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Complementary medicine use and cancer survival: A negative correlation

We know that alternative medicine use is associated with poorer survival in cancer, but what about the use of so-called “complementary medicine,” “complementary and alternative medicine,” or “integrative medicine”? Bad news. There’s still a negative correlation between the use of pseudoscientific and unproven medicine and cancer survival, even when used with conventional cancer therapy rather than instead of it.

By definition, alternative medicine consists of treatments that either have not been shown to work or have been shown not to work. To paraphrase an old adage yet again, medicine that has been shown to work with an acceptable risk-benefit ratio ceases to be “alternative” and becomes simply “medicine”. We also know from multiple sources of data that the use of alternative medicine to treat curable cancers is highly correlated with a decreased chance of surviving such cancers. Indeed, less than a year ago, I discussed in my usual inimitable fashion (and at my usual inimitable length) about a study showing just that, in which alternative medicine use was associated with a 2.5-fold increased risk of death for combined breast, prostate, lung, or colorectal cancer patients, and a whopping 5.7-fold increased risk of death for breast cancer patients. But what about so-called “complementary and alternative medicine” (CAM, sometimes referred to as “complementary medicine” and also now more commonly referred to as “integrative medicine”)?

That’s a bigger question, because most cancer patients who use unscientific treatments (or, as I like to call them, quackery) don’t use them instead of conventional cancer therapies, but rather in addition to such therapies. Indeed, there is a whole specialty known as “integrative oncology” devoted to combining quackery with real science-based oncology. (Yes, I know that I’ve probably just offended the Society for Integrative Oncology by saying that, but it’s true. After all, the SIO welcomes naturopaths as in its membership, and two past presidents have been naturopaths.) Their rationale is that it’s the “best of both worlds,” but is it really? For instance, we know that patients who choose to use CAM, particularly dietary supplements, are more likely to refuse adjuvant chemotherapy for breast cancer, with higher CAM use more strongly correlated with refusal of chemotherapy. And these are results that were published by a naturopath associated with SIO!

Of course, the counterargument made by CAM advocates, like SIO, is that “integrative oncology” makes it more likely that cancer patients will complete their science-based recommended chemotherapy, because they can receive whatever “natural” therapies they’re interested in in addition to the chemotherapy and are thus less likely to decide to forego chemotherapy in favor of quackery. We don’t know whether that is true or not, but a recent study suggests that the argument of the SIO and other advocates of “integrative oncology” might not be as potent as they think it is. The study was published in JAMA Oncology a week and a half ago and is entitled “Complementary Medicine, Refusal of Conventional Cancer Therapy, and Survival Among Patients With Curable Cancers.” It’s by Skyler B. Johnson, Henry S. Park, Cary P. Gross, and James B. Yu, basically the same team that did the study last year on alternative medicine and decreased cancer survival. Its findings are worth discussing in depth.

Complementary medicine: Who chooses it?

I think it’s worth repeating something I discussed last year regarding one aspect of cancer that’s very important, at least with respect to alternative medicine or “CAM”. Unlike the case for many conditions commonly treated with alternative medicine, whether or not a treatment works against cancer is determined by its impact on the hardest of “hard” endpoints: Survival. A patient either survives cancer (however that’s defined, be it five, ten, or whatever year survival) or does not. Even the “softer” endpoints used to assess the effectiveness of cancer treatments tend to be “harder” than for most other diseases, such as progression-free survival (the cancer either progresses after treatment or it does not) or recurrence-free survival (a cancer either recurs after treatment eliminates it, or it doesn’t). Although there are lots of other aspects of cancer treatment to be assessed, such as quality of life and adverse reactions, at the very heart of evaluating any treatment for a specific cancer are the questions: Does the therapy save the lives of cancer patients? Does it prolong survival, and, if it does, by how much and at what cost? To this, we can add: Does the addition of so-called “complementary” therapies to known, effective conventional cancer therapies improve survival? Does it improve quality of life? For instance, one could argue that if such therapies improve quality of life, they are worth using, even if they have no effect on survival or progression-free survival. However, if such therapies are associated with an adverse effect on cancer survival, the argument that they improve quality of life, even if supported by evidence, rapidly becomes untenable.

So let’s look at the study itself. The authors’ rationale is spelled out in the introduction, with “complementary medicine” henceforth abbreviated, per the authors’ choice as “CM”:

Despite the widespread use of CAM, there is limited research evaluating the association of CM with survival. We previously investigated alternative medicine (therapy used instead of CCT) and showed that its use (vs nonuse) was associated with an increased risk of death,11 but we did not investigate CM. Approximately two-thirds of patients with cancer believe that CM will prolong life and one-third expect it to cure their disease.5 Although it is possible that CM may improve outcomes by helping patients tolerate conventional medical care and complete their recommended therapy, CM may result in inferior survival as a result of delays to receiving proven CCT and refusal of other recommended CCTs.12-14

Therefore, in light of the lack of knowledge regarding the association between CM and overall survival in patients with cancer, we used a large national database to identify patients who underwent CM for cancer in addition to CCT. We investigated factors associated with selection of CM, the association between use of CM and delay of initiation of CCT or refusal of further CCT, and how these factors seemed to mediate survival outcomes in patients who used CM compared with those who used no CM.

The previous study by Johnson et al last year used the National Cancer Database (NCDB), which is a joint project of the American College of Surgeons and the American Cancer Society. It is a clinical oncology database sourced from hospital registry data collected by the more than 1,500 facilities accredited by the American College of Surgeons Commission on Cancer (CoC). Data cover more than 70% of newly diagnosed cancer cases nationwide and are used to develop quality improvement initiatives and set quality standards for cancer care in many hospitals across the US. Not surprisingly, this year’s study uses the NCDB as well. Using this database, the authors carried out a retrospective observational cohort study of 1,901,815 patients from 1,500 CoC–accredited centers across the United States who were diagnosed with nonmetastatic breast, prostate, lung, or colorectal cancer between January 1, 2004, and December 31, 2013. Patients were matched on age, clinical group stage, Charlson-Deyo comorbidity score, insurance type, race/ethnicity, year of diagnosis, and cancer type. Use of CM was defined as “Other-Unproven: Cancer treatments administered by nonmedical personnel” in addition to at least one CCT modality, defined as surgery, radiotherapy, chemotherapy, and/or hormone therapy. Treatment refusal was defined as any NCDB-documented refusal of chemotherapy, radiation therapy, surgery, and/or hormonal therapy found in the patient record. Treatment refusal did not include patients not receiving treatment because of contraindications or patient risk factors, nor did it include cases where treatment was recommended but not received for an unknown reason. Treatment delay was defined as the number of days between diagnosis and first treatment with chemotherapy, radiotherapy, surgery, or hormonal therapy. The results in these patients were compared to a matched cohort of patients pulled from the same database.

