it is old age), a very simplistic and rigid person could draw the (mistaken) conclusion that chemotherapy has never “cured” anyone. This sort of statement says more about the speaker than the topic.

This demonstrates – once again – that going to Mike Adams or Joe Mercola for medical information is like asking your cat for investment advice.

Buy catnip futures.

Prometheus

My cat warned me about the financial crisis of 2008. I should’ve listened to him instead of getting him neutered.

@ Prometheus:

Right now, my cat already gives better health advice than any of the usual suspects- i.e. none.

Keeps mum on stocks, too.

@George

While I am overjoyed that your treatment appears to have been successful, I would caution you against using your own experience as evidence that something ‘worked’. Just as anecdotes about chemo NOT working for someone with your disease profile wouldn’t prove that chemo DOESN’T work, so too for the reverse case.

I wish you many long, happy, and cancer-free years.

By the same (lack of) statistical clarity employed by wooists to knock chemotherapy, one could say that homeopathy and vitamins kill at the same rate as chemotherapy. 100% of all users die. At least SBM makes the effort to look at the effectiveness of treatments. Adams, Null & Co would be out of business in a month if the crap they peddle were analyzed scientifically for efficacy.

Keep in mind that the govt’s definition of “alternative medicine” definition includes the building blocks of life, namely nutrition, which “conventional” doctors don’t even study.

The SBM crowd likes to make fun of homeopathy, but everything from nutrition to physical therapy is technically alt-med. If it’s not a drug, they seem to think it’s not medicine.

Come to think of it, that may be the problem with our health care system, we have come to define the practice of medicine as the prescribing of medication alone. In that case, it would make sense for doctors to go into joint practice with pharmacists, who know more about the actual medicines than the medicos.

However, it’s nice to see somebody who, in taking apart some woo-woo arguments against chemo, actually admit chemo’s limitations. How often do patients get this kind of information?

And considering how little of “standard” medical practice is actually tested by the gold standard of double-blind, placebo-controlled trials, I wonder SBM can even find a leg to stand on much of the time.

Just read the science articles of this newspaper for a year – time after time approved medical therapies are disproved and – if patients are lucky – disapproved.

Here’s a great expostulation of the root cause: http://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-and-medical-science/8269/

Fascinating screenshot. Saved and bookmarked – in the event that I’m ever unlucky enough to be diagnosed with cancer, I’ll mention it, because that’s precisely the sort of question I could see myself asking.

No touchy-feely stuff, just “What are my options, and for each of those options, what’s your best guess as to the probability of overall survival on 1- 2-, 5-, and 10-year timeframes, and is there any data that supports that guess? Even if the green bar is big, I promise not to sue you if my individual toss of the dart happens to land in the red part. Show me the numbers, and then we’ll talk about whether the side effects are worth it.”

(I’m not sure if that means I’ll be a good patient or an annoying patient… probably depends on the doctor. To borrow a car analogy, some mechanics provide a cup of coffee and a free wash/wax, and some mechanics let you watch over their shoulder while they’re wrist-deep in parts. Both types of shops do equally-sound mechanical work while keeping their customers happy.)

I was a bit surprised that even a total loon like Mike Adams would go so far as to make such an absolutist statement claiming that not a single person has ever been cured of cancer by chemotherapy in the entire history of “western medicine.”

Sounds like Mike was just channeling Joey Goebbels

Keep in mind that the govt’s definition of “alternative medicine” definition includes the building blocks of life, namely nutrition, which “conventional” doctors don’t even study.

Bullshit.

The SBM crowd likes to make fun of homeopathy,

For good reason.

but everything from nutrition to physical therapy is technically alt-med. If it’s not a drug, they seem to think it’s not medicine.

Bullshit.

Come to think of it, that may be the problem with our health care system, we have come to define the practice of medicine as the prescribing of medication alone.

Bullshit

In that case, it would make sense for doctors to go into joint practice with pharmacists, who know more about the actual medicines than the medicos.

In appropriate circumstances, this is already happening.

However, it’s nice to see somebody who, in taking apart some woo-woo arguments against chemo, actually admit chemo’s limitations. How often do patients get this kind of information?

AFIK, this is routine.

And considering how little of “standard” medical practice is actually tested by the gold standard of double-blind, placebo-controlled trials, I wonder SBM can even find a leg to stand on much of the time.

