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In which Orac, amazingly, publishes an article on integrative oncology in Nature Reviews Cancer

Over the years, my goals in doing this blog have evolved. Now, I want to do more than just blog about the issues of science and pseudoscience in medicine that are this blog’s primary raison d’être (along with the occasional post on more generalized areas of skepticism or the even more occasional political rant). I also want to publish my science-based critiques in the peer-reviewed medical literature. My first crack at came in the form of an article by Steve Novella and myself published last month in Trends In Molecular Medicine entitled Clinical trials of integrative medicine: testing whether magic works? Even better, thanks to a press release and how the editors made the article free to all, it garnered more social media attention than any article previously published in TMM, and the editor has informed me that it “shot straight to the top of TMM’s ‘Most read’ article list and I anticipate it staying there for quite some time.” For this, Steve and I thank you, our readers, and those of you who spread the news. We’re hoping that this success garners more offers to write review and commentary articles for the peer-reviewed literature about topics near and dear to us.

Note to journal editors: Hint, hint!

Now, I’m happy to announce another commentary in the peer-reviewed literature. It’s an article I wrote for Nature Reviews Cancer that just appeared online yesterday entitled Integrative oncology: Really the best of both worlds?. I must say, I’m quite proud of this one, and it is a big deal. If you look up the impact factor for NRC, you’ll see it’s around 35, which is between The Lancet and JAMA.

Accessing this article is a little more difficult than accessing the previous one was, but not that much. Normally, NRC articles are behind a paywall. In this case, my article is not behind a paywall, which is unusual, nor does it require a subscription to NRC or any Nature journal to be accessed. It does, however, require a Nature.com login, which can be obtained for free, at, yes, Nature.com. Yes, I know it’s a bit of a pain and that many of you won’t want to register yet another login, but I assure you it will be worth it. Not only do you get access to my article, but there’s a lot of other cool science stuff at Nature even for free. That’s why I hope that a lot of you will do it and download the article. Read it, learn from it, and, hopefully, enjoy it. Let’s see if we can do it again and make this the most accessed article in NRC history.

Finally, consider this the comments section for the article. This is the sort of feedback authors just don’t normally get.

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]

19 replies on “In which Orac, amazingly, publishes an article on integrative oncology in Nature Reviews Cancer”

Congratulations! Top-tier medical journals have noticed for a long time that people are more interested by woos than by rational approaches.

“Dear Dr Corcos,

Thank you for sending a proposal entitled “A universal treatment for cancer: Cell Inflation Assisted Chemotherapy” to Nature Reviews Cancer.

We have now had the chance to take a look at your proposal and I’m afraid we’ve decided not to commission an article on this topic. I think you should aim to have your ideas published in a primary, clinically focused cancer journal, rather than a review journal.

Thank you for taking the time to contact us with your suggestion and for your interest in Nature Reviews Cancer.

Best wishes,

Nicola McCarthy Ph.D
Chief Editor
Nature Reviews Cancer “

Congratulations!

I signed up and downloaded the article.

It’s certainly a good thing to have a consistent voice for science out there in the literature.

I note that Nicola McCarthy was the editor who invited me to write this review, but the process took so long (completely my fault, I must add) that it ended up being completed under the new editor, Sarah Seton-Rogers, as McCarthy moved on to another job in May.

Loved the opening quote. Never heard of OCCAM, what an abuse of the acronym.

Your article is an indictment of professional and academic medical integrity in the USA today.

I hope it alerts some of the readership to the egregious advance of nonsense into modern medicine.

Great article! I was able to get into the full article – Perhaps because my PC is on the network of a large healthcare organization?

In other news, the “If you haven’t received that [registration confirmation] email, click here to have it resent” link at nature-dot-com is broken.

Congrats! I’ve only skimmed so far, but IMHO the part at the end about placing SB oncology within a non-woo ‘holistic’ frame is really important. I think the reasons too few docs do so probably trace back to ‘efficiency’ mandates from insurance companies and hospitals, though physician training in surgery and ‘surgical culture’ probably play a role as well.

My point is, putting SBM in a beneficial holistic wrapper won’t be something individual surgeons can just do by themselves. They’ll need institutional support, and face a certain uphill battle to get it. This paper strikes me as as a good contribution to such an effort.

First, because it’s peer reviewed in a well-known journal, The Powers That Be will pay more attention to it than any blog post or even mainstream news item.

Second, although not stated explicitly, the article lays the groundwork for making an economic argument for HolisticSBM to TPTB.
a) HSBM is good medicine. It can lower costs by improving outcomes such that patients will require fewer additional services.
b) HSBM is good for hospital revenues since patients are now (rightly) demanding more ‘whole person’ treatment of serious disease, and meeting that demand means fewer folks will take their (ugh) ‘business’ outside the hospital to CAM profiteers. Moreover, patients will be more pleased with the services they receive, more willing to return to the Med Center for future care, and more likely to recommend it to friends.
c) I’m not sure about this, but I’d guess HSBM would be cheaper than adding CAM to the institutions program. I’d guess a ‘board certified integrative oncologist’ with a staff of acupuncturist ‘doctors’ (and maybe a guru or two) would come at a higher labor cost than adding some dieticians, exercise therapists and psychiatric social workers to the staff.
d) HSBM is less likely than CAM to get TPTB laughed at in the medical community, and pitched properly more likely to get support in the form of grants from legitimate funders.