Regarding the 258 patients found in the database, the patients who used CM tended to be younger (mean age, 56 vs. 62 years); female (77.1% versus 48.8%); have breast cancer; be of higher socioeconomic status and higher educational level; have private insurance; have stage I and III disease; have a Charlson-Deyo comorbidity score of 1 (i.e., have one relatively mild comorbid condition compared to a score of 0); and to reside in the Intermountain or Pacific West. In other words, these patients were very similar to the patients who chose alternative medicine instead of conventional treatment in the study last year. A prior study also noted the high concentration of CAM schools in these states, and state legislation favoring CAM.

One interesting tidbit that I noticed in eTable 1 in the Supplemental Data section was that, in the multivariate model, those using CM were more likely to be treated in an academic medical center (odds ratio 1.88, p=0.004), which, sadly, is not surprising given how many integrative oncology programs have sprung up like so much kudzu in medical schools and academic medical centers. Sadly, integrative oncology is, if you exclude the Cancer Treatment Centers of America, primarily a creature of academic medical centers—at least thus far. That this is true is primarily a failure as academics like myself to assure that the medicine being taught and practiced in what should be bastions of science-based medicine is, in fact, actually science-based.

The other interesting thing about the characteristics of the patients choosing CM (to me, at least) was that in the raw data (eTable 1 again) they tended to be more common in either stage I or stage III. First, remember that these were potentially curable patients; so patients with stage IV disease at diagnosis were excluded from this study. Stage III patients tend to have the most locally advanced disease and require the most aggressive multimodality therapy to achieve remission or cure; so intuitively it makes sense that such patients might be drawn to CAM or CM. They’re in for a harder time, with larger, more invasive surgeries plus nastier adjuvant treatments. But what about stage I? Well, it turns out that in a multivariate analysis, there wasn’t a significant difference between CM use in stage I versus stage II patients, but there was increased use (hazard ratio 1.68) in stage III patients relative to stage I. As the authors speculate:

We also found an association between a higher stage of cancer and greater likelihood to select CM (vs a lower stage of cancer), which has been unexplored in prior literature, to our knowledge. It is unclear if the higher stage of cancer motivates patients to select CM or if patients who select CM present with more advanced disease as a result of delay in screening or diagnosis, given that the majority of CAM use is intended to prevent illness or disease. There is evidence to suggest that a less hopeful cancer prognosis is associated with use of CM. We excluded patients with incurable disease to account for this potential contributor to use of CM.

As for the rest of the characteristics associated with CAM use (white race, higher socioeconomic status, etc.), these are fairly consistent with the characteristics previously shown in multiple studies to be correlated with CAM use for more than just cancer; so there were no surprises there.

Finally, also remember that this study specifically looked at patients who had chosen at least one conventional treatment for their cancers and also chose CM. Presumably, that means that they chose the first curative modality usually used for these cancers (surgery for breast, colorectal, or non-small cell lung cancer; surgery or radiation therapy for prostate cancer; surgery or chemoradiation for small cell lung cancer). It was thus (mostly) refusal of adjuvant chemotherapy and/or radiation therapy that was correlated with CM use. Adjuvant therapies, of course, are not primarily curative in themselves; they are intended to decrease the risk of disease recurrence.

Complementary medicine use and cancer survival

We know that delays in treatment are associated with poorer survival; so the first correlation that the authors looked at was whether use of CM correlated with delays in treatment. Patients who chose CM did not have a detectable delay in initiation of treatment compared to patients who did not use CM in addition to their conventional therapy (29 days versus 28 days between diagnosis and initiation of therapy). CAM/CM use was, however, associated with a higher likelihood of refusing conventional therapy compared to no CAM/CM use, such as surgery (7.0% versus 0.1%); chemotherapy (34.1% versus 3.2%); radiation therapy (53.1% versus 2.3%); and hormonal therapy (33.7% versus 2.8%). These are huge differences in uptake of therapies designed to cure (or increase the probability of curing) these cancers. At the very least, these figures suggest that when the SIO or other CAM advocates claim that CAM is good because it keeps these patients undergoing conventional therapy, they’re either full of it or at the very least way, way, way overstating the case. I suppose one could make the case that the refusal of conventional treatments would be much higher in these patients without “integrative oncology” teams keeping them in the fold, but that’s an argument without any data to support it and this bit of data to suggest that, even if integrative oncology does keep patients wanting “natural” therapies in the fold of science-based medicine, it’s not doing a very good job of it.

But what about survival, which is where the rubber hits the road in any cancer treatment regimen? In multivariate analysis controlling for cancer type, age, sex, income, educational level, clinical stage, and Charlson-Deyo comorbidity score, use of CM was associated with a greater risk of death (hazard ratio 2.08, 95% confidence interval 1.50-2.90). This Kaplan-Meier survival curve tells the tale:

Complementary medicine versus no complementary medicine
Complementary medicine versus no complementary medicine

That was for all four cancers. When the authors looked at specific cancer types, they noted that the use of CM was associated with poorer five-year survival for breast cancer (84.8% vs 90.4%) and colorectal cancer (81.8% vs 84.4%). However, they did not note any statistically significant differences seen in 5-year survival for patients with prostate or lung cancer. In multivariate analysis that did not include treatment refusal or delay, receipt of CM was independently associated with greater risk of death for breast cancer (HR, 1.94; 95% CI, 1.24-3.05) and colorectal cancer (HR, 2.61; 95% CI, 1.21-5.60). Of course, the question here is whether treatment delay or refusal associated with CM use could explain the increased risk of death in patients using CM. The answer appears to be that it explains a fair amount of it. In a multivariate analysis that included treatment refusal or delay, the effect disappeared, and there was no longer a statistically significant association between CM use and the risk of death (HR, 1.39; 95% CI, 0.83-2.33). Thus, the negative correlation between CM use and cancer survival appears to be due primarily, if not completely, to the association between CM use and treatment refusal, a conclusion noted in the Discussion section.

Finally, this study, of course, is not without its shortcomings. First of all, it is retrospective and observational, which means that one can always question how well confounding factors were controlled for by the authors. Another significant limitation is that this study could not incorporate into its multivariate model confounders that could influence survival, such as “aversion to cancer screening, refusal of treatment of noncancer-related comorbidities, body mass index, smoking history, burden of disease, functional status, individual income and educational levels, details about incomplete or dose-reduced treatments, and cancer-specific survival.” (I’m not sure about BMI, as the NCDB does record height and weight, from which BMI can be calculated.) On the other hand, it’s quite possible that the adverse association between CM use and cancer survival might have been underestimated because patients receiving CM were younger, more affluent, privately insured, and, by and large, healthier than those who didn’t use CM, which could have produced a bias towards greater survival for patients who used CM. Also, there’s no evidence about types of CM used.

