Jul 07 2008
Death by “alternative” medicine: Who’s to blame?
One of the more annoying duties I used to have several years ago at our cancer center was to “show the flag” at our various affiliates by attending their tumor boards. I say “annoying” not so much because the tumor boards themselves were onerous or even uninteresting but rather because traveling to them used to cut into my already limited time for research, given that these tumor boards were always scheduled on days on which I didn’t have to be in clinic or the operating room. In other words, they always took place on my research days.
One of our affiliates was a nearly an hour and a half drive away, and many of them were close to an hour away. When you add up travel time and the tumor board, that’s easily more than three hours eaten up, all too often right in the middle of the day. In actuality, though, several of the tumor boards themselves were quite good, one of which being the aforementioned one that required nearly a 90 minute drive to reach. (It helped that they served a really nice breakfast there, too, but they also have really stimulating discussion about various cancer cases.) One of the weird things about these tumor boards is that I was viewed as–and I quote–the “outside expert.” This was particularly disconcerting the first year I had the job. There I was, fresh out of fellowship, being looked up to as the “expert” by physicians, many of whom who may have been in practice for 10, 20, or even 30 years. Somehow I managed to muddle through without making too big a fool of myself. These days, years later, I almost even feel as though, for breast cancer at least, I am worthy of the appellation of “outside expert.” Experience does matter, I guess.
Maybe about three years ago, I found myself attending a tumor board at one of our affiliates that brought up issues that I do not see that often. It brought up a rather difficult issue, one that I hadn’t given as much thought to before as perhaps I should have or that I have in the years since I started blogging actively about so-called “alternative” medicine. I hadn’t been expecting anything out of the ordinary when I arrived at the hospital auditorium. As usual, I said hello to the oncologist who runs the tumor board, a private practice oncologist for whom I had considerable respect and with whom I have shared a few patients. There were some amusing technological difficulties with the computer projection of the radiological studies and pathology slides having to do with a problem moving between a Mac and a PC with the projector, and my attempt to apply my knowledge of the Macintosh in the service of helping them figure out the problem was in essence rebuffed. So, I sat down and let them figure it out on their own without my input, concentrating instead on the coffee and breakfast that was provided. (A common theme for morning tumor boards is food, in case you hadn’t guessed by now. Attendance rises in direct proportion to the quality and quantity of food.)
The first two cases presented were not particularly unusual, and we discussed them in a pretty standard fashion, but the last case presented was tragic in the extreme. If you’ve been a regular reader of this blog, you may have an idea of the general parameters, but this one shocked even me. The case involved a woman in her early 30’s, who presented to a surgeon with a small palpable breast mass. Her primary care doctor had appropriately ordered a mammogram and ultrasound, which the surgeon dutifully presented. The odd thing was that the films were from 2002. The surgeon presenting explained that this woman had presented over three years prior to him for the evaluation of this mass. On mammogram, there was a mass less than 1 cm in diameter, which was confirmed by ultrasound. The edges of the mass weren’t quite smooth enough to consider it very likely benign. Consequently, the mass fell into that gray areay that we in the biz call “indeterminate,” which is basically a code word for “we don’t know if it’s cancer or not and the imaging doesn’t look sufficiently ‘benign’ for us just to follow it.” To put it even more bluntly, it needed a biopsy. The surgeon described how he dutifully did an ultrasound-guided fine needle aspiration of the small nodule.
The results? Adenocarcinoma. Breast cancer. Not much of a surprise, given the appearance on ultrasound.
Here’s where things got interesting. Apparently, this woman was a die-hard believer in “alternative medicine.” And I do mean “die hard,” as she will quite likely die very hard for her beliefs, if she has not already in the interval between this tumor board and now. She absolutely refused any surgery or treatment for her cancer. It was explained to her that a less than 1 cm tumor with no evidence of spread to the lymph nodes carried a highly favorable prognosis, with upwards of 93% long term survival with proper surgery and radiation therapy combined with adjuvant chemotherapy and/or hormonal therapy. Here was a patient surgeons love, because we have a very high probability of curing her.
This woman would have none of it. She wanted to pursue “alternative” medicine. And pursue it she did, with a vengeance. For three years, she disappeared off the radar screen.
A few weeks prior to the tumor board, she had reappeared in this surgeon’s office. In the interim, she had tried Essiac tea, homeopathy, Hoxsey therapy, the Gerson treatment, and Reiki therapy, among others, all the while visiting various “healers.” The results? If you’ve been reading here, you can guess the result.
Her tumor had progressed.
Not only had the tumor progressed, but it had progressed a lot. When the surgeon saw her again, now more than three years after her diagnosis, her tumor had grown to 5-6 cm in size. It was now stuck to the chest wall, distorting her nipple, and ulcerating through the skin in a five centimeter area of bleeding, disgusting goo. Indeed, the surgeon even showed a picture of it. In addition, she had developed easily palpable axillary lymph nodes (the lymph nodes under the arm) on physical exam and complained of bone pain strongly suggestive of metastases to the bone. Even if she did not now have metatastic disease to the bone, her chances of cure had been vastly diminished, as she had clearly moved up from a highly curable clinical Stage I to a difficult to cure clinical stage IIIC. (If she had bone metastases, she was no longer curable at all.) This patient was in serious trouble. You would think that, finally–finally–she would have realized her mistake in not having gone with surgery and conventional medicine.
You would be mistaken.
The patient still steadfastly refused all surgery, chemotherapy, and radiation. Against all evidence that the course she had chosen thus far had not resulted in the elimination of her tumor that she expected, she nonetheless insisted on continuing with various alternative medicine treatments. Against all evidence to the contrary, she continued to refuse any form of “conventional medicine.” She still believed that her ” healer” could save her life, even though she now had a large, bleeding, stinking mass in her breast stuck to her chest wall that had three years ago been a pea-sized cancer that could have easily been excised with a small surgical procedure. She was well on her way to dying in the horrific way that so many women died of this disease 100 years ago. And the cost was more than just the growth of the tumor. The woman had three small children at the time of her diagnosis. Seeing what was happening to her, her husband had finally recently filed for divorce and custody of the children, basing his claim on the fact that, due to her progressing cancer, the poor woman would soon no longer be able to care for them properly and that she had rebuffed all of his attempts to persuade her to get proper medical treatment. He was right. Hearing this tragic case, I felt myself becoming simultaneously enraged and a little bit choked up. By presenting this case, the surgeon was in essence asking for advice, and none of us really had any words of wisdom to give him. He was up against religious or quasireligious fervor, and no amount of reality would change this woman’s mind in any way. He was desperate to help her but utterly helpless in the face of her beliefs. His only hope was that she had actually come to him again. Maybe he could finally reach her.
It was at this point the discussion took a second unexpected turn.
The medical oncologist who ran this particular tumor board stood up and addressed the attendees. She emphatically said that she viewed this case as a failure of the medical system. The medical system failed, she claimed, because it had been unable to reach this woman, because this woman had not gotten psychological help to help her to see the truly self-destructive course that she was taking. I had to disagree strongly and told her so.
The discussion became considerably more animated after that, with several doctors taking issue, including me.
How, I (and others) asked, could this be a failure of the medical system when the woman was given all the information necessary to make an informed choice and chose quackery? How, we asked, can this be a failure of the medical system when the woman continued in this course despite the fact that her primary care doctor, her surgeon, and her family begged her over and over and over again to reconsider? How, we asked, can this be a failure of the medical system when the tumor’s progression was obvious to even the most casual observer, given that it now was bleeding and eroding through the skin? We pointed out that the old cliché that you can take a horse to water but you can’t make him drink applies very well to this case. The woman had been given every opportunity. She had been brought right up to the water three years ago. It was not the system’s fault that she wouldn’t take the last step and take a drink. She had been (and was at the time of the tumor board) a competent adult. (I do not know if she still is, because I do not know if she is still alive.) Unlike minors, she is perfectly free to refuse treatment or to opt for whatever treatment she wishes, no matter how blatant the quackery. There are just some people for whom no amount of counseling or discussion will persuade. Respect for patient autonomy tells us that we must not force her to undergo the appropriate treatment, no matter how much it breaks our hearts to see a young woman with three young children throw her life way.
Faced with these objections, the oncologist changed her emphasis a little, and said that, had this been her patient, she would have viewed the failure to persuade her to see reason as a personal failure. I could see this point of view somewhat, but even so she seemed to be being a bit harsh on herself. On the one hand, I could respect her point of view, in which the inability to persuade a patient not to throw her life away would have been viewed as a profound professional and personal failure as a doctor. On the other hand, not everyone can be persuaded, no matter how good a physician is. If this woman had any mental illness that was leading her down this path, it couldn’t be discerned, unless one defines failure to face reality as a mental illness. If that were the case, a large proportion of the population would have to be hospitalized, given the rampant credulity and failure to face reality about so many issues that plagues our society. Indeed, refusing to face reality seems to be part of human nature. It’s just uncommon for it to be taken to such an extreme.
I used to be very reluctant to agree with a couple of my co-bloggers when they call alternative medicine “cult” medicine, but this woman demonstrated that maybe they know something I don’t. What else could explain her extreme inability to admit what was happening to her? What else could explain her inability to recognize or admit that all the quackery she had tried up until that point had failed utterly? What else could explain her intention to pursue even more of the same? I still think of her, two or three years later. These days, I wonder if she is still alive. Chances are, her faith in “alternative” medicine killed her sometime between that tumor board and now.
The discussion ended unresolved, although most of us weren’t able to think of anything further that could have been done in 2002, nor could we think of anything that could be done then, given that the patient was still refusing any sort of non-alternative therapy. Indeed, we were rather puzzled why she came back now if she were sure that she had no intention of accepting any sort of conventional therapy. Perhaps even she didn’t know, or perhaps her coming back was a cry for help, a manifestation of a realization that she didn’t want to face that her choice was clearly not working and her health was seriously deterioriating. Whatever the case, in situations like this, no matter how frustrated and powerless we feel, all we can do as doctors is to be there, ready to help and nonjudgmental as possible–and hope that when and if the patient comes back there is still something we can do.
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David – thanks for the touching story. However, I was expecting your discussion to go to the obvious point that the people who are truly to blame are the “alternative healers” who offered her false hope in their ineffective treatments. They lured her away from effective medicine, and they kept her away despite the obvious failure of their treatments. They stole her life with their fraud.
Blame also lies at the feet of the various regulatory bodies – the legislators who have passed laws allowing charlatans to practice medicine without a license as long as they call it “alternative.” Forty years ago they would have been shut down, now they thrive in a friendly environment.
To a lesser extent blame lies with those members of the media who failed to exercise basic journalistic integrity by credulously promoting utter nonsense. Some surveys have shown that acceptance of CAM is largely due to positive media reporting. Every time a charlatan appears on Oprah, more people like this patient will die as a result.
And finally, I do think the medical profession shares some of the blame – as a profession we have sat on the sidelines while antiscientific ideology has infiltrated medicine at every level. Every physician who is not outraged and actively working against the rise of CAM is to blame.
Orac, please duck over to MHA and post Part 1.
A common theme there (as you no doubt remember) is the “you never hear of <insert woo> failing, so it always works” argumentum ad ignoratum.
The fact that there’s no way, even now, to tell what has happened to this woman is a fine example of why: woo runs on amnesia.
What a tragedy. My only objection is to the admonition to be “nonjudgmental.” I’m sure you didn’t mean it in the way I’m thinking of it, but: if there was a failure of the medical profession, it may have been that her doctors were not judgmental enough. Not of her, per se, but of her choices and of those who provided those choices. Did her doctors tell her that those methods are worthless quackery and that their practitioners are either charlatans or know-nothing ditzes? Sure, I wouldn’t have said those things at first, either, because I would have hoped to get through to her without having to resort to such definitive, but provocative, language. But later on…
I’m one of the “cult” bloggers, in case it isn’t obvious.
Dr. Moran, I hope you’re still out there, because this is the theme of a lot of your comments and I’m sure you have some useful thoughts about it.
I hadn’t seen the other comments when I posted mine. I agree totally with Steve Novella and Overshoot.
It is a failure of our medical system as we have allowed quackery to be practiced.
Sorry about that. I had to see a patient and didn’t refresh my screen and hadn’t seen the other comments. I see Dr Novella already mentioned my point.
Yes, to the first part, in no uncertain terms, although the words “useless” and “ineffective” were used.
I’m surprised, though, that you would say that the doctors should have told her that her “alternative” practitioners are charlatans or know-nothing ditzes. Remember, the goal is to try to get the patient to accept and undergo science- and evidence-based treatments and thereby to save her life. That goal is the only goal that should be in a doctor’s mind when facing such a patient. The price of failure is the death of the patient.
In my experience, the quickest and surest way to alienate such a patient and to guarantee that she will not listen to a thing that you say after that is to start attacking her current practitioners in such a nakedly judgmental way. Because the patient chose those practitioners, she will almost inevitably interpret such attacks on her practitioners, no matter how justified, how well-argued, or how true, as attacks on herself. Indeed, calling the practitioners “quacks” and “charlatans,” particularly on the first visit, is about as counterproductive a strategy as I can imagine. (It’s rarely such a great idea later on, either, after the patient has invested a great deal of time, money, and herself in the woo in question.) That’s why I must strongly disagree with the last part of your statement. It may be appropriate at some point to drop the “Q-bomb” (perhaps later on, after her tumor had grown), but telling when that point is is very difficult and fraught with peril. More often than not, such characterizations will not help the physician attain his goal of persuading the patient to let him try to save her life.
If in some forms alt-med is indeed a “cult,” as you characterize it, ask yourself this: What’s the usual reaction of cult members to direct attacks on their beliefs or their cult leader? It ain’t to say, “Oh, yes, you’re quite right. How could I have been so stupid?” It’s to circle the wagons, view the attacker as an enemy and infidel, and to push back or run away.
Sometimes the best you can do is to persuade the patient to accept science-based therapies while at the same time pursuing woo. If the woo probably doesn’t interfere with effective therapy, the compromise is acceptable. Sometimes you can even sell it as “using both methods.” As long as it doesn’t interfere with real therapy, most doctors will swallow their objections and hold their tongues in order to see that the patient is cared for as appropriately as possible. I certainly would.
Steve:
I mostly agree with you. All of those factors are in fact to blame. However, the point of this post was not to be a general treatise on the factors that are to blame for the infiltration of quackery and its tolerance, using this case as an introduction. I’ve written such posts here and elsewhere. Rather, it was to focus very narrowly on just one aspect of the issue, the role of individual practitioners and how powerless we can be to dissuade a patient like this from such a self-destructive path, thanks to the cult-like nature of a lot of “alt-med” devotion.
I also wanted to express my puzzlement over the apparent attitude of one of the oncologists at the tumor board, who seemed to be laboring under the delusion that she could persuade any patient to accept science-based therapy. It’s a noble sentiment, but ultimately self-defeating. It also betrays a bit of hubris for anyone to think that she should always be able to persuade a patient of the rightness of her recommended course of action, and it’s an utterly unrealistic standard, to boot. Holding oneself to such an unattainable and unrealistic standard is a guarantee that when one fails one will place far more blame on oneself than is warranted. Not all such patients can be persuaded to see the light.
That was more the point of my post. Perhaps I didn’t do as good a job of explaining it as I thought, or maybe I should have given the post a different title.
I might even go a step further. If a doctor were always able to persuade any patient to accept the MD’s recommendation, that would destroy the principle of patient consent. There’s no consent if the patient is ultimately incapable of making any other choice.
Accordingly, I would argue that “omni-persuasiveness” would actually be a bad thing.
David,
I am confused. In your latest comment you seem to be of two minds. On one side, you seem to say that the oncologist could have persuasive power with the patient, when you say that calling the alt-med practitioners charlatans would alienate the patient (alienate her how? Was she on the fence?) on the other side, you say that the oncologist was wrong for thinking that anything could have changed the patient’s mind.
Which is it? It’s my opinion that, once it was established that the patient could not be reasoned with, the doctors are free to use words like “quack” and “charlatan”. It doesn’t do anything to convince the patient that she should be using science-based medicine, but it can’t help but give the doctors the satisfaction of “calling a spade a spade”.
This is the evil that prospers when good people do nothing.
It’s not about getting the “satisfaction of calling a spade a spade.” Who cares if a doctor feels such satisfaction? It’s not about the doctor, anyway, nor should it be; it’s about the patient. It’s about never closing the door for the patient to come back if she changes her mind.
Once again (although you couldn’t know that since that was my first post here) I have expressed myself poorly. I wasn’t trying to say that it was about the doctor – at least, no more than you were when you discussed on the tumor board the feeling of ineffectiveness on the part of the doctors.
However, you still haven’t answered my question. Is the doctor able to influence the patient that is “dead-set” on alt-med? If so, I can see the need to “pull punches” when it comes to expressing their opinions on alt-med practitioners. If not, then what does it matter if you call them on being “know-nothing ditzes”?
It seems to me that you are telling doctors not to feel bad because they can’t change the mind of the patient – except when they do.
Christian Scientists – should MDs tell them their religion is nonsense?
Patients who don’t try alternative treatments but simply refuse life-saving treatments for whatever reason – maybe they want to die – is it our responsibility to change their mind?
I think the answer to both questions is no. Doctors have a responsibility to patients but patients have the ultimate responsibility for their own actions.
One thing we could do much better is develop individual long-term caring relationships with patients so they might be more willing to trust us and let us educate them. A good family physician can fill that role.
The ultimate solution is (1) better education in science and critical thinking, and (2) prosecution of quacks.
You are implying that you now have reliable cures for breast cancer. But I had heard that you don’t. It seems like you’re saying this patient would definitely have been saved by your treatments, if started in the early stage. Or are you saying that although you have no reliable cures, death from breast cancer is less unpleasant now, because of new surgical technology?
You leave a lot unstated, expecting us to fill in the missing info with anti-alternative science assumptions.
This is the art of medicine – In practice you sometimes have to balance antithetical goals. On the one hand, for example, you want to properly motivate patients with a realistic assessment of the situation – how severe is their disease, what is the likely outcome if they refuse treatment, etc. You also want to maintain a therapeutic relationship, and you also want to avoid potentially harmful psychological stress. You have to reach an individual balance in each case – there is no algorithm.
There is a skill to strongly advocating SBM and criticizing quackery without alienating the patient. That doesn’t mean you can always be successful – sometimes the patient is truly a lost cause.
(I sense there is a blog entry in there.)
The long term survival rate for properly treated stage I breast cancer like the one this patient had is over 93%. That’s pretty reliable, in my book.
Even for a patient with a tumor as advanced as this patient’s was when she presented again three years later, we have a great deal to offer for palliation and lengthening survival, even if we can’t cure breast cancer if there are distant metastases.
For those who have reading comprehension problems, David wrote: “It was explained to her that a less than 1 cm tumor with no evidence of spread to the lymph nodes carried a highly favorable prognosis, with upwards of 93% long term survival with proper surgery and radiation therapy combined with adjuvant chemotherapy and/or hormonal therapy. Here was a patient surgeons love, because we have a very high probability of curing her.”
93% long term survival – that is a very specific evidence-based statement of probable outcome.
What a tragic, thought-provoking story, and what a thoughtful discussion! Thank you, Dr. Gorski and commenters.
From Dr. Gorski’s post:
Perhaps pride over her long-running disagreement with her husband and perhaps others?
What terrible situation this woman is/was in. Similar to a suicidal patient asking for help almost. Very moving post which shows me how science based doctors have so much to balance, while quacks are jerks with simplistic and horribly dangerous perspectives.
Since Pec’s reading comprehension is so poor she should go to a chiropractor at least 20x daily, ease up that blocked energy so she can understand what a teenager could have after reading this post.
I suspect that those of us who deal with knowledge as fluid and evolving have a greater understanding that few things (if anything) are written in stone. This makes it easy to change tack quickly and reasonably effortlessly. We also tend to get less hung up on being wrong – it’s not so…personal. Faith, by its very nature, is not only personal but also requires blocking out anything that undermines faith (denial is built into faith in many ways, it’s perhaps even essential for faith).
As for the woman being talked about in the blog. I actually think it would take a huge amount of personal courage and honesty to be able to admit to oneself (let alone others) that you’d made a mistake so big and stupid that you’re now dying horribly and essentially alone from it. Many people – particularly people who consider themselves clever or a bit better than everyone else – don’t report when they’ve been conned. It’s embarrassing. Particularly if you’d been manipulated in such a way that your entire family had been alienated, your bank accounts have been drained, or you’ve fallen prey to thinking someone is your friend or cares about you when they just wanted your money and are actually killing you (and if your healer is actually a genuinely caring person, it becomes even harder for people to accept). People are afraid of death and pain, CAM cancer quacks and con artists exploit this to the max (by pretending surgery and chemo don’t work, by lying about CAM treatments, by creating conflict in families and isolating the sick person from people who advocate for EBM, etc). I suspect most people who die due to faith based beliefs go to their grave clinging to their faith. After all, it’s often all they’ve got left if they’ve alienated family and friends. And if they’ve based their choices on repercussions in the “afterlife”, they’re perhaps not even that invested or attached to this life to begin with (a lot of people who invest heavily in faith seem to not think much of life and the world, but rather see being alive as a punishment and prelude to something better later).
pec said,
“You are implying that you now have reliable cures for breast cancer. But I had heard that you don’t.”
This is dishonest of pec. There was a whole discussion with pec and others in another thread where the information about cancer survival rates was thoroughly discussed. pec may “have heard” that we don’t have reliable cures, but she also “has heard” that we do. She is choosing to hear the myth and not the truth.
Or perhaps pec really just can’t actually integrate/hear any information that contradicts her faith? After all, she’s got a lot invested in her beliefs about both doctors and CAM. For instance, she blames doctors for not actively forcing people to lead healthy lifestyles (apparently it’s medicine’s fault that pec now has to look after her mother who apparently didn’t eat well or exercise, and that pec herself didn’t encourage to adopt a healthy lifestyle). I think pec’s omnipresence on these boards – despite having no actual interest in EBM – speaks to her dedication to promoting CAM and investment in demonizing medicine. Of course, she could also be protecting and promoting her or her employer’s commercial interests.
David, I appreciate this insiteful post. Alienating a patient, in any way, cannot be a good thing. The fact that the patient returned shows the doctor did his best.
My, local NPR station (WAMC, Albany, NY) is run by a hypochondriac and has many shows revolving around health. And quackery is welcome. I tried to get the “Health Show” to feature reports critical of CAM. The producer labeled me an “anti CAM lunatic.”
Then, I tried to get “How to Save Your Life” (hosted by a neurosurgeon, Phillip Stieg) to feature a piece critical of naturopathy. He never had the courtesy to respond. Later, he opined that winter depression is caused, in part, by the fact that we don’t sweat out toxins in cold weather. (What is it about the egnorance of NY neurosurgeons?)
Then, a show featured a natuopath’s take on cancer prevention. I was formulating a response to the MD who moderates the show, when she aired another show featuring an ND. Resistance is futile.
BTW, if they don’t remember, I appreciated assistance from Dr.s Atwood, Hall and Gorski over the years.
Anyway, my sister always admonished me that you catch more flies with honey that with vinegar.
There might be some benefit to having licensed naturopaths in this situation. If this patient went to the naturopath and was not urged to seek regular medical help at every visit, then that naturopaths’ license should be revoked and this patient’s family should sue this naturopath for gross negligence. Call me crazy, but I actually think there might be an advantage to regulating naturopaths through state licensing.
Which is why, IMHO, it’s important to establish a “This is what I advise you to do, but whatever you decide please come back every <insert regular interval> to monitor progress and discuss how you’re doing” relationship.
Who knows? Maybe if the patient had been confronted with a nonjudgmental record of how her disease was progressing she would have found it harder to back herself into the corner she did.
“The long term survival rate for properly treated stage I breast cancer like the one this patient had is over 93%. That’s pretty reliable, in my book.”
But we have never resolved certain questions such as over-diagnosis and lead-time bias. Most patients with her early diagnosis would never have progressed to fatal cancer, and her cancer might have progressed even with standard treatment.
So we are back to that unsolved problem again. You can insist all you want that you cure 93% of these cases but you know how misleading that is.
Vinny,
You are mistaken about public benefit. Licensure protects quacks from criminal prosecution. If they practice within “the standard of care” as defined by their quack associates, they cannot be held accountable.
Then, one is left to argue the “preponderance of evidence” before an unsophisticated jury in a civil case. What to you, and me, is clear is actually cloudy for the general public.
Experience does not show any advantage to licensure. Licensed chiropractors needlessly kill people (think, stroke) with impunity. You are not crazy; just a bit misinformed.
pec,
“Most patients with her early diagnosis would never have progressed to fatal cancer”
Most people with your astute interpretative skills would not progress past a 5th grade education. Why do you bring up such nonsense? I suspect “pec” might be another nick used by the creepy character known as antivax.
Pec,
The correct statement would be: With standard medical treatment, most people (93%) would not have progressed to fatal cancer.
You think that this would be the outcome without medical therapy and you are DEAD wrong.
Joe, I might be interested to find what actually occurs in states where naturopaths are licensed and patients seeking their care have visible cancer such as this patient. There are laws about offering quack cancer therapies.
Vinny,
The authority on this is our own Dr. Atwood. http://www.naturowatch.org and more. It is difficult to glean information on this topic (cancer and other mistreatment) because there are no standards for reporting. In addition, there are disputes among NDs concerning who really qualifies as an ND.
Well Vinny even Gorski will tell you that most early stage cancer or pre-cancer never would progress, with or without treatment. So the public has been misled into thinking there are reliable cures for cancer, as long as it is diagnosed early.
But early diagnosis results in many early cancers or pre-cancers being found that would never have bothered the patient if left alone.
Yes it’s possible that some early cancer that would have progressed is cured by the standard treatments. But nothing like what has been implied.
Maybe 93% of the diagnosed and treated early cancers are “cured,” or at least do not recur within a specified time, such as 5 years. But how many would have progressed without any treatment? Certainly not 100%.
After correcting for this sort of thing, you wind up with a very small probable success rate for the standard treatments.
pec,
I am really disgusted with your comments. You continue to offer misinformation even after you have been shown why it is wrong. All this has been covered before. And none of it has anything to do with this patient. Her cancer DID progress.
The tumor board was a group of specialists who knew all about things like lead time bias and who knew what the statistics are and what they really mean. Even if you want to quibble about whether the 93% was accurate, you can’t deny that there was an excellent chance that early surgery would have cured this woman’s cancer.
You are quick to criticize, but you don’t offer any suggestions. If you have anything better to offer breast cancer patients than modern scientific medicine, please tell us.