More bullshit. A lot of interventions can’t be tested that way – surgery, for instance?

Just read the science articles of this newspaper for a year – time after time approved medical therapies are disproved and – if patients are lucky – disapproved.

Yes, science progresses, while alt-med stays stuck in the remote past – as if that’s a good thing.

kilroy (#12) claims:

“Keep in mind that the govt’s definition of “alternative medicine” definition includes the building blocks of life, namely nutrition, which “conventional” doctors don’t even study.”

This is a musty old canard, a favorite of the “alt-med” apologists and is, of course, completely wrong.

“Nutrition” is taught in every medical school in the US, UK and EU. It may not always be labeled “nutrition”, but it is taught in courses titled “biochemistry”, “physiology”, and the like.

What “kilroy”, and others of his ilk, really mean is that medical schools – until very recently – haven’t taught the eccentric, unsupported and often bizarre nutritional claims made by the “alt-med” crowd. You know, the ones about how eating the “right” foods will keep you from aging and how “nutrition” (usually some proprietary supplement) can “cure” cancer, heart disease, cataracts and enlarged prostates.

Unfortunately, the marketing directors of many medical schools have convinced the faculty to offer courses in phony “nutrition” and other “alt-med” practices, so kilroy’s argument has a short shelf life. What will they claim next – that “conventional” doctors don’t learn about “vital energy fields” in their physics classes?

Prometheus

>”Keep in mind that the govt’s definition of “alternative medicine” definition includes the building blocks of life, namely nutrition, which “conventional” doctors don’t even study.
The SBM crowd likes to make fun of homeopathy, but everything from nutrition to physical therapy is technically alt-med. If it’s not a drug, they seem to think it’s not medicine.” -kilroy71

Wow! Funny then how my “conventional” doctor does talk to me about nutrition.
And did send me to physical therapy after I mentioned I had neck and back pain after an accident.

Of course, she didn’t try to sell me “magic water” or “special diets” as a cure either.

> “And considering how little of “standard” medical practice is actually tested by the gold standard of double-blind, placebo-controlled trials, I wonder SBM can even find a leg to stand on much of the time.” -kilroy71

Considering how Alt-med doesn’t even use those trials because every time someone does, it proves the Alt-med to be just fraud, one wonders how Alt-med can even find a leg to stand on any of the time.

Kilroy’s argument seems a bit like the following: Imagine a car manufacturer trying to sell people on the safety features of a new vehicle. When asked for tests showing the effectiveness of the features, the equivalent response was to a) call into question the idea of testing things, and b) insist that other manufacturers never put brakes on their vehicles.

Not only are some chemotherapies effective against some cancers, but the only case of a person being cured of HIV/AIDS was the result of chemotherapy.

Timothy Brown, an American living in Berlin, was diagnosed with HIV in 1995. In 2006, he was diagnosed with acute myeloid leukemia (AML), unrelated to his HIV. In 2007 and 2008 Brown underwent three grueling rounds of chemotherapy, two with raditation,followed by stem cell transplants from a compatible donor with a rare inherited mutation, called delta32, which prevents some strains of HIV from attaching to CD4 T-cells and thus confers immunity to those strains of the virus.

Both the chemotherapy and the transplants were intended to treat Tim Brown’s AML, which is now in remission, but they also have cured him of HIV, by completely wiping out his immune system and T-cells that the virus attaches to, hides in, and replicates through. Since then, the most sensitive diagnostic tests available have not been able to detect in him any sign of HIV infection. He is considered to be the first—and only—person cured of HIV.

Unfortunately, this cure will not be an option for most people with HIV. Stem cell transplants, and the chemotherapy and radiation that precede them, are expensive and risky procedures with long-lasting negative effects. Given how effective and tolerable antiretrociral treatments for HIV are now for most people, stem cell transplants just aren’t a practical approach. More crucially, delta32 mutations are very rare, occurring only in people of northern European descent, and only 1% of those. Very few people living with HIV would be able to find a delta32 donor who is compatible in terms of ABO blood type, human leukocyte antigen system (HLA), and other features.

I watched a good friend die by refusing “standard” cancer treatments, like chemotherapy and surgery, in favor of herbs and drinking colloidal silver, some 10 years ago. Her death was relatively swift, but fairly horrible. How can these people live with themselves?