From my perspective, though, this is probably the biggest problem with the study:

The use of CM was likely underascertained given patients’ hesitancy to report its use to clinicians and for database registrars to code this use reliably. However, this factor was likely a highly specific variable, which includes only those who actually used 1 or more forms of CM. In addition, it is possible that clinicians were more likely to document the use of CM when patients were using noteworthy therapies that may have resulted in refusal of CCT.

Given that only 0.01% of the patients examined fit the inclusion criteria of using CM plus at least one conventional therapy tells me that CM use was probably seriously under-ascertained. How representative this subset of patients is of the likely much larger number using CM during that period can be debated. This, however, is a shortcoming of the NCDB, which was not designed to study alternative medicine or CM. You can see that from the data field Johnson et al were forced to use: “Other-Unproven: Cancer treatments administered by nonmedical personnel.” A lot of CM is administered by legitimate medical personnel, including physicians. That right there might be the source of under-ascertainment for purposes of this study.

Pseudoscientific complementary medicine: A continuum

Proponents of integrative oncology, CAM, and integrative medicine often discuss “alternative medicine” use as though it were a different beast from “complementary medicine.” The reason is simple: Choosing unproven therapies instead of conventional medicine is inarguably bad in a physician’s mind, while advocates can do mental gymnastics to convince themselves that adding unproven treatments to conventional therapies is good, or at least not harmful. That’s why I like this point made by the authors:

Our work demonstrates that CM and alternative medicine likely represent entities along a continuum, rather than being distinct entities. Although we consider complementary (or integrative) medicine to integrate unproven nonmedical methods with conventional therapies, and alternative medicine as the use of unproven methods instead of conventional therapies, our work demonstrates that patients who use alternative medicine and CM are often behaving similarly in refusing conventional treatment. As a result, like the patients using alternative medicine (who do not undergo any initial CCT), patients using CM are also placing themselves in an unnecessarily greater risk of death by refusing some CCT.

Let me put this a slightly different way. When you integrate unproven medical therapies (or even outright quackery) with conventional science-based medicine, you do not make science-based medicine better, nor is there good evidence that adding pseudoscience to medicine entices significant percentages of patients who would have chosen to forego conventional therapy in favor of quackery into undergoing conventional therapy. As Johnson et al point out, it’s a continuum, and the patients who undergo CM, rather than rejecting conventional therapy in favor of quackery, are not as far down the path of pseudoscience as the patients who do reject conventional therapy, but they’re of the same mindset. It’s a matter of degree. Consequently, they are clearly more likely to refuse adjuvant therapy, and, if this study is replicated using other datasets, to die of their disease because of that refusal.

Anyone who reads this blog or my not-so-super-secret other blog knows that I am not a fan of alternative medicine. I’m also not a form of alternative medicine’s “more respectable cousins,” like CAM, CM, “integrative medicine,” and especially “integrative oncology.” It’s clear from numerous studies that alternative medicine does not have even a neutral effect on cancer survival; its effect is uniformly negative. This study strongly suggests that even just “integrating” such therapies into science-based oncology could have a pernicious effect on patient survival. At the very least, it suggests that integrating quackery with oncology doesn’t keep patients on the path of science-based treatment who would not already have used conventional treatment anyway, thus undercutting one of the most commonly used arguments by advocates of “integrative oncology”.

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]

89 replies on “Complementary medicine use and cancer survival: A negative correlation”

Integration of a single variable to oncology therapeutic-treatments adds mind boggling complexity.

This is exactly why artificial intelligence (AI) is healthcare’s “best” tool to make or break integrative medicine.

MJD says,

Elementary my Dear Watson?

Does this mean you now have a new fetish or perseveration subject? Have you abandoned your latex? Will you revive your Mallard Adhesive website as a blog, this time with purchased or public domain images? Will UFOs land on the White House lawn this Wednesday?

Just asking for a friend.

Yes, it’s his new “book.” There’s nothing like imagining expertise in “AI” when you don’t know a car from a cdr.

@ Orac,

I enjoyed the post and appreciate your efforts to communicate the risks of integrative oncology.

@ sirhcton,

Your four (4) questions go from unreasonable to bizzare.

1) Does this mean you now have a new fetish or perseveration subject?

Answer: No, just intellectual curiosity.

2) Have you abandoned your latex?

Answer: Yes, here at RI.

3) Will you revive your Mallard Adhesive website as a blog, this time with purchased or public domain images?

No, my business partner retired and I thanked him for his entrepreneurial effort.

4) Will UFOs land on the White House lawn this Wednesday?

Answer: I don’t know, what does your source (i.e., friend) say.

Learn more about Michael J. Dochniak (MJD) @

https://www.amazon.com/default/e/B002P9CA2K?redirectedFromKindleDbs=true

@ sirchton**:

If you peruse MJD’s LinkedIn profiles you will discover that he has been employed in avenues unrelated to adhesives- in fact, he has worked as a job coach and instructor.

Perhaps if he wasn’t so glued to ideas about these products ( see present day entries at LinkedIn), he might find meaningful employment helping young people with disabilities become employed. That’s a useful position.

Similarly, Jake Crosby is also stuck***

** -btw- how does one pronounce your nym ?- I’ve always wondered
*** ( see his Linked In)- he has a family that runs a company/ hedge fund- and might, other than wasting his time on a blog hardly anyone reads, ask his mother or uncle for a position in advertising, corporate social media, publicity, whatever. so that he would be assured a career with insulation from critique.

Note that both my suggestions probably involve writing which these fellows seem to cherish.

NOW: does everyone STILL think that I’m mean?

Where’s the picture of the half-naked fat guy wearing VR goggles and some sort of suction bra when you really want it?

I hope someone studies the role of the providers of alternative therapies in this at some point. I suspect they’re not actively encouraging patients to stick to their science-based treatment.

Denice Walter writes,

NOW: does everyone STILL think that I’m mean?

MJD says,

What do you think of Orac’s post?

I’m interested in what you think about integrative oncology adversely affecting patient survival.

Please advise.

MJD:

Obviously patients who refuse part of SBM ( such as adjuvant therapy) can be in a worse position than those who don’t – they may not survive as long. Possibly, because they feel secure that altie additions are helping them, they may think it’s alright to refuse part of SBM or delay treatment. Thus, belief in integrative oncology may not be in patients’ best interest: universities and medical schools should be more cautious in recommending or offering these so-called treatments.

NOW, what do you think of MY commentary above?

I’m not here to hold your hand Denice, but, thanks for a very good summary of Orac’s post.