What do you think this woman should have done when she was diagnosed?
Harriet,
Isn’t it obvious? She should have had chiropractic manipulation or yoga and she would have been cured. Wait a darned minute. Pec, were you the alternative healer for this patient?
Don’t put words in my mouth (or blog) that I didn’t say. It’s incredibly annoying, and you do it over and over and over again, even after you have been corrected over and over and over by me and others. You clearly misunderstood my early post. (Big surprise.)
The very early stage cancers to which I referred were very tiny, many of them microscopic or at most a few millimeters of preinvasive cells. They were a lot less than 1 cm in diameter, and most of them were not already invasive (i.e., they were DCIS). For such tiny, preinvasive tumors it is true that many will probably not progress. The problem is that we don’t know which ones will and will not progress, which can lead to overtreatment. Moreover, in young women, there is a tendency towards more aggressive tumors; it would be folly and insanity not to treat a 1 cm tumor in a young woman.
However, we do have a pretty good idea that most 1 cm frank cancers will indeed progress. The rate of progression is highly variable, but most will progress–especially if they are large enough to present as a palpable lump, as was the case with this woman. Indeed, we even have a study that shows how long it takes 1 cm tumors to progress to 2 cm. Granted, this study involved older, postmenopausal women; so slower-growing tumors were more common, but it does give an idea.
“we do have a pretty good idea that most 1 cm frank cancers will indeed progress”
And what percent of those are completely cured?
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pec – So your argument against treating cancer with EBM is that it’s not a 100% “complete cure” rate? And you’re making this argument after reading about how a woman died because she refused EB medical treatment precisely because she believed people like you who spread lies about EBM cancer treatments as a means to promote the kinds of toxic or useless “alternative” treatments that resulted in the progression of her cancer to the point where it is/will be fatal?
David,
I appreciate the point of this tragic story, and I agree with your perspective completely—including the issue about talking with patients, my previous, frustration-born statement nothwithstanding. I especially agree with your point about the hubris of the oncologist seeming to think that she should be able to convince any patient. I have sensed that same hubris among some physicians, and have begun to wonder if it has something to do with why they have become so tolerant of quackery recently. A patronizing stance, perhaps…”(well, ha ha, this person isn’t too bright, but I’ll just humor her about the woo and take care of business myself…)”? Something else (see below)?
I agree with others who decry medicine’s general tolerance of quackery as one of the problems here, and with Harriet’s point that we, as a society, fail to teach science adequately. I agree, as I’ve written here before, that the best we can so is to “lead a horse to water.” See: http://www.sciencebasedmedicine.org/?p=97#comment-3018
Having said all that, I still think that there’s room for some debate about how to approach individuals. In the comment linked above, I asked Peter Moran, a thoughtful surgeon with whom I mostly agree about such things, the following:
“why denigrate our hard-won expertise and professionalism by calling it “a high-handed, ‘we know best’ stance and arcane argument from plausibility”? Would you say the same about a lawyer, a commercial airline pilot, an accountant, a civil engineer, an astronaut, or many other experts whose knowledge necessarily includes much that is technical, esoteric, complex, and difficult for even smart, educated people to understand without specific training? [etc.] ”
He replied: “No, because quackery only flourishes in medicine. Only there do do useless methods seem to work well enough to mislead a lot of intelligent and vocal people. [etc.]”
I thought about responding to that at the time but didn’t, and now seems to present another opportunity. Yes, it’s true that few people would pay for a ticket on a flying carpet, but it’s not true that few people get scammed by con artists other than quacks. A common scam is the get-rich-quick scheme aimed at retirees; there are frequent stories about the elderly losing their entire “nest eggs” to scams. How should a lawyer or an accountant respond to a retiree asking his opinion about such a prospect(us)? I would fully expect such a professional to tell my mother, if she were to ask, that the proposal is a “scam.” Anything less would be a failure of legal or accounting ethics. I’d be especially angry if, after any equivocating by that professional, my mother ended up being sucked into the scam—which, of course, could be every bit as injurious as quackery.
My point is that I’ll bet most of us would expect a lawyer or an accountant to call a scam a scam, assuming that it were identifiable as such. Why, then, don’t we expect the same of MDs? Hubris, maybe? Could it be that such hard-ass truth-telling seems too crude for us god-like physicians? Or could it be that many physicians, in what has become the norm for liberals in the US at least, feel so guilty about everything that they don’t think that they have the right to call a scam a scam?
I don’t pretend to know the answers, but the questions need asking. A couple of other thoughts: there’s usually a difference between putting down someone’s religion and putting down someone’s woo, Christian Science being an exception. Nevertheless, I’d have no trouble telling Christian Scientists that their religion is nonsense (”dangerous nonsense” is probably how I’d put it), I’d just not do it in the context of the doctor-patient relationship. (Not that there would likely be one…) Religions, as Sam Harris and Richard Dawkins and others have been arguing lately, have no legitimate claim to protection from reasoned inquiry.
Second thought: I imagine Vinny had his tongue in his cheek when he suggested a possible “benefit to having licensed naturopaths in this situation,” but check out this article for a similar, albeit contrived, example: http://www.annals.org/cgi/reprint/137/8/660 An example of “bait and switch,” if you ask me.
I can’t help but think of the woman in this post and when her death ultimately arrives, Science-Based Medicine will still take the hit for letting her die. Whether rushed to the ER or wasting away on hospice, her death certificate will not read vitamin deficiency or disruption of vital energies and be signed by an ND. No, most likely it will have a science-based cause of death and will have an MD’s signature on it.
There is one industry, other than medicine, absolutely plagued with woo and it amounts to hundreds-of-millions, if not billions of dollars wasted on ridiculous beliefs and stupidity. It’s high-end audio and audiophiles. It’s an industry grotesquely filled with equipment, terms, publications, and trade shows dedicated to claims and “knowledge” that is not only unprovable, but has regularly been deconstructed by double-blind listening tests. Fortunately, it is financed by the rich, ignorant, and self-righteous and not by insurance companies or tax dollars. Despite information being available to the contrary, the woo portion of the industry is so profit-heavy they proliferate every avenue of consumer electronics and continue to thrive.
Check out: http://www.randi.org/jr/2007-09/092807reply.html#i4 or http://users.cwnet.com/kant/myths.htm There’s lots more just a Google search away.
At least when someone with more money than brains buys a $25K amplifier, or spends $12,000 on speaker cables, or $485 on a wooden knob ( http://www.museumofhoaxes.com/hoax/weblog/comments/4309/ ), people don’t get hurt.
Hydrogen powered cars, fuel saving magnets, and air intake “tornado” devices are pretty woo’ish, but still, no human lives at risk.
It sure does point to a non-scientific and gullible population quick to dismiss the old cliché “if it sounds too good to be true. . .”
This is what I said Fifi:
“Maybe 93% of the diagnosed and treated early cancers are “cured,” or at least do not recur within a specified time, such as 5 years. But how many would have progressed without any treatment? Certainly not 100%.”
Not at all what you thought I said.
And no one here at SBM has ever been able to provide an answer.
If 93% of early-diagnosed patients survive with standard treatment, we cannot assume they would have all died without it. Let’s say half would have died without it — then the cure rate would be 47%, not 93%! Get it? But we can’t assume half would have died without treatment.
How can we know what the cure rate is? Either the SBM bloggers are keeping it a secret or they just don’t know.
The cure rate for this type of cancer when diagnosed early is somewhere between 0% and 93%. Well that’s useful information, isn’t it?
In the three years that I worked as an oncology nurse I saw three patients who chose no treatment disguised as alternative treatment. All three of them continued to believe in their choice until they died. One patient sent blood samples to some guy in Greece and he sent back herbal supplements and diet requirements (lots of grapes, for some reason). Another was actually “treated” by an MD with vitamin shots and coffee enemas. The third took vitamins and a vegetarian diet (I guess cancers are obligate carnivores). What I didn’t understand in any of the cases was why their families, who brought them to the hospital when they were unable to refuse in the late stages, did not sue these “alternative” quacks. Their loved ones lives had been stolen from them and they didn’t sue. If it had been an oncologist whose recommended treatment didn’t work as they expected it to, there would have been suits and threats of suits. But not with the quacks. The only thing I guess I can learn from that is that “bedside manner” has a lot to do with it. Otherwise I am clueless.
I would estimate the cure rate with alt therapies to be between 0% and 0%.
It is like the case that got me interested in quackery, a 20 something female with an osteosarcoma of the leg that instead of amputation opted for naturopathic therapy. I saw her just before she died as he entire leg was necrotic and infected with mixed synergistic gangrene. She refused therapy as she wanted her naturopath to treat her (The only reason she was in the hospital was she passed out from bleeding out of her leg). She was convinced she could still be cured. You get to see many wasted lives in medicine, but this was one of the more tragic.
I mostly see those who refuse HAART for AIDS in favor of alt therapies ad it breaks my heart to see another pointless death.
I still do not know how to respond to these sorts of cases, and in the end we are responsible for our own destiny. I think its the 6th amendment to the constitution that enshrines out inalienable right to be stupid. I occasionally get to practice it in the blog.
David, can you give us some more background on this woman? We can’t decide whether the system failed her unless we assess whether any known systemic deficiencies contributed to her bad decision.
For example, what was her ethnic, cultural, and socioeconomic background? I’m not being a relativist here. Obviously, she was wrong and her doctors were right.
My question is whether her doctors took stock of the ways in which her background might have been influencing her decisions. Why was she so reluctant to have surgery? Did she simply believe it unnecessary because she had such great alternative medicine, or was her reticence based on some further misgivings or misconceptions about medicine? For example, did she have insurance? Did she trust her husband to watch the kids if she had to go to the hospital?
Did her doctors seek input from other professionals, e.g. social workers, health educators, or nurses when deciding how they were going to go about convincing the patient to comply with treatment.
If her medical team explored all options and still couldn’t reach her, then it wasn’t the system or the doctors. Even the best efforts won’t succeed 100% of the time.
There was a case where a woman wanted a VBAC and had a large baby (8 lbs 2 weeks before birth and 10+ at delivery), and the OB said no, so she opted for a home birth with predictable results.
The child was brain damaged at birth, the midwife who did the home birth didn’t have insurance, so guess who was sued?
You guessed it, the OB who said a VBAC was too dangerous.
http://homebirthdebate.blogspot.com/2008/01/23-million-lawsuit-alleging-doctor.html
The jury did find the OB was not at fault.
pec said “The cure rate for this type of cancer when diagnosed early is somewhere between 0% and 93%. Well that’s useful information, isn’t it?”
Actually, the cure rate is about 93%, with a about a 7% chance of failure.
So tell us, what would have been your advice to this woman? What sure fire cure would have actually worked at the vaulted 100% rate?
Dr. Gorski wrote “In the interim, she had tried Essiac tea, homeopathy, Hoxsey therapy, the Gerson treatment, and Reiki therapy,”…
Tell us, pec, what are the documented cure rates for:
Essiac tea?
homeopathy?
Hoxsey therapy?
Gerson treatment?
Reiki therapy?
Show us where it is recorded and documented, we really want to know what would have been a better way to treat this woman.
pec, you didn’t answer the question. So is your argument against treating cancer with EBM is that it’s not a 100% “complete cure” rate?
Do you think that people should do nothing if they’re diagnosed with cancer? Or do you believe they should opt for CAM methods like the woman discussed in this blog did?
“So is your argument against treating cancer with EBM is that it’s not a 100% “complete cure” rate?”
Well I guess you are not going to get it are you? I said the cure rate is unknown. That doesn’t mean I think homeopathy or something else is better. But this post strongly suggests that the standard treatments are evidence-based and reliable, and that we know how often they work.
If I am skeptical about one something, why do you conclude that I am selling some other thing?
When Gorski says his cure rate is 93% he probably means that 93% of the patients he treats for this type of cancer survive at least 5 years. He doesn’t know how many would have survived that long without his treatment. And he is not telling us how many survive 5 years but have a later recurrence.
It sounds good to say 93% are cured. It sounds like mainstream medicine really is making progress towards curing cancer.
But we know from other sources that very little progress has been made. Cure rates for early cancer have risen, but we don’t know if those rates reflect real cures or just over-diagnosis and lead-time bias.
I don’t think you are going to comprehend this Fifi so just continue rejoicing about the wonderful progress in the war on cancer.
[...] 2008 · No Comments Dr Dave Gorski has sparked off an interesting discussion on the topic: Death by “alternative” medicine: Who’s to blame?. A patient with early stage breast cancer is advised on a course of medical intervention but elects [...]
Pec – we actually do understand lead-time bias, and understand your argument that it is possible that science has not progressed at all in the fight against cancer. There is quite a large amount of solid evidence to the contrary, and whatever you may present, there is no better hope for a complete cure for cancer than the steady march of science. If you think there is, then please share it.
I’m curious, if it was you after discovery of a PALPABLE mass, tell us, what would YOU do? Would you take the route this misguided patient took, which is to essentially do nothing, or would you undergo science-based treatment?
Regarding this tragic story, I hope it is distributed in full graphic detail, pictures and all, to oncologists everywhere so they may present it to the next patient who opts for alternative therapies when faced with a similar challenge. Perhaps this poor woman’s plight can be used to knock some sense into others who’ve been misled by those trying to get rich by selling false hopes and death.
pec – You routinely promote various sorts of CAM with absolutely no skepticism or evidence. I find it odd that you’re only critical about EBM and not things that claim to be medicine but have no evidence to support their healing claims. Technically that makes you cynical about EBM (meaning that you believe the worst) not a skeptic. Since you’ve shown no skepticism about CAM alongside your cynicism about EBM, it appears to be a faith based belief in CAM that you’re expressing. Cynicism and faith are two sides of the same coin, and neither are the currency of skepticism (a word you throw around but seem not to understand).
As tragic as the story is there is an assumption that the woman was treated irresponsibly by her ‘healers’. Yet there is no evidence that that is the case. It is possible that some – or all – of her healers urged her to seek medical care, and that the potions they suggested to her may have been described as adjunctive rather than curative. We just don’t know from the facts as presented here so we shouldn’t automatically condemn her healers.
I see an energy healer regularly and he has several times urged me to see an M.D. when he has sensed a condition in my body that he said was beyond his powers to heal.
I don’t write to persuade anyone that an energy healer can actually ’see’ illness in the body (even though much to my continuing amazement this healer has been 100% correct in his diagnoses of my illnesses over a period of many years ) , only that healers can be as ethical as any M.D.
Pec,
So your problem is that you are upset that EBM dares to have a 93% cure rate for the stage of breast cancer this woman had when she was first diagnosed? EBM should not be making progress toward curing cancer because you are rooting for sCAM? This isn’t a baseball or football rivalry.
oderb,
You sound as if you are lucky. Have you given consideration to the possibility that your “energy healer” may be an excellent diagnostician and knows when there is nothing wrong with you and therefore his treatment works. When he realizes something is wrong with you, he refers you to an MD?
I am told by a licensed ND that for whatever reasons certain individuals who have cancer refuse to follow conventional treatments and seek all sorts of alternatives.
This ND refuses to treat anyone with cancer who is not already under care of an oncologist.
Liability is one of the reasons for this.
I personally know one person, who came to this ND seeking alternative cancer cures. The patient, a mother of 2 young children, refused the ND’s advice to follow her oncologist’s recommendations. She went to Mexico for some bizarre treatment, which included following an extreme diet, and took turn for worse after several weeks there. The patient panicked and called the ND from Mexico, was urged to return immediately to the States, to trust her MD, and to apply the same zeal in seeking alternative cures to following her oncologist’s orders.
The woman THEN came back, underwent bone marrow treatment, and is dong well several years later.
It makes sense that had an oncologist a patient sold on various alternative treatments, the MD might refer that patient to a licensed naturopath, who would assist the patient in following the oncologist’s protocols.
Weing, don’t knock it, as this <a href-”http://www.quackometer.net/blog/2008/07/alleged-victim-of-oxford-nutritionist.html”<ghastly case of a woman who was left brain damaged after a nutritionist advised her on a detox diet shows, knowing the limits of your competence is a very necessary and desirable quality.
Quackometer link.
Apologies for html blunder.
weing,
Your comment begs the question of how he knows what is or isn’t wrong with me. He is not medically trained, and even if he was he finds often conditions that are entirely asymptomatic.
Interestingly he often seems to be better at diagnosis than healing (he has several times told me that I was developing a cold or flu when I felt fine. He was right, and he also couldn’t stop the flu from coming which he acknowledged was beyond his powers).
He has told me that he helped save several peoples’ lives by sensing tumors before they were symptomatic and urging them to see a doctor asap. In each case a tumor was found. (His work apparently so impressed several M.D.’s that they now see him regularly themselves)
How he can sense most illness is of course a mystery to me, but I am no longer a skeptic that he has a gift that is entirely beyond explanation by conventional science or medicine (and which I would love to see subjected to a RCT – something he has indicated he would eager to participate in.
oderb,
You say your healer has a gift that is “entirely beyond explanation by conventional science or medicine.” Just because you can’t think of an explanation doesn’t mean it can’t be explained.
Even if it can’t be “explained,” certainly it can be studied. If nothing else, you could learn things about it: whether it is consistent, whether it works for every patient, whether he can detect one kind of cancer better than another, etc.
But the first step is to make sure the gift really exists. You may find it hard to accept, but it’s possible that both you and he are mistaken. Similar claims have been tested in the past and have been shot down.
If he is willing to participate in a test, have him get in touch with the James Randi Educational Foundation as soon as possible. He stands to win a million dollars.
Please do urge him to apply, because if he really has this abiility and can demonstrate it, it will revolutionize our understanding of the world.
pec,
You are talking about lead time bias and other statistical problems. We understand that. But in the case discussed, the patient already had a growing cancer. If left untreated, what were the chances of it NOT killing her? I can’t give you an exact number, but we have a pretty good idea from historical comparisons that the chances of it NOT killing her were very small. The chances of a 5-year cure were 93%. The reason we use 5 years is that recurrences after that length of time are very rare.
Please answer the question we have asked: what do you think the woman should have done?
oderb,
He may be a natural diagnostician, if such exist. More likely it’s a skill that has been honed in over time. He may not even be aware of how he does it. Just like a tennis pro or baseball pitcher may not be able to describe what they do. In fact, if they pay attention to their swing or throw, they get off their game.
[...] (5) Death by “alternative” medicine: Who’s to blame? (2008, July 7) David Gorski. http://www.sciencebasedmedicine.org/?p=15 [...]
weing,
Or- the guy may just be guessing wildly. If you consider that an “energy healer” cannot treat anything, he should always send a person to a doctor for proper diagnosis and treatment.
Joe,
Confirmation bias is certainly possible.
“You are talking about lead time bias and other statistical problems. We understand that.”
So if you and Gorski understand that, why did he pretend there is a general 93% cure rate? This is exactly the kind of deception I have been concerned about.
Harriet,
I appreciate your fair and open minded comments, and I will speak to him about the Randi Educational Foundation.
pec,
He did not pretend there is a 93% cure rate. There is no deception. 7% are not cured. Is it possible you are dealing with self-deception here?
“He did not pretend there is a 93% cure rate. There is no deception. 7% are not cured.”
What percent are cured weing?
pec
Sorry, but I don’t understand what you are seeking?
The quote was not “cure”, it was “93% long term survival”. I believe the definition of long term survival was 5 years, and there was the statement that there are few re-occurrences after 5 years. Obviously, cancer is not like chicken pox – you can get it again even if you’ve already had it once.
Are you
1) looking for a definition of “cure”?
2) asking how many patients are “cured” given some agreed definition?
3) suggesting that science-based medical cancer treatments provide no benefit, and that any perceived benefit is actually a statistical illusion?
If you have an alternative suggestion for how this patient should have been advised/treated, could you please share it with us?
“What else could explain her extreme inability to admit what was happening to her?
What might explain it might be a variant of postpartum psychosis or puerperal psychosis. I see this as a very specific type of psychosis induced in women in the postpartum period to cope with metabolic stress. If she had 3 small children, then she was in the postpartum period.
My explanation of postpartum psychosis is that it is a “feature” to shed an unsustainable metabolic load following pregnancy. If a mother cannot sustain the metabolic load to generate sufficient milk to sustain her infant until the infant is weaned, what were her options in “the wild”?
The critical metabolic load that must be sustained in lactation is gluconeogenesis. Lactose in milk can only be made from glucose and from 3 carbon precursors. Fat only generates 2 and 4 carbon precursors. Fat can be used to make ketone bodies; it cannot be used to make glucose or lactose for lactation. When more glucose is needed than is being supplied by the diet, the body induces cachexia, which turns muscle into amino acids which then get turned into glucose in the liver. Often that glucose is used for glycolysis and is turned into lactate; the lactate then gets turned into fat to get rid of it. This is what happens in sepsis, muscle is lost and fat increases.
Some tumors produce cachexia. If the tumor is producing agents that signal “the same” metabolic stress that triggers cachexia, those same triggers may also trigger postpartum psychosis in susceptible individuals. Such individuals may appear to be perfectly rational, and are “sane” in a legal sense (in that they are able to tell right from wrong). They may not have the ability to tell that their delusions are not reality.
I blogged about metabolic stress induced postpartum psychosis in the context of infanticide, but it is long and some of it is quite disturbing.
http://daedalus2u.blogspot.com/2007/08/low-nitric-oxide-acute-psychosis.html
In this case, if there was an underlying metabolic stress that was causing psychosis or a sub-clinical delusional state, fixing that metabolic stress might allow the psychosis to resolve enough for her to appreciate treatment would be effective and is her best option. According to my low NO hypothesis of everything, what brings on this type of metabolic stress is insufficient mitochondria in the liver and peripheral tissues, one way to increase that is by increasing NO levels. Increased NO via the placebo effect is the only mechanism by which CAM stuff has any effects. If she did have low NO, getting placebo treatments that raised her NO levels may have been helping her metabolic stress so she “felt” better, but not her tumor so it continued to progress. If the tumor is deriving ATP from mitochondria, NO might accelerate its growth. If it is getting it from glycolysis, it might not.
I only know what was presented. The woman was Caucasian and upper middle class. That her husband stuck with her as long as he did before deciding to divorce argues that he was probably devoted, but it’s not definitive evidence. The hospital at which the tumor board took place had an excellent department of social work; so I’d find it hard to believe that they didn’t at least try to get social work involved. I wish I could tell you more, but tumor boards usually don’t go into enough detail to learn all that information, and, as I pointed out, it was somewhere around three years ago.
pec, I tire of your B.S. I really do. Commenters here, including myself, have been exceedingly and admirably patient with you, arguably far more patient than is warranted, and the concept of how we determine efficacy of therapy has been explained to you time and time and time again. Yet you keep regurgitating the same nonsense, completely undeterred, while accusing people of “deception.” There comes a point when it is clear that you are ineducable, and I think you’ve passed that point.
Did I say “93% cure rate”? No, I said a 93% rate of long-term survival, slightly lower for ten year survival. That’s what cancer surgeons and oncologists use. We rarely use the word “cure.” Breast cancer can still come back as long as 20 years later or more, but the chances become increasingly low with the passage of time.
What we are really looking at with this unfortunate woman is the natural history of untreated breast cancer. For that we do have data, mostly from the era before the days of mass screening programs. For example:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1925646
http://www3.interscience.wiley.com/journal/112679768/abstract?CRETRY=1&SRETRY=0
In an earlier comment, I also cited a recent paper that shows the rate of growth of a 1-1.5 cm cancer.
This is old data, but it shows what happens when breast cancer is left untreated. The reason the data is old is because untreated breast cancer is now, thankfully, a pretty rare phenomenon–but not rare enough, as this woman showed. Also remember, we are not talking about a tiny focus of preinvasive cancer (i.e., DCIS) in this woman.
David Gorski – I, personally, am impressed by the patience that you and the other EBM bloggers have shown with your faithful pro-woo, anti-EBM cynics. Particularly since pec either can’t or won’t understand what is being written (my bet is it stars with can’t and ends with won’t try to understand, or she/he is just in the CAM biz) and keeps asserting falsehoods about what you have written. May I just say, though it may be tedious to keep explaining things to pec (particularly in light of her attempts to assert you’ve claimed something different than you have) but I suspect that it may actually be helpful to any readers on the fence or who have little understanding biology to see the facts laid out and explained in detail, as well as getting a glimpse into the inevitable results of wandering too far into the land of CAM. Personally I think it’s likely, based on the tactics used, that she (or he) makes a living out of CAM somehow and is mainly here as a disrupter.
The reality is that a lot of people in the general public who use CAM believe that it’s based in science, it’s good for them to get a glimpse of the likes of pec and antivax. Some quite rational people get led down the garden path since they assume that there’s science at work and the pseudoscience mixed in with a few commonly known facts can have an internal logic that’s wrong but still cohesive (just like how novels and stories we tell ourselves have an internal logic even if they’re not based upon facts or in the real world). Having done yoga for quite a while, tried various CAM treatments and just knowing people into esoterica of various kinds, I can see how many people who don’t understand how their mind or body works can get sucked in….particularly if they’re having a health or emotional crisis of some kind and are vulnerable to persuasion and manipulation.
“Did I say “93% cure rate”? No, I said a 93% rate of long-term survival”
I don’t care if you call it “cure” or “long-term survival.” That is entirely irrelevant to my point.
Ok I will use your terminology and see if you can understand me. You are claiming, or seeming to claim, that 93% of these patients survive long-term thanks to your treatments.
You allow your readers to draw the seemingly obvious conclusion — that all or most of these patients would not have survived to 5 years, or whatever you define as long-term, without your treatments.
But we know that what may appear to be cancer at the time of diagnosis often does not progress and the patient never dies from it.
Any normal reader would interpret your statement as claiming a 93% success rate.
I will try using an analogy and hope someone gets it. Let’s say I claim to have an effective treatment for the common cold. I’ll call it “MiraCold.” My advertisement says that 93% of patients who tried my remedy were free of cold symptoms one week later. Hurrah!
But wait, say the skeptics, maybe some of those patients would have been free of cold symptoms a week later even WITHOUT MiraCold. Maybe MiraCold only really helped 10% of the patients, maybe even less. WE JUST DON’T KNOW how effective MiraCold might be.
Ok, that was my point. I hope the analogy will help someone here get my point, because it is important. Cancer treatment statistics are at least partly an illusion.
Thank you for your wonderful patience.