In all fairness, not that I’m sure why I bother, chemotherapy cures few or no solid tumors. Lance Armstrong needed chemotherapy to survive, but he also needed surgery. For whatever reason, if you don’t remove the primary, there’s little chance of cure in testicular cancer. Only hematologic malignancies can truly be cured by chemotherapy alone. Within hematologic malignancies, though, cures are possible for ALL (95+% in childhood ALL), APL, (some) other types of AML, Hodgkin’s, some non-Hodgkin’s, and hairy cell leukemia. Treatment for CML is not curative, but it makes CML a truly chronic disease, like diabetes or hypertension. In fact, I’d rather have CML than diabetes, if I had to choose one: it’s less likely to kill me through complications.

As for side effects, yeah, they can be nasty. But they aren’t usually. The most common statement I’ve heard when seeing a patient after their first chemotherapy is some variant of “how underwhelming”. They had it built up to a horrible thing in their minds and then…nothing. Maybe a little nausea. Maybe not. In any case, not the horrifying endless emesis of the pre-5HT days. No torture, nothing worth dying to avoid, just a boring and possibly mildly uncomfortable day.

The SBM crowd likes to make fun of homeopathy, but everything from nutrition to physical therapy is technically alt-med.

Umm…no. That is, yes, we like to make fun of homeopathy, at least until it gets dull and we want more challenging targets. But nutrition and physical therapy are very much parts of standard medicine. To give a few examples: the majority of hospitals have dieticians who round on patients and make recommendations for optimizing their nutritional status (both as inpatients and after discharge.) Nutrition and proper eating are the critical to the treatment of diabetes. And physical therapy (along with occupational and speech therapy) is a basic requirement in settings ranging from the ICU to outpatient. In short, I don’t know where you even get the idea that nutrition and PT aren’t part of standard medical care.

If it’s not a drug, they seem to think it’s not medicine.

Surgeons everywhere, including orac, will be stunned to hear this.

If it’s not a drug, they seem to think it’s not medicine.
Surgeons everywhere, including orac, will be stunned to hear this.

Radiotherapists likewise.

My mom has APML (acute promyelocytic leukemia).

The mortality rate in 1957, when it was first characterized, was 100%, generally within just two weeks of when symptoms were first observed in a patient. It’s the most aggressive form of leukemia known.

In 1973, Bernard et al. demonstrated that APL leukemic cells
were relatively sensitive to chemotherapy (daunorubicin) that yielded a complete remission (CR) rate of 19 (55%) in 34 patients with APL.

Today, in 2011, with the addition of ATRA and ATO to daunorubicin, the 5 years survival rate is close to 95%.

Either there’s something pretty crazy in the air that has magically increased a survival rate from 0% to 95% over the last 55 years or so, or chemo works.

It is true that “There is not a single cancer patient that has ever been cured by chemotherapy”, and not in some hand-waving epidemiological sense, either. A cure in infectious disease leads to an undetectable level of the pathogen, and the absence of recurrence. A “cured” cancer patient, no matter how the cure is come by, will still have many foci of cancer cells within their body, many completely unrelated to the original cancer. And if they live long enough, eventually these foci will become malignant – it’s evolution in action. A “cure” for cancer is basically a Whac-A-Mole game: how long can you continue to smack down each new neoplasm?

A “cured” cancer patient, no matter how the cure is come by, will still have many foci of cancer cells within their body, many completely unrelated to the original cancer. And if they live long enough, eventually these foci will become malignant – it’s evolution in action.

Um, where are you getting this statement? There are plenty of people out there who have cancer, get treated, live 20 or 30 (or more) years, and die of something non-malignant many years later. It’s true that curing one cancer doesn’t prevent you from ever getting another cancer, but saying that (for example) your lymphoma isn’t really cured because 10 years later you got a breast cancer is like saying that the strep throat you had as a kid wasn’t really cured because you got a pneumonia when you were 70.

I have known more than 10 people who all died from cancer and all of them took chemo. That is a 100% failure rate. So, I have to say that NO it does not work.

Chemo ony targets cancer cells. It does not solve the problem as to how the cancer formed in the first place. So, if you do not get rid of the cause, then you will not solve the problem.

Giving a cancer patient chemo is like watching a building on fire and you only put out most of the fire and leave the rest alone. Eventually it will flare back up again.

To kill cancer, you have to start at the source – the immune system. Find out what started it and you will find out what stops it.