Q. Can you clarify “more cautious”.

@ Denice Walter

[Because there was no reply option to your post asking about my nym.]

I certainly don’t think you are mean, although a comment or two might be classified as testy.

As for pronouncing my nym, the easiest would be “sir ton” or something close. Consider the hc part to be swallowed into non-existence.

i>By definition, alternative medicine consists of treatments that either have not been shown to work or have been shown not to work.
…by highly biased, sometimes incompetent, ruling parties. I would rest MSM’s case with even simple things like their continued mishandling of vitamin C and D for well over half a century (2/3rds-4/5s C ???).

I include some foreign approved treatments as CAM since foreign countries have drugs rejected in the US and nutraceutical treatments.

To paraphrase an old adage yet again, medicine that has been shown to work with an acceptable risk-benefit ratio ceases to be “alternative” and becomes simply “medicine”.
…after a century, or two, or three. Witness vitamin C and maritime scurvy, 1500s-1900. Same problems today.

My limited experiences
Does [CAM] therapy save the lives of cancer patients? Yes, better than either MSM or CAM alone
Does it prolong survival, and, if it does, by how much 4x OS 1%
… at what cost? over 90% discount on total cost/billing

OK, 1, how is it reasonable to complain about “science” or “medicine” and not finding the relationship between scurvy and vitamin C when the scientific method wasn’t even developed until at least the 1600s? “No one used a tool that hadn’t been developed yet!” Also, since the relationship between scurvy and citrus fruit was described by James Lind in 1753 (even if it wasn’t implemented by the Royal Navy until 1795), saying 1900 is completely incorrect.

2, you are as dull and predictable as MDJ.

Asorbutic techniques were irregularly used across these centuries, apparently discovered and lost or not well disseminated several times in different centuries. The British merchant marine didn’t adopt it until later in the 19th century. Other countries lagged too, hence another lasting British advantage on the seas and battles.

Kind of the situation with higher dose applications of C and D3 today. Not well disseminatated, lots of sad “could have been saved” stories.

I know your frustration JT. It’s sometimes like dealing with dull children, and defiant children proud of their ignorance.

I’m missing the original long version of the 1st post, and the separate 2nd half, in the filter.

Asorbutic techniques were irregularly used across these centuries, apparently discovered and lost or not well disseminated several times in different centuries.

Well, it’s rather crudely constructed, but more complex than anything MJD is likely to emit.

@prn If a cancer patient has a scurvy, by all means give C vitamin. Otherwise, C vitamin has no effect as demonstrated n + 1 times. There is a paper from China:
https://academic.oup.com/jnci/article-abstract/85/18/1483/909782
Supplements have no effect to mortality, as shown any number of times.
You definition of bias seems that if I disagree with results, there is a bias. Actually, you should us tell what was the bias in the study Orac cited.

Aarno, specific and flawed studies’ failure won’t prove a general negative or even anything in particular. Adversarial science is often more a marketing or political exercise than real science – we used to have these exercises in other industries too.

MSM trials often inadequately stratify to remove gross dilution of the previously identified beneficial class(es) of patients as well as fail to replicate many specific factors of success. Things like specific molecule in a family, dosage, duration, frequency, by one or more orders of magnitude – oops. Often these are multiple, so ridiculously large failures to replicate successful treatment conditions that it is hard to not interpret them as adversarial science.

At least it is easy enough to apply the old IV vitamin C treatments in real life that these various MSM Brainiacs have repeatedly missed/refused to adequately perform, we don’t even care now what MSM conjectures (eye rolls) in our medical decisions at home. Also we often can measure and improve responses that normal patients can’t achieve, hence they deteriorate and even die. In some years we had an RN and IV C immediately available nearby, very handy for crises like terminal cancer, serious invenomation, and infections.

Otherwise, C vitamin has no effect as demonstrated n + 1 times.
This assertion is shear dogma. The last 20 years a number of papers have been published to (re)show the mechanism and effects of IV vitamin C. Recently a successful sepsis treatment paper was recently added in MSM with vitamin C being a principal component despite relatively low dosage.

“…we don’t even care now what MSM conjectures (eye rolls) in our medical decisions at home.”

This comment is better suited to the new Dunning-Kruger article on RI.

@ MJD:

I wasn’t asking you to “hold my hand”.. Do I have to spell everything out in CAPS?

I was merely telling you that you have better options in life than focusing on your idees fixes. You might actually find meaningful employment that can help people.

Denice Walter writes,

You might actually find meaningful employment that can help people.

MJD says,

Your temporary heartfelt concern for me almost brings me to tears.

Q. Are you bipolar.

There’s been concern all along but you were unable to discern it.
Why do you think that most of us who respond to you do it?- it isn’t SOLELY for lurkers’ benefit.

Are you bipolar.

This may well qualify as the most fucking obnoxious comment that has come out of the diarrhea-filled object atop your neck-stalk. I know more than one person with bipolar disorder, and every last one is more intelligent (and witty) than your pathetic ass could ever hope to be. You’re nothing but a smarmy little shit, and I hope you’re spat upon wherever you go.

and every last one is more intelligent (and witty) than your pathetic ass could ever hope to be.

We are generally an interesting bunch, it’s true.

d’Bacon, you should consider who all really represent a ferocious D-K, n=0 POV here. Say what you will about the formal pubs on IV vitamin C, you and many folks here simply have no basis at all on several IV vitamin C subjects (beyond pure conjecture and idle gossip) that we have had dramatic examples consistent with the old literature.

For some years, we were fortunate enough to have 16-24 x7 availability on IV vitamin C, an RN, and MDs on phone, house or video call to do this.

@ Orac:

NO problem.

He just illustrates how he doesn’t comprehend subtle messages or other people’s abilities or intentions.
Julian had it right on the D-K post.

MJD would do well to read that post and the regulars’ comments in detail

@ Narad:

He doesn’t get that Orac and his people are trying to help him …MOSTLY. Some give up from frustration.

Oh, I’m not trying to help him; back in the good old killfile days, he was one of my earliest entries. (If I could get my own place with, y’know, a desk, I could persevere on the pattern matching.) And I’ll bet that he comes up with something even more stupid in response.

I know. Notice that I said, “Mostly”?

But I do think that a few of Orac’s minions cherish the anxious hope that he could be helped somehow.
( Personally, I put the likelihood of that occurring at rather less than 10%)
Maybe a few imagine that piling on him might amount to a virtual intervention but…I doubt it would work.

There’s a reason I counsel students and potential students not people with mental illness or cognitive issues.

There’s a reason I counsel students and potential students not people with mental illness or cognitive issues.

I’m sure you don’t actually think these are mutually exclusive, but uhhhh, thanks, I guess?