Fifi,
People with inadequate knowledge will make up stories that are internally consistent and confirmed by whatever pseudoscience is around. I recall, when as a teenager, I began having stabbing upper abdominal pain. It felt like someone was sticking a pin into a voodoo doll of me. That is what I thought as my body sensations were consistent with that theory. I began feeling weaker and looking pale. I could barely cross the street. I decided to see a physician and was immediately hospitalized for a bleeding ulcer and treated appropriately.
weing – Exactly and this is why it’s so important to present people – not the faithful but the misled or misinformed – with the evidence and make clear the connections so people can draw their own conclusions. It’s the difference between propagandizing and educating – and it does people a service to show them the logical process and evidence so that they can learn how to think critically.
Most of us are also pretty swayed by how we feel about something – even when it’s a subject that’s more about evidence than emotions.
Glad you got that bleeding ulcer taken care of and didn’t feed your paranoia about supernatural attacks! Imagine if you’d gone to see an energy healer… There’s a self confirming loop in a lot of the CAM treatments that actually brushes off the worsening of symptoms as “detoxing” and I could see a similar loop happening with people who think they’re under “energetic” attack who go see a “healer”. As the symptoms got worse the client would start to believe that the attacks were getting worse and would seek the protection of the “healer” more and more and go to greater lengths to protect themselves using talismans, potions, aura cleansing and so on.
When people I encounter challenge survival rates like this, I like to use the analogy of the police officer with a “bullet-proof” vest. Yes, it won’t protect 100% but does that mean that he/she shouldn’t use it?
Pec, wow I think I just got stupider from your last post. Your MiraCold analogy is really really poor.
First off you are equating an advertisement’s claim with decades of peer reviewed research. Done by people with a much deeper understanding of statistics than you. The cartoon version of science you set up is decidedly childish and overlooks the fact that all the questions you pose have been looked at exhaustively. This notion that cancer rates havent been corrected to account for those who might get better without treatment is straight up rediculous. You’d have to be extremely naive to think that researchers just deliberately overlook this simple concept.
Secondly a skeptic doesn’t assume that the cold “cure” doesn’t work based on not knowing how it works. The skeptic looks at the claims, and compares these claims to the available evidence. If there is no clear evidence a skeptic will look at how plausible the cure would be based on our understanding of science. There is no dismissal based on ignorance, it’s based on the quality of the evidence and the probability the claims being made are plausible.
pec – You’re still trying to pretend that a potential cancer (the ones that may or may not progress and are not definitively cancer yet) is the same as a cancer that has progressed to being an early stage, treatable cancer. Oh wait, no, you’re comparing cancer to the common cold and suggesting (by making that analogy) that cancer “clears up” without treatment in the same way that a cold does.
It appears that you’re the one trying to mislead any readers of this blog and create false impressions.
pec refuses to answer the question yet again.
What would you have had the Woman in question do?
Put up or shut up.
Pec, you’re right, there is some of the 93% that would likely experience no further cancer growth even after a diagnosed, palpable malignancy. I don’t believe anyone said that the patient would have 0% chance of survival if not treated by real medicine.
I sincerely hope you’re not asking science to prove what that percentage is. To do so would imply a study involving, among other things, a randomized control group who did not receive treatment. Obviously, such a study is morally reprehensible.
So the ONLY morally acceptable course of action is to look at the high rate of fatality for untreated cancer demonstrated in the cited historical data, and continue working to move the 93% to 100%.
But the truth of what Dr. Gorski and the doctors in the study said is completely unchanged. From that point in the cancer’s progression, the patient would have had 93% of enjoying a dramatically better life than she is now experiencing.
Oh, by the way, the statement that we “don’t get it” is insulting. You are the only one introducing the “implication” into Dr. Gorski’s account, and then you’re criticizing the very implication you introduced.
Finally, since the patient didn’t herself invent any of the alternative therapies she tried, those that promote those therapies and contributed to her belief in their efficacy now share responsibility for what happened to her.
pec,
I’ll try one more time:
Some early cancers may never progress. We have discussed how that can skew the statistics. But that doesn’t apply to this case. This patient did not have an early cancer. She had a large cancer that was already growing, and we have historical data to show that it almost certainly would have eventually killed her without treatment.
We know that there was a 93% chance she would be alive in 5 years with appropriate treatment. We know there was a very small chance she would be alive in 5 years without treatment. I don’t know the exact numbers, but I imagine Dr. Gorski could dig up the numbers somewhere. Let me throw out an educated guess: maybe there is a 5% chance. I’m sure that’s not the exact number, but I doubt if it could be much higher than that. So you could say that of the 93/100 who are alive in 5 years, 5 of them would have been alive anyway. If only 88% survived due to treatment, does that change the recommendation to have surgery?
You are correct that there is a subtle difference between saying “this treatment produces a 93% 5-year survival rate” and “this treatment will increase your 5-year survival rate from 5% to 93%.” You are wrong when you say we don’t know what the true success rate is. We do know. If we don’t succeed in communicating it properly to the patients, that’s another matter entirely.
“suggesting (by making that analogy) that cancer “clears up” without treatment in the same way that a cold does.”
Do some reading Fifi, and you will find out that yes, cancer is often destroyed or contained by the immune system. Even Dr. Gorski will tell you this. There are mainstream medical articles that will tell you this. For example, autopsies show that a very large percentage of people who died from something other than cancer, had what would have been diagnosed as cancer. But they never got sick from it. This is especially true in older people where even cancers that are progressing can grow extremely slowly. But it’s true for all of us — the immune system destroys cancer cells all the time, and even what it does not destroy is unlikely to cause disease.
Never heard about this before? No, the medical industry would rather you don’t know, so they can take all the credit.
spurge – I think pec is pretty desperate to distract from the original topic which does – even without visuals – give a very graphic illustration of what happens when people choose woo over EBM. I think it’s important to note that the patient in question didn’t do nothing, she actively pursued CAM treatments *instead* of EBM. It’s entirely possible that the treatments she pursued did worse than nothing and actually contributed to worsening her health.
I actually had a conversation about reiki and cancer with a reiki practitioner once. (Putting aside belief in these things or not for a moment.) Since cancers are about unchecked growth – too much life energy! – many reiki practitioners believed that reiki should never be used on cancer. Apparently this belief has changed – which is not surprising since cancer and AIDS seem to send CAM practitioners and supplement manufactures into a feeding frenzy. I guess it’s pretty hard to sell woo for any illness that there are reliable, relatively comfortable. EBM treatments for so it’s always going to be the difficult, likely to be fatal kinds of diseases that get woo’s attention.
“Some early cancers may never progress. We have discussed how that can skew the statistics. But that doesn’t apply to this case.”
I was not talking about this case! I was talking about Gorski’s claim about a 93% success rate.
Saying “some early cancers may never progress” is utterly misleading. MOST early cancers will never progress.
Saying most early cancers will never progress is grossly misleading. Saying some early cancers will never progress is more accurate.
Since anecdote seems to count more in some circles than mountains of real data, I present a bit of family history:
My mother lost her mother when she (my mother) was ten years old — to breast cancer. Original diagnosis was not much past the point described, but since at the time (1930s) the treatment options were limited, the odds were not in her favor.
It took a long time, her illness (and its toll on her family) was not something that a young girl should have had to watch. I can see some of the consequences echoing into a fourth generation.
pec – From my understanding, a cancer going into spontaneous remission or pre-cancerous cells not becoming cancer isn’t the same as a cold that resolves itself. Though I’m not an oncologist and claim no expertize about cancer so I’m open to any misunderstandings I have being clarified by one.
The point is, making an analogy between cancer and the common cold is an attempt to paint them as being the same. And, of course, just one more way for you to avoid actually answering the questions about what you’d recommend regarding the case being discussed in this blog or what you would do yourself if diagnosed with cancer. You’re dancing fast but we can all see you still haven’t answered the question and are trying to divert the conversation from the CAM practitioners responsibility and contribution regarding the death of a woman they were treating. In this case, it wasn’t EBM treatments that failed her but the treatments she sought from CAM practitioners – who no doubt hold the same cynical, anti-EBM beliefs you do (as well as the same faith in CAM) and may have contributed to the progression of her illness.
Now are you ever going to answer the questions you’ve been asked about what you believe should have been done in the case presented as the original topic?
pec sez:
But we know that what may appear to be cancer at the time of diagnosis often does not progress and the patient never dies from it.
Any normal reader would interpret your statement as claiming a 93% success rate.
Not the usual audience here at SBM, I’d venture to guess. It’s mainly a skeptical crowd here, so we understand what he’s saying — he’s saying there is a 93% survival rate, which is the best that can be said. It is impossible to know how many of those would have survived anyway, because we never get to know what might have been.
That said, without treatment, the survival rates are much lower than 93%, so while some of those 93% probably did not have an aggressive cancer, most of the probably did. That’s one of the fundamental challenges in medicine — trying to figure who really should get which treatment, given that you don’t know whose cancerous lump is bad and whose isn’t. The best that can be done is risk-benefit analyses.
Have you ever left the house, and then driven back to make sure you really did lock the door? I have. Nearly every time, it was locked. Should I stop going back when I doubt myself? If I did, I might leave the door unlocked, and a burglar might gain entry to my house. That would be bad, so I keep going back, because really, going back isn’t such a big deal. The risk of leaving the house unlocked outweighs the cost of going back to check.
Same thing with deciding who should get a lumpectomy or mastectomy. Does the risk of the tumor turning out to be aggressive outweigh the pain and suffering and surgical risks that will go along with the surgery? Sometimes it does, sometimes it doesn’t. The dilemma for oncologists and surgeons is that by the time you know it’s an aggressive tumor, it’s too late for surgery to have such a good survival rate. Inevitably, less aggressive (or even noncancerous) ones will be removed, which is unfortunate, but I think it’s generally worth it. Meanwhile, researchers are working hard to figure out better ways of deciding which tumors should receive which treatment — and which should be simply left alone. There’s some interesting genetic research in this area. But until they have a more reliable way of sorting the bad tumors from the not-so-bad tumors, there are going to be unnecessary surgeries. It is an imperfect world. The best medical science can strive for is continuous improvement.
pec said,
“I was not talking about this case! I was talking about Gorski’s claim about a 93% success rate.”
For crying out loud, pec, the 93% was specifically about this case. Read Dr. Gorski’s words again:
“It was explained to her that a less than 1 cm tumor with no evidence of spread to the lymph nodes carried a highly favorable prognosis, with upwards of 93% long term survival with proper surgery and radiation therapy combined with adjuvant chemotherapy and/or hormonal therapy.”
The 5-year survival rates for other types, sizes and stages of cancer are different from 93%.
pec said,
“Saying “some early cancers may never progress” is utterly misleading. MOST early cancers will never progress.”
I suppose that might be true if you’re talking about the earliest stages where diagnosis is not yet possible. It is not true about diagnosable breast cancers. Some diagnosed breast cancers may never progress, but they are a minority, not a majority. We have done our best to explain that to you in another thread. There’s no point in repeating it here.
I think pec is operating under the misconception that all “cancers” are the same. I am no expert in this, but my understanding is that there are at least hundreds of different types of cancers depending on the tissue compartment it develops in, depending on which gene(s) have been activated or deleted and depending on what growth factor(s) it is/is not susceptible too.
The example given much earlier of people dying before their cancers have progressed was prostate cancer, not breast cancer.
Just a little PR/propaganda perspective here…If pec can do some damage control for CAM by spreading a bit of doubt about the dangers of cancer – but lots of doubt about the efficacy of EBM cancer treatments – then I suspect she hopes to take attention away from the horrific case above and CAM’s contribution. If she can minimize the dangers of cancer and present it as being the same as the common cold, it’s easier to sell supplements and CAM since people think they’ve got time do experiment and there’s not a lot of danger. Cancer sufferers are one of the biggest target market for woo (apart from the worried well) so damage control is important – particularly when the case presented so clearly illustrates the fatal mistake and dangers inherent in choosing CAM over EBM treatments with a decent track record.
Fifi,
I used a simple analogy to help you understand lead-time bias and over-diagnosis. But unfortunately you don’t even understand what an analogy is! A sad example of the results of our education system.
And I do not doubt the dangers of cancer! And I don’t know anything about any CAM treatments for cancer, and am certainly not promoting anything.
My point is that we should be more afraid of cancer, not less. If someone gets a real case of it there is not much hope. Most Americans are blissfully unaware of this, and think the medical industry has come up with cures (or whatever you want to call a successful outcome).
Cancerous cells do not equal the disease of cancer. Cancerous cells are often harmless, the disease is often fatal.
What exactly is a “real case of cancer” pec?
A tragedy. The good that may come from such a horrible case is the feeling amongst physicians and the public that “there ought to be a law..” It is lucky that the surgeon had a chance to see the outcome: most of the time they don’t. The oncologist doesn’t either. Folks like me get to. We in primary care see this more and more, but none so tragic.
My patient, years ago, tried to treat her lung cancer with x-714. She was unmovable. Not by her husband, sons, family. I gave her good hospice care as much as I could. Not as tragic as a young mother, but tell that to the grandchildren.
She had to order the treatment from Canada, since the “doctor” had been run out the US of A.
pec said,
“If someone gets a real case of it there is not much hope.”
(1) For some reason pec is in denial. We showed her irrefutable evidence that modern medical treatment has improved survival rates, and that many cancers are actually cured, and she refuses to listen.
(2) Even when a cancer is incurable, there are effective palliative treatments, and there is always hope. Hope for a better quality of life as long as life lasts. See “The Anatomy of Hope” by Jerome Groopman.
And she’s still not answering: what does she think the patient Dr. Gorski described have done?
pec – Why would you want to spread fear about cancer and EB cancer treatments at the same time? People need to be informed so they can make informed decisions for themselves, not afraid of both cancer and EB treatments….unless of course the point is to make them look elsewhere for treatment….
You seem to consider yourself an expert on cancer (I don’t and am quite open to being corrected when I’ve misunderstood something by someone who is an expert, though I’m skeptical of your expertize and understanding so that would mean an actual oncologist.). What are your credentials? What evidence do you base your ideas upon? So far you’ve offered nothing but assertions and in all the other threads you only ever offer personal anecdotes – what do you have to offer here? What’s your experience in studying and treating cancer? We know you dismiss EBM, so what ARE your ideas based upon?
Quite true. In fact, even cancers coming from the same organ and tissue type can have enormous variability. I cited a study in one of my comments above that showed that the doubling time of a 1 cm breast cancer in women between 50-69 years of age averages 1.7 years. However at the two extremes, it ranged from 1.2 months for 5% of women with the nastiest tumors to 6.7 years for the 5% of women with the most indolent tumors. This doubling time increases with age, implying that older women tend to get less aggressive tumors. Younger women (such as our patient above), it is known, tend to get more aggressive tumors.
Indeed, the subclassification of breast cancers has progressed to the molecular level, with two major subtypes (luminal and basal), further subdivided into a total of five molecular classifications, with different characteristics, different behavior, and different sensitivities to various types of chemotherapies. Indeed, the Oncotype DX gene profile is an example of how we are now trying to overcome the problem of predicting who will progress and who will not, allowing us not to have to give chemotherapy to every woman when it will only benefit a minority. In other words, it’s how scientific medicine is trying to differentiate from tumors that have a low probability of metastasis (and therefore may not need chemotherapy) from those with a high probability of metastasis, for which chemotherapy is most beneficial.
What do you mean by a “real” case of cancer? Please define it. From my perspective, by virtually any reasonable definition, the woman in this anecdote had a “real” case of cancer, but I suspect that you don’t use the same definition as we do.
And why do you say there is not much hope? The amount of hope of a cure for an individual patient very much depends upon the type and stage of cancer the patient is diagnosed with. In the case of breast cancer, for instance, as long as it has not metastasized past the axillary lymph nodes, breast cancer, even locally advanced disease, is still potentially curable, although the likelihood of achieving long term survival decreases with increasing size of the tumor and increasing number of lymph nodes with cancer in them, among other factors. Pancreatic cancer, on the other hand, is horrible; only a minority of patients have potentially resectable disease when diagnosed, and even those who do and undergo successful surgery can only expect about a 30% chance of surviving five years. Going back to more favorable cancers, Hodgkins Disease is highly treatable with good results.
pec,
You state: “My point is that we should be more afraid of cancer, not less. If someone gets a real case of it there is not much hope. Most Americans are blissfully unaware of this, and think the medical industry has come up with cures (or whatever you want to call a successful outcome).”
This is an absurd statement. Without exception, my friends and family fear the word “cancer”. I’ve never heard ANYONE (before you) suggest that medical science had beaten cancer, or that malignant cancer was anything other than a dance with death.
And if this is your point, then your earlier statements make no sense. You’ve been pressing us to admit that some cancers go away on their own. That’s certainly not going to increase people’s fear of cancer.
You’ve insulted us by saying we don’t get it and that we’re uneducated.
You’ve ignored the words in the article and repeated comments saying that the 93% applies to the palpable, malignant cancer in this case. Because of the size of this cancer and because it is proven malignant (and has killed or will kill the patient), lead-time bias and over-diagnosis are irrelevant.
You’ve played fast and loose with the term “early cancer”, apparently applying a definition that doesn’t have meaning in this case.
And you’ve repeatedly refused to offer any alternatives to the course of action the patient’s doctors took.
The only conclusion I can draw is that you’re deliberately trying to cast doubt and confusion into this discussion, and to lessen the impact of this story for the next woman who faces this terrible disease.
Why are you doing this?
Peter Hansen said: “A tragedy. The good that may come from such a horrible case is the feeling amongst physicians and the public that “there ought to be a law..” It is lucky that the surgeon had a chance to see the outcome: most of the time they don’t. The oncologist doesn’t either. Folks like me get to. We in primary care see this more and more, but none so tragic. ”
Agree completely. If I had a loved one who had a similar diagnosis and was considering false therapies over real medicine, when all gentle arguments had failed, I’d want her oncologist to pull this case, pictures and all, out of a drawer and present it in full glory.
“What do you mean by a “real” case of cancer?”
Obviously the example you gave was a real case. A real case is when the cancer cells make the person sick.
But many diagnosed cases of cancer, especially when found early, are not “real,” because they never would have progressed. Yet these are treated and counted as successful.
I am not saying you should not treat early cases that might never have progressed. I don’t know. It depends on how well your treatments typically work. And that is something we don’t know.
Palliative treatments are another story. If you can make a dying patient feel better I have no criticism of that.
But I am trying to get at the reality, which no one here seems to care about.
You have to compare cancer mortality relative to the general population (not relative to diagnosed cases). If mortality (relative to the population) has decreased for a certain type of cancer, then you have to consider if it might be because of treatments, or something else. For example, if lung cancer decreased over a certain period that could be because of a decrease in cigarette smoking, rather than better treatments.
Has mortality from breast cancer (relative to the population, not diagnosed cases) decreased over the past 30 years? By how much?
You still have to interpret the data carefully. If mortality from a certain type of cancer decreased it could be because some other cause of mortality has increased, and some patients who might have died from one are now more likely to die from the other.
There is no simple way to answer this question.
But I am pretty certain that your 93% success rate is misleading and wrong.
Be as “pretty certain” as you like based on no data that you can cite. It’s not “misleading” or “wrong” for a 1 cm stage I breast cancer.
You’re quite good at providing a thin veneer of seeming to understand what you’re talking about, but that’s all it is, a veneer. It doesn’t take much to tell that your “understanding” of the concepts of lead time bias, length bias, cancer staging, and cancer biology, such as they are, are a mile wide and a micrometer deep, not to mention distorted by some very peculiar ideas about “conventional” and “alternative” medicine.
I and others have patiently tried to educate you regarding these concepts, but you appear to be uneducable. You don’t show any evidence of actually having understood (or even read or looked at) sources cited in answer to your questions.
pec – I’m still curious as to what benefit you feel there is to making people more afraid of cancer? And what you feel should have been done in the case in this thread?
In another thread you insisted that doctors should withhold medication as a means to force/blackmail patients to conform to a healthier lifestyle. (If you don’t remember, it was in the thread where you blamed doctors for the fact that your mother didn’t exercise or eat healthily, and is on medication for emotional issues, and as the reason why you feel burdened with caring for her.) Since you advocate blackmail and the use of force regarding lifestyle changes, what do you advocate when someone refuses cancer treatment?
pec – It should also be noted that though you have refrained from promoting CAM in this thread (not surprisingly considering the topic!) you consistently promote the concepts promoted by chiropractors and other “energy healers” (using terminology specific to chiropractors but denying familiarity with chiropractic!).
I find it odd that you subscribe to the concepts of chiropractic and are apparently – subtly and not so subtly – promoting a chiropractic perspective on cancer in this thread. (I did a little google about chiropractic and cancer and your arguments and information seem lifted wholesale from quite a few sites.)
Pec
Pec said: “But I am trying to get at the reality, which no one here seems to care about.”
Please stop statements like that – a whole community here is trying to understand you and is giving you a fair hearing. Because we disagree with you doesn’t mean we don’t care or don’t understand.
The reality is that the odds are 93% chance of 5-year survival from that point in the cancer (positive biopsy, 1 cm, no evidence of spread) given the recommended treatments.
You want to know (and want medical science to present) what her survival odds would be without surgery, radiation and chemo. And people here are telling you (and would tell the patient) that they are significantly lower. The historical data and indeed this case itself provide data to support this.
If you want proof and are willing to read and understand it, I’m sure the doctors in this blog can point you to the research supporting each of the treatments. But we will never see a clinical trial where all care is withheld from a set of patients with palpable malignancies just to see how many MIGHT survive.
Pec said: “You have to compare cancer mortality relative to the general population (not relative to diagnosed cases). ”
What possible relevance does this have to this case? This woman’s cancer WAS diagnosed, and the 93% refers to a diagnosed case at this stage of development. I would imagine she couldn’t possibly care less about the rates compared to the general public.
Pec, there is no evidence in any of your arguments that the patient’s doctors misled her in any way, or that Dr. Gorski’s blog is misleading.
pec,
Why are you talking about breast cancer mortality rates? They are irrelevant to the 93% figure Dr. Gorski cited.
The overall mortality rate from breast cancer is something completely different from the long-term survival rate in patients already diagnosed with breast cancer.
Shut up Fifi, you have no brain.
Fifi,
Apparently you struck a nerve. Good work. I never thought her ideas represented a chiropractic perspective. No wonder it doesn’t make sense.
If breast cancer treatments were improving over the past 30 years or so, we would expect a declining mortality rate during that time.
The mortality rate per incidence has probably declined a lot — because of improved screening and earlier diagnosis. If incidence seems to rise but mortality stays constant, the cure rate seems to rise. That’s an illusion.
You have to look at the mortality rate relative to the general population. Do you see breast cancer mortality declining very much?
http://www.cbcrp.org/publications/papers/Mayer/page_08.php
I haven’t seen that so far, but maybe someone here knows better.
I see that some of the readers of this blog are incapable of understanding anything at all about research. But I suspect that Dr. Gorski might have some idea what I am saying. He just refuses to get my point, although it should not be so terribly difficult.
Just show me that breast cancer mortality in the US has been declining to a significant degree. If not, then explain why.
I am still searching.
pec wrote,
“Shut up Fifi, you have no brain.”
Speak for yourself, pec. Couldn’t your brain come up with any response but a personal insult? He who first resorts to ad hominems has lost the debate.
Since pec thinks saying “shut up” is acceptable, I wish I could tell her to shut up, but I’m too polite.
Of course it is possible that treatments are improving even if mortality rates are not decreasing. For example, if heart disease mortality is decreasing then people who might have died from heart disease but didn’t might later die from cancer. Just an example. Or cancer incidence, and death, might increase as the population ages. Or environmental toxins might contribute.
There are many factors involved. But I am asking for data showing that the treatments work and have been improving.
pec said,
“Just show me that breast cancer mortality in the US has been declining to a significant degree”
We did that before. Once is enough. Why do you refuse to listen?
Criminy, pec, can’t you even cite something that supports your point? That link starts out: “In the United States as a whole, breast cancer mortality rates have declined somewhat in recent years.”
Perhaps I hit a subluxation and released some of pec’s toxic thoughts and feelings? Who knows, maybe I’m saving her from breast cancer as we speak by helping her to release her toxic, unloving emotions around her mother and being a caretaker?
I am insulting Fifi because he/she/it is nasty beyond belief. References to my mother are beyond what is reasonable or acceptable, even at an atheist/materialist blog. Fifi, would you like me to make nasty comments about your mother? If you want to start an insult contest I’m sure I will win, since you are not only nasty and cruel but an ignorant moron.
Maybe you should read past the first sentence Harriet.
“during the twenty years from 1970–1990, death rates showed a small but significant increase for white women of about 0.3 percent per year”
And anyway, as I have been trying to explain, most of these reports are hard to interpret. When they say “death rates” it isn’t always clear what they mean. And a lot of the reports ignore over-diagnosis and lead-time bias, etc.
pec – I am only sharing what you yourself have already said yourself previously about your feelings about mother and doctors. Your mother is quite probably a lovely woman, even if you find it frustrating that she relies upon doctors for her medical needs and didn’t choose a lifestyle you approve of. Depression is nothing to be ashamed of and I certainly don’t look down on someone simply because they need some help coping. So, I’m not commenting on your mother who I don’t know but upon you and what you’ve expressed regarding your relationship with your mother and the beliefs you’ve expressed regarding cancer. It seemed quite relevant since you previously expressed a belief that emotional issues regarding mothers and mothering were a cause of breast cancer.
Feel free to make up insults about my mother, she is a doctor after all so you constantly insult her by extension in your posts here anyway.
pec said,
“Maybe you should read past the first sentence Harriet. “during the twenty years from 1970–1990, death rates showed a small but significant increase for white women of about 0.3 percent per year”
Maybe you should read past the second sentence, pec:
“During the 1990s, however, mortality rates fell in white women by 2.5 percent a year, while they declined more slowly in black women, at a rate of 1.0 percent. The decline in mortality has largely been attributed to broader screening leading to earlier stage at diagnosis, so it is understandable that access to and utilization of screening and treatment has been hypothesized as the major reason for these disparities in mortality. However, as we will see, the data on changes in incidence and mortality suggest that changes in treatment, not early detection, may play a more important role in explaining the recent decline in mortality.”
That sounds to me like it refutes your claim rather than supporting it.
pec – Your beliefs about the causes and treatments for breast cancer are, of course, very relevant to this discussion. Particularly since the case being discussed in this thread involved someone seeking “alternative” treatment to EBM with predictably dire results. You’ve yet to explain why you’d want people to be more afraid of cancer? And why you’d want to create further fear about EBM?