(not a) Doctor Smart:

I have known more than 10 people who all died from cancer and all of them took chemo. That is a 100% failure rate. So, I have to say that NO it does not work.

The plural of anecdote is not data. And since you are an electronics technician, you have no idea on how the immune system works. It is a bit more complicated than a radio communications system.

“I have known more than 10 people who all died from cancer and all of them took chemo. That is a 100% failure rate. So, I have to say that NO it does not work.”

Fortunately, scientists and oncologists do not consult with radio technicians when researching chemotherapeutic medicines or planning treatment for a cancer patient.

Smarty, why don’t you “write up” your research and submit your study to a medical journal…instead of “bestowing” your knowledge here?

Well, I’ve always heard that people function as “naive scientists” or “naive psychologists” but this is the first time I’ve ever encountered a “naive statistician”.

Hello, my brother’s stalker. Nice to see you again. I’ll tell my brother you have arrived. He loves to pick on you.

Use common sense. It works better than your mud to man theory of the universe. Common sense prevails all else. If ony our goverment knew that little fun fact.

Tell me, “Smart”, if you needed to repair a radio, would you test to make sure that your repairs worked?

Except you and Medicien Man, along with “Televisionless Consersvative”, all occupy the same body.

You, and all of the voices in your head, are idiots.

Oh great…just when we thought that the radio tech couldn’t be “topped”…we can await the yahoo’s learned brother. I’m just in the mood now to hear what the voodoo medicine man has to say.

lilady, there is no brother. They are all sock puppets of the same guy, an electronics technician working for a HAM radio equipment manufacturer in the Southern US. If he continues to be an idiot, I’ll just post his webpage, the one that he has been known to link to in his one of his many ‘nyms.

Stop being an idiot, Mr. JRH.

My brother’s stalker, Chris, is delusional. I have NEVER worked on a radio in all of my life. I work with electronics, but have never worked on a radio before.

I do, as a hobby, like to read about and learn about the medicinal uses of herbs and spices. While liberals use “medical” pot they tend to believe that pot is the only plant that has a “medical” use. Did you know that OAK tree leaves can be used in a poltice to stop bleeding and heal wounds? This was an old native american use, but our very own U.S. Special Forces Survival Handbook has a chapter on wilderness survival and injury/wound treatment in the wild. One such instance has this exact same native remedy. This special forces survival manual (I have several variations) lists numerous plants worth eating and making medicinal uses of. There is a slave right now that is used in the Armed forces for use on gunshot wounds and deep lacerations. It is called Oakin. You can buy a downgraded version of it in most any vitamin store or pharmacy worth its name. It uses OAK TREE leaves as part of its healing mechanism.

So, Chris, before you go off another tangent remember that some people do actually read more than phony peer reviewed nonsense.

I have done my homework. I have printed thousands of pages and have numerous books on medicinal uses of herbs and spices. Many of these uses are actually used in the U.S. Armed forces survival manuals. So, I guess now the Army is full of woo too?

If you are wondering what I would be doing with a United States Army Special Forces Wilderness Survival manual, the I guess you would get goosebumps (if you believe they exist) to learn I also have Special forces Escape and Evasion manuals and Special Forces Booby trap/homeade wilderness weapons manual as well as navigation/map reading manuals and other such interesting topics. It never hurts to be prepared for the future.

These manuals can be purchased through any gun vendor or gun show or such for less than $5 each. Some are better than others. The British SAS survival manual is okay for building shelters and staying alive under adverse weather condition in enemy territory, but the Special Forces guide to homeade weapons and killer traps is the best. Same stuff that Rambo used, only far less Hollywood and far more deadly. Most special forces training manuals cover medicinal plants for wilderness survival.

So, chris, you see, Pot is not the only “medicine” plant that is useful.

As far as cancer goes, the spice Tumeric has been shown in some cases to be otent cancer fighter, but also disturbes the metabloism of oxalate and can cause kidney stones is used for long periods of time. Vitamin C injections directly into the tumor has shown in a number of cases to cause tumor shrinkage. Vitamin D and Selenium both have been shown to decrease the risk of getting certain cancers in the first place.

Chris, do you know what White Willow bark is or what it does? Some dumb peer reviewed crap will not help you survive in the world. White Willow Bark is where Aspirin is derived from. It is a natural pain killer and blood thinner.

See, I know more than you think. You just think I sit around and figit with radios all day. I do not. You never told me what you do except stalking my brother and accusing me of working on radios. Maybe I could poke fun at your profession/delusion for a change.