@ JP:

Obviously not.
I mean that I am not working with a population that is primarily labelled or self-identified as SMI or MI.
Some students may have a mental illness or AS but that’s not why I’m there.
Most are ESL/ EFL women or adults trying to return to complete a degree and in need of a mentor/ counsellor. I help where I can. Having studied psych and languages is not a hindrance,.
Mostly, it’s how to get them IN and then, THROUGH.

You’re probably being prudent. Us mentally ill (bipolar, at least) folks are fascinating but tricksy. I personally have been able to charm the pants off (metaphorically speaking, of course) of almost every mental health professional I have encountered and get them to let me do pretty much whatever I want. (By which I basically mean drink and use recreational drugs and have my idea of fun; even Dr. Hong, who was very negative and strict about my drinking, came around to a sort of resigned and understanding and even good-humored wink and nod.)

You probably couldn’t handle me. 😉

JP,

Does he (Dr. Hong) know about the exact quantity of booze & drugs you use each month?

Just asking because myself, have a tendency to minimize (quantities usually, not the date that happened) and I know enough to recognize that I’m fooling myself.

Alain

I mean, really though, what would you define as “primarily labeled” as mentally ill? It’s prettt primary for me, I mean, that’s why I’m seeing my therapist. She also really loves me and finds me enormously stimulating as a person, according to her. A lot to of why we meet weekly is just to keep tabs on my moods; I was hypomanic and verging on manic for a while and she definitely noticed. We even drew up some stuff on how to deal with it.

But she works in a small rural mental health clinic and deals with pretty much everything. (I like her very much and I think she’s eminently smart and qualified.) She says that I’m a highlight of her week, haha.

Although actually the broken foot and being laid up has pushed me into a depression, so there’s that.

JP, I’ve worked in different types of jobs rather than only IN mental health clinics- with disadvantaged youth, people who are hiv+ and with families as well as with international students. Some clients have had mental health issues/ drug/ alcohol use but that wasn’t why they were there- more likely they were there because of hiv : needing legal assistance, counselling or housing or because they had dropped out of school as teenagers and wanted to attend college.
.
Over the years I’ve been responsible for elderly family members with LONG TERM life threatening conditions and for managing family investments/ business concerns so I didn’t want to work in hospitals as well.
It’s a choice. I’ve studied and had training in both experimental and clinical psychology.

Believe it or not, I’ve also worked in advertising and as a tax consultant for small businesses.
I’ve been able to do so because my family had investments and property which I inherited..

Anyway, I think on another part of the comments about anti-intellectualism.

My dad would have had none of it. He was, in fact, in the high school chess club and the chemistry club. He was a very smart guy. He did in fact get about a year of school at the University of Washington before he had to leave for family reasons.

(Dang, I forgot where I was going, but anyway, he was a very good dad. He took me fishing and any “guy stuff” I liked. I never got into his mechanic stuff; that wa my brother’s thing. But he and I were news junkies; we would go on a walk every Sunday to get the paper. Of course, my favorite bit was the comics, but we always read the papers and talked about the news.)

Dang it, I’ve had beer and now I can’t remember where I was going.

But just because I’m currently listening to Gordon Lightfoot (I love Gordon Lightfoot), but here’s a story:

Apparently back in the day, although he was a folk singer, he had a very yuppie-ish audience.

Anyway, my parents as young people, and their parents and cousins Darrell and Lucinda (we are very close to this day) got tickets to a Gordon Lightfoot shoe at THE FREAKING SCHNITZ in Portland. They were folk music fans of Gordon Lightfoot and had no idea of upper class behavior, which this was a thing at this concert.

So they show up in jeans and flannel, folk country music working class music fans. My dad was six foot two and a logger / logging mechanic and downing the little glasses in the lobby.

So the show comes and this loud, giant, man is yelling, “Play cotton Jenny!” and generally carrying on. They were happy not to get kicked out and were kneeing my dad the whole time, haha.

Anyway, I thought it was funny. There are even funnier about my dad before he gave up drinking (before us kids were born.)

Leonard Cohen signs of the Name written on the heart of us, the blues of the Gypsies of the Jews, but it is not exactly the same for us. That is all I can say. But bless him.

Denice Walter writes,

There’s a reason I counsel students and potential students not people with mental illness or cognitive issues.

MJD says,

I’m proud and fortunate to have counseled and assisted individuals with mental illness and cognitive issues as a Job Coach for Goodwill of the Heartland in Iowa city, IA.

@ Denice Walter,

This is what Temple Grandin had to say about my book titled, Autism Patents and Beyond (Nova Science Publishing):

“A monumental piece of research to assemble all these patents related to autism.” – Temple Grandin, Spokesperson on autism, Author of Thinking in Pictures and The Autistic Brain

@ Orac,

Thanks for sticking with me all these years!

I’m proud and fortunate to have counseled and assisted individuals with mental illness and cognitive issues as a Job Coach for Goodwill of the Heartland in Iowa city, IA.

Are you aware than Goodwill has disabled people working for them for pennies on the dollar? It’s a frigging racket.

This is what Temple Grandin had to say about my book

Well, I’ve sent a query to her about whether or not it was made up by your favored vanity press.

Trying again

Does the addition of so-called “complementary” therapies to known, effective conventional cancer therapies improve survival? Does it improve quality of life? For instance, one could argue that if such therapies improve quality of life, they are worth using, even if they have no effect on survival or progression-free survival. However, if such therapies are associated with an adverse effect on cancer survival, the argument that they improve quality of life, even if supported by evidence, rapidly becomes untenable.
Improved quality of life is the easiest part for nutrition based CAM treatment of cancer and is the source of a lot of confusion about CAM “success” for the unwashed (from MSM doctors to high school chemistry dropouts).

Reliable, predictable, improved OS, with papers cross checked by responses and measurements, is a much more difficult thing, usually more complex formulation at higher nutraceutical dosages. More difficult, both technically per se, and with the interference one suffers due to hospitals, drs, regulatory, and insurance.

The payoff of correctly done CAM is better OS and Quality of life, with fewer side effects. The first line of chemo for colorectal cancer, stages 2 thru 4, is Folfox. Folfox notoriously damages organs and disables people, starting after about 8-10 cycles. Out of hundreds, one patient made over 20 cycles of Folfox. My observation on added CAM improvements without oxi- exceeds a period for 200 cycles, without disability. All the similar CRC patients with peritoneal, etc mets, treated by regular surgery and MSM chemo alone, from 2009-11 are long dead. HIPEC, an extraordinary surgery, did enable some survivors.