Since you only question EBM and are never skeptical of “alternatives”, your ongoing attempts to misrepresent evidence is cynical not skeptical. This means you’re not seeking “reality” but actually wishfully attempting to create an “alternative” reality (or at least the illusion of one, a pseudo-reality to accompany the pseudoscience of subluxations).
pec said,
“And anyway, as I have been trying to explain, most of these reports are hard to interpret.”
Maybe for you, but not for some of us; certainly not for Dr. Gorski.
“When they say “death rates” it isn’t always clear what they mean. ”
It may not always be clear from secondary sources what “death rates” mean, but they are always carefully defined in the primary sources.
“And a lot of the reports ignore over-diagnosis and lead-time bias, etc”
Dr. Gorski understands more about over-diagnosis and lead-time bias than you or I ever will, and he has written about those factors on this blog. He takes all those pitfalls into consideration before he reaches a conclusion. He has read everything worth reading in the literature on the subject. He is a breast cancer surgeon and researcher, and this is his particular field of interest and expertise. He is not just blindly quoting someone’s numbers; he is offering a critically thought-out interpretation of the best available evidence.
If that’s not good enough for you, I guess nothing could ever be.
There’s also a study that indicates that one contributing factor in delaying treatment and mortality for black women with breast cancer is a belief that chiro is a treatment for cancer (along with predictable socio-economic factors).
http://jama.ama-assn.org/cgi/content/abstract/279/22/1801
Well Harriet I guess I will just have to stop thinking and accept everything Dr. Gorski says on the subject. Who am I to express any skepticism when we have here such an infallible all-knowing expert? Let is remember to always defer to the experts and the authorities. Even if they imply that 93% of cancers can be successfully treated now, thanks to all-knowing and almost godlike doctors and our infallible materialist medical science and all the kind and wonderful drug companies. How could we live for a minute longer without them? In fact, I recommend that MDs such as Dr. Gorski start ruling the world. Maybe they could start a Church of the All-Knowing and Infallible.
Why think when we have Gorski and others like him. Let us always defer to their greatness. Amen.
And don’t worry about getting cancer. The wonderful mainstream treatments work 93% of the time! Do not doubt that figure for one second. Do not dare doubt anything proclaimed by the great, the infallible, Dr. Gorski.
Thank you Harriet for setting me straight. I thought Dr. Gorski was human. Oh how could I ever have thought such a thing?
pec – No one is suggesting Dr Gorski is god as far as I can see, it’s just being pointed out why he’s considered an expert (due experience, training, ability to understand those studies or articles you find so confusing, etc). Does recognizing someone else’s expertise in an area that you’re not an expert in feel like supplicating yourself to a god to you? Is your ego so bound up in your beliefs that it feels like complete surrender of body and soul to admit that an idea you hold is misguided? Or is this really all about religion for you and you see EBM and science as a threat to your faith?
Once again, though you keep claiming skepticism, you’re actually expressing cynicism. (Your assertions are based upon no evidence and you continue to hold tightly to cynicism DESPITE the evidence you’ve admitted you don’t know how to interpret and find confusing – this makes you quite distinctly not a skeptic or your assertions skeptical in nature. It does make them cynical and predicated upon a strongly held belief that is apparently impervious to evidence and reason).
There’s no point in worrying about getting cancer – or being terrified of getting cancer for that matter – since that does nothing to prevent or treat cancer. One should simply take the practical preventative steps (eat well, exercise, don’t smoke or whatever health/debauchery trade off one chooses, etc), be aware of family history and take the appropriate actions, and get on with living and enjoying life (something which being chronically fearful tends to inhibit). If there’s no afterlife then this is the only one you get, so you might as well enjoy it as much as you can. If one gets diagnosed with cancer, then it’s about being able to make an informed choice about treatment options and being thankful for the friends and family who love you and support your through the process of healing (or if the cancer is fatal, dying).
Once again, what good do you think promoting fear of both cancer and EBM does? And how do you balance that action with the idea that you hold that negative and unloving thoughts cause cancer?
As noted before, the 93% figure was in relationship to the particular type of breast cancer being discussed in the case presented here (once again you’re misrepresenting things to create hyperbolic assertions). Why do you keep trying to pretend 93% applies to all cancer? And why does it bother you so much that women may be less afraid of some forms of breast cancer because the survival rate has risen? I though you were advocating for reality and being realistic? Doesn’t your advocating fear of breast cancer conflict with your beliefs that women should be sending loving messages and feelings to their breasts to prevent cancer? Aren’t you now, according to your own beliefs, attempting to sow the energy seeds of cancer in women’s breasts by trying to make them afraid of breast cancer and that their breasts will kill them?
Does pec have anything meaningful to do with her/his life?
My wife is a retired military officer and she devotes 40-50 hrs a week to charitable and public benefit causes.
“GET A LIFE!!!!!!!!!!!!!”
Bravo, pec.
Hang in there.
pec sais, “Well Harriet I guess I will just have to stop thinking and accept everything Dr. Gorski says on the subject.”
No, pec, you will have to think even harder to understand what Dr. Gorski says and why he says it and then present credible evidence to show us why you think he got it wrong.
pec,
So you are pissed off because sCAM treatments have a 0% cure rate for cancers. This bothers you to no end, as it’s not fair. Therefore those damned EBM practitioners just have to be wrong. You will show them. You will not go down without a fight. Materialism and atheism just has to be wrong because… it’s just so wrong.
There are many factors involved. But I am asking for data showing that the treatments work and have been improving.
Yes, you are. Over and over and over again.
And you’ve been given such data over and over and over again. It’s clear that you can’t understand it, and wouldn’t accept it even if you could.
I see that some of the readers of this blog are incapable of understanding anything at all about research.
Well, one certainly is.
pec said “Well Harriet I guess I will just have to stop thinking and accept everything Dr. Gorski says on the subject. …”
Immediately followed by: “And don’t worry about getting cancer. The wonderful mainstream treatments work 93% of the time!”
You are not thinking very well if you believe that is for all types of cancer. It was noted that statistic was for a very specific size, type and stage of breast cancer. Actually, you were told that multiple times.
But somehow, you cannot get it to your head that there is an improvement in breast cancer survival over the last 30 years.
Also, you seem to have forgotten that the woman’s chances for survival declined substantially in the three years of other kinds of treatments. Can you honestly sit there and tell how great and wonderful non-mainstream medicine is without any evidence presented other than this woman’s story?
What are the long term survival rates for Gerson’s treatment? What are they for Hoxley’s method? Where are those numbers? Tell us why that woman was better off going to those folks than the oncologist.
Also, a small sidestep in the “real cause of cancer”… which one? The one that includes being born with the BRCA1 or BRCA2 gene? Or the one that includes having been infected with hepatitis B or human papillomavirus microbes? Or the ones that involved ingesting tobacco for years? Or, and this actually happened to someone I know — she got a minor mouth cancer which she thought was from her habit of constantly sucking on a mint. Or the cancers that hit children who have not done much more than just live a couple of years, like leukemia? Or the ones from being exposed to radon?
weing ridicules pec and says “Materialism and atheism just has to be wrong because… it’s just so wrong.”
The problem with materialism and atheism is its being so “right”.
If I remember correctly “scientific” materialism and atheism amounted to something like state religion in the Soviet Union.
Still having fun conducting show trials and purges, Comrades?
Hermano,
She’s the one who considers us materialists and atheists. That is her ad hominem label for us, not ours. Now you want to call us commies? That’s ad hominem not ad Hahnemann.
Pec cites articles that refute his/her own assertions, and both he/she and Hermano insult us.
There is a difference between argument and debate. Pec and Hermano are here to argue and are avoiding any real debate, and pec is clearly here to obfuscate the discussion and confuse anyone reading the followup to Dr. Gorski’s sobering and informative blog posting.
If someone is reading this to help with their own difficult decisions, please don’t let pec influence you any more than you would let the guy on the street corner with the tinfoil wrapped around his head influence you with his leaflets. If you have cancer, don’t let people like Pec succeed in their mission to shorten your life to promote their own confused agendas.
Rick0,
You have a nice science based medical AND argument clinic here.
Which reminds me http://youtube.com/watch?v=uLlv_aZjHXc
weing said “She’s the one who considers us materialists and atheists. That is her ad hominem label for us, not ours. Now you want to call us commies?”
I’d love to see her call Michael Shermer that! (note: he is very libertarian)
hydrogen cyanide,
Which authority figure are you kowtowing to now?
Well, definitely not you!
Why do you care?
Oh, and communism and libertarianism are economic ideas.
The system that the Panama Canal Zone was run under would have been considered “communism” because everything was owned by and run by the Panama Canal Company (from its beginning to about 1990). If one needed a light bulb changed in your housing quarters, you called the PanCan maintenance for that service (see stories here: http://www.czbrats.com/Menus/Story_Menu.htm ). The Panama Canal Company was actually part of the US Army Corps of Engineers. So that means that the entire Canal Zone, from the civilians operating under the umbrella of the Panama Canal Company, and the military personnel on the multiple military bases (like Ft. Kobbe, Ft. Sherman, Howard Air Force Base, Ft. Amador, Ft. Clayton and others) were operated under a communistic system administered by the Pentagon in the USA!
Basically, they have nothing to do with science.
Now, answer my question!
What are the numbers, statistics and data for the survival rate of cancer for Gerson, Hoxley, Reiki and the other “alternative” methods used by the woman that Dr. Gorski wrote about?
“the evidence you’ve admitted you don’t know how to interpret and find confusing”
Shut up Fifi, you’re a moron. The evidence is confusing to EVERYONE, including the great Gorski. You steadfastly miss every single point and you are incapable of anything resembling rational thought. I am not reading or answering any more of your comments.
“Once again, what good do you think promoting fear of both cancer and EBM does? And how do you balance that action with the idea that you hold that negative and unloving thoughts cause cancer?”
Oh I couldn’t resist. You’re such a dope. I have been trying to make a point about statistics. I don’t hold any idea about unloving thoughts causing cancer. And I don’t promote fear of cancer and EBM.
You are incredibly stupid.
“you will have to think even harder to understand what Dr. Gorski says”
He has not said anything that explains how he “knows” the success rates of his treatments. He won’t even admit it’s a hard problem with no simple answers.
“you cannot get it to your head that there is an improvement in breast cancer survival over the last 30 years.”
No I can’t get that into my head because it is bs. They can’t do experiments to show treatment vs no treatment, so inferences are made based on data which is influenced by many variables. If you compare breast cancer mortality relative to all cause mortality, or relative to the population, or relative to incidence, you get different answers.
I explained a lot of that before. A complete waste of time because no one here wants to question the medical science they adore so passionately.
Wow pec.
The amount of projection you do is astounding.
It is not surprising you have fallen back on name calling.
You should be ignored.
You bring nothing and learn nothing.
Pec scares me.
How can science based medicine even hope to help people who are true believers when we cannot even convey to true believers a basic understand of statistics and physiology?
Skip,
In order to understand statistics and physiology you have to want to learn them. Then you have to make the effort. If you don’t want to learn them, you will not make the effort. Those are the blind that will not see. Notice also how convinced pec is of her beliefs. I wonder if it’s ever been tested how conviction correlates with knowledge? I recall reading somewhere that it doesn’t. I wonder if there is an inverse relationship.
Someone I know likes to say “If you can’t understand; maybe it’s you:”
http://www.apa.org/journals/features/psp7761121.pdf
The article is titled Unskilled and Unaware of It: How Difficulties in Recognizing One’s Own Incompetence Lead to Inflated Self-Assessments
I find it quite amusing that pec is accusing people who advocate for EBM of being uncritical of medicine (not the alternative to medicine but medicine itself).
Firstly because the statistics she’s having a hard time understanding (and keeps randomly and inappropriately attributing) are all generated by EBM and she only knows about them because Dr Gorski brought them up for discussion.
Secondly, this blog’s archives (and yesterday’s post about heart scans) are full of critiques of practices in medicine that aren’t evidence based. There are also plenty of critical posts by people who advocate EBM – granted they’re usually discussions about evidence and ideas, not hysterical posts calling people “stupid doodyheads” (but when one lacks evidence or a coherent idea, I guess this is the best that can be done).
One thing pec seems to fail to understand when she tries to cast EBM as a religion and doctors as priests, is that because EBM isn’t based on faith, it’s not destroyed by being criticized. It is, in fact, strengthened and improved.
And, I’m curious what being an atheist has to do with any of this…unless, of course, pec is advocating a religious perspective based on faith and faith healing? Pec and others are, of course, free to refuse treatment with EBM (as some religious organizations and many cults require of adherents – and as was the case with the woman in the case discussed in this blog who put her faith in energy healers). I don’t take issue with people making personal choices about their health (sad thought it may be) or how they live their life – what I take issue with is people being scammed when they’re sick and vulnerable (by anyone).
I take issue with is people who try to pretend their faith is science or evidence based, fear mongering about cancer and EBM while promoting energy medicine (particularly in light of the story above), and attempts to spread pseudoscience as a means to dress up faith as science.
This EBM movement is, of course , driven by insurance companies trying to get out of paying for what they agree to pay for.
This trend has been increasing in the past ten or twelve years and the only thing I can see is that it prevents injured people from getting the care they need. (One factor that also drives people to the Alt provider)
In the workers comp arena, for example, “treatment guidelines” are generated, which are “apparently” based upon “evidence”. They continue to reduce recommended treatment for everyhting and are used as “law” by insurnace companies to deny payment for services. In Texas, it is EBM that has driven so many doctors, MD’s, DO’dsand DC’s out of the system, leaving injured workers unable to provide for their families and stranded with inadequate treatment and no where to go.
The only ones benefiting from this EBM movement are the insurance companies and that is a fact.
I read all these pseudo-intelectuals posts about EBM and I can see, between the lines, that they are not involved in treating people who are being depribed of care because of it.
The insurance companies are just like the oil companies in that they increase their profits continually but continue to provide less. (Poor analogy but it is early).
Ask the doctor who gets half or a third of what they bill for paid and most will tell you that it is insurance companies who drive the wagon and it is them who want this EBM bandwagon to contiue down the rosd it is on.
[...] Further, there are many cases where false hope lured patients away from very treatable cancers with high cure rates. (David Gorski relates a case over at science-based medicine.) [...]
I just went back and read the thread about the belief that “unloving” thoughts and maternal issues cause breast cancer and I now realize that it was Hermano and antivax who were defending that idea in that thread, not pec. Much as I suspect that pec’s belief in energy medicine and subluxations that she’s expressed do lead her to share their faith in that idea (subluxation being a chiropractic concept and terminology), I consider it a matter of personal integrity to be open and honest when I discover I’ve made an error or a false attribution. (Plus, my interest and motivation for engaging here isn’t to be “right”.) It’s also quite possible that pec’s faith is of a different denomination than Hermano or antivax’s since different religions and faith based CAM concepts can be very different from each other and, though most may talk about various forms of life or divine healing energy, what they believe about that energy and where it comes from can be entirely at odds at times.
So, your claims that insurance companies are fans of EBM is just patently untrue and yet another attempt to hide just what a profit driven industry CAM actually is, how much government lobbying goes on in the US by the CAM industry as they attempt to remain unregulated and avoid being responsible for maintaining ethical and evidence based practices and claims.
Actually medical insurance companies have accepted CAM because it’s cheaper to provide than EBM. Insurance companies aren’t doctors, they’re the same people who insure your home and so on. They routinely refuse EBM treatments and make the practice of medicine more difficult. For instance, most insurance companies don’t cover psychotherapy even though the evidence points to it being more effective than medication alone. Why? Because psychotherapy tends to be a long process. They’re corrupt and all about making profit – which is why they endorse CAM treatments since EBM can be much more expensive.
Medical insurance companies aren’t EBM or even medicine, they’re insurance companies. They’re just as connected to CAM as they are to EBM, if not more so and are just another profit driven arm of the health care and “wellness” industry that doesn’t actually have much to do with the practice of medicine. In Canada, which has universal health care, medical insurance covers non-cosmetic dental work, glasses/contact lenses, and CAM. Not surprisingly, these same insurance companies have been vigorously lobbying for the privatization of medicine in Canada. Not that universal healthcare doesn’t have its problems and challenges but clearly the drive for profit is behind unethical behavior by all kinds of people/groups associated with medical insurance, clinics that put profit before patients, supplement manufacturers and naturopaths, and other people who play with people’s lives for profit.
Question for the moderator of this excellent blog: at what point is a poster deemed sufficiently disruptive, troll-like, and incapable of enhancing the mission of this site to be banned?
On another special interest site I used to frequent, the moderators revoked the rights to post of a person who had made 10,000 posts (!) because he was deemed disruptive.
I used to find pec’s comments entertaining but now they are simply cloying and repetitive.
I realize I am an active reader but not an active poster, so I don’t suggest that my vote have much weight, but was curious what the point of view was here. It’s a tough question because most who frequent presumably believe, like I do, in free speech and inquiry. But it is seemingly hard for the regular posters to ignore a troll.
I agree with the assertion that the medical system failed in this case, not at the time of the initial diagnosis of the cancer, but well before that when the woman decided to place her trust in alternative practitioners over medical ones. It was at that point she obviously found something lacking in the medical; find that “something”, combine it with the empirical efficacy of SBM, and it will be the alternative health industry that dies rather than curable cases like this one.
nwtk2007 wrote: “The only ones benefiting from this EBM movement are the insurance companies and that is a fact.”
Can you provide a reference for this fact?
This is at direct odds with documented recent history. The EBM movement is an academic movement. While I have quibbles with it – it has nothing to do with the insurance companies. That is just made up anti-scientific propaganda.
Insurance companies try to limit what they pay for. Sometimes they are a restraint on overuse (see Harriet’s excellent post on CT angiograms). Sometimes they hamper good care. The current situation is very problematic – and I am not defending insurance companies. My point is – they are just using what’s out there for their own ends. They also refuse to cover drugs for non-FDA approved uses – even when they are evidence-based. So should we argue that insurance companies are the only ones driving and benefiting from the FDA? That would be equally absurd.
No one likes to be told “no.” The reality is we cannot offord all the healthcare that everyone wants and that we have the technology to deliver. This means we have to make decision about what to cover and what not to cover. Science is the only way to objectively make those tough choices. What’s the alternative?
I think that leaving posts up that obviously demonstrate ignorance and even trollish behavior is useful.
People need to be able to see such posts and decide for themselves if the poster is real and if the ideas expressed in it make sense or not. When such posts are taken apart by those who do know what they are talking about, it becomes more obvious for the readers who are less sure of their science to become more aware of how science works.
The eventual goal of those who run this blog is for the people who read it to become informed and to be able to think for themselves and be able to analyze quackery and recognize it when they see it.
Leaving up obvious examples of quackery, showing the false arguments that quacks use, showing that quacks have no special knowledge, and can be mean and vindictive a$$holes when their pet woo is gored is a useful demonstration.
[...] Death by “alternative medicine”- Who’s to blame? The case involved a woman in her early 30’s, who presented to a surgeon with a small palpable breast mass. Her primary care doctor had appropriately ordered a mammogram and ultrasound, which the surgeon dutifully presented. The odd thing was that the films were from 2002. The surgeon presenting explained that this woman had presented over three years prior to him for the evaluation of this mass. On mammogram, there was a mass less than 1 cm in diameter, which was confirmed by ultrasound. The edges of the mass weren’t quite smooth enough to consider it very likely benign. Consequently, the mass fell into that gray areay that we in the biz call “indeterminate,” which is basically a code word for “we don’t know if it’s cancer or not and the imaging doesn’t look sufficiently ‘benign’ for us just to follow it.” To put it even more bluntly, it needed a biopsy. The surgeon described how he dutifully did an ultrasound-guided fine needle aspiration of the small nodule. [...]
Oh yes I must be an ignorant troll if I ask for evidence about how often your treatments work. I should know better than to ask a question when I already know you don’t have an answer. It’s very disruptive to be asked a question you can’t answer when you are supposedly an exalted authority. Just think, Gorski knows more than I could ever possibly know about cancer research and statistics, and yet he doesn’t have an answer. Now that is terribly disruptive. I didn’t even realize medical school teaches research and statistics. How disruptive of me to think I might also know something about that, when I didn’t even go to medical school.
http://jama.ama-assn.org/cgi/content/full/300/2/173 might be apropos of nothing or pertinent to this discussion.
Apparently, under some circumstances, “conservative management” beats conventional drug treatment for surviving cancer.
Here is the WSJ take http://blogs.wsj.com/health/2008/07/09/drugs-give-no-advantage-to-older-men-with-early-prostate-cancer/.
Hermano,
What that study illustrates is EBM in action. Now elderly men with prostate cancer will not be subjected to chemical castration, and if they have the poorly differentiated type, they can decide based on the evidence available.
Hermano – Yes, “watchful waiting” is one of the methods employed by medicine for certain cancers in certain people at certain early stages. Clearly it doesn’t apply to the case this blog details, which quite graphically illustrates how resorting to alternative therapies – and not watching or waiting, just choosing treatments that aren’t based on evidence – may even be worse than doing nothing in some cases. Since you’ve proven yourself to be a vocal supporter of CAM and unproven “alternative” cancer treatments, and it’s already been established that different kinds of cancer require different treatment, what’s the point that you’re trying to make? That EBM works and is constantly self critical and looking to minimize useless treatments and maximize non-invasive ones based upon weighing the evidence and the cost/benefit ratio?
From the article
“The standard options for men with prostate cancer that hasn’t spread to other parts of the body are radiation, surgery or “watchful waiting” — doing nothing, and keeping an eye on the cancer. Watchful waiting can be a good option for older men, because prostate cancer often grows so slowly that it doesn’t wind up causing major problems.”
pec said ” It’s very disruptive to be asked a question you can’t answer when you are supposedly an exalted authority. ”
Which is why I keep asking you for the documented survival rate for Gerson’s, Hoxsey and the other therapies for the woman’s breast cancer! What are they, please?
Actually pec, you’ve been given answers to the questions you’ve asked numerous times but continually dodge questions you’re asked. You’re apparently unwilling or unable to understand that different forms of cancer require different treatments. I understand that you like simple, absolute answers – such as provided by faith healers. Apparently you prefer absolute answers even if they’re untrue – I suspect this has something to do with your vividly apparent resentment of the expertize of others and the respect they’ve earned. It seems that you’re the one clinging to the god-like expectations and vision of doctors (and science), and being bitterly disappointed when they aren’t gods who are capable of making your mother exercise and eat well (against her will) or her emotional issues magically disappear.
Shut up Fifi. I have merely asked for sources that indicate something about how well the current standard treatments are working. The only answers I have gotten are that it’s hard to say. Ok well, these experts must have some reason to believe in their treatments.
This post is about one unfortunate case. Is that EBM? No, but it is supposed to horrify us into thinking the standard treatments are just wonderful.
All I am asking for is scientific and logical thinking. Instead we have hysteria and emotion and reverence for the medical industry.
A lot of the supposed progress in treating cancer is illusion. Many of the research reports neglect to mention the common sources of bias. And they often don’t specify what mortality rates are being compared to.
It is very hard to know how well cancer treatments work. That is my main point. I have not seen anyone try to respond, except with hysterical insults.
weing wrote “What that study illustrates is EBM in action. Now elderly men with prostate cancer will not be subjected to chemical castration, and if they have the poorly differentiated type, they can decide based on the evidence available.”
Presumably the chemical castration treatment had been approved by the FDA and had received the imprimatur of the science based medicine prior to this recent study.
I guess the patients would have been better off taking a homeopathic in this case.
Um, did you just decry hysteria and emotion but start your post with “shut up”? Seriously, you should think twice about just repeating back to me my observations about yourself if you’re just going to confirm I was right about you being hysterical (in this case hysterically funny!) and emotional in the process of doing so!
I always find it odd when someone says “scientific thinking” simply because it reveals a lack of understanding of what science is – as well as being an indicator that someone is probably a proponent of “magical thinking” but feels insulted by having their magical thinking pointed out as such. Science is a methodology, a discipline. Plus, using “scientific thinking” just reveals (again) that your main tactic is an attempt to present science as a religion (followed by an attempt to present their religion as science). Religious belief is a personal matter, science isn’t.
pec said “All I am asking for is scientific and logical thinking.”
So am I… Tell us exactly what the survival rate is for that woman’s cancer is using Gerson’s, Hoxseys and the other treatments. Be sure to include the back up documentation.
Hermano – Actually no. Granted “a homeopathic” (I suspect you mean a homeopathic remedy) wouldn’t do anything but, as the example in this blog illustrates, the watching part is absent (the watching is a very important part of “watching and waiting”). And why would one spend money taking “a homeopathic” when it does nothing? The men in question would not only be subjecting themselves to a useless treatment that had nothing to do with their cancer, but they’d also be wasting time and money in the process – ultimately they’d be worse off in a number of ways.
nwtk2007 wrote: “The only ones benefiting from this EBM movement are the insurance companies and that is a fact.”
Steven Novelle wrote – “Can you provide a reference for this fact? ”
Steven Novella also wrote – “This is at direct odds with documented recent history. The EBM movement is an academic movement. While I have quibbles with it – it has nothing to do with the insurance companies. That is just made up anti-scientific propaganda. ”
First of all, just make a few calls to providers in Texas and see if they take workers comp cases and if not why.
Also get a hold of the “Official Treatment Guidelines” used in Texas.
This is how it works: A patient injures their back, is unable to work and their is no light duty available. The doctor prescribes three weeks of PT at three times per week. The guidelines, supposedly EBM, say that only six sessions are needed and thus will not preauthorize more than six. Many times they will just deny the pre-auth and wait for the doctor to resubmit or appeal, an additional 10 – 15 days wait in addition to the three days wait for the initial pre-auth and subsequent allowance for six sessions or flat out denial
The patient is limited to the six because the insurance companies use the guidelines as law and they are supposed to be based upon evidence. Tell me, how could their be evidence to be applied across the board to all back injuries.
The ortho wants to get an MRI of the low back but the guidelines, evidence based (horse crap), say it is not needed until four weeks of conservative treatment has been done, but the pre-auth is only for six sessions or two weeks worth, which they later deny payment for because a whore, peer review doctor who they have now hired will say it was all not medically necesssary, based upon the EBM official treatment guidelines which he will quote, again, as if they were law.
The MRI is done anyway because the ortho says it was needed, and initial MRI’s do not need pre-auth. The MRI shows a large HNP with nerve root impengement but the insurance co denies payment for it because the evidence based guidelines say it was not needed and should not have been done in the first place.
See my point. Very typical in well over 80% of the cases.