@ Chris: What about “sylph”…sock puppet or drive-by poster?

I suspect that “sylph” did a paste up job and is clueless about the comparisons between successful curative treatments of cancer and another totally unrelated cancer…focusing on “foci” that will eventually become malignant and kill you. Of course Dianne did a commendable dissection of “sylph’s” silly post.

@ Chris:

is pretty popular over at Pharyngula.

@ “Doctor Smart”:

So tell us, in your expert opinion: what causes cancer to form? I was under the impression that it was primarily genetic mutations, which would require…what? Fixing the DNA in all of your cells?

Maybe the issue isn’t that doctors haven’t considered the problem of fixing the root cause(s); maybe the issue is that it’s way more complicated than you seem to grasp.

Whoops, that’s what I get for not previewing the comment first. The first sentence should read:

“< / snark> is pretty popular over at Pharyngula.”

[Spaces added to prevent the faux tag from being eaten by the blog software again.]

Reading these “arguments”, I was reminded of an engineering joke: “First they say it can’t be done. Then you do it, and they complain it can’t peel pineapples.”

David N. Brown
Mesa, Arizona

Lycanthrope:

is pretty popular over at Pharyngula.”

Huh? This is confusing, and is without merit without some kind of evidence. Like a link to the thread in question. By the way my surname starts with an “H” not an “M.”

Doctor Smart/Medicien Man/I.M. Smart/Televisionless Conservative/JRH has been banned from other blogs. I doubt Mr. JRH would have lasted any time at Pharyngula due to insipid stupidity.

Chris:

My remark to you was regarding a “sarcasm tag” I’ve seen used at Pharyngula: [/snark]. I don’t have a link to an example, sorry. But it wasn’t about the popularity of you, me, or Doctor Smart at that blog, if that’s what you thought I meant.

The first two times I tried to write that comment, I used the < and > marks, and for some reason the blog software edited the mock tag out, and I hadn’t bothered to preview my comment to see if this would happen. So I ended up posting a sentence with no beginning, twice.

I have no idea what the bit about the spelling of your name is regarding; I made no reference to your surname, and I definitely spelled your given name correctly.

I hope that clears up the confusion.

@Dr Smart:
Giving a cancer patient chemo is like watching a building on fire and you only put out most of the fire and leave the rest alone. Eventually it will flare back up again.

If you know a way of directing the immune system so it will stop the fire coming back after chemo or radiotherapy or surgery have quelled the immediately life-threatening flames, then all you have to do is prove that it works in controlled trials, and a Nobel prize is yours!

This is what happens when I try to write anything at 1:30 AM…

Apparently you can’t use the pointy brackets at all. They just won’t show up. At least not to me – I’m assuming this is the case for everyone. Or am I just a complete inept?

What I originally tried to write:
(pointy open bracket) /snark (pointy close bracket)

What this produced:
(nothing)

What I eventually switched to:
[/snark]

What I tried to write in the first sentence of the second paragraph of my previous comment:
“…I used the marks (pointy open bracket) and (pointy close bracket)…”

Cripes. I apologize for all the helpless words I so cruelly minced here tonight. I wash my hands of the whole affair, and leave my comments as a testament to my facepalm-worthy stupidity and a warning to others to stay away from the pointy brackets.

@ Lycanthrope: Now, you are infringing on my territory (“Apparently you can’t use the pointy brackets at all. They just won’t show up. At least not to me – I’m assuming this is the case for everyone. Or am I just a complete inept?”) How dare you!

Everyone knows I am the most “complete inept” on this site and I will fight anyone who disputes that I am also the undisputed queen of run-on sentences.

I learned “typing” (not keyboarding) (far) too many years ago in Junior High, on a manual typewriter…hence my heavy banging of the keys. It was a strict QWERTY keyboard with none of the computer keys. Further along during my stellar career in public health I used word processing on the ancient WANG computer, then used WordPerfect on the large desktop computer. I wouldn’t even attempt brackets and Chris often has to do the “links” for the articles I cite.

I find it amusing that you even attempted the pointy brackets…it takes some of the heat off my “real” totally inept skills and lack of punctuation…I keep forget that the (.) is my friend…much to the bemusement of other posters here.

The > and < symbols surround real formatting tags in the comments, like italics. I would like to think the software strips anything that looks like a tag but isn’t one it thinks is safe for our protection.

Mephistopheles O’Brien,
Only those in league with the Devil can get pointy brackets to appear in a comment like that 😉

@ Chris

I Was Guardian of the Poll at pharyngula. I lasted two years. I still guard polls that this great ape at pharyngula tried to fornicate.

However, captain blackbeard (Ed Brayton) banned me becuase he couldn’t handle me or my name there.

Shows how little you know.

Thanks for this article. Chemotherapy and radiation therapy gave my cousin 8 more months to live before she died from an incurable brain tumor at age 14. This time wasn’tworthless to her or her family.

@Denice

Lance Armstrong did have surgery, but his testicular cancer recurred. The point is that there are a few solid tumors for which chemotherapy can actually treat stage IV disease successfully. Perhaps a better point to make would be that rarely does cancer treatment these days consist of a single modality. It’s almost always multimodality and multidisciplinary. Expecting chemotherapy alone to cure any malignancy makes less sense than expecting surgery alone to cure any malignancy (surgery can, actually, but, depending on the tumor, combining it with chemotherapy and radiation greatly increases the chances of cure).

Something else that ticks me off in these discussions (though I’m sure this won’t be a new observation to any of the regulars): the way alties always decry “reductionist Western medicine” for oversimplifying everything and not personalizing treatment. Bullshit. Seems to me that it’s usually the CAM peddlers who claim “Cancer is always caused by this!” and “My woo can heal everyone!”

Until I started reading this blog, I never realized just how mind-bogglingly complicated cancer research really is. Sure, I knew that different cancers were treated differently, depending on type, stage, the patient’s history, etc., but I couldn’t see just how deep the rabbit hole goes, as it were. I knew that treatment protocols had come a long way, but I would still wonder idly, “But why don’t we have a cure?” Now I get it.

So don’t you dare tell me how those “evil allopaths” just don’t get it, and how they only treat the symptoms. Those “evil allopaths”, who I call “legitimate doctors”, are the ones who are actually doing something about anything, while the alties have the luxury of sitting back and claiming they have all the answers, while never being held properly accountable as far as backing up their claims goes. Must be nice.

(End of rant, whew. Like I said, probably nothing here that hasn’t been complained about a thousand times already, but I had to get that off my chest somehow.)

@ lilady:

Fear not – I shall defer to you, Your Maladroitness. 🙂 And hey, I tend to whack the keys pretty hard myself, a practice I no doubt picked up from my dad, who probably learned on typewriters himself.

@ Turtle:

My condolences.

This time wasn’t worthless to her or her family.

This. That’s part of why chemotherapy is so important; every case is different, but there are bound to be lots of cases like your cousin’s, where even if a cure is off the table, extending remaining lifespan even by a matter of months is a precious and worthwhile thing.

@ Orac:

I know.I don’t think you got my gist- I should have said ” anti -SBM screeds”- altho’ chemo is their numero uno.

-btw- my cousin is in the same boat as Lance, since 1993! Also 2 friends in the multi-boat.

Just read the comments, and something I felt like adding about an earlier troll’s comment:

Who cares what the government (through lobbyists) defines as “alternative”? We’re a segment of the population that rejects such false dichotomies. There’s no such thing as “alternative” medicine. The term is a marketing gimmick, based on cultural indoctrination, not on actual characteristics.

If you know a way of directing the immune system so it will stop the fire coming back after chemo or radiotherapy or surgery have quelled the immediately life-threatening flames, then all you have to do is prove that it works in controlled trials, and a Nobel prize is yours!

It’s not as bad as that…Part of the way hematologic stem cell transplant works is “graft versus tumor”, that is, the transplanted immune system can sometimes mop up residual tumor cells. And there’s a new agent out for prostate cancer which is an immune system inducing agent. Not to mention the now old standby rituximab and other passive immunologic therapies. And the new retroviral therapy for CLL at Penn–though we don’t know how well that will work yet. Mainstream medicine is definitely onto ways to tweak the immune system into recognizing and destroying tumors.

The problem is that virtually every immune therapy in existence works best when the tumor burden is quite small. No one’s ever gotten a cure using immunotherapy alone when the tumor is large or arguably even grossly apparent. And some tumors are easier for the immune system to mop up than others. Finally, stimulating the immune system is not, as implied by the original poster, simple or risk free. People die of immune over reactions and morbidity with immunotherapy can be substantial. So I doubt that even when/if we ever optimize immunotherapy we’ll be able to completely do away with surgery, radiotherapy, and “conventional” chemotherapy. (Or even targeted agents.)

Expecting chemotherapy alone to cure any malignancy makes less sense than expecting surgery alone to cure any malignancy (surgery can, actually, but, depending on the tumor, combining it with chemotherapy and radiation greatly increases the chances of cure).

I would quibble with this a little: if we believe cancer (at least some cancers, for example breast) is a systemic disease by the time it’s detectible, then one could argue that in principle of all the available modalities only chemotherapy has the potential to cure as a single agent since the others are local treatments. I find it interesting that this isn’t true, even when it appears that it should be. For example, a breast cancer where neoadjuvant chemotherapy was given and a CR obtained still requires mastectomy or at least local resection. Why is that? Cancer stem cells perhaps? Chemoradiation can be curative in some cases (i.e. head and neck cancers even when stage IVa/b) but again not chemotherapy alone. What does radiation do that chemo can’t? It’s an interesting problem-IMHO anyway.

To bring it back on topic, I think this illustrates the difference between SBM and “alternative medicine”. In CAM failures like this would result in either patient blame (they didn’t follow the diet well enough, didn’t think positively enough, etc) or simply ignoring the failures and clinging to the rare anecdotal successes. In SBM, failures-and partial successes-are met with questions like, “Why did tamoxifen work in patient A but not patient B?” (Leading to the discovery of hormone receptors.) “Why did the cancer recur even though the surgery appeared to have got it all?” (Leading to the development of adjuvant therapy.) “Do we really need margins THAT wide?” (Leading to lumpectomy and modified radical mastectomy.) CAM never adapts and improves its therapies. SBM does.

For example, a breast cancer where neoadjuvant chemotherapy was given and a CR obtained still requires mastectomy or at least local resection.

Actually, we don’t know that for sure. We continue to advocate local therapy because (1) we don’t have solid evidence that it is safe not to perform surgery and (2) the pathologic examination of tissue is only a relatively small sampling of the tissue, particularly in the case of a mastectomy. Just because there is a pathological complete response does not necessarily mean that there aren’t tumor deposits that were simply missed. To cover the entire specimen satisfactorily to be very sure that there are no remaining tumor deposits would not be practical, as it would take hundreds of sections and many hours of a pathologist’s time just to do one patient.

As for margins, don’t get me started on that. The question of what constitutes an “adequate” surgical margin is perhaps one of the least strongly science-based aspects of the surgical resection of cancer, with adherents every bit as dogmatic for various answers to the question as any clergy.

Every time I read some of these CAM websites, I wonder how many people get taken in by the nonsense. And, it is not just cancer that these “experts” discuss…although that has to be the most egregious of their assaults on medicine.

I have a friend who twenty odd years ago was diagnosed with a very aggressive type of breast cancer due to mutations in one of the BRCA genes. This woman had two young children and was 38 years old. She had several lumpectomies and underwent radiation and chemotherapy and had an elective oophorectomy Her sister also had breast cancer and then ovarian cancer and did not survive. About four years ago, cancer was found in the other breast…a totally different non-aggressive type; owing to her past history she underwent the same regimen again. She has just had elective mastectomy and reconstruction on both breasts, which for her were 12 hour procedures as the only donor sites for reconstruction are transplanted adipose tissue from her back. She views her surgeons and her oncologists who provided these life-saving procedures and treatments as heroes.

Another friend is undergoing treatment for multiple myeloma for which there is no cure, but the regimen of chemotherapy and occasional blood transfusions enabled her to see her son get married, enjoy the birth of her only two grandchildren and to go on a trip to Alaska with me, my hubby and two other friends in July.

Chemotherapeutic treatments have enabled my one friend to live out her live and to extend the life of my other friend.

As for margins, don’t get me started on that. The question of what constitutes an “adequate” surgical margin is perhaps one of the least strongly science-based aspects of the surgical resection of cancer, with adherents every bit as dogmatic for various answers to the question as any clergy.

Ah, come on, get started. It’d make an interesting post. I’m not a surgeon, so I mostly just know the mastectomy versus lumpectomy/radiation trial and am not at all up on the data/controversy in general. But if there is little strong evidence for a given margin, isn’t that a good opportunity to run a clinical trial? Maybe we’re taking too much tissue. Or not enough. Either way, surely more information would be better.

I’ve heard the argument made that neo-adjuvant therapy might actually result in worse outcomes in breast cancer than surgery and adjuvant. I’m not sure how good the data is-I’ve drifted into hematology and haven’t kept up with solid tumors the way I should. OTOH, a friend of mine got some very promising looking outcomes with pre-op chemoradiotherapy so maybe breast will join head and neck in being a non-surgical disease soon. Needs some randomized trials though.

Limited sampling is a problem in defining true CR. Maybe we need to use more PCR: extract the RNA and look for definitive mutations, if known, or tissue that shouldn’t be there (i.e. cytokeretin bearing tissue in lymph nodes.) That would be less pathologist time intensive, though more prone to false positives.

A guard against poll crashing. Wow. Talk about stupid. The whole point of poll crashing is that it demonstrates the worthlessness of your typical online poll. They’re unscientific, especially since the people who take the poll are often people from within a specific target audience of the host. When PZ sends people like us to crash the poll, he’s undoing that, as well as showing that results can change wildly depending on who is made aware of it.

Oh, and every troll claims that every banner can’t handle their truth, even if they were demonstrably violating rules of conduct. I spent a year dealing with a racist troll who said I couldn’t handle the truth while constantly throwing up straw men. He apparently couldn’t handle the fact that I had an opinion he didn’t provide for me.

If you are wondering what I would be doing with a United States Army Special Forces Wilderness Survival manual….

Why would anybody wonder about that? It’s common as dirt among 14-year-olds who’ve discovered the Loompanics catalog and blowhard Internet tough guys.

Lycanthrope:

I have no idea what the bit about the spelling of your name is regarding; I made no reference to your surname, and I definitely spelled your given name correctly.

It does a little bit, it is a bit befuddling. I figured if you were being sarcastic you thought that my last name was “Mooney.”

I don’t comment often at Pharyngula, and in both places it is just “Chris.” Though the *&^%#! registry software that I stumbled with at freethoughtblog would not let me use any uppercase letters.

Chris:

Ah, I get it now! Nope, although I do enjoy the sarcasm, I was just making a statement that time. Simple misunderstanding, all because of some disappearing pointy brackets.

Continued insipid stupidity from Mr. JRH, who was banned from several blogs while pretending to know medicine (sock puppet names include: Doctor Smart, I.M. Smart, Medicine Man, Medicien Man, and my personal favorite, Televisionless Conservative). This is how he actually describes himself on his own website:

Grew up in rural Mississippi, a member of the Southern Baptist Convention. Graduated with an AAS in Electronics Technology, been working for a HAM radio equipment manufacturer for almost five years as a Technician. In 2004 received my Technician Class Amateur Radio Operator’s license. Live in north Mississippi and enjoy talking about religion, politics, and science.

Which explains why he does not understand what websites selling herbal preparations are not scientific evidence, that internet polls are worthless, and why he should not be taken seriously. To be charitable I would not say he is entirely stupid, but he is undereducated and does not realize that fact. He is a classic case of Dunning-Kruger syndrome.

To be charitable I would not say he is entirely stupid, but he is undereducated and does not realize that fact.

He apparently also doesn’t realize that “ham” isn’t an acronym. And, really, after seven years he still hasn’t gotten to General class?

Who are we to say, that the sock puppets’ religious affiliation, education and work experience don’t leave him/them well-qualified to discuss medicine? Not residing in Northern Mississippi, I simply don’t know if he/they is/are regarded as the town intellectual(s) and the “go-to guy(s)” for advice about medicine. If I ever actually purchase a “ham radio” and find myself residing in Northern Mississippi (shudders), the radio technician with the AAS degree, would be my “go-to guy”.

(no attempt at pointy brackets)…but you get my opinion on the trolls’ medical opinions.

ok. You officially lost me. What is all of the sudden ham radio mississippi AAS degree talk all about? Are you people trying to refer to me?

Better question. What kind of mushrooms and you been slurping?

And people call me crazy.

North Mississippi? I am in wisconsin. Speaking of medicine, you people must be using some of your “medical” pot while you write.

lilady, please do not characterize an entire state on the actions of one person. Actually the University of Mississippi did ask Blaylock to stop using them as an endorsement (especially since he got the name of their medical school wrong). It is also one of the two states that does not allow philosophical exemption to vaccination.

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