…two-thirds of patients with cancer believe that CM will prolong life and one-third expect it to cure their disease.
In skilled hands for stage IVs, prolonged life can be a reasonable expectation. Cure rates can be improved, according to foreign scientific papers of offshore treatments in MSM journals. I chose some of these myself, based on their superior OS features and additivity.

Discord can be a problem
Yes, I wasted two weeks trying to climb the medical pyramid on nutritional issues on arrangement of a first surgery, where they admitted some of what I wanted included was due in 8 months. Finally we did things more or less my way, an agreed standoff, “don’t ask, don’t tell” what’s in the nutraceutical milkshakes. And they still don’t know about a few other things.

Likewise, later, I half wasted 1.5 weeks on an MD Anderson thoracic surgeon, before a I found a better talent, a foreign trained surgeon that also better accommodated my position for a second stage surgery. “Half wasted” – I was better prepared for presentation the next time around, to a better oncology surgeon.

Delays
initiation of conventional therapy: 27 days, after squabbles
initiation of some potent CAM items that crucially performed as described in medical lit, 1-2 days

Besides gratuitous personal attack, what’s your point Narad?

When I say “potent CAM”, I mean items that show or are associated with an observable response, some even considered extremely unusual.

A lot of CAM I consider stuck in a spectrum between window dressing with uninsightful research or clinical expectations, or more Quality of Life oriented with some immune support, somewhat parallel to Orac criticisms. These CAM levels are not head on changing cancer’s growth or spread or shrinkage/dissolution.

To me, a potent CAM produces change in the monitoring (scan, bloodwork) and/or the underlying cancer, sometimes well beyond normal treatment modes.

Besides gratuitous personal attack, what’s your point Narad?

That you’re tediously long-winded and your comments are essentially devoid of content. HTH. HAND.

prn,

If I follow your logic, not only MSM (your words) is doing it wrong and the sCAMsters are doing it wrong?!?!

Good thing you have internet access; else, it would be extremely lonely on your island.

Al

Al, I reserve judgement on the many CAM doctors I don’t know. Too many miscast stories make me wary and bait shy. The history of medicine shows a lot of ambitious people in general providing a limited set of benefits, with big promises, with competitive, disparaging tactics to their competitors.

The biggest dirtballs I’ve personally seen were some MSM doctors that used and abused my well insured parents. One parent was butchered in a long, unnecessary, botched operation in the 60s that I am sure rewarded the doctor and hospital handsomely but nearly killed the patient who never fully recovered. Another parent, I realize now was greatly misled as to survival prospects on terminal metastatic cancer, being quoted overall survivor stats with at least 50%-60% of the patients having a curative surgery. This for a stage IV patient several decades ago, with all the most expensive trimmings available and some unnecessary treatment pains.

@prn You still do not cite a paper that shows that C vitamin is useful as adjuvant cancer therapy.
If a sizable part of population benefits supplements, a study would show that. If only negligible part benefits, why the fuss.
Regardless of that, why take pills ? Lime juice tastes better, and raises quality of life even more.
Folfox is DNA synthese inhibitors plus folinic acid to help side effects. Show show as that C vitamin have same effect as folinic acid.

@prn You still do not cite a paper that shows that C vitamin is useful as adjuvant cancer therapy.
Some useful pieces of published information are in series of papers by Poydock; by Riordan et al; by Levine et al (NIH), mostly various kinds of lab results and case histories that the crowd here will be dismissive of as too preliminary and too sparse, but I’m fine with as part of the resource base. Other specific vitamins have their own literature series.

If a sizable part of population benefits supplements, a study would show that.
That is merely an expression of faith. Perhaps contrary to your expectations, MSM studies aren’t performed in potent therapeutic combinations, at best nibbling at the lowest ranges of only 1-2 biological/molecular entities for minimal responses.

If you had syphilis, would you be impressed with researchers who droned on about their repeated failures with 5 – 20 units of penecillin for a few days?

If only negligible part benefits, why the fuss.
Because many could benefit if applied correctly, more generally.

Show [us?] that C vitamin have same effect as folinic acid.
IV vitamin C is complementary to 5FU-LV for KRAS mutant cells, not a direct replacement. If you take specific molecular entities as the anticancer vitamins, not just any old versions out of 5,10 or 20 relatives, the issue is to what degree they are additive or synergistic on a particular cancer’s inhibition. Also with strong vitamin combinations, you can measure side benefits (e.g. improved bone density while on chemo) rather than just negative side effects.

“The payoff of correctly done CAM is better OS and Quality of life, with fewer side effects.”

The “payoff” of CAM in the real world* is much poorer survival and lowered quality of life (as established by a comprehensive study comparing standard therapy for pancreatic cancer and Dr. Nicholas Gonzalez’s coffee-enema-and-supplements protocol).

“Twelve months after enrollment, 56% of chemotherapy-group patients were alive; 16% of (Gonzalez’s) enzyme-group patients were alive. The longest survivors were one chemotherapy-group patient who died at 39.5 months and one chemotherapy-group patient…at 37.5 months (ie, the closing date of the data analysis) and, at the time of manuscript submission, was still alive at 40 months.

The Gonzalez regimen was not only much worse than standard treatment in this study; it was also substantially worse than the experience of more than 20,000 comparable patients in the US between 1988 and 2001, as reported by the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute.

The Columbia trial also looked at ‘quality of life’:

In this study, patients in the enzyme-treatment and chemotherapy groups had similar scores in quality of life at enrollment, but the enzyme group fared much worse than the gemcitabine group in the subsequent year…Pain levels appeared to diverge during the initial 6 months of the study and were more severe among the enzyme group."

https://sciencebasedmedicine.org/gonzalez-regimen-for-cancer-of-the-pancreas-even-worse-than-we-thought-part-i-results/

*Of course, sCAM artists can always claim that “he (they) Did It Wrong”. There are many, many excuses for woo failures. Admitting one is wrong is never an option.

And Orac has written about Jess Ainscough and her mother, both of whom died from cancer after following the Gerson Protocol.
Complementary and Alternative Oncology doesn’t work.

Jess Ainscough and her mother are examples of an alternative therapy by people in the unwashed category of technical knowledge. They have nothing to do with combined CAM and multimodal treatments including a chemo component.

So…
Jess and Sharyn Ainscough used the Gerson Protocol and died.
The study above says that people who use CAM to treat cancer either on its own or in conjunction with SBM have lower survival rates.
The bottom line is, using CAM is counterproductive in every case.

Jess Ainscough and her mother are examples of an alternative therapy by people in the unwashed category of technical knowledge.

Have you been [url=https://www.youtube.com/watch?v=w6sp1akv-Kc]washed in the blood of the lamb[/url]?

d’Bacon you’re getting off into those alternative medicine weeds too. Personally, I’m interested in complementary, multimodal medicine because that’s where I’ve seen successes amongst friends and family and makes the most sense to me.