The guidelines say on average a worker should only be out of full duty work for, say, six days for an injury such as this. But the treating doctor knows the patient is at risk of further injury and exacerbation if he goes back to work so he keeps the patient off work until he can be sure it is safe for the patient to go back to work. The insurance company denies payment of income benefits based upon the EBM guidelines. The patient is forced to try to go back to work or go hungry because he can’t work and then has to wait for months for a hearing, not to mention the eventual cost of an attorney, to find out that he might or might not win in the hearing. Throw in a company who won’t allow a worker back to work with out a full release without restrictions and it really gets stupid.
It goes on and on almost ad infinum.
So you see, that is how insurance companies are using EBM to their advantage. And who is really the ones to say what is evidence based and what is not? There is such variance in anything evidence based because evidence exists to the contrary of everything under the sun, both for and against any aspect of care or treatment.
The guidelines even say that they are not to be used in the way they are being used but even the legal system goes along with it.
Also, it appears that injured workers cannot sue workers comp insurance companies for bad faith and employers most certainly won’t.
Shall I go on?
EBM does not necessarily mean the most inexpensive medicine. Often it does, but often it doesn’t as well. For example, breast MRI is increasingly being covered by insurance companies because studies have supported its use in many clinical circumstances. In the old days, a woman would have gotten just mammography and ultrasound, but now most women with breast cancer also get an MRI at more than $1,000 a pop before surgery because there is evidence to support its use. Insurance companies used to fight it when MRIs were ordered, but now for the most part they routinely approve them..
nwtk – All you’ve done is point out why private medical insurance and corporate medicine is a bad idea (again) and that medical insurance companies aren’t interested in appropriate, evidence based, medical treatment because they’re trying to limit how much they pay out and create one-size-fits-all standards. Certainly insurance companies may claim they’re creating evidence based standards but, as the evidence constantly proves, one size does not fit all when it comes to medical treatment, which just goes to show that like the supplement manufacturers and some non-evidence based CAM practitioners people appeal to EBM for authority even when what they’re doing is antithetical to EBM.
(s)CAM = “Faith Based”… I like the analogy!
Could someone differentiate EvidenceBM and ScienceBM?
Would it be accurate to say that EBM aims to find the most effective treatment available, whereas SBM concerns with whether or not treatments are consistent with current sciences?
Are SBM sciences restricted to biological, or physical, does it also include social sciences such as economics and anthropology?
Pec >”I have merely asked for sources that indicate something about how well the current standard treatments are working. The only answers I have gotten are that it’s hard to say. Ok well, these experts must have some reason to believe in their treatments.”
This again! What is your precise question? We know from vast experience that without treatment patients with a biopsy diagnosis of invasive cancer nearly always fare badly, with relentlessly advancing local disease and the devopment of progressive metastastic disease in many cases. Even every “alternative” testimonial assumes this to be the case.
Yet you have been offered statistics showing that, with conventional treatments, a varying number of such patients, depending on stage and cancer type (>90% in some instances), will live on for twenty years or more without further evidence of cancer.
What, then, might modify the conclusion that our treatments are “working”? Let us consider this.
Well, we admit that rarely some kinds of cancer (breast and melanoma) can recur even after twenty years, but this is very rare, and available statistics give an approximation of how often that might occur (2-3% at most).
We also know that occasional cancers of some types can stay stationary for long periods, and may even never progress at all. But remember that most cancers are already symptomatic — a sign of probable cancer progression — when we treat them. We also don’t yet have the capacity to sift out the cases discovered prior to the onset of symptoms that might do equally well without treatment, so this is of no practical importance outside of the design of screening programs intended to detect cancers before they cause symptoms.
It is also true that even after efficacious treatments the biological properties of the cancer is the dominant determinant of outcomes, i.e. whether the patient surtvives cancer-free or not. Are you deducing from this that we should NOT treat the cancer, when we know what usually happens if we don’t treat them?
Or are you frustrated that we cannot give you concrete survival figures to within the nearest percentage point? What, precisely, are you worried about?
Pec, give it up. The’ve got you. Given a condition that has a 93% chance of long term survival with medical care, you would also go for the medical care. Sure you might do some concurrent Alt treatment, but you would do the medical. If you didn’t then you would be getting exactly what you wanted, no matter what the out come.
And FiFi, what a name, you are right about what this shows about the insuance companies. I am just showing you that EBM is going to be used in this fashion in any arena that it can be.
As to the MRI’s being approved by the insurance company for breast cancer evaluation, I would first ask why an insurance company gets to determine medical necessity in any case? I have seen an insurance adjuster, under oath in a deposition, state that she has denied payment for medical services be cause of the lack of medical necessity but then in the same deposition could not define medical necessity. Second, I would point out that on health insurance plans, the facilities on contract have agreed to accept sometimes less than a third of the billed amount from the insurance company and thus the insurance company is much more apt to go along with the study.
With insurance companies it is definitely about bucks baby, nothing more. You ain’t in their good hands. According to the McKenzie reports they are now boxing gloves.
My main point is that EBM will be “used” like this but when it starts costing someone more money, they will turn against it, who ever they may be. They use the EBM line just as anti Alts and anti-chiro’s will use the Nette case.
nwtk – The fact that someone misuses or misrepresents something doesn’t invalidate it, it just means it’s been misused or faultily applied. EBM is about the practice of medicine. Medical insurance is about making money via gambling on the odds (and making sure those odds are in the insurance industry’s favor – all the same criticisms of the many other arms of the insurance industry apply). How you get from there to proposing that people who favor evidence based medicine over faith based “alternatives” to medicine are “using” Sandy Nette’s horrific paralysis at the hands of a non-evidence based chiropractor who clings to ideas like subluxations seems like a leap. They are not “using” Sandy Nette, they are supporting her in her battle to prevent other people from being injured as she was by faith based alternatives to medicine.
I highly suggest checking out the interview with Sandy Nette
http://www.youtube.com/watch?v=SHX7m09OZ8E
Hermano asked,
“Would it be accurate to say that EBM aims to find the most effective treatment available, whereas SBM concerns with whether or not treatments are consistent with current sciences?”
No it would not. My formula is SBM=EBM + CT.
Science-based medicine is evidence based medicine plus critical thinking about what the evidence really means.
Are chiropractors more likely to paralyze their patients than surgeons to remove a wrong organ?
http://news.postbulletin.com/newsmanager/templates/localnews_story.asp?z=2&a=349993
H. Hall,
Thank you for clarifying this.
I had an impression that the opposite was the case,
EBM = SBM + CT
It’s well worth reading the article Hermano links to because it shows how the doctor in this particular incident admitted and took responsibility for his mistake immediately, figured out how it happened and voluntarily stopped practicing while the incident was investigated. It also shows how the hospital apologized to the patient and investigated the mistake and just generally treated the person who the mistake harmed with compassion and respect. This serves as a stark contrast to how the faith based chiropractor who paralyzed Sandy Nette, and professional chiropractic organizations and supporters, have responded to her. Once again this highlights the difference in professional ethics and honesty between EB practitioners and faith based practitioners.
Fifi writes “doctor in this particular incident admitted and took responsibility for his mistake immediately”.
I am admittedly naive but I suspect that there was a critical time
interval when the surgeon met with his personal and hospital legal teams and was advised on how to best deal with this situation.
Hermano, you can try to diminish the differences in response as much as you like through non-evidence based conjecture but it doesn’t diminish the difference in the responses at all. There’s no reason to believe that the faith based chiropractor who paralyzed Sandy Nette didn’t call his lawyer immediately with the intention of avoiding responsibility for his actions. Speculation aside, I think this is a fantastic illustration of the ethical divide between medicine and faith based chiropractors. Interestingly, Sandy Nette isn’t out to stop all chiropractors from practicing, just those whose practice is based on faith not evidence.
It should also be pointed out that the doctor in the linked article probably is unlikely to make the same mistake again because he’s taken responsibility for it and figured out why it happened. The chiropractor who paralyzed Sandy Nette refuses responsibility despite the evidence so clearly intends to keep on doing exactly the same thing over and over again, knowingly risking paralyzing other clients. As do all faith based chiropractors who do neck adjustments to correct “subluxations” and who refuse to acknowledge the risks of neck adjustments or inform their patients of the risks.
“Are chiropractors more likely to paralyze their patients than surgeons to remove a wrong organ?”
Are surgeons more likely to save a patient’s life by removing the right organ than chiropractors are to save a patient’s life by manipulating their spine?
Hermano thought it was EBM=SBM+CT. It should be, but it isn’t. EBM has been hijacked and improperly applied. He should read a few of the so-called “evidence-based” books out there. I’ve reviewed one on the evidence for energy medicine and I own a copy of “Somatovisceral Chiropractic: An Evidence-Based Approach.” There is nothing I would call credible scientific evidence in either book. EBM has become a buzzword and an excuse to use any “evidence” from testimonials to junk science to support a belief.
I love the way FiFi uses the term “faith based’ chiropractic, as if the belief in medical science has no faith component to it.
EBM is just a better gamble and you believe in it because you get better odds than Alt treatment, even though there are really no odds in Alt treatment as I see it.
If there is a 93% chance of long term survival and you take it then you see that as better odds but you accept it on faith. EBM seems more credible to you so you have faith in it and thus you believe it is the better choice.
The so called “faith based” chiropractors are not relying on a persons faith and beliefs any more than the allopath, one just, in your view, has better odds of things happening the way you want it than the other.
And my previous point FiFi was that anti chiro groups do not morn for what happened to Ms Nette, they are lapping it up like a thirsty dog. They don’t give a rats a$$ about her any more than medical science truly gives one about the thousands of deaths they cause each year thru mistakes.
You FiFi said, “this highlights the difference in professional ethics and honesty between EBM practitioners and faith based practitioners.” in reference to the way the hospital handled the doctors mistake as opposed to the way the chiropractor has alledgedly handled his. What a joke. Events like this just don’t happen very often in chiropractic and thus we are not a astute as the medical profession in handling them, mistakes that harm, I mean.
I still have a tough time understanding how so many have become so self righteous about this case in the face of the daily harm medical science does.
H. Hall,
I am not suggesting that chiropractic has any value and you have not answered my question.
nwtk2007 – We don’t need to depend solely on ”belief” in medical treatments; we can test them. We can have justified “faith” in science-based treatments because they have been tested. If a treatment has not been adequately tested, then all we have is belief. If it has not been tested, we have no way of knowing the odds.
“anti chiro groups do not morn for what happened to Ms Nette, they are lapping it up like a thirsty dog. They don’t give a rats a$$ about her any more than medical science truly gives one about the thousands of deaths they cause each year thru mistakes. ”
This is malicious and untrue. It is despicable for you to even suggest such a thing. If anyone doesn’t give a rat’s posterior, it’s the chiropractors who continue giving treatments that are not known to have any benefit and that have a chance of creating “locked in” quadriplegics, and who don’t even want their patients to know that such disasters have happened.
“I still have a tough time understanding how so many have become so self righteous about this case in the face of the daily harm medical science does.”
Please read my blog post on “Death by Medicine.” Medicine does good as well as harm. It is irrational to look at the harm without putting it into perspective with the good. It is irrational of you to question our criticism of a tragic, avoidable disaster by invoking the tu quoque fallacy.
Hermano insists that I answer his question: “Are chiropractors more likely to paralyze their patients than surgeons to remove a wrong organ?”
I don’t have accurate statistics, but I have never heard of a surgeon removing a stomach instead of a gallbladder. The case mentioned was of a paired organ, a kidney. I would guess that such errors are somewhat less common than chiropractic strokes. But I don’t see what that has to do with the price of spaghetti.
Why do you ask?
pmoran,
“you have been offered statistics showing that, with conventional treatments, a varying number of such patients, depending on stage and cancer type (>90% in some instances), will live on for twenty years or more without further evidence of cancer.”
You are claiming to have found effective treatments for certain kinds of cancer, specifically breast cancer in this post. But I believe that is inaccurate, since I have been searching for data showing a significant decline in cancer mortality, relative to population, and did not find it.
I have found articles saying that cancer remains undefeated, and I have made sure to ignore all alternative medicine sources, since they are likely to be biased against mainstream medicine.
All of the information I have read lately on cancer (none of it non-mainstream) says the only progress has been in diagnosing and treating early cancer (of course that progress could be mostly an illusion, because of lead-time bias and over-diagnosis), and certain childhood cancers.
I have not seen any claims for invasive breast cancer treatments with a high level of success. Yet that is what you are claiming.
There is a discrepancy. I just want to understand this, because this is important and I don’t like deception.
I do not practice or promote any form of alternate cancer therapy.
pec
Care to link to any of the information you are talking about?
pec,
I don’t recall them claiming a high level of success for invasive breast cancer. This was a tumor less than 1 cm and no lymph node involovement. This was not an invasive tumor at the time of diagnosis. Please define your terms. When you say invasive, what do you mean?
involvement
pec – If you don’t like deception, why do you engage in it routinely? This is just a repeat of you telling me to “shut up” before decrying the very kinds of hysterical and emotionality you claim to not be into (not to mention that you’ve been trying to promote both fear of cancer and EB cancer treatments, you know, whip up a bit of hysteria). Once again, you’ve clearly been being deceptive in your attempts to fudge numbers, apply them to things they don’t apply to, pretend that you aren’t an advocate of faith-based alternatives to medicine, and in saying you have evidence but never presenting any and on and on.
weing,
You can go back and read their claims in the comments on this post. They are claiming high rates of success with invasive breast cancer.
With early cancer, it’s hard to estimate the success rate because of over-diagnosis and lead-time bias. If, let’s say, 90% of diagnosed early cases would never have progressed, then a 90% success rate would mean the treatment is useless (I am NOT saying those are the rates, just trying to illustrate my point).
This is a hard question, and no one here seems willing to tackle it.
Gorski has written about over-diagnosis, but only in the context of questioning the value of certain screening technologies. He never ties that in with questions about treatment efficacy.
pec,
This was a palpable mass that on biopsy was confirmed to be an adenocarcinoma. My understanding of lead time bias is apparently different from yours. Lead time bias wouldn’t apply in this case. The natural history of the disease from this point, as illustrated by this patient, is pretty much guaranteed.
I knew that hermano was back when I saw over 190 comments to this post. Surprisingly, he asked some interesting questions. Harriet, his point about bashing chiropractors when the number of severe injuries they caused may favorably compare to the number of severe injuries a surgeon causes is valid. On the other hand, Harriet’s point about the number of lives saved or improved by surgeons compared to the benefit chiropractors brought with that particularly nasty manipulation is a valid response.
Hermano, it goes back to this issue with homeopathy and other techniques that have no benefit compared with tested and efficacious medical practice. When these alternative methods hurt people, the benefit/harm ratio is too low.
BTW, in case you are looking for certainty, nothing is 100% guaranteed in medicine except for death.
BTW, it may be very benefitial to ban pecking on this blog. It is just so irritating and a complete waste of time.
weing – Which is why pec chooses faith based alternatives to medicine that involve a belief in an omnipotent god. Plenty of people manage to balance out their faith and getting EB healthcare (they may pray as well but that’s besides the point, they don’t reject medicine just because it’s not religion or get confused about the two). Pec is evangelical, she sees EB medicine and science as the enemy. She’s like a new age version of those ladies who come around trying to sell the Watchtower door to door.
weing,
Who said anything about certainty? I am asking if their claims for great success in treating this type of cancer have any validity. It would be deceptive of them to make those claims based on bias and illusion, instead of careful and logical inferences from data.
There is little motivation to inform the public about this. The cancer industry would rather we think there has been great progress.
Aren’t you at all interested in finding out whether a cancer treatment works 90% of the time or only 10% of the time? This is about logic and probability, not certainty.
And I am not an unscientific dummy. I learned statistics while getting a PhD, which could make me more qualified than Harriet or Gorski to interpret the research.
Fifi,
I have realized that you are a cult follower of the “skeptic” movement. Your learned to “argue” by following a set of rules the “skeptics” have written up. I may as well try to communicate with an automaton.
That’s why I just ignore your irrelevant, irrational comments.
Sorry, I got the impression that you were looking for absolute numbers. Still, what Gorski posted, 93% still applies and the figures he gives (93% long-term survival) are for this type of tumor at that particular stage. Without treatment, the course is as in this case.
pec–
“Aren’t you at all interested in finding out whether a cancer treatment works 90% of the time or only 10% of the time? ”
As others have already pointed out on this thread, I think the only way to know what cancers would go away on their own is to do a study where a large number of cancers go untreated. That’s reprehensible, and I know you don’t want to see lots of people suffer horribly just to get a “true” baseline. But do you see another way of obtaining the information? How do you propose getting your numbers? What would the study look like?
“his point about bashing chiropractors when the number of severe injuries they caused may favorably compare to the number of severe injuries a surgeon causes is valid.”
Actually, it isn’t. First, it’s changing the subject to distract from the topic at hand (tu quoque: a logical fallacy that we discuss frequently because it’s such a favorite of the IMC crowd). That’s why Harriet correctly wondered what injuries caused by a surgeon had to do with the price of spaghetti. Second, the whole reason that cervical spine manipulation has no valid risk/benefit ratio is that its proven benefit is 0, as is the prior probability of its being useful for anything other than neck pain—which has neither been proven nor is likely to be superior to far less dangerous “hands on” therapy, such as massage. Thus no amount of risk is acceptable.
pec – It’s more than a little bit ironic that you’re trying to make “skeptic” into an insult while you’re concurrently claiming to be here simply as a skeptic. I’m certainly a critical thinker and skeptical but I’ve never been part of a “movement” (though I’m glad one has emerged) – critical thinking and healthy dose of skepticism is just a natural result of being taught to think and learn for myself as a child. As pointed out earlier, you’re actually being cynical about EBM since you continually propose the worst and ignore evidence when presented.
One thing that is a shame about the pecs of the world is that they actually distract discussion of very real issues (not the fabricated ones being raised here to distract from the obvious inefficacy of faith based alternatives to medicine for breast cancer). The bloggers here do a good job of bringing up issues within medicine and medical systems that need to be discussed and addressed – real changes that need to be made in medicine – and they do this even despite knowing that pecs and antivaxs will latch onto these critiques to use to denigrate all of medicine and promote faith based alternatives to medicine.
Really, at the end of the day, if all this is the best pec can do to attempt to diminish the impact of the very sad, and quite horrific, story above, her attempts are weak. One reason why there’s a push in the CAM community to drop “alternative” and to push “complimentary” is that anyone with half a brain – including those who believes in energy healing – isn’t going to tell women not to use EBM for breast cancer since it’s such an incredibly and obviously unethical thing to do. Clearly people who are trying to diminish or demonize current medical treatment for breast cancer are a fringe group that even many involved in CAM would not want to be associated with. It is strange that the three most active anti-EBM posters here all promote chiropractice and subluxations!
vinny, on 10 Jul 2008 at 8:25 am, wrote “Harriet, his point about bashing chiropractors when the number of severe injuries they caused may favorably compare to the number of severe injuries a surgeon causes is valid. On the other hand, Harriet’s point about the number of lives saved or improved by surgeons compared to the benefit chiropractors brought with that particularly nasty manipulation is a valid response.”
More to the point, there is nothing, beneficial, done by chiropractors that cannot be done more safely, otherwise. (Except manipulation of the lower back in some types of acute pain. But that is not chiro since health professionals do it, too.) When chiros avoid the neck snap (and don’t try to “treat” infants, juveniles, or actual illness) their ministrations are probably harmless; but they are also useless.
It is simpler to go to a masseur, who won’t waste time with a pretend work-up and a fantasy diagnosis. If one suspects a real illness, the first stop should be an MD/DO.
That’s why the information I cited was from the 1800s and early 20th century. Since the 1930s, it’s been rare to see completely untreated breast cancer, making it (thankfully) hard to find enough such patients to do a study, and it would be highly unethical to do any sort of study that resulted in breast cancer patients not being treated.
“93% still applies and the figures he gives (93% long-term survival) are for this type of tumor at that particular stage. Without treatment, the course is as in this case.”
You are saying that this kind of tumor would have, in most cases, progressed to serious disease, and that the standard treatment for it, in most cases, is successful.
In other words, you are actually saying this type of cancer is virtually curable.
But you have no real basis for that assumption.
As Gorksi says, the experimental comparison of treated vs. untreated cannot be done. SO WE DO NOT KNOW.
But there are other ways of trying to get at some kind of estimate. Aren’t you curious about the effectiveness of these treatments?
Since we cannot have untreated controls, we don’t even know if the standard treatments might sometimes be harmful!
There are some people — those providing the standard treatments especially — who are content to not know and would rather the public does not ask these questions.
But I am not asking an impossible question. You can’t hide behind ethics, since there are ways of looking at the data that can at least help us get rough estimates.
One approach, which I already mentioned, is to look at mortality rates for certain types of cancer. Cancer mortality in general has declined a bit recently, but that might be because of decreased cigarette smoking.
If the standard treatments were good and getting better, we would expect dramatic declines in cancer mortality over the past 30 years. Do you see that for breast cancer?
It is not easy to find this information, even for the great experts here. Mortality rates are often calculated relative to incidence — so as incidence rises (partly because of better diagnostic technology) more cases are diagnosed. So even if many of the diagnosed cases would have never progressed even without treatment (and Gorski has written about this), they are counted as successfully treated.
Fifi,
You apparently don’t understand the use of quotation marks. By “skeptic” I mean a member of the pseudo-skeptical political organization. I am a skeptic, you are a brainwashed pseudo-skeptic.
pec – No my dear confused lady of the Watchtower knocking on the science based medicine door to peddle your faith, you are very much a cynic and a faithful believer in subluxations, energy medicine and the like.
pec said “I am a skeptic,”
No, you are not.
Every time I see the use of “Allopath” to describe EBM practitioners, I think of “Allosaurus”… Is it the intention of CAM promoters that we subliminally associate the title with something big, ferocious, extinct and dumb?
And, pec, you are entirely free to choose to use faith based alternatives to medicine or do nothing if you yourself get breast cancer if you feel that medical treatments for cancer are useless. Not that I’d wish what happened to the woman who refused medical care and chose faith based alternatives to medicine to happen to you, but you do have the right as an adult to refuse medical treatment and live and die with the consequences.
I never said the standard treatments are useless Fifi. I said I would like to have some idea of their success rate.
Pec, if you would like statistics about incidence and mortality over time, divided by race, sex and age, refer to the NIH’s SEER (Surveillance, Epidemiology, and End Results) database.
For breast cancer specifically, refer to this set of statistics:
http://seer.cancer.gov/csr/1975_2005/results_merged/sect_04_breast.pdf
I don’t think the doctors are claiming a dramatic increase in their ability to cure breast cancer. They are saying that their methods are good to begin with. This SEER database only goes back to 1975, and resection for breast cancer has been going on for much longer than that. Therefore I don’t think you would find a dramatic increase in mortality in this database.
If I am not mistaken, the methods are indeed getting more precise, so the mortality rates are still declining modestly.
You can still find relative 5-year survival rates for breast cancer patients compared to the general population. SEER does that. And what may be surprising to you is that these rates are quite good.
When does one give up on trying to reason with the peckers here? When has enough time been wasted on this fruitless effort?
Anyway, I want to propose a new topic for Steve since his specialty is neurology. It always confused me to hear the rationale from neurologists for administering aspirin versus aggrenox, versus plavix in terms of secondary stroke prevention. Furthermore, the manufacturer claims that taking dipyridamole and aspirin in separate formulations rather than taking aggrenox is not as effective due to some “magical” property of aggrenox coating. The initial study showing a benefit to aggrenox versus aspirin was small and since then we have seen large scale studies confirming this benefit. However, how good are these studies when it has been shown that taking dipyridamole in addition to aspirin is not benefitial and therefore the rationale for even doing such studies was flawed? It also makes no sense to see a recommendation to switch a patient from aspirin to plavix or aggrenox in a patient with a recurrent stroke. Steve, could you discuss this topic for the benefit of other doctors who read this blog?
It occurs to me that the doctor in the story above was dealing with a patient with beliefs that are probably very similar to pec’s: she was afraid of cancer and medical treatments for cancer (even though they’ve helped many people and give a better than 9 in 10 odds for survival in regards to the type of cancer she had), she believed that faith based alternatives to medicine and unblocking “energy” could cure cancer or were better than medical treatments, she had a problematic relationship with her family that involved arguments over EBM vs faith based alternatives to medical treatment…to name just a few similarities.
pec – You’ve certainly been given “some idea” of the success rates for medical treatment of cancer – over and over again. In fact, you’ve been given a very good idea. I’m glad you’re finally coming around and can now at least admit that medical treatments for cancers are useful. If you can be reached then it gives some hope that others, who share your (and the woman in the case above’s) belief in energy blockages and faith based alternatives to medicine, may also be reached and may choose useful treatments alongside any alternatives to medical treatment they may seek out as well.
I was googling for “locked in quadriplegics chiropractic” and came across
http://en.allexperts.com/q/Spine-Surgery-3304/locked-cervicle-thorasic.htm.
“Topic: Spine Surgery
Expert: Jerry Ryan, Ph.D.
Date: 8/3/2007
Subject: locked cervicle and thorasic
Question
I WILL HAVE NECK PAINS AND THEN I WILL WAKE UP AND BE ON LOCKDOWN WITH MY NECK AND THORASIC. I CANT NOT SIT, STND OR ROTATE MY HEAD I AM IN SUCH AGONY. I WAS TOLD I HAVE A BULDGING DISCK C4 5 AND PROTRUDED DISC C3 AND SPONDYLOSIS IN CERVICAL AREA. BUT NO ONE KNOWS WHY MY SPINE LOCKS UP. I AM 34 HEALTHY, RECEIVING CHIRO CARE IS THE ONLY WAY TO GET MY MOBILITY BACK. HELP WHAT WHY AND HOW AN I PREVENT THIS.
Answer
In my opinion, the locking up could be caused by muscle tension in the area. The muscles could be tightening up in a guarding reaction to help prevent any further damage to the neck. This type of muscle contraction could include the thoracic spine area as well.
I would recommend massage, heat, and possibly traction to the neck area. Check with your chiropractor about a traction device to use at home prior to bedtime. Relaxation techniques like meditation/prayer at bedtime can help reduce the muscle tension as well.
Thank you for your question, Jackie. I hope that my answer was helpful.”
Hermano,
Are you pointing out that an “expert” refered someone to a chiropractor and the patient who claims that chiropractic is the only one who can help? Big deal, I know of an expert on vodka who would provide this patient with relief as well. How is this in any way contributory to science based medicine? Your comments typically fall into several groups:
1. Well I know a well respected person who recommends this type of therapy. Your idea of a respected expert opinion is different from doctors who wish to discuss science behind medical therapies.
