Orac’s mail bag: Quacks do better than medicine!

We get hate mail. Or I do. True, I don’t get an inordinate amount of hate mail, but I do get some. A lot of the time, it’s rather boring and predictable, which is why I don’t often respond to it on the blog, although sometimes against my better judgment I respond by e-mail. That happens less and less frequently, though, given my e-mail volume between work, personal life, and the blog.

Less tiresome is hate mail from proponents of alternative medicine whom I have apparently really, really annoyed. Well, sometimes it’s less boring. Often it’s very boring indeed, but sometimes when I’m in the mood, just the right e-mail with just the right tone and just the right challenge will arrive and I will see a “teachable moment.” Yesterday, someone named “Steve” provided me just that, because apparently he was very, very unhappy at something I wrote about chemotherapy for cancer last week. This led him to write to me last night with an e-mail challenging me to reply with a rebuttal that “makes sense.” Given that Steve packs his e-mail with every alt-med apologist canard in the book (or at least a lot of them anyway), I realize that, no matter how much sense my reply will make to rational people, it probably won’t make sense to Steve. Remember, however, that this is a “teachable” moment. I’ll even be nice and not reveal Steve’s full name publicly, even though I’m under no obligation to do so. After all, as it says here in my e-mail policy, any e-mail to the blog is fair game to be posted on the blog. I know, I know. Usually, I’m much more “insolent,” but this is a teachable moment, and I’m feeling in an unusually mellow mood. I hope that doesn’t make this less educational and entertaining. So let’s dig in.

Steve begins:

When it comes to the topic of cancer quackery, and the manner of deciding which therapeutic modalities to pursue in reversing disease, I, along with many level-headed individuals, am left to one conclusion: carefully analyze and compare “survival rates”.

For example, in this country, the survival rates of people with advanced stage pancreatic cancer, under chemotherapy, is LAUGHABLE. Why not–Chemotherapy is probably one of the most toxic agents known to man (derived from mustard gas, a poison in used on soldiers in World War II). I hardly know where to begin to explain why the logic of giving poison to a person who is suffering from severe illness is at best, severely flawed–at worst, DEADLY. Is the logic that, although a poison such as chemotherapy will make a healthy person sick, it will nonetheless make a sick person healthy what we as a nation, with disease care costs skyrocketing under “Osamacare”, should be embracing?

“Obamacare”? What does the Patient Protection and Affordable Care Act (PPACA) have to do with quackery? Well, to me the only thing it has to do with quackery has been the efforts of advocates of quackery like Senator Tom Harkin (D-IA) or Orrin Hatch (R-UT) to take advantage of the PPACA to insert mandates that insurance companies and insurance exchanges cover various woo under the new law. His non sequitur about the PPAC aside, Steve seems to think that all or most chemotherapy is derived from mustard gas. True, one class of chemotherapeutic agents (appropriately enough, the nitrogen mustards) owes its existence to the study of mustard gas. Several of them are even still in use, including cyclophosphamide, melphalan, and chlorambucil. Indeed, cyclophosphamide is very effective against breast cancer when combined with, for instance, the chemotherapy drug doxorubicin, and the reason that some of these drugs are still in use, even 60 years after their development is because they work. Steve’s view of chemotherapy is stuck decades in the past. Maybe he’s been watching too much Love Story. Or maybe not. One problem with that movie was that, the sicker Ali McGraw’s character got, the better looking she seemingly got.

Of course, these days chemotherapy is so much more than toxic compounds. There are numerous classes and types of chemotherapeutic drugs. And, Steve, believe it or not, only few of them are derived from nitrogen mustards. Indeed, some of them are even derived from plants, such as the bark of the Pacific Yew tree (taxol), the periwinkle plant (vinca alkaloids), or, my favorite, the Happy Tree (camptothecin, irinotecan, topotecan). Then there are new classes of targeted therapy that attack a key signaling pathway in cancer cells necessary for growth and invasion, designed with the explicit intent of being less toxic than previous chemotherapy regimens.

As for the pancreatic cancer reference, all I can say is: Well, duh! Every physician treating cancer patients knows that pancreatic cancer, once it metastasizes, is a fatal disease. It’s one of the cancers that we admit that we don’t do very well with, which is why we do research to try to do better. We know that chemotherapy alone for pancreatic cancer has a dismal record when it comes to survival rates. It is, however, not useless. For example, 5-FU and gemcitabine have been shown to prolong survival in pancreatic cancer patients, as have other chemotherapy regimens. It is true that these increases in survival are relatively unimpressive, on the order of a few months, but, as I put it before, those few months of 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. Other examples exist. 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.

More importantly, no one is claiming that chemotherapy is the answer to cancer. In fact, multimodality therapy is the way cancer is treated, including various combinations of chemotherapy, surgery, and radiation therapy, sometimes with hormonal therapy or various forms of targeted therapy. There are relatively few cancers that chemotherapy is expected to cure. Leukemias and some lymphomas come to mind, but that’s about it. It’s a massive straw man Steve is arguing against, a common straw man that alt-med advocates who have a problem with scientific medicine try to hold up as being the prevailing belief among oncologists, radiation oncologists, and cancer surgeons. Not that that stops him:

Consider that the cost of disease care in this country is the highest among all the nations, YET, the survival rate of the chronically ill and degenerative diseased is worse than some third world countries. Why? Because the U.S. medical profession has adapted the “atomist” mentality. This is the mindset that says “Do whatever it takes to force a symptom to disappear.” An example of this logic is a motorist driving along when his oil light comes on, and so he pulls over, opens the hood, and clips the wire to the oil light, thinking he’s fixed the problem–i.e.. until his engine freezes up. This mentality has long overtaken what was originally stated by Hippocrates (who stated that “non-patentable” FOOD should be one’s medicine), namely “Do no harm”. That so-called “quackery” (when viewed by the medical profession), is the philosophy of supplying the necessary raw materials to the body so that the body can rebuild and heal ITSELF.