@ Narad:

When I first encountered prn I though he might have represented PRN.fm because his methods so resembled megavitamin therapy promulgated there. But I believe he informed us that he DID have SB therapies in his treatment.

But the study discussed in the OP shows that not all takers are so fortunate as he has been.

@prn Am I becoming a psychic ? I did know that results were premilinary 😉
What the right dosage ? Difficult to know with preliminary data.
Therapy consist DNA and RNA synthesis blocking. it is difficult to believe most difficult problem in this situation is lack of vitamins, which any case could come from food.

Aarno, nutraceutical dosages can be directly titrated, trialed and even plotted within their known MTD, with careful prep work and some allowances for unexpected complications by close monitoring, with less hazard than standard chemo.

it is difficult to believe most difficult problem in this situation is lack of vitamins
Vitamin deficiencies are still common in cancer, even C and D, but that is not the last issue to determine therapeutic levels.

which any case could come from food
Not really. For IV vitamin C, a single example, the more useful range is probably 50 – 100 grams of ascorbates per infusion with a chemo/nutraceutical stack. I’ve had biomarkers rising exponentially at ca 30 grams IV vitamin C turn off and drop back 70-80% at 60 grams. If you tried to inject several thousand lemons, you could not achieve the concentration of ascorbate for a good blood level, where some of the other excess contents would probably kill you including the sugar load. Ditto vitamin D3 from livers.

Aarno, I’ve said IV vitamin C (intravenous vitamin C) at least 3 times here. Your citation is for ORAL vitamin C, where peak oral ascorbate uptake is limited and peak blood levels very limited, known (to some) and published since the 1940s. The often cited Mayo Clinic studies in the 70s/80s clearly flubbed on this lack of basic or background research too, despite Pauling et al’s repeated promptings.

High bloods levels of vitamin C fight cancer at least several ways:
– prevent and reverse the formation of HIF-1a, the important hypoxia inducible factor
– neutralize histamine, an important factor to trigger VEGF-A production and to change polarity of WBC immune functions against cancer recognition
– recharge WBC cells’ ascorbate stores for their attack mechanism
– increase transfer by glucose transport proteins into the cancer cell
– accumulate in KRAS mutant cancer cells (instead of glucose) and deplete their GAPDH stores
– attack exposed sites near copper and iron, based on Fenton reaction after peroxide formation
– reduce inflammation and resultant cytokines including IL-6 levels
– synergize cell death with other nutraceuticals like menatetrenone (and 5FU).

Vitamin C selectively kills KRAS and BRAF mutant colorectal cancer cells by targeting GAPDH. Science. 2015 Dec 11;350(6266):1391-6.

Vitamin C Against Cancer (2017)
https://www.intechopen.com/books/vitamin-c/vitamin-c-against-cancer

Histamine has important complex roles, good and very bad, in cancer. It triggers inflammatory responses, VEGF-A production and suppression of immune responses to cancer. IV vitamin C modulates and moderates it.

@prn Why would oral C go to urinclaine and IV would not? How can kidney tell the difference ?
What were your biomarkers, again ?
Only citation you gave was about KRAS gene, so I pass other claims. Article is about killing cultured cells with C vitamin. This is very far from a succesfull therapy.

@prn Why would oral C go to urinclaine and IV would not? How can kidney tell the difference ?
It’s the other way around. Due to gastric limitations, only a fraction of oral vitamin C transports to the bloodstream and then the urine. IV dumps C into the bloodstream directly, “100%”.

What were your biomarkers, again ?
I don’t say specifically which are done at home. My marker orders are between normal clinical use and those for well funded research protocols or those of some experts. Very low value, secondary markers are tested less often. One such marker became active, doubling a number of times and blew through the upper limit while I wasn’t watching it closely. But then I hammered it too.

Only citation you gave was about KRAS gene, so I pass other claims. Article is about killing cultured cells with C vitamin.
The cite essentially shows that the specific vitamin C – colorectal cancer target is has been accepted scientifically for over 10 years now. KRAS and BRAF mutants with overactive HIF-1a,-2a, are the most deadly CRC without good MSM answers for large fractions of patients.

This is very far from a succesfull therapy.
Various current and historical papers were close enough for my purposes to utilize with various labs, post docs and expertise a la carte. Again I add C as a component, alongside other chemo, generics and supplement components. “So weak” that oncologists just snicker themselves wet, except they don’t have long term survivors, which they realize after they sober up.

clarify on C connection
One such marker became active, doubling a number of times…But then I hammered it too…
…by re-increasing the IV vitamin C dose (double) to the dosage of IV C dose two years earlier.

Again I add C as a component, alongside other chemo, generics and supplement components.

Where and under what authority do you do this? What are your qualifications to order the addition of anything to a medical therapy? How many times have you done this, and what were the results, over what period of time?

The home front. Our multigen family utilizes several MDs with various top notcher credentials. We pretty much have service and scripts on demand. If desired, from home service to same day service with the latest (well, at the cancer start, or updates since) GE-Siemens-Roche equipment.

We’re pretty happy with all our IV vitamin C results in a number of its long published roles during this decade, a couple of which involved likely cessation. It simplifies our lives on the medical front, adds home convenience, adds certainty and confidence in a comfortable but sometimes hot zone.

@prn Btw, I love that MSM. You are not one, are you ?
As for IV C, you did not answer my question. How much C do you have in urine ?
As for biomarkers, I would like see some progress with cancer.
Because mutation is known, MSM would use KRAS inhibitors. They actually do mouse work:
https://www.nature.com/nm.1890

I am non-medical; on the buy side of medicine.

I don’t check for vitamin C deficiency, the primary use of urinary vitamin C testing. I just pay attention to large intakes 🙂

As for biomarkers, I would like see some progress with cancer.
Me too

Because mutation is known, MSM would use KRAS inhibitors.
Those are still in trial e.g
T Tran, Steven Rosenberg et al
“T-Cell Transfer Therapy Targeting Mutant KRAS in Cancer”
N Engl J Med. 2016 December 08; 375(23): 2255–2262
“Despite decades of study, there is currently no drug or vaccine that can effectively target the KRAS G12D protein in humans”

https://www.nature.com/nm.1890 no luck there –
Error: page not found

I know that this makes me a terrible person, but reading through your blog I really, really want to follow the people who used alternative medicines to treat their cancer while learning about the facts so as to rub them to the patients’ faces when they are near death, and then post their stories into online anecdotes to once again rub the salt to their family members and anyone else believe in this quackery. They deserve so for their stupidity.

I happened across an MSM paper with doubled survival for what is typically a CAM tx.