2. Verbal attacks.
3. Questioning statistical analyses.
I wish you could focus on part 3 and actually contribute to a meaningful discussion here. It is obvious that you do not know or understand medical pathophysiology. However, you write well and sometimes make clever anecdotes.
I am hoping you will devote your energy to something that might contribute positively to discussion here. I submit the same challenge to any other non-medical participant here.
” I’m glad you’re finally coming around and can now at least admit that medical treatments for cancers are useful.”
You’re a real dope. I never said anything about whether I think they are or are not useful.
“You can still find relative 5-year survival rates for breast cancer patients compared to the general population. SEER does that. And what may be surprising to you is that these rates are quite good.”
I AM NOT SURPRISED! Increasing early diagnosis practically guarantees the rates will be good and getting better.
pec said
“I never said the standard treatments are useless”
Then she said “I never said anything about whether I think they are or are not useful.”
Apparently she doesn’t think they are useful or useless. I’m confused.
OK, I guess what she’s saying is “Since early diagnosis makes it harder to interpret the statistics, we should ignore those who have carefully studied all the evidence and are telling us that the treatments are effective after correction for lead-time bias. We should just give up and say we don’t have any idea whatsoever whether cancer treatments do any good.”
The SEER statistics are for INVASIVE cancer, for crying out loud! They do not include the types of cancer that might never progress.
pec – Well it’s good to know you’re at least at a point where you can admit you have no idea whether medical treatments for the particular kind of breast cancer being discussed are useful or useless. This is still progress since admitting you don’t know is the first step, and it’s a giant step since you’ve been presenting yourself as being an expert in statistics and cancer with greater knowledge than those with training in these areas who write this blog. Really, I’m quite pleasantly surprised you can admit you don’t know
I NEVER SAID I THINK THEY ARE USEFUL OR USELESS.
I have been asking for evidence.
I KNOW THAT I DON’T KNOW FIFI, THAT WAS THE WHOLE POINT.
YOU DON’T KNOW EITHER. YOU JUST THINK YOU KNOW.
YOU ARE SO DUMB I CAN’T BELIEVE I AM BOTHERING TO REPLY TO YOUR INANITY.
Actually, Fifi probably isn’t dumb at all. He/she/it is pretending to be utterly stupid just to have some fun.
K. Atwood wrote “Harriet correctly wondered what injuries caused by a surgeon had to do with the price of spaghetti”
Conceivably, the case of the Minneapolis surgeon had EVERYTHING to do with the price of spaghetti.
The recent increases in the price of spaghetti result from the world-wide grain shortages and increases in flour prices
http://www.nytimes.com/2008/04/27/nyregion/nyregionspecial2/27Rflour.html .
The surgeon’s home town is historically known as “The Mill City” and is home to General Mills and Minneapolis Grain Exchange http://www.mgex.com/ .
The surgeon claimed his error resulted from being distracted by numerous beeper calls http://www.startribune.com/lifestyle/health/22795054.html .
It’s possible that some of these calls came from the surgeon’s broker’s desk at the Grain Exchange during an especially volatile trading period.
pec, while I don’t claim 100% certainty (that’s the area of faith, like your belief in subluxations), I’m quite willing to trust people who have earned my trust by repeatedly showing integrity and honesty through their words and actions. Trust is a somewhat different animal than faith. Trust is based upon someone repeatedly showing – providing evidence – that they’re trustworthy. Now, that doesn’t mean they won’t make mistakes or have biases, which is why I may trust someone’s abilities in a certain area but I still rely upon my own discretion when making choices for myself. I wouldn’t advise anyone to rely upon faith regarding their own health, whether it be in a medical practitioner or someone providing a faith based alternative to medicine. Faith involves believing in something or someone DESPITE the evidence (like your faith in subluxations and that energy blockages cause illness).
“The SEER statistics are for INVASIVE cancer, for crying out loud! They do not include the types of cancer that might never progress.”
Harriet,
And you are claiming that most patients with this diagnosis would die without treatment, and 93% would survive with the standard treatments?
If that is what you are claiming, can you show evidence?
So, if you don’t know whether medical cancer treatments are effective or not, why would you want to make people more scared of cancer? Why would you want to spread fear based upon your own ignorance?
K. Atwood,
What is this IMC crowd whose tactics I emulate?
Are they anything like the IMF?
If yes, please count me in, I hear their buffets are first-rate.
pec, you don’t consider those statistics evidence?
pec said, “And you are claiming that most patients with this diagnosis would die without treatment, and 93% would survive with the standard treatments? If that is what you are claiming, can you show evidence?”
Yes, that is exactly what we are claiming for the case in question, and you have been shown historical evidence.
Here it is again:
http://cat.inist.fr/?aModele=afficheN&cpsidt=1352900
The 5-year survival for untreated breast cancer is in the range of 18-19%. The median survival is 2.3-2.7 years.
The untreated survival rate will vary by type and stage, and historical comparisons are problematic because early reports may not be interpretable by type and stage, but these numbers give us a reliable ballpark for untreated breast cancer in general.
So here’s your answer: 19% survival without treatment; 93% with.
Are you satisfied at last?
Harriet – Since it’s a five year survival rate being discussed, does that mean the 19% who don’t undergo treatment may still have some progression of their cancer during those five years (but not die) or die from the untreated cancer (or require treatment) at some point after the five years?
Darn right! See the link. 10 year survival rates were in the 3% range.
[...] to go to a naturopath instead of an MD, that will do you zero good. You might wanna read this: Death by alternative medicine And if you wanna know why it seems that your friend is helping people when he is actually doing [...]
Thanks Harriet, so I guess that means that ultimately the survival rate for untreated breast cancer is only 3% if we look at it longterm (maybe less if we followed that 3% for another five years?). If I’ve got that wrong please correct me!
Zeteticon sez:
Every time I see the use of “Allopath” to describe EBM practitioners, I think of “Allosaurus”… Is it the intention of CAM promoters that we subliminally associate the title with something big, ferocious, extinct and dumb?
*chuckles*
Actually, I think the term “allopath” may predate “allosaurus.”
*looks it up*
“Allosaurus” was first described in 1877. Meanwhile, according to dictionary.com, “allopath” dates to the 1820s. Both words draw from the same roots, though, so the similarity is not coincidental. “Allosaurus” literally means “different lizard”, while “allopath” means “different suffering”. “Allopath” was coinced by homeopaths as the opposite of homeopath. The principle of homeopathy is that “like cures like” — diseases are treated homeopathically, that is with something that produces the same symptoms as the target disease. “Allopathy” thus logically means treating with something that causes different symptoms than the target disease.
As it happens, most mainstream medical treatments do not produce similar symptoms to the thing they are trying to treat. That’s kind of the point, in fact.
I prefer to take it in a slightly different direction — allopaths are people who believe that different things cause different diseases. I think some alties do use the term in that way, mainly those who feel that disease has only one single root cause (subluxations, energy imbalance, etc).
“I prefer to take it in a slightly different direction — allopaths are people who believe that different things cause different diseases. ”
I feel very strongly that we should not ever use, or accept the use of the term. The mainstream is not in any way constrained by such philosophical or theoretical principles. It is eclectic and empirical in its choice of treatments and would gladly apply a “like cures like” principle wherever that was known to be effective. In fact, some homeopaths like to claim vaccination as an example of that principle.
I first encountered the term being used by orthodox chiropractors, another group that finds it advantageous to suggest that there may be more than one valid system of medicine.
I suspect Pec will have to pick up the goalpost and move with it again.
I do not use the term to describe mainstream medicine. What I meant was that when alties use the term, I prefer to take it in a somewhat different manner than was originally intended. This helps me avoid taking offense and getting upset, which doesn’t really help anything.
Since most alties don’t even know what the term originally meant, it hardly matters how I take it. They just use it to promulgate the false dichotomy between different kinds of medicine.
Harriet, you probably are aware I can’t access that article. And chances are it doesn’t address the sources of bias I am trying to get you to acknowledge.
pec – Really? There’s no restricted access to the abstract of the study (it’s not an “article”, though the abstract is easier for lay people – myself included – to understand) so this sounds like yet another attempt to use denial to avoid acknowledging that your question has been answered….over and over and over again. Chances are you aren’t addressing the sources of your bias that you’re trying not to acknowledge.
pec, there are these buildings in most municipalities that are called “public libraries”. Many of them actually subscribe to the services that can get you those papers. Try to find one in your local area, they are great places for research.
pec,
I’m about ready to scream!
Here’s the abstract: “Knowing the clinical prognosis of untreated breast cancer is useful in dealing with patients with neglected disease or in environments with poorly developed healthcare systems. This study analyzes historical survival data in two sets of untreated patients: (1) 250 patients followed until death (up to 12 years) for which autopsy results are available and (2) an amalgam of 1,022 patients from several papers. Data from nine published papers underwent actuarial analysis. Median survival time of the 250 patients followed to death was 2.7 years. Actuarial 5- and 10-year survival rates for these patients with untreated breast cancer was 18.4% and 3.6%, respectively. For the amalgamated 1,022 patients, median survival time was 2.3 years. Actuarial 5- and (partially fitted) 10-year survival rates for these patients with untreated breast cancer was 19.8% and 3.7%, respectively. Historical data of untreated breast cancer patients reveal a potential for long survival in some cases. The spectrum of clinical aggressiveness of breast cancer varies between virulence and chronic disease.”
We have all acknowledged the sources of bias you keep talking about. Dr. Gorski was the first one to discuss those sources of bias before you ever mentioned them.
These numbers are for untreated cancer, so the lead time and other biases are not considerations. If you are saying that these patients might have appeared to survive longer because they were diagnosed earlier (which is what lead time bias means), then correcting the numbers would make the 5-year survival rate even smaller, makiing an even stronger case for the benefits of treatment.
I just posted a link 3 times and it didn’t show up.
Cancer Undefeated
John C. Bailar, M.D., Ph.D., and Heather L. Gornik, M.H.S.
The New England Journal of Medicine
I posted the link 3 times and it did not show up.
I don’t know why, but I cannot post that link. But you really should read it Harriet.
I read that abstract and it ignores the things I have been saying. The Bailer article explains some of it.
And I could not tell from just the abstract.
And please don’t scream, at least not until you do some more reading.
What is meant by “historical?” In the past, cancer was diagnosed later, so survival time was necessarily shorter. Over-diagnosis was less likely, so mortality relative to incidence was higher.
You are missing every point I make. You should at least read the Bailer article. But I have read a lot more along those lines.
Harriet – You’re talking to someone who doesn’t even understand the difference between an abstract and an article (or who didn’t even bother following the link you provided IF, and it’s a big if, she even understands the difference). You’ll never get through to pec, she’s a troll plain and simple, the only reason to bother interacting with pec is to provide explanations for others who get misled by the thin veneer of science that gets spread over faith based alternatives to medicine. If one woman understands that the pecs of the world are liars from all the explaining you’ve done and choose EBM over woo, you’ve saved a life.
Plus, I have a sneaking suspicion that pec has a very personal vendetta against doctors. She revealed it when she claimed she was a victim because she had to look after her ailing mother, and that it was medicine/doctors’ fault for not forcing her mother to eat healthily and exercise, and it was medicine/doctors fault that her mother has mental health issues (she seemed to want to believe that the medication was somehow the cause , a common mindset in those into energy medicine and such). I’m starting to suspect that pec was diagnosed with the same kinds of mental health issues but thinks that having mental health issues is something to be ashamed of (or that it means she has to understand her mother rather than resent and blame her), so rather than accept the diagnosis she’s decided that doctors and medicine are always wrong. If that’s the case, annoying as she can be, clearly it calls for compassion (though not shoring up her delusions).
A lot of people with mental health issues who don’t want to acknowledge them find refuge in new age beliefs. Not that I think everyone into new age stuff and energy medicine is suffering from mental health issues (I think most are just indulging in fantasy that they really want to believe is real and are looking for some coddling or something to belief in that provides the answers to life’s uncertainties…but isn’t that nasty “traditional” religion of their parents, they’re innovators!…and the promise of surviving death…always a good seller!). It provides an arena for people with mental health issues to have others take their paranoia seriously (hello antivax!); for others to accept their hallucinations as visions of other worlds and “real” alternate realities or glimpses into the afterlife; and of course to share a delusion that we can control the material world via our thoughts and are really super evolved star beings/angels that are chosen and better than anyone else (shhhh, it’s a Secret!). A lot of it is harmless, some of it is deadly.
Now, of course, there are people in the medical profession who have mental health issues too. However, most will get treatment and resolve or treat their issues. Those who don’t often end up being the quacks who find their symptoms reflected in the superstitious beliefs about magical energy and move into woo (though some clearly just do it for the money). Clearly none of us like thinking we’re not in control of our thoughts and that our perception of reality is askew and unreliable. Of course, anyone who even dabbles in science and neurobiology knows that the very premise of science is that our senses are unreliable and that we’re prone to believing what we want to believe. Hence the methodology employed.
pec, I suspect you’re just pretending that the link didn’t post so you can pretend that Harriet is censoring you.
Here’s the link, it’s about overall cancer rates not the specific kind we’ve been discussing – so not actually relevant to the statistics we’ve been discussing. I wonder if pec is trying to “move the goal posts” as predicted or just really so ignorant that she doesn’t understand that we’re talking cancer apples and cancer oranges here. It’s worth remembering that nobody here has made any assertions about cures for cancer – other than pec claiming that people believe there’s a cure for cancer (which IS possible if she runs in energy healing and supplement circles because they often claim to have cures for cancer). The general public, however, is still busy running marathons and wearing pink ribbons as a means to raise money for cancer research.
http://www.ncbi.nlm.nih.gov/pubmed/9164814
pec,
You are attempting to deflect the discussion from the effectiveness of cancer treatment vs non-treatment to quibbling about how much progress has been made in recent years. Very effective treatments had already been developed by 1970. Bailar and Gornik showed that overall cancer mortality plateaued betwen 1970 and 1990, decreased between 1990 and 1994, and then slowly began to improve again. They offer their opinion of what the numbers mean, taking into account confounding factors like early diagnosis.
I read the Bailar/Gornik article. I also read the letter written in response that was published in a later issue. I’ll quote it in full so you can’t claim you don’t have access.
“To the Editor: In their Special Article, provocatively entitled “Cancer Undefeated,” Bailar and Gornik (May 29 issue)1 acknowledge the substantial changes in mortality due to cancer during the past 20 years in men and women under the age of 55 years. The authors note that for this age group, there has been a 25 percent decrease in all cancer-related deaths, a 23 percent reduction in deaths from breast cancer, and a slight but definite decline in mortality from lung cancer; for persons of all ages, there has been approximately a 15 percent drop in deaths from colorectal cancer. Bailar and Gornik believe these changes reflect changes in the incidence of cancer or early detection, discount entirely the impact of therapeutic intervention, and argue that progress will occur only through a national commitment to prevention.
Nobody disputes the merits of cancer prevention. By now, eliminating the use of tobacco products — particularly among the young — has become a social and legislative issue; sufficient research has already been performed to justify the needed behavioral changes. Reducing exposure to known carcinogens such as ultraviolet light, hepatitis B and hepatitis C viruses, asbestos, and excess ethanol has received widespread attention, as has the importance of screening for breast, cervical, and colorectal cancers. The recent development of germ-line genetic-testing techniques will probably identify people at very high risk for breast, colorectal, and ovarian cancers in whom prophylactic medical or surgical interventions, or both, may be of value. A major component of the National Cancer Institute’s budget is for cancer prevention, and in 1996, a distinguished panel of experts in this area was commissioned by the institute’s director, Dr. Richard D. Klausner, to provide an external critique of this effort.
Bailar and Gornik reveal their underlying bias by choosing to ignore the influence of treatment on the reduction in cancer-related mortality among persons under the age of 55 years. During the past 25 years, previously fatal conditions, such as advanced testicular cancer,2 Hodgkin’s disease,3 and childhood leukemia,4 have become curable in more than 70 percent of cases, and up to 50 percent of patients with non-Hodgkin’s lymphomas may now be cured.5 Prospective, randomized trials have shown that postoperative (i.e., adjuvant) therapy leads to a 25 to 30 percent reduction in mortality among patients with locally advanced breast cancer 6 or colorectal cancer.7 Reductions in cancer-related mortality clearly have multifactorial explanations, but for Bailar and Gornik to dismiss widely used, well-accepted advances in treatment is not only absurd but also potentially damaging to patients with newly diagnosed malignant conditions, who may be influenced by the publicity surrounding this extreme view to reject life-saving treatment.”
You might be interested to know that Scientific American has just come out with a special issue on “New Answers for Cancer” with an article on “Gaining Ground on Breast Cancer – The newest targeted therapies are helping doctors to tailor increasingly effective treatments to individual patients.”
But even if no progress had been made since 1970, we would still be able to show that treatment was far superior to non-treatment. I’m sure even Bailar and Gornik would agree with that.
After clicking on the link that Fifi provided, I clicked some of the links on the right of the abstract. I came across this paper:
http://caonline.amcancersoc.org/cgi/content/full/56/3/168
Even it makes the distinction between three types of cancer stages when reporting survival rates” “For White women, 5-year relative survival increased from 90.7% to 98.5% for localized disease, 68.8% to 82.9% for regional stage disease, and from 18.0% to 27.7% for distant stage disease. Among African Americans, relative survival increased from 84.8% to 92.2% for localized disease, and 55.1% to 68.3% for regional stage disease, but there was minimal improvement (15.1% to 16.3%) for distant stage disease.”
You guys sure can go on.
Based upon reading the posts here, over all I would say that there are improvements in cancer survival rates, mainly due to changes in lifestyle and much less so due to changes or improvements in treatment.
Alt treatment is not a good choice for cancer treatment, but the Alts do a better job of educating the public about lifestyle changes and how to prevent cancers by avoiding substances which cause it or are associated with it. They might very well, indirectly, be a leading cause of improvements in reduction of death due to cancer and overall survival rates.
Faith based care is misunderstood by this forum. The faith is from the patient, not the doctor. People don’t know stats about any of this so they have faith in one or the other, conventional or Alt, and go with that faith. Conventional health care is absolutely faith driven. It is the patients beliefs that bring them to one or the other and it is their faith in the care they receive that drives the success. One single episode in a family, no matter how anecdotal it might be to the “educated science expert” will alter that faith for the entire family, which ever way it goes.
Don’t underestimate the effect anecdotal “evidence” will have on this faith.
Also, the general population doesn’t care a bit about the science of it. They haven’t a clue about the science of it.
Thus the best the conventional allopath can do to prevent people from choosing the Alt road, is to educate patients better and start getting more involved in their patients lives rather than riding the “I’m a doctor” band wagon, writing scripts and heading for the golf course.
nwtk2007: “mainly due to changes in lifestyle and much less so due to changes or improvements in treatment.”
Actually, it is early detection and early treatment that improved outcome.
From the above link – “CONCLUSIONS: The war against cancer is far from over. Observed changes in mortality due to cancer primarily reflect changing incidence or early detection. The effect of new treatments for cancer on mortality has been largely disappointing. The most promising approach to the control of cancer is a national commitment to prevention, with a concomitant rebalancing of the focus and funding of research.”
Did you see the part about “The effect of new treatments ….. has been largely disappointing”?
Everybody who posts anywhere on the internet wants to be the intelectual. Hell, I can’t even spell it. Sheeeesh.
Any links from after 1997 about that?
And changing incidence means prevention by what ever means and NOT treatment or early detection.
nwtk, you based your conclusions off the posts you read here. That’s not what you ought to draw your conclusions from. If you peruse the provided links, you might learn that the studies were more rigorous than you suspect.
Besides, talking about what drives the recent improvement in survival rates does not bear upon the fact that a great majority of people do survive breast cancer. They survive because of medical treatment. Not because of lifestyle changes.
sometimes coming in late can have it’s advantages.
I’m astounded. I really am. I haven’t seen this level of willful ignorance in years. And I congratulate the blog’s authors for being patient about it.
But. . . where’s the whale.to cites ? (/joke)
V, I read the links too. I even sited one. You missed my point. I am not disagreeing with you, you are just looking for an argument.
nwtk2007
I think you based your conclusions based on pec’s posts. Lifestyle changes can only get you so far. Question for you. Do you think the Bailar article only refers to lifestyle changes for prevention and not chemoprevention? Would you consider using tamoxifen in high risk women to be a prevention measure? Now, I gotta get back to the golf course and see if I can beat my prior score of 38.
“Faith based care is misunderstood by this forum.”
I make the distinction between science-based treatment and belief-based treatment. People who recommend questionable treatments “believe” they are effective but don’t have any evidence to support their beliefs. Scientists don’t “believe” anything: they reach provisional conclusions based on the best available evidence.
nwtk2007,
It sounds as if you read the comments about the Bailar article but did not read the letter published in answer to it. Please read my 7:45 comment above where I copied it in full.
It says, “Bailar and Gornik reveal their underlying bias by choosing to ignore the influence of treatment on the reduction in cancer-related mortality…” etc. The letter pretty much shoots down the Bailar article. I’m wondering why you choose to quote Bailar but not the critics.
No one doubts that prevention is better. The letter rebutting Bailar points out that “A major component of the National Cancer Institute’s budget is for cancer prevention.” But once cancer has developed, there can be no question that modern cancer treatment is far more effective than no treatment or than any alternative treatment.
You and Bailar are quibbling about how fast cancer treatment is improving, not about whether cancer treatment works, which was pec’s original question.
I think part of the problem in such discussions is that medicine is complicated. It is actually not very susceptible to generalized answers to such questions as “how well do treatments work?” and “is progress being made?” yet these are the questions the public poses.
Thus, when Harriet and David and I think about such questions we think of the very high cure rates obtained with, and the good progress being made in the treatment of certain stages of breast, bowel, skin cancers and some kinds of leukemia, childhood and testicular cancer.
Pec and others probably mainly have in mind common aggressive, or advanced cancers where progress is admittedly small, and survival is infrequent once the cancer is beyond the scope of surgery or radiotherapy. These cancers are most obvious to the public. All the cured patients don’t wear signs saying “I had cancer ten years ago”, while the deaths are obvious and all too frequent.
The more aggressive varieties and stages of breast cancer, NSCLC and pancreatic cancer would be examples from this other end of the spectrum.
I cannot believe the hostility that you so-called educated physicians display against pec. Is suggesting chiropractic manipulations or that she has reading comprehension difficulties the way to hold intelligent discussions about science? As a non physician,all I know is that every cancer patient whom I have ever known who died from the disease had been treated with chemotherapy. While I am against quackery, and you use that term without substantiation, don’t you think it is time to classify chemotherapy as quackery also?
“Bailar and Gornik believe these changes reflect changes in the incidence of cancer or early detection, discount entirely the impact of therapeutic intervention, and argue that progress will occur only through a national commitment to prevention.”
Well Harriet, the point is that not every expert agrees with you and other die-hard cheerleaders for the cancer industry.
I am not saying it is all one way or the other. I am saying it is not an easy question to answer, for anyone, and the experts don’t all agree.
A lot of the raving about the wonderful progress has political motives, so if you are actually a skeptic you should be skeptical.
“But once cancer has developed, there can be no question that modern cancer treatment is far more effective than no treatment or than any alternative treatment.”
There can be no doubt — no, that would make us feel bad. But there also can be no comparison, for ethical reasons.
So we do not know that modern cancer treatment is far more effective than no treatment. It might be somewhat more effective, or a little more effective, or it might actually be far more effective. We don’t know.
If we are not brainwashed cheerleaders for the cancer industry, we admit it is hard to know how effective the mainstream treatments are for each type and stage of cancer.
And I said that, according to Bailer and many other sources I have read, there are effective treatments for certain types of cancer, especially childhood cancer.
In general, though, progress has been slight, according to some experts.
Of course most want to believe the propaganda. Providers of mainstream treatments and the public all want to believe it.
There is no monolithic “cancer industry.”
The battle with cancer is not a football or basketball game. It is much more complicated than some would have us believe. There are no cheerleaders unless you call the families of the patient rooting for him/her, cheerleaders. No argument about more progress having to be made, but a lot of progress has been made. The patient in this case did not take advantage of it. You can always find someone with a different opinion. That does not mean they are correct. Remember the basketball player a few years ago who was told by his doctor that he couldn’t play? He sought out an opinion that suited him and dropped dead taking practice shots. So be careful about seeking confirmation of your beliefs and wants. If you ever find a lump in your breast like this patient, what would you do? Call Dr. Gorski?
Harriet, you say the letter to the editor above shoots down the Bailar and Gornik paper.
No, it doesn’t shoot it down. It augments the conclusion by pointing out the success of treatment of cancers which occur prior to age 55, nothing more. The author of the letter fears that conclusions which emphasize prevention over treatment will cause some patients to avoid treatment. At least that is how it reads to me.
You sound like you have a bias yourself.
Again, yes pec is wrong and treatment is better than none at all and I believe that pec would choose treatment over no treatment if diagnosed with cancer.
And weing, I think tamoxifen would be would be an OK choice for women who have had previous est-pos tumors and who are being treated for such as well. It might also be considered in women with a strong familial tendency towards development of said type of breast cancer.
I am curious, exactly what is the risk of stroke associated with this drug?
And hey, 38 is not bad for your first four holes!
If there’s a cancer “industry” then surely it includes all the supplement manufacturers and potion makers who claim their products prevent or cure cancer with no proof? Clearly it benefits the industry selling “prevention” or “natural cures for cancer” if the general public are both terrified of cancer and also afraid of proven cancer treatments (or get the impression that treatable cancers, like the one in the example above, can’t be treated). Obviously people who claim illness is due to subluxations and energy blockages also have something to gain by spreading misinformation and claiming they’re providing cancer prevention treatments.
Cancer prevention lifestyle strategies are really very simple, exercise and eat a healthy diet that’s got lots of leafy greens (that means foods in their natural forms). It doesn’t require expensive supplements or vitamins (which in some cases actually contribute to causing or acerbating certain forms of cancer according to research) and it doesn’t require fixing your karma or energy (cancer isn’t a punishment for being a bad person). All the same, depending on one’s genes, one still might get cancer so it’s important to know one’s family history and communicate it to your physician. While people can certainly enact these changes in their habits themselves, sometimes people benefit from some support in creating and maintaining new habits. Often just having a friend or partner make the changes with them will be enough, there are now also all kinds of online groups and easy to use programs that are generally created for weight loss but are just as easy to use as a way to measure and be accountable for lifestyle changes made for other reasons.