Having been through one difficult major surgery in recent years — nothing that serious, life-threatening etc. — I know how alone and scared you can get while hospitalized. I had the benefit of being thoroughly prepped by the very HSBM team of my surgeon. But there are times when you just need someone you imagine knows something to comfort you. Your loved ones or the nursing staff can do some ‘hand-holding’ but it’s not the same because you know they don’t know what’s going on.

It would seem CAM-providers offer than kind of authoritative hand-holding. On the SBM blog today, an exasperated Mark Crislip links to a article from Kaiser Permanente’s in-house journal on integrating naturopathy with conventional care. This passage caught my eye:

Other features of naturopathic care may also be helpful to or resonate with patients. Naturopathic physicians may spend more time with their patients than their conventional medicine primary care peers, and their medical offices may provide for a less sterile and more pleasant and healing environment. Naturopaths will support and reinforce the world view of the patient who prefers dietary and herbal modalities to drugs in ways that allopathic physicians may not. Naturopaths will take time and effort to carefully review dietary and lifestyle patterns and may offer prescriptions in these areas at a level of detail that exceeds what is commonly provided by allopathic primary care physicians.

Other than the herbal remedies, there’s nothing in there SBM can’t do. Hospitals don’t have to look like Death. Somebody can explain the scrips instead of just handing out the pills or slips. Somebody can give the patients more time, and show more empathy. Time is money, of course, but IMHO this is a spend now save later proposition.

Instead of pain-management follow-ups with over-paid quacks, how about mandatory bi-weekly support-group meetings for 3 months (with the social-worker/facilitator paid for by insurance) for every patient emerging from major invasive surgery?

I understand surgeons don’t need to spend time with patients, and it can even be counter-productive to their work (if the sufferings of Wilson on House have any real-world referent). Speaking for myself, I don’t need that much attention attention from the surgeon. A skilled PA knowledgeable in the specialty fills the bill quite nicely.

Just off the top of my head I can come up with several other ‘holistic care’ strategies for hospitals. Somebody could come up with an un-embarassing hospital gown. The food doesn’t have to suck. There can be WiFi in every ward, so patients can surf/Skype/Netflix, and the hospital can aquire loaner laptops for folks who don’t have their own for nothing or next to — you wouldn’t believe what corporations and schools dump into recycling when they do periodic tech upgrades. Send a couple volunteer English majors down to Salvation Army or Goodwill with $500 and build a lending library… Build a lounge where those patients who wouldn’t be at undue risk could be wheeled and spend time with carefully selected docile shelter kitties they could even adopt when they go home… (OK, maybe that’s a stretch, but a little brainstorming would easily generate lots of ideas outside the current, uh, box.)

Of this I’m confident: If hospitals and med centers add CAM practitioners and make them play by the same rules as real doctors — same patient loads, schedules, facilities etc. — they will fail spectacularly. I’d guess any Integrative Oncologists worth their salt in the terms of Integrative Oncology would demand more: more time with patients, more ‘healing supportive’ environments. The SBM docs should go, “See? That’s what we need. Give that to us first. We’ve proved we deserved it!”

As Dr. Gorski wrote in Nature Reviews Cancer:

It is possible to introduce scientifically supportable elements of CAM, such as certain dietary and lifestyle interventions167, into oncology as science- and evidence-based supportive modalities, in essence reversing the rebranding that integrative oncology has been so successful at.

Bingo!

Great paper! I plan on sharing it with my woo loving family and friends. I’m very happy that you are raising these issues in forums that will add a little extra gravitas to your eminently sensible arguments.

One question, Who is this Gorski guy? Maybe you should get him to write on science blogs.

Will keep this handy for when I see people on Facebook promoting things that are going to get people killed. Happens depressingly often…my family, ugh…

Congratulations, Dr. Gorski!

I’m a little bummed my application to introduce an entire platform for genomic IT principles into primary was not well received by the NHSC. Something that will be the future for much more effective health care than the waste we have in practice today. I applied my concepts to genetic testing for predisposition on multiple cell & molecular pathologies, cancer and diabetes being a couple of them. There was a news segment (Rock Center, if I remember) on smart phone applications to give patients access to their own information. And as stated in the documentary piece, IT modeling will be our future in primary health care.

Anyway, always enjoyable to read your perspective. Time to dose my pseudo-homeopathic coffee fix….

Congratulations.
I think all the hard work from this blog, SBM and the various other skeptical blogs and podcasts is finally starting to pay off.

@ Sadmar

Build a lounge where those patients who wouldn’t be at undue risk could be wheeled and spend time with carefully selected docile shelter kitties they could even adopt when they go home… (OK, maybe that’s a stretch, but a little brainstorming would easily generate lots of ideas outside the current, uh, box.)

Maybe not that much a stretch (full disclosure of COI, I love kitties).
“Pet therapy” is being experimented upon in certain places, notably with the elderly. See the following example in a hospital in Montpellier (in French):
http://youtu.be/5YqiNw1dr_M

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