The study below shows an effect parallel to one naturopathic type intervention in cancer care, available for over 100 years but uncommon in MSM cancer care today. 1/3 more of these incurable pancan patients on PERT were able to take chemo. The overall median life span with PERT, chemo or not, was doubled. Often people take PERT because of frequent or continuing severe abdominal pains…

“…The possibility of [pancreatic insuffiency] and its treatment with PERT (Pancreatic Enzyme Replacement Therapy) in patients with pancreatic cancer has been consistently ignored in previous clinical trials of chemotherapy agents. The present study suggests that PERT increases tolerance to chemotherapy, and opens the question of whether the efficacy of standard chemotherapeutic agents could be improved by the inclusion of the evaluation and treatment of PEI with PERT as part of the best standard of care in these patients.”

Impact of the treatment of pancreatic exocrine insufficiency on survival of patients with unresectable pancreatic cancer: a retrospective analysis, Domínguez-Muñoz et al. BMC Cancer (2018) 18:534

The real life examples I’ve seen suggest that complementary naturopathic tx will have 1-4 dozen different nutritional entities added to conventional treatments. Several individual entities will perhaps be more important than even this PERT example to a patient, the best specific items varying greatly with the patient.

There is a tremendous disconnect between MSM, the public, and the most effective CAM.

Many, probably a huge majority, of the patients in the JAMA study I would classify as willy nilly, fickle patients that have no basis or consistent delivery in any integrative system, CAM or MSM. They try this or that 2-3 random entities for a week or a month, or perhaps, with greatly inadequate advisors MD or otherwise. These patients essentially have small or no chance because they typically don’t have strong internal tech capabilities or discipline to choose well and treat consistently, while their available choices suffer disruptive interferences from MSM at multiple (all) levels.

As weak as I think many naturopathic provider choices can be on therapeutic nutrition, the typical MSM ones appear far weaker or worse to me. When I go hunting for MSM trained drs, I might be looking at their skills, experience and research on 1-5 entities and most won’t even withstand that level of expectation.

Thanks for the link.

So they were dying of unresectable pancreatic cancer anyway. But adding pancreatic enzyme, which they were short of, increased the mean survival from 95 days to 189 days. That’s nice but far short of a cure.

And I see when the treatment doesn’t work you blame the patients!

Mostly I blame MSM and to an extent the existing CAM providers. Most patients are going to be dependent on the (poor) choices in the marketplace, even when they try hard to take responsibility for their health. The underperforming and truly bad CAM providers I see more as a product and a symptom of our current legal-political economic structure – often by the many arms of what might be called the Medical-Industrial-Political complex.

MSM has many biases against cheap, non-proprietary medicine and techniques. I’ve saved a bundle finding these, for better results, testing and deciding for myself.

Whatever you attribute the problems to, there is a lot of MSM disruption and misleading information pushed about/onto CAM – therapeutic nutrition, where CAM’s style of therapeutic nutrition appears most accessible to ordinary people through integrative providers.

That’s nice but far short of a cure.
That improvement is for only one small step. What I’ve seen in real life, is that with enough such biological and chemical improvements, inoperable patients finally become eligible for curative surgery(s). Every such step is precious, so I’ve been interested in collecting as many cheap, extra “good steps” as possible…

Have any of those real life cures been documented in a case report so others can learn from them and put that information to use?

I don’t know of anyone in integrative care who has made it as a case report. The only acquaintance I know that has coverage was the best responder in an NIH trial of one of their longest term projects.

From my point of view, multimodal (including MSM) – CAM patients have more hurdles:
More prejudicial interactions with MSM drs, and alienation.
More fragmented care from more drs, even MSM multimodal.
Less 3rd party money – insurance, research groups (NIH/NCI, hospital or pharma)
the other NIH – not invented (sold) here
simple disbelief, at least until 3 sigma. Kind of late to be useful.

at least until 3 sigma

This is cute. Such outliers are normally censored in routine statistical analyses.

Narad: This is cute. Such outliers are normally censored in routine statistical analyses.
That’s fine for questions about the main population itself, the people who died sooner than later. But it ignores the potential to sieve the outliers for simple “luck aspects” vs information on potential improvements, especially if you have more and better data on the individual case(s) and advanced skills available.

Stephen Jay Gould ‘s “The Median Isn’t the Message” is a good starting point for that discussion, and it goes on into the personalization of medicine, and n=1 trials.

So none of the cures you describe have been documented so other people can learn and benefit from them. That doesn’t help improve medical care much.

Science is a collective process of trying to figure out if things work, how well they work, how they work, and how we can make them work better. And the first step in that is to document what you actually did (the test or experiment). That gives you a record to work from when you try to repeat the treatment or compare results from a different treatment.

I have enjoyed some of Stephen Jay Gould’s books but didn’t read that one. The problem with your N=1 self medication tests is that you don’t have enough different samples for the same treatment to even know what the median or mean is. And you probably need to repeat the same treatment for at least 100 different subjects to pin down the sigma enough to tell if you have any 3-sigma subject responses.

Your approach to medicine makes me think of someone self-medicating themselves for the common cold. They eat chicken with rice every day because they don’t have the energy to fix anything more complicated. They decide it helps, so they decide to test if it works better when seasoned with garam masala or ras al hanout. The first time they use garam masala and get well in a week and a half. The second time, they use ras al hanout and get well in 10 days. But they aren’t sure whether they got the ras al hanout from the Istanbul market or the Middle East market and they are different formulations. But they are sure that ras al hanout is a better cure for the common cold than garam masala.

So none of the cures…
I squirm the way you keep throwing “cures” around. I think more in terms problems, tools, steps, and (cumulative) results for some particular problem at hand..

…..you describe have been documented.
I am using other people’s underutilized documentation.

….The problem with your N=1… is that you don’t have enough different samples for the same treatment to even know what the median or mean is.
Extensive markers and measurements can allow detailed comparisons with the vast literature base.

For n=1, an informed, continual trials approach is inherently much different. It has some greater necessities, and (potential) advantages on measurement and specific performance testing. For one readable account on his approach, see Ben WIlliams’ Surviving Terminal Cancer: Clinical Trials, Drug Cocktails, and Other Treatments Your Oncologist Won’t Tell You About, with his updates at virtualtrials[dot]com

And you probably need to repeat the same treatment for at least 100 different subjects to pin down the sigma enough to tell if you have any 3-sigma subject responses.
You’re missing the 3 sigma usage. For a given level of MSM medical treatment/technology (say 2010 publications), either OS less than 0.3% on std of care for a large scale dataset, or, for skewed data and a smaller dataset, a somewhat different point in time, the survival time 3 deviations beyond the median.

Your approach to medicine…
is more results oriented, small scale science and technology.

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