If someone finds themselves morbidly obsessing about cancer and terrified of it, and that it interferes with them living and enjoying their life now, then a bit of psychological support and counseling may be in order. After all, why let the fear of cancer rob you of you of the very life you’re afraid cancer will take!?!
nwtk2007,
You mean there is more than one?
I’m sorry I’ve been away. There have been home issues to deal with. I’m truly amazed at how long this comment thread has gone, and unfortunately I see the same people making the same dubious assertions over and over again. I thank Harriet and Kimball for being so diligent in pinch-hitting in my absence.
Perhaps those who think that treatments don’t do anything for cancer is, of course, a load of hooey, depending upon the cancer. Yes, there is still pancreatic cancer, which remains almost as deadly as ever. But other cancers are treatable. Another aspect that people forget is this: Even if progress in terms of overall mortality has not been dramatic but rather evolutionary, the morbidity of the treatments has become much, much less. Let’s take a look at breast cancer. As recently as the 1960s and 1970s, the disfiguring radical mastectomy was the standard of care for all breast cancer, even small ones. Treatment then evolved to the less disfiguring but still fairly radical “modified radical mastectomy” and then to the lumpectomy and axillary dissection with radiation therapy. These days, we no longer take out all of the lymph nodes under the arm anymore; we do a sentinel lymph node biopsy, which removes only one or a few. If you don’t think these are “advancements” because they don’t by themselves improve survival (indeed, they were found to produce equivalent survival to older, more radical operations), you clearly have never dealt with breast cancer patients.
Now we’re going even further, developing ablation techniques using either cryoablation (freezing) or radiofrequency ablation (burning) for the use on small breast cancers. In colon cancer, the story is the same with the development of laparoscopic techniques that provide equivalent local control of the tumor with much less pain and a much shorter recovery period. Meanwhile, thanks to better chemotherapy regimens, median survival for metastatic colon cancer to the liver has improved from a dismal six months 20 years ago to the 15-20 month range, with good quality of life. No, it’s not a cure, but is progress.
Regarding stroke risk, I think it depends on age, the older the greater the risk. About 5 out of 10,000 more than those not on it.
pec wrote – “So we do not know that modern cancer treatment is far more effective than no treatment. It might be somewhat more effective, or a little more effective, or it might actually be far more effective. We don’t know.”
You perhaps don’t know, but there’s enough reliable evidence to make a reasonable assumptions(not 100% certainty, something scientists never claim, that’s the domain of religion and shysters selling fake cures) about most cancers. As you’ve repeatedly been informed, there are many different kinds of cancer and morbidity and effectiveness of treatment varies so the repeated generalizing you do makes no sense. We also don’t know with 100% certainty that a healthy lifestyle prevents cancer, we do however have enough evidence to reach a reasonable conclusion that leading a healthy life can be preventative (but it’s also clear that even people who lead healthy lifestyles get cancer).
We do know what happens when cancer is left untreated from historical data (it’s no coincidence that the case above sounds like something from medieval times). Now, to be fair, it IS possible that the alternative treatments to medicine that the woman in the case above used actually made her cancer worse. Actually, it’s somewhat likely. No doubt she was told she was just “clearing toxins” when she felt worse, since that’s the standard altie line when someone reacts badly to a lotion or potion. Sadly it seems that the “alternative” cancer treatments (and even prevention recommendations) may be much worse than doing nothing – from the Hoxley treatment which contains arsenic to megadoses of vitamins that actually make cancers worse.
Once again, I have to wonder what benefit pec gets from trying to spread fear of both cancer and medical cancer treatments… Or if it’s just a personal vendetta against doctors she’s waging… Whatever the case, clearly she’s got some purpose for being her constantly promoting subluxations and trying to whip up unreasonable fears about medicine. There are plenty of very real things to critique in medicine and how it’s practiced (and the bloggers her routinely do so), so why does pec keep serving up this red herring unless she’s personally or professionally invested in it?
nwtk – My mistake. I wrote the post before you later commented on the Bailar paper.
pec writes,
“So we do not know that modern cancer treatment is far more effective than no treatment. It might be somewhat more effective, or a little more effective, or it might actually be far more effective. We don’t know.”
You are blatantly denying the evidence that Harriet Hall and others have provided you–19% survival for no treatment, and 93% survival with treatment. Bailar’s paper does not refute this evidence because he only analyzed those over age 55. The woman in question was in her 30s.
Clearly you cannot be convinced to change your mind when concrete evidence against your opinion is presented to you. That goes against the very heart of skepticism–being able to admit when you are wrong, and to follow the best evidence wherever it leads.
“You are blatantly denying the evidence that Harriet Hall and others have provided you–19% survival for no treatment, and 93% survival with treatment. ”
You are blatantly ignoring the sources of bias that Dr. Gorski has written about. And even though he is a cancer treatment provider, he admits we cannot compare treatment to no treatment, for ethical reasons.
Historical data can be very misleading because there was no early diagnosis technology until relatively recently, so non-aggressive cancer might never have been diagnosed. The historical data may have included mostly deadly forms of cancer, while the more recent data includes tumors not destined to become aggressive.
Now it is very common for non-aggressive cancer to be diagnosed and treated, and these cases are all counted as successful. It is not known how many would have progressed and caused disease, if not treated.
Different experts have completely different views on the effectiveness of mainstream treatments, and I have been trying to explain why I think that is. I am constantly misquoted as having said mainstream treatments are useless and alternative treatments are wonderful, when I have not said or implied anything like that.
The controversy exists because no one seems to have a clear answer. The comments here have been emotional, not rational. No one has even tried to understand why the reports are biased and hard to interpret, or why the real effectiveness rates are unknown.
pec,
That’s the way it is. We often have to make decisions with incomplete information. Everyone has a bias. That’s part of being human. What’s yours?
weing,
Whether or not I have a bias is utterly irrelevant to what we are debating right now. Claims of a 93% effectiveness rate are not based in scientific reality. I am pointing out the inaccuracy and no one here wants to face the fact that the actual rate could be much lower.
Instead of rational responses I get hysterical insults.
Hi all,
may we copy a part or all of the original text by David Gorski in our forum at
http://www.transgallaxys.com/~kanzlerzwo?
We are dealing with the most cruel charlatan scene ever, the Hamer-scene, which is using the insane ideas of the ciminal pychopath Ryke Geerd Hamer.
Do not fall for believing that Hamer himself is the driving force. No, the driving forces are groups which, driven by greed and/or insanity, on their own indoctrinate, manipulate, and ripp off cancer patients. No survivors…
In the USA and Canada they operate under the name “German New Medicine”, “New Medicine”, or “Meta-Medicine”.
So far we found more than 150 cases of death, and to show you what I am talking about, this is the memorial for one of the victims:
http://www.ariplex.com/ama/amamiche.htm
Orac, Peter Moran, and Terry Polevoy know the story already and wrote about it some time ago.
The danger by the Hamer-Scene became worse because the second generation of doers is active now in large scale. So we started domains to warn about that matter:
auf Deutsch: Die Todessekte:
http://www.todessekte.de
in English: The Death Sect:
http://www.deathsect.com
en francais: La secte de la mort:
http://www.secte-de-la-mort.net
le forum en francais pour la site “La secte de la mort”:
http://www.secte-de-la-mort.net/phpBB3/
Wiki “Neue Medizin” in English, French, German, Italian + other languages
http://www.ariplex.com/nmwiki
in Italy the journalist Journalist Ilario D’Amato writes the “Dossier Hamer”:
http://www.dossierhamer.it
The question raised by David Gorski “Who is to blame?” can be concentrated to these groups:
1. medical associations which do not cut off medical doctors who use Hamer’s insane ideas to “treat” patients.
2. the court and attorney scene by not persecuting the criminals who are responsible for all the sorrow and death.
3. the politicians who don’t give a damn about anything at all, except for their “diets”.
4. the media for refusing to report about the crimes committed by the charlatans.
Since spring 2007 we try to tell American journalists that the “meta-mediciners” in the USA commit a large-scale fraud with several dozens world famous screen actors like Ben Kingsley, Tommy Lee Jones, Geena Davis, etc., who they abuse for their PR:
http://www.transgallaxys.com/~aktenschrank/gigantic_fraud_exposed/metamedicine_fraud_with_celebs_4_3z.jpg
http://www.transgallaxys.com/~aktenschrank/gigantic_fraud_exposed/metamedicine_fraud_with_celebs_2_2.jpg
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What we found out:
http://www.transgallaxys.com/~kanzlerzwo/showtopic.php?threadid=2391
Some weeks ago we got into contact with NBC and gave them the material.
No reply.
This reply we got from a Californian TV station:
we have rec’d these emails…. but this is not a story for our area… this
doctor does not reside in Northern California.
These “journalists” to not know that the AMERICAN screen actors are Americans?
These “journalists” to not know that it is AMERICANS who die because of the Hamer scene?
These “journalists” to not know that it is on AMERICAN ground where all this happens?
The media PUSH charlatans by giving them huge parts of broadcasting time and newspaper place.
The media BLOCK OFF information about the crimes committed by charlatans.
We can’t cure all that at once, but TWO things we CAN do:
1. cleaning up with charlatans by expelling them from medical associations and by taking off their approbation.
2. build an own information system against the monopoly of the commercial media.
Thank you for your help,
ama
Bias is always relevant. Your bias prevents you from accepting the claim of 93% long term survival in this particular type of cancer. If you do find a lump on your breast and find it to be an adenocarcinoma your bias may stop you from seeking treatment. Will you call Dr Baillar and have him recommend prevention or Dr Gorski?
As a ‘quack’ (not really, actually) that works full-time for the NHS in the UK I would like to add that I feel that it would be inappropriate for ANYONE remotely ‘quack-like’ to treat this type of patient.
The very fact that the patient was accepted for a consultation implies that the practitioner considered that he or she could help!
I’m freakin appalled. Really. These patients need help and the CAMs need locking up. How can this be defended?
http://jonathanhearsey.com/?p=35
JH
># weingon 10 Jul 2008 at 8:26 am
>BTW, in case you are looking for certainty,
>nothing is 100% guaranteed in medicine except for death.
You should not bet on that!
The anthroposophs, insane as they are, claim that they will be reborne endless times, so that going into the grave now plays no role.
This is why they give a damn about healing. They claim that the illnesses are punishment for deeds in earlier lives, and doctors must not interfere with karma!
This is the reason why the anthropopophs WANT children to become ill with “children illnesses”, like measles. Measles is a HIGHLY important matter as it makes FEVER, and FEVER IS GOOOOOOOOD!!!!!!!!
Who do you think caused the measles outbreaks? it is the anthroposophs with their lies. They make people believe that measles are NECCESSARY for the development of the body.
Look here: http://www.pharmamafia.de
(Hey, the web-site maintainers do need help with translation!)
Pec
You’ve said: “The comments here have been emotional, not rational. No one has even tried to understand why the reports are biased and hard to interpret, or why the real effectiveness rates are unknown.”
You’ve consistently responded to the most emotional, and have neglected to respond to the rational challenges to your constant generalizations. You say the data is complicated, you say we should fear cancer more, you call us names like “cheerleader” and talk about the “cancer industry”. You talk about lead-time bias and over-diagnosis, which are irrelevant to the subject of this blog.
I would like to know how an actual cancer patients should interpret and use YOUR arguments in their decision making.
Can you please be specific for just a moment? Let’s say we have a patient with breast cancer. Let’s say, just for the sake of argument, that she is in her mid 30s and is diagnosed with adenocarcinoma. Let’s say the cancer has progressed to a palpable 1 cm in size. Let’s say her doctor, based on the best information available to medical science, 93 out of 100 patients in similar situations will survive 5 years given with proper surgery and radiation therapy combined with adjuvant chemotherapy and/or hormonal therapy.
Given this hypothetical case, what would you advise the patient to do?
“Your bias prevents you from accepting the claim of 93% long term survival in this particular type of cancer.”
This is so stupid. I explained the scientific reasons for questioning the 93% rate.
I am not saying anything about whether or not cancer victims should get the standard treatments.
Oh, and by the way
You said: “Claims of a 93% effectiveness rate are not based in scientific reality.”
You are the only person who has said the treatments are 93% effective. The statement from the case was that, with treatment, there is a 93% chance of long term survival.
By mis-quoting Dr. Gorski, you’re setting up a false strawman just to knock it down. As has been said before, the patient’s doctors did not say “You have 0% chance of survival without treatment and 93% with treatment”. But that is what you, Pec, are indicating that they said, which is unfair and misleading.
As the original blog so graphically demonstrated, lives are at stake here. So please do not generate unnecessary confusion through inaccurate statements.
Your response illustrates a well known ego defense mechanism that allows you to maintain your bias.
I understand that the case in question sought out Hoxey and Gerson. These two “ancient” alternative therapies have not been on the cutting edge for years. Each of the proponents and inventors of these methods had to go to Mexico because they were persecuted by the U.S. FDA and other so-called authorities who kill cancer patients with their ineffective, although sometimes palliative, chemo agents. Many physicians in the U.S. fear such similar actions, and do not dare go against the establishment.
As an oncologist, you better believe in nothing else other than chemo, radiation, or surgery, or the same will apply to your license to practice. You may publicly deny this, but this is how the pharmaceutical companies control the medical profession; by controlling the FDA.
If I were diagnosed with a difficult cancer to treat, too far gone for just surgery or radiation, I would go on anti-fungal medication, follow an anti-fungal diet, and travel to Italy to be treated by Tullio Simoncini, MD, and his intravenous sodium bicarbonate, to alkalize the blood. Of course, if any of you traditional therapists were to advocate this, you would surely lose your license to practice medicine in your state. Anti-fungal and alkalizing medication would surely put chemotherapy companies out of business.
“Given this hypothetical case, what would you advise the patient to do?”
I wouldn’t advise a cancer patient because I am not an MD or any kind of health care provider. I never claimed that I was.
The only advice I might give them is to do a lot of reading and thinking before trusting any health care provider, whether mainstream or alternative.
As long as the time to do the reading doesn’t allow a T1 N0 M0 to progress into T1 N1 M0, I hope.
>If I were diagnosed with a difficult cancer to treat, too far gone
>for just surgery or radiation, I would go on anti-fungal medication,
>follow an anti-fungal diet, and travel to Italy to be treated by
>Tullio Simoncini, MD, and his intravenous sodium bicarbonate,
>to alkalize the blood.
So you are on a suicide trip and want to spend 150000 bucks for it?
You can have you death cheaper: just jump from a skyscraper!
http://cryptocheilus.wordpress.com/
pec said, “This is so stupid. I explained the scientific reasons for questioning the 93% rate.”
You explained the reasons for questioning the survival rate for cancers that are diagnosed early and might not have spread. This was not one of those.
For a case like this one, you questioned whether the historical comparison data are valid. I acknowledged that they are imperfect, but they are the best we have, since we can’t do a controlled study with a no-treatment arm.
We showed you detailed data on the changes in cancer statistics over many years. We showed you the best evidence we have. We showed you that the biases have a small, not a large influence. We showed you why even the most skeptical critic would have to accept that the 93% survival rate for this patient was far, far better than the survival rate without treatment. Would it satisfy you if the doctors told the patient that the survival rate with treatment was 93% and that they didn’t have exact numbers for the survival rate without treatment but that it was much, much lower?
If you want to imagine that her survival rate without treatment would be “closer to zero” than to 93%, go ahead and imagine it, but don’t expect anyone else to believe it.
pec, you wrote “I am not saying anything about whether or not cancer victims should get the standard treatments.”
You have been discussing the value of conventional cancer treatment with several medical doctors here.
Let’s say, God forbid, you found yourself in the position described by RickK101.
Based on the information you received here, would you be more or less likely to seek conventional treatment?
“We showed you that the biases have a small, not a large influence.”
You did not show anything like that.
Harriet, why do you think there are experts who say medical science has made very little progress with most forms of cancer?
pec,
Those medical experts have biases and, if they say what you think they say, they are wrong. We have made progress in treating some cancers as in this case and others mentioned. There is still too little progress in advanced disease, and in other tumors like pancreatic cancer.
Pec says we did not show her that the biases have a small, not a large influence. I think the information we presented speaks for itself.
She said the true effect of treatment for the patient in question could be anywhere from 0 to 93%. Could any rational person really think that it could be 0% or even 10%?
pec said, “Harriet, why do you think there are experts who say medical science has made very little progress with most forms of cancer?”
They are not really talking about the overall progress; they are not comparing cancer treatment in 2008 to cancer treatment in 1808. They are fixating on what they perceive as not enough further progress after, say, 1970. They are comparing actual progress to the ideal of a cure for all cancers. They are talking about the fact that the prognosis for some cancers like pancreatic cancer is still poor while ignoring the many other cancers that can be cured. They are talking about their personal interpretation of recent statistics that others interpret quite differently. They are ignoring what Dr. Gorski pointed out: that improvements in treatment may improve the life of cancer patients even when they don’t improve survival.
You can find experts who say almost anything, experts who disagree with each other, experts who are biased, and experts who are just plain wrong. That’s why we don’t blindly follow authorities. I’m wondering why you would choose to accept the word of those particular experts.
I am confident that even those experts who say science has made “very little progress” would readily admit that modern cancer treatment as a whole is far superior to no treatment or to the treatment available in 1800.
“you can find experts who say almost anything, experts who disagree with each other, experts who are biased, and experts who are just plain wrong. That’s why we don’t blindly follow authorities.”
Harriet, it was you who told me I was not qualified to question Dr. Gorski because he is such a great expert.
So, I should have blind faith in certain experts but I should doubt others? Since I am not qualified to think about these things, according to you, I must have blind faith in someone. But who? Only those who make a good profit working in the cancer industry?
“She said the true effect of treatment for the patient in question could be anywhere from 0 to 93%. Could any rational person really think that it could be 0% or even 10%?”
It could very well be more than 10%. It could be more than 20%, or more than 30%, more than 80%. Who knows? We don’t seem to have any reliable way of finding that out.
The changes in mortality for most types of cancer from 1970 to now are not very great. Your assumption is that terrific treatments were already in use by 1970, and very little improvement was made after that.
But we don’t seem to have reliable data to support your beliefs, which appear to be based mostly on faith in mainstream medicine.
“modern cancer treatment as a whole is far superior to no treatment or to the treatment available in 1800.”
Surgical technology is much better now. Whether surgery is generally the best approach for cancer is debatable. But if a patient is going to have surgery, it’s better to have it now than in 1800.
pec – I already explained the difference between trust and faith. Blind faith, whether it be in subluxations or a doctor, is foolish. You’ve already shown you have blind faith in subluxations. Blind cynicism is equally as foolish. Clearly you have a very cynical prejudice against Dr Gorski and have blind faith in anyone who you think is saying what you want to hear (though, as it’s been pointed out, you’re hearing something that isn’t actually being said because that’s what you want to hear). I’d assume that the doctors who did the study you believe supports your position (but doesn’t) also “make a good profit working in the cancer industry” but you don’t question their integrity because you, mistakenly, believe that their abstract supports your position.
Apparently you’re not qualified to UNDERSTAND what’s being discussed based upon the evidence of your misunderstanding, that doesn’t mean you can’t think about things you don’t understand but it does mean that your opinions are pretty worthless because you don’t know what you’re talking about. But, I thank you for your persistence because everyone’s patient explaining to you over and over again has given me much more insight into cancer than I would have had otherwise, which is the reason I visit this blog in the first place. Apparently your reasons for being here are more obtuse and have little to do with learning or understanding.
pec said, “Harriet, it was you who told me I was not qualified to question Dr. Gorski because he is such a great expert.”
You are distorting my words. I told you Dr. Gorski has a great deal more knowledge than either you or I. You asked if you should believe him and stop thinking. I told you you should not follow his authority but think for yourself even harder and try to fully understand what he says and why he says it. Once you have done that, if you present convincing evidence that he is wrong, you will have as much credibility as he does.
Right now we don’t know what your credibility is – it might be 93% or it might be 0%.
pec said, “Whether surgery is generally the best approach for cancer is debatable.”
In some cases it may not be the best approach. In certain types and stages of cancer it is clearly the best approach, and that is not at all debatable. In other cases a combination of surgery and other treatments is preferable; and that is not debatable either. There are thousands of studies comparing different methods of treatment for specific types and stages of cancer.
Can you seriously think that it was “debatable” whether the patient in Dr. Gorski’s example should have had surgery?
I suppose next you’ll be saying it’s “debatable” whether patients with bacterial pneumonia should take antibiotics. After all, some of them would have survived without treatment; and antibiotics can cause serious side effects; and we can’t ethically do studies of pneumonia with a no treatment arm. There is a bias because we can’t assume all the treatment successes were really due to the antibiotics. Are we lying to patients when we tell them there is a 93% cure rate with a given antibiotic? We really don’t know. It might be anywhere from 0% to 93%.
I think you’re capable of “debating” anything.
Harriet,
I don’t think it’s debating but mental onanization.
No, you have been told you’re not qualified because (1) the content of your comments is incontrovertible evidence that you do not know what you’re talking about and (2) because your obtuse repetition of the same talking points over and over and over again after I and many others more patient than I have explained your errors again and again demonstrates that, at least right now, you are uneducable on this issue.
I repeated the question because it never was answered. You said treatment can’t be compared to no treatment for ethical reasons. You don’t know how your treatment would compare to any of the alternate treatments, or whether this patient would have done better with yours.
When a patient has a potentially deadly disease it makes sense to try something that you feel is likely to help, even if you do not have objective evidence that it will. In your experience you probably have seen many similar patients who survived. However, you cannot tell how many would have survived without your treatment, because you cannot easily predict which tumors will become aggressive.
Maybe this patient had a form of cancer that was going to become aggressive no matter what. Your assumption is that she would have been fine with mainstream treatment, but will die because she chose an alternative. Maybe that’s true, or maybe it isn’t. My point is that cancer is not well enough understood for you to make that assumption.
Your post was intended to convince people that alternative medicine can be lethal. However because of the limited current understanding of cancer and because of the well-known sources of bias, your certainty is unwarranted. I feel that your motivation is more political/ideological than scientific.
As I keep saying, I am not promoting any alternative cancer treatments. But you do not have good evidence that mainstream treatments are generally superior, since comparisons have not been made. And since mainstream results have barely improved in decades, maybe the general approach should be modified in some way.
Ahhhh, so pec thinks it’s “debatable” whether arsenic is poisonous now. I wonder if she has enough faith in her beliefs to try that one out on herself…. or if she just wants other people to use these “alternative” cancer treatments. Who knows, she’s been avoiding telling us what she’d do if she was diagnosed with an aggressive cancer. Would she do nothing because she believes that doctors are lying about cancer? Would she choose to try alternatives as the woman above did? Would pec even go to get tested if she felt a strange lump in her breast? Does pec even do a regular breast self exam? Would pec even know she had cancer until it had progressed to the stage of the woman above?
No, it is true to a high degree of certainty. You can play the old “argument from ignorance” or “argument from uncertainty” logical fallacy game all you like, but it’s just obfuscation.
“AMA” responded to me in this way:
>>So you are on a suicide trip and want to spend 150000 bucks for it?
>You can have you death cheaper: just jump from a skyscraper!
My point was that everyone whom I have ever known who died of cancer had treatment with chemotherapy.
Am I saying that chemo causes cancer? Of course not, but it does not save lives. It should be labeled as quackery also.
The majority of people posting here are quick to label things they do not know about as quackery. I know about chemo, and it is quackery, sanctioned by the pharmaceutical companies. Physicians, try going against them, and you will see how long it takes for you to be blackballed.
Everyone, whom I have ever known that died, was breathing before dying. Breathing is quackery, If you never breathed, you will not die.
I know plenty of people who have died from cancer that never had chemotherapy.
otr6686–
You can also say that most people who have survived cancer had chemotherapy.
I think that pec is not worried about getting cancer because she has already attained the status of Clear and is on her way to becoming an Operating Thetan.
Harriet Hall said:
I know it was a sarcastic comment an all, but I’ve been debating another person in an online community forum that thinks just that. He thinks that vaccinations are just stressors no different from the disease itself, and that people just need good[sic] nutrition (He has some wild ideas about foods too).
It is frustrating, but in the process I learned a lot. This blog actually helped me in understanding what he was talking about and how dangerous it all was. Kimball’s article – in special – here and on other sites about Naturopathy made me understand things beyond the apparent “nice guy talk”, and “I’m here just asking questions” thing.
I’m not comparing that person to pec because I think she would also find this guy I was discussing with completely bonkers.
I stopped discussing with that guy after he started tauting me about a bet. He would inject HIV+ blood in himself, or catch TB on purpose, and he would show that his Pranayama and rigorous nutrition alone would make him immune to those diseases. It serves as a constant reminder that there are people that believe in strange things… it’s like a generalization of Poe’s law. And to add a little information that person is a Hindu Naturopath in training.
Fifi,
You seem quite obsessed with the idea of me getting cancer, which shows just how malicious you are. I know I promised not to respond to your malice and stupidity any more. But I just want you to understand I have noticed just how full of rage you must be. Probably because of an unhappy childhood, resulting in severe mental illness and retardation. Maybe some radical surgery and toxic chemo would help. It’s worth a try.
I believe the mainstream approach to cancer may be wrong, at least for certain types of cancer. Attacking cancer cells as if they were analogous to a bacterial infection may be reasonable in some cases but not in others. I think that cancer cells are sometimes a symptom of a more general disorder. That could be why cancer sometimes recurs after surgery and chemotherapy — the general disorder has not been treated.
In other cases cancer might actually be the disease and eradication of the tumor (if localized) could result in a complete cure. But all cancer is approached in this way by mainstream medicine.
Alternative medicine is more likely to be holistic — in other words, a larger context is considered, rather than focusing only on the cancer cells.
I do not know of any alternative cancer cures, have never been a health practitioner, am not selling anything (I have to keep saying that over and over). I am only suggesting that medical researchers consider that cancer cells might sometimes be a symptom of a more general syndrome.
I am skeptical about mainstream cancer treatments because I do not necessarily agree with the reductionist approach (in some cases it is the best approach, but in many others it may not be), and also because the evidence shows that cancer is not nearly as curable as the public has been led to believe.
pec, I think it would be very unfortunate if you got cancer, I’m just curious as to what you’d do IF you were diagnosed with cancer. Even Hermano who who seems to share quite a few of your views and who has offered you his support is curious about this, as are many others. I actually think it would be very unfortunate if you did have cancerous growth because I suspect you’d either never get it diagnosed because of your fear of doctors and you’d ultimately follow a similar course of action as the woman in the case above and it would lead to an unnecessarily early death. Just because I think you have some kind of obsession with doctors and medicine, and some misguided beliefs in subluxations and the like, doesn’t mean I’d wish or want you dead. I suspect you may be projecting your own desires onto others. One reason I think blogs like this are so important is exactly because of people like the woman in the case above and yourself.
>“She said the true effect of treatment for the patient in question could be anywhere from 0 to 93%. Could any rational person really think that it could be 0% or even 10%?”
Pec> It could very well be more than 10%. It could be more than 20%, or more than 30%, more than 80%. Who knows? We don’t seem to have any reliable way of finding that out.
Pec, I am still trying to understand you. There may be others who think the same.
Have you missed the point that the 90%+ figure for twenty year survival with early breast cancer refers to the percentage of patients who are not only alive twenty years after treatment, but who are also CANCER-FREE.
How do you think that patients get to be cancer-free without a “true effect” from the treatment? The spontaneous remission rate for symptomatic breast cancer is known to be tiny.
pec says,
“I am skeptical about mainstream cancer treatments because I do not necessarily agree with the reductionist approach.”
I think this is the key to our frustration with pec: she is not operating in the same world view we are. She espouses a philosophy, similar to a religion, that posits non-material entities and unmeasurable energies. She thinks some vague “holistic” approach is philosophically preferable to science, which she sees as having a materialist and reductionist philosophy.
Science is not a philosophy or a belief, it is just a practical method of figuring out how the world works, a method that has demonstrated its worth and its ability to predict. I don’t know of any better method. Apparently pec thinks she does.
pec refuses to understand when I tell her that science doesn’t follow any philosophy. She can’t show any evidence that her non-material, non-reductionist world view has ever led to any real progress or verifiable knowledge. She can’t offer any way to test her world view or her claims.
We are speaking the language of science; pec is speaking the language of philosophy. No wonder we can’t communicate.
What pec fails to understand is that medicine does treat cancer in a holistic way. Apart from the obvious advise that the medical community gives in terms of prevention, not to mention the research that’s also gone into lifestyle aspects of cancer expression, there’s also the research into the biological and psychological impact of support groups who help people cope with the emotional aspects of cancer. That seems to cover body, mind and soul (if we consider our emotions to be what we’re talking about when we say “soul”).
It doesn’t sound to me as if any of these alternatives to medicine actually cover all three, certainly in terms of body there’s some failings.
Our definition of holistic is treating the whole patient, considering “real” factors like lifestyle, psychology, family, socioeconomic status, cultural background, etc.
pec’s definition of holistic is not limited to “real” factors; it includes factors that most of us think are imaginary. If they are not imaginary, at least there is no evidence that they exist, and pec has not told us how we could find out whether they exist.
In 1925, Francis Peabody said, “the secret of the care of the patient is in caring for the patient” and that idea is central to good medicine. All good clinicians are “holistic.”
By the way, the idea that science hasn’t considered “that cancer cells might sometimes be a symptom of a more general syndrome” is a ridiculous straw man argument. Science is working hard to understand what factors allow cancer cells to develop and what factors allow them to escape detection, to multiply, to invade, and to kill.
Harriet, exactly. I just thought it was worth pointing out that the claims pec was making about medicine not being holistic and alternatives to medicine being holistic are false if one considers (and understands) the meaning of the word.
When I use the word “soul” I’m using it to speak about people’s emotional life, the “soulful” aspect of our life (to me this covers everything from personal emotions to cultural aspects of who one is). I don’t see it as being something supernatural.
“Have you missed the point that the 90%+ figure for twenty year survival with early breast cancer refers to the percentage of patients who are not only alive twenty years after treatment, but who are also CANCER-FREE.”
No, I haven’t. But you have missed the point about over-diagnosis. Even Dr. Gorski has written that most early cancer would never progress to cause symptoms or death, even with no treatment at all.
So if 90% of treated patients survive 20 years, you would have to subtract the percentage that would have survived 20 years without treatment, in order to find the actual cure rate.
We do not know what percentage would have survived anyway, because most patients are treated. But we do have some evidence from autopsies showing very high rates of some cancers in people who died from another disease or old age.
This shows that cancer cells do not necessarily cause disease. Eradicating early cancer with surgery, chemo, etc., does not always make a practical difference.
This does NOT mean the standard treatments are worthless. It means we do not really know their worth.
How do you think that patients get to be cancer-free without a “true effect” from the treatment? The spontaneous remission rate for symptomatic breast cancer is known to be tiny.”
You can’t really know that, since most patients are treated. And, as I said, it is well known that cancer cells do not necessarily cause disease or death.
pec,
You are mixing up prostate cancer in the elderly with breast cancer in a young woman. Two totally different animals. Lead time bias does not apply in the case of a palpable tumor. I mean, what are you waiting for? Metastases to show up before you say it’s a cancer that will progress? I’m sorry, but no matter how much you dislike Dr Gorski for being an arrogant surgeon, but the statistics that he gives you are correct.
You say cancer is a symptom of another disorder. Yeah, we know that. Several in fact. Once we understand the mechanisms and can interfere with them, it will be the ultimate cancer prevention.
“You are mixing up prostate cancer in the elderly with breast cancer in a young woman.”
No, what I said is true of many other cancers besides prostate cancer. You have not read about over-diagnosis. Even Dr. Gorski has written about it.
And I have no personal feelings against Dr. Gorski. This is a scientific debate.
You can’t possibly know if his statistics are correct, since even he admitted it is not possible to know.
You are still mixing them up.
pec said, “You can’t possibly know if his statistics are correct, since even he admitted it is not possible to know.”
You are misquoting Dr. Gorski. What he really said was, “No, it is true to a high degree of certainty.”
Apparently pec wants 100% certainty and exact numbers and absolute answers. Those don’t exist in science.
A high degree of certainty is the best we ever get. It’s plenty good enough for most purposes. It got us to the Moon.
pec,
You didn’t respond to my analogy about antibiotics for pneumonia: some patients would survive without treatment; there is a bias because we can’t assume all the treatment successes were really due to the antibiotics. We can’t do a study with a no-treatment arm; we have only historical data, and past diagnoses might not be accurate, and we are diagnosing more pneumonia today because of better technology. Are we lying to patients when we tell them there is a 93% cure rate with a given antibiotic? We really don’t know. According to your reasoning, it might be anywhere from 0% to 93%.
And you didn’t answer my question: “Would it satisfy you if the doctors told the patient that the survival rate with treatment was 93% and that they didn’t have exact numbers for the survival rate without treatment but that it was much, much lower?”
I’ve written no such thing, at least not as an over-arching statement that applies to all cancer. If that’s the message you got out of my posts, you clearly did not understand. Moreover, in this context, when we talk about “early” cancer, we mean really early cancer, as in clusters of cancerous cells, usually cells that have not yet invaded. We are not referring to a 1 cm invasive tumor.
Why is the difference so hard for you to understand?
Pec, medicine is complicated and every word can be important to the meaning. I clearly specified “symptomatic” breast cancer.
Dr Gorski was referring to an apparent small excess of tiny cancers found only when screening very large populations of patients. We suspect from the available statistics that some of these may never progress during the lifetime of the patient, but so far as we know none of these ever go away without treatment, either.
“when we talk about “early” cancer, we mean really early cancer, as in clusters of cancerous cells, usually cells that have not yet invaded. We are not referring to a 1 cm invasive tumor.”
A lot has been written about over-diagnosis and it might be more of a problem than you realize Even cancers defined as invasive might never cause disease.
Over-diagnosis can have adverse practical consequences, since the standard treatments can damage health and shorten life. But I am talking about the statistical problems that result from counting over-diagnosed cases as successfully treated.
When I get a chance I will link to articles that explain it well. It’s obvious no one here has read any of them.
It is impossible to know how many patients are over-diagnosed and assumed to be cured when they never were sick. It is only possible to estimate, and there are different approaches to estimating.
“An overview of seven autopsy studies documents a median prevalence of 1.3% for invasive Breast Cancer (range, 0%-1.8%) and 8.9% for ductal carcinoma in situ (range, 0%-14.7%).[15,16] Detection and treatment of these lesions constitute overdiagnosis and do not confer any benefit to the patient. It is currently impossible to distinguish with certainty the cancers that will progress from those that will not.”
http://breast-cancer.kb120.com/Breast-Cancer-Screening—Harms-of-Screening_3.html
If those very small precancerous conditions were found in autopsy, then those people weren’t over-diagnosed, were they?
Having cancer that undoubtedly started out that way and then progressed I wish I had been “over-treated” at an earlier stage.
Breast cancer is nothing to play Russian roulette with. What a great joy it will be when we can always find it before it becomes dangerous and remove it, being certain that that person will live a long and productive life free of breast cancer.
Fifi wrote: pec, I think it would be very unfortunate if you got cancer, I’m just curious as to what you’d do IF you were diagnosed with cancer.
_____
And she still has not answered that question. If one will extrapolate from the advice that she said she would give to others who had cancer, then following her own advice,Pec would read and think about the problem. Unfortunately, because she is the patient this time, she will need to stop the reading and thinking eventually and act. And the passivity of Pec’s mental onanization (per Weing’s comment) is what is concerning, that she will not act and just rot in place.
It is telling that Pec has showed the most emotion when responding finally to Fifi’s valiant and compassionate attempts to have Pec identify and state the implications of her mental meandering to HERSELF. Other than that comment of Pec suggesting that Fifi try chemo and surgery to solve the problem of Fifi’s so-called vicious anger (all I can see is Fifi’s compassion and interest), Pec’s tone is one of practically comatose blandness. I think it’s good that Pec is showing emotion.
Of course, Fifi would only use chemo and surgery to combat cancer, not to treat anything else. It is very hard for Pec to grasp this aspect: specific treatment tailored for the individual and their disease. Her security blanket is tightly wrapped around the nature-knows-best/universal-size-fits-all pacifer/dummy (for you British readers).
Harriet is trying to gently peel off that security blanket (Kudos, Harriet, you have taught me a lot in the process!) and seems to have come to the conclusion that the security blanket is not able to come off. I would agree. Hopefully, Pec will continue to read posts here and comment. Who knows, maybe that security blanket will start to feel unnecessarily heavy and not so comforting after all.
pec – So why do you trust articles on a Chinese website that’s tagline is “BKB120.com – Give you happy and healthy life”. Apparently they’re promising to live you long time! Why do you trust these people’s interpretation? There’s no indication that anyone writing the articles knows anything about medicine or statistics, and the “about” page just takes one to more advertisements in Chinese and tells you nothing about who’s writing the articles or running the site! It seems you’ll trust anyone who tells you want you want to hear! That is the very definition of confirmation bias! Considering that the Chinese are some of the biggest manufacturers for ingredients for supplements and are constantly being caught for doing so in incredibly unsanitary conditions (and environments that exploit workers and put them in danger). It’s such a problem that even the usually very face-saving Chinese government has had to admit it! Of course, that didn’t happen until after lead and plastics and so on had been found to be accidentally (and sometimes intentionally!) finding their way into foods and had killed quite a few pets in North America and made some people in Canada got quite sick from taking Chinese medicines!
There are many thousands of websites and articles saying the same kind of thing. I linked the first one I found, since I only had a minute. If you want mainstream medical articles on the subject of over diagnosis, there are plenty.
It’s pretty darned silly to distrust a website merely because it’s Chinese, but then Fifi is pretty darned silly.
pec said,
“An overview of seven autopsy studies documents a median prevalence of 1.3% for invasive Breast Cancer (range, 0%-1.8%) and 8.9% for ductal carcinoma in situ (range, 0%-14.7%).”
The fact that these were found only on autopsy means that they were not diagnosed during life and I’m guessing they were mostly so small they would not have been diagnosed by current diagnostic methods. These numbers don’t tell us anything about overdiagnosis or about whether these lesions would have progressed if the patient hadn’t already died of other causes.
pec said, “I am talking about the statistical problems that result from counting over-diagnosed cases as successfully treated. When I get a chance I will link to articles that explain it well. It’s obvious no one here has read any of them.”
Please don’t bother with those links. It’s obvious to everyone else that we not only have read about it, acknowledged it, and discussed it, but that Dr. Gorski was the one who brought the subject up in the first place. We all agree that overdiagnosis and early diagnosis make the survival rate look higher. We are not disagreeing with you about that. We are disagreeing about how to weigh that fact in deciding how to treat.
We get it, pec. We all get it. You still haven’t answered my question: “Would it satisfy you if the doctors told the patient that the survival rate with treatment was 93% and that they didn’t have exact numbers for the survival rate without treatment but that it was much, much lower?”
pec – No, the reason not to trust the website is because there’s no transparency regarding who wrote the articles or who runs the website. Since the site seems to be based in China, a country thats government keeps a very tight rein and heavily controls what is and isn’t allowed online, and involves itself heavily in propaganda and international image control – and there have been some very big scandals involving supplement and food manufacturers in China – putting this site in context is important. Or don’t you endorse a holistic perspective on information and communication? Or is that only relevant to you when it doesn’t confirm your bias?
“Would it satisfy you if the doctors told the patient that the survival rate with treatment was 93% and that they didn’t have exact numbers for the survival rate without treatment but that it was much, much lower?”
We do not know that it’s much much lower. We don’t know how much lower it might be. That is my point.
It is so easy to mislead the public by claiming success rates like 93% without even mentioning that the no-treatment survival rates are unknown, and difficult to even estimate.
If I had not objected to Dr. Gorski’s claim of 93%, everyone here would have accepted it happily and without question.
And that is what has been going on. We see these inaccurate and overly optimistic claims all the time, and most people do not question them. Most people are not in the habit of thinking about statistics, so they don’t realize how easy it is to mislead with numbers.
And I think Americans might pay more attention to their lifestyle if they realized the safety and effectiveness of mainstream cancer treatments is not really known.
“Approximations of the magnitude of the problem of overdiagnosis range from 10% to 30% of newly diagnosed Breast Cancer cases, depending on utilization and intensity of screening.[23,24]”
Pec, why did you not quote the above, from the source you supplied? ( http://breast-cancer.kb120.com/Breast-Cancer-Screening—Harms-of-Screening_3.html )
It would seem to supply the kind of information you keep stating is not available.
Of course, the true rate of overdiagnosis of pregressive cancer would be much lower in normal surgical practice, where many of the cancers are still found by women as a newly developed lump, even among women already involved in screening.
The rate will also presumably be lower in younger populations, so that autopsy rates for undiagnosed cancers will also exaggerate the influence of non-progressive cancers on cure rates over a twenty year time frame. Many of the cancers found at autopsy will be obvious cancers that were simply missed during life in a rarely screened aged population. They would be deadly in longer-living patients.
I hope you grasp the fact that much of this is mainly of relevance to how we screen patients and what we do when we find tiny abnormalities on screening (many tiny lesions are simply reassessed at six monthly intervals looking for changes suggesting a progressive lesion). It can have no influence on what we advise to a person with a biopsy diagnosis of invasive breast cancer. Do you agree?
pec – You’ve expressed already that you think doctors and medicine should be in the business of scaring and blackmailing people into making healthier lifestyle choices. That seems highly fascistic to me – like playing god with people’s lives – not to mention unethical. How do you square this logically with your belief that doctors want to be gods? Are you sure it’s not you who wants doctors to be omniscient and omnipotent gods?
WEING, in responding to me and pretending to use valid principles of logic which would only convince the uninitiated, wrote:
“Everyone, whom I have ever known that died, was breathing before dying. Breathing is quackery, If you never breathed, you will not die.”
Shame on you for that cheap shot! I cannot believe that you really missed my point. The reason your “logic” does not hold up is that breathing is not touted as a modality to manage cancer; chemotherapy is.
otr – Actually, breathing is touted as a means to manage and prevent cancer. Pec routinely promotes yoga for this purpose, as do many in the yoga industry. Shame on you for not even knowing what you’re advocating in terms of “alternative modalities to medicine”!
Fifi wrote “Zing!”
May I add- Otr, of course people die after receiving chemotherapy. The point you need to realize is that many also experience long term survival, one may call it a cure, after chemotherapy; it depends on the type and stage of the cancer.*
When you are short on facts, and logic, you should limit yourself to asking questions.
*I will dare to put words in Dr. Gorski’s mouth and say he would tell you the same is true for surgical treatment of some cancers.
pec,
So do you think the patient with the 1 cm cancer should have been told “The 5 year survival rate with treatment is 93% and we have no idea whatsoever what the survival rate is without treatment?” Do you think a patient with pneumonia should be told there is a 93% cure rate with antibiotic X but we have no idea whatsoever what the cure rate is with no treatment?
I’m curious. I really am. What do you think doctors should tell patients?
“It was explained to her that a less than 1 cm tumor with no evidence of spread to the lymph nodes carried a highly favorable prognosis, with upwards of 93% long term survival with proper surgery and radiation therapy combined with adjuvant chemotherapy and/or hormonal therapy.”
Exactly my point. Early cancer is considered highly curable, but this is partly just an illusion caused by the incorrect assumption that every small tumor is likely to grow and spread and cause disease and death, if untreated.
93% sounds very good! But maybe it’s more like 50% or 60%. We don’t know, and we don’t really care as long as we can say 93%.
And we don’t know the success rates of various alternative treatments, since most have not been formally studied, so we can say with great certainty that they are all complete failures.
We can say what we like to say, and what people like to hear. And then we can all feel good, and Fifi won’t be scared.
Harriet,
Bacterial infections and antibiotic treatments are understood much better than cancer. You know that, and there is no point pretending they are comparable.
pec said,
“If I had not objected to Dr. Gorski’s claim of 93%, everyone here would have accepted it happily and without question.”
Wait a minute! That claim was true! The survival rate for treated patients IS 93%. That is documented. You can’t question that. What you are questioning is only how much of that survival rate is actually due to the treatment.
We have given you the best estimates of people who deal with this stuff on a daily basis and have read ALL the pertinent medical literature and who FULLY understand the biases of early diagnosis and overdiagnosis. You don’t accept those estimates but you don’t offer any better ones. The very source you cited estimated the effect of overdiagnosis at 10-30% but you didn’t even offer that. (Not that it applies to the patient with the 1 cm lesion).
You just keep pretending we don’t think biases exist after we have told you we do. You keep deliberately misunderstanding us. You remind me of a little kid who keeps asking “why” or saying “I don’t wanna” just to aggravate the adults. It gets very tiresome.
pec said,
“Bacterial infections and antibiotic treatments are understood much better than cancer. You know that, and there is no point pretending they are comparable.”
The principle is the same. We can’t tell the patient what the cure rate is with no treatment, since all we have are historical data and since diagnostic methods are different today. Answer my question: What would you tell the patient?
pec said,
“93% sounds very good! But maybe it’s more like 50% or 60%. We don’t know, and we don’t really care as long as we can say 93%.
And we don’t know the success rates of various alternative treatments, since most have not been formally studied, so we can say with great certainty that they are all complete failures.”
Can’t we say with considerable certainty that the treatment is better than no treatment? Can’t we say that we have credible evidence for the survival rates with this treatment and we have no credible evidence for survival rates with the various alternative treatments? Of course we can’t say they are all complete failures! They haven’t been tested.
pec, why do you believe I’m scared of cancer? Are you sure you’re not projecting your own fears onto me? Really, being afraid of the unknown serves no useful purpose and it’s a very limiting way to live one’s life. Earlier in this thread you said you felt people should be MORE afraid of cancer! However, if I was afraid, wouldn’t this be just how you believe I should feel? If you believe others should feel more scared of cancer, how do YOU feel? Aren’t you afraid? If not, why do you feel others should be? I’ve been advocating a calm and reasoned, evidence based approach to both prevention and treatment. Wouldn’t it make you happy if you’d convinced me that I should be afraid of cancer since that is your stated goal in disputing the evidence for surgery and chemotherapy?
My personal philosophy involves embracing the moment and living my life in a way I enjoy. You just never know when you’ll be hit by a bus or keel over dead. I don’t exercise and eat a healthy diet because I’m afraid of cancer, old age or death, I do it because it makes me feel better in the present and I just enjoy eating well and physical activity with friends. What motives you to eat a healthy diet and to exercise?
pec – And why would you want people to be more scared of cancer if you believe that most cancers aren’t even dangerous or likely to progress?
There is actually considerable information about the success rates, or rather lack thereof, of “alternative” cancer treatments, providing a consistent pattern of inflated claims that do not stand up when put to the test. Giving them the benefit of the doubt merely encourages fraud and quackery.
http://caonline.amcancersoc.org/cgi/content/full/54/2/110
The same applies when you examine data supplied by the promoters –
http://www.users.on.net/~pmoran/cancer/Alternative_studies.htm
– I am prepared to look at any method that can produce a few contemporary cases of unmistakable cancer remission in common types of established, invasive cancer. None of them can satisfy even this modest challenge..
otr,
I did not refer to breathing as a modality for treating cancer. It’s a modality for preventing death. It is obviously faulty logic, just like yours. That was the point.
pec,
Are you saying that we are not aware of lead time bias? We are.
Are you saying that we are equating DCIS and other preclinical lesions with with T1N0M0 cancer of breast? We are not. Are you saying Dr. Gorski is lying or is wrong about current medical treatment resulting in 93% long term survival in T1N0M0 breast cancer? Do you have data to back that up? Are you possibly lumping alternative treatments, as in this patient, with EBM to give lower survival rates for current therapy?
Fifi writes:”Shame on you for not even knowing what you’re advocating in terms of “alternative modalities to medicine”!”
Yes, shame on me because I know nothing about Yoga in the cure of cancer. And yes, Joe, I am not an oncologist, so I know very little about traditional therapy, except that it doesn’t work for very long.
For the past 25 years, I have worked and been associated with the finest alternative immunotherapists abroad. They are harassed in the United States so they do not practice here. They cure cancer. They do not just offer remission for five years. I have seen many patients cured after their traditional physicians have staged them as terminal.
I do not know the qualifications of Fifi, Joe (who is so sure that I know nothing that I should ask questions only of you great gurus) and Weing. If you are oncologists, then I am not surprised that your methods are to insult those who disagree with you. It is no wonder that, under your treatments, cancer survival has been pathetically low in the United States, for the past 50 years.
otr6686 said ” They cure cancer. They do not just offer remission for five years. I have seen many patients cured after their traditional physicians have staged them as terminal.”
Then all they need is some evidence, and they might be eligible for the Nobel for Medicine. Where is that evidence, or do we just have to believe it because you said so?
“That claim was true! The survival rate for treated patients IS 93%. That is documented. You can’t question that. What you are questioning is only how much of that survival rate is actually due to the treatment.”
Yes of course. It’s the kind of deception that fools most people.
I think we have a much better understanding of which bacterial infections require antibiotics, and which would be resolved without treatment. Of course it has been common for MDs to prescribe antibiotics unnecessarily and we now realize that can be harmful.
Maybe cancer research will lead to a better understanding of which cancers are likely to progress.
I think that when cancer is a symptom of a more general disorder, it will recur in spite of the standard treatments. So I think the standard treatments work best when they aren’t needed, for cancers that would never have caused disease.
Another confounding factor is that the standard treatments may increase mortality from other causes, therefore lowering the cancer mortality rate for treated patients.
Since I don’t believe cancer occurs just by accident, at least not usually or always, I question the idea that eradicating cancer cells cures the disease.
When cancer is local, and when it did occur by accident and is not just a symptom, then maybe eradicating the cells does cure a disease that would have progressed.
I don’t think anyone really knows the answers to these questions.
otr,
Define cure. Does the patient not returning for more treatments mean they are cured? Could it be they are dead? I am sorry if you felt insulted when I pointed out the flaws in your logic. You reminded me of the Hollywood actress that couldn’t believe Reagan won the election as no one she knew voted for him.
“Since I don’t believe cancer occurs just by accident, at least not usually or always, I question the idea that eradicating cancer cells cures the disease.”
So you think that removing a tumor by surgery does not lead to remission. I also infer that you believe that a mutation in a gene, which may have various environmental causes, cannot lead to unregulated cell growth and, therefore, cancer.
Otherwise, what would you mean by a cancer occurring “just by accident”?
“I also infer that you believe that a mutation in a gene, which may have various environmental causes, cannot lead to unregulated cell growth and, therefore, cancer.”
I don’t think that cancer can always be explained that simply. There can be problems with the immune system, for example, that prevent it from destroying cancer cells that a healthy immune system would have destroyed.
The overall health of the body may affect its ability to prevent the abnormal growth of malignant cells.
Mainstream medical science has not focused on this kind of approach to understanding the cancer. The assumption is usually that cancer starts because of something like a genetic mutation, and once it starts it will progress to cause disease.
But we know that the body defends itself against potential cancer all the time. Why does this defense sometimes fail? Why does cancer often recur after it has been surgically and chemically destroyed?
“Mainstream medical science has not focused on this kind of approach to understanding the cancer. ”
This sounds like a straw man argument. This has been and continues to be an area of research since at least when I was in medical school, and that was almost 30 years ago. The way I see it is that various researchers are, pardon the pun, pecking away at various components of the biology of cancer.
weing,
The standard mainstream treatments do not consider the health of the immune system, just the opposite. The assumption is that cancer starts because of an accident, a genetic mutation, and eradicating the tumor will cure the disease.
Alternative approaches — and I do not promote any of them — are MUCH more likely to consider cancer a disorder involving more than cancer cells. Whether they succeed or not, at least they try to strengthen the immune system and promote general health.
Mainstream standard treatments only target cancer cells. They weaken the immune system, making it harder for the body to defend itself.
I am NOT saying alternative medical science has found answers — I really do not know. But at least they do not focus exclusively on eradicating cancer which is at least sometimes a symptom rather than cause of disease.
Maybe an ideal approach would know when it makes sense to consider cancer cells the disease and destroy them, and when it makes sense to consider them merely a symptom, and to look for other causes.
When people hear that a cancer treatment has a 93% success rate they assume that cancer research is on the right track. That is probably why it has stayed on that track for so long.
pec said,
“Maybe an ideal approach would know when it makes sense to consider cancer cells the disease and destroy them, and when it makes sense to consider them merely a symptom, and to look for other causes.”
An ideal approach is to destroy the cancer cells and ALSO to look for any underlying factors that might have predisposed the patient to develop cancer. That’s what science is trying to do.
pec said,
“When people hear that a cancer treatment has a 93% success rate they assume that cancer research is on the right track. That is probably why it has stayed on that track for so long.”
The public might ask why the success rate is not 100%. I don’t think you can assume you know what the public assumes. I don’t think the public’s opinion has anything whatsoever to do with the direction of cancer research. I think the public strongly supports cancer research. I think scientists, not the