While there are numerous modalities available for treating serious, degenerative disease that fit the “do not harm” bill, they nonetheless, DO NOT fit the “doctor’s” bill. In other words, profit margins in the area of alternative, “non-patentable” modalities are far smaller than those of the toxic drugs that are manufactured by the pharmaceutical industry (some, which retail for as much as TWO HUNDRED THIRTY DOLLARS, yet cost only ELEVEN CENTS to manufacture). Forget street drugs. The pharmaceutical industry, with the money its players make, in comparison (or in contrast) makes street drug pushers look like PEASANTS. Hmmm. Could it be that the patient’s health is “NOT” the highest priority? It would certainly seem so.

You know, whenever I see someone use Hippocrates’ statement about “let food be your medicine,” I know I’m in for some serious woo, and Steve doesn’t disappoint. I should play the game “count the logical fallacies” in the paragraph above. The renaming of “health care” to “disease care”? Check. The claim that doctors only treat symptoms? Check. Quoting Hippocrates (who was not really correct about food and medicine)? Check. The claim that doctors aren’t interested in nutrition? Check. Personally, I’d be interested in the statistics showing that the survival rate of the chronically ill is so bad in this country. I actually know some of them, such as the fact that deaths from heart disease have been declining steadily since the 1950, and cancer mortality has been declining since the 1990s. Life expectancy has been rising, and age-adjusted death rates in the U.S. have been steadily decreasing over the last thirty years. Don’t believe me? Check out Figures 1 and 2 in the latest National Vital Statistics Report. The simple fact is, more people are living longer, and that’s largely thanks to modern medicine. So what does Steve offer as an alternative?

Quackery:

I strongly recommend that you watch the ENTIRE “Gerson Miracle” (2004) video. In it, you will discover a number of very interesting FACTS. For example, many of the patients who are treated by the Max Gerson clinic in Tijuana have gone there AS A LAST RESORT, after medical “pseudoscience” has failed them. Some have literally had less than a couple of months to live. I find it very ironic that an industry that claims to have “the world standard” in medical treatment appears to have the fewest numbers of answers when it comes to the terminally diseased patient–being EASILY outshined by other nations with budgets that are only a small fraction of the U.S.’s. It would almost appear as if they are being funded by funeral homes.

I’ve never seen this particular video, but I have watched The Beautiful Truth, which is a more recent paean to the quack known as Max Gerson. The Gerson therapy, regular readers might remember, consists of a special diet, lots of supplements, plus (yum, yum) coffee enemas. In brief, there is no evidence that the Gerson therapy prolongs survival in cancer. None. Nada. Zip. Perhaps I should rephrase that to say that there is no good scientific evidence from preclinical or clinical studies supporting the efficacy of the Gerson protocol There is, however, Gerson’s (in)famous case series. Too bad that the NCI examined that case series and found no compelling evidence for prolongation of cancer survival. As Peter Moran explains, these cases are not persuasive at all. Many of them either didn’t have cancer at all or Gerson’s case reports were not convincing that they did. Many never had a biopsy to provide incontrovertible evidence of cancer. Remember, these are the best cases Gerson could come up with. The very best. Too bad Gerson’s best was never good enough.

To Steve, apparently and in contrast,” conventional science-based medicine’s best is never good enough to Steve:

I could literally go on, but my stomach can’t take it. What I WILL say in conclusion is that, when it comes to “quackery”, it seems that the medical profession has it backwards. In reality, the “quacks” are the “failures” (i.e. failures in healing people and saving lives, NOT failures at becoming “filthy” rich), and while not every alternative modality may be as effective as the next, THE VAST MAJORITY have one thing in common, i.e., the “DO NO HARM” philosophy.

Let me just say in closing that emergency room workers are probably the only exception to the major disgrace that the (Rockefeller-started) medical industry has become–they HAVE saved many lives, and I give credit to the many emergency room workers and paramedics (yes, I know some of them are doctors) that have faithfully carried out their sworn duty.

I love the little “some of them are doctors” jibe in the paragraph above, placed oh-so-matter-of-factly in parentheses). It reminds me of “some of my best friends are Jews” or “some of my best friends are black.” True, they’re not the same thing, but they’re in the same family. “Some of my best friends are…” gambit is intended to preemptively blunt criticism for racism or bigotry. In Steve’s case, he’s trying to preemptively blunt criticism that he has a bug up his butt about doctors, in essence grudgingly admitting that, in the case of emergency and trauma physicians, doctors can actually do some good. But to him that seems to be the only case where doctors do any good.

I will agree with one thing Steve said–sort of. Many alt-med modalities “do no harm,” but that’s because they don’t do anything at all. They are nothing but placebos. On the other hand, a depressing number of them. I do like Steve’s take on one of the oldest alt-med tropes I know of, namely the pharma shill gambit, you know, the claim that the only reason people like myself use and promote science-based medicine is because we’re all in the pay of big pharma or because we make obscene–excuse me, “filthy“–amounts of money using and administering the products of big pharma.

So, there you have it. A truly heapin’ helpin’ of alt-med tropes and logical fallacies, all packed into a rather compact form. But Steve’s not done. Oh, no. He has to conclude before his challenge:

I already know that I am probably on the red list (the list of those “troublemakers” that will first be rounded up when marshal law hits this country), so I really have nothing to lose in voicing the truth.

No further comment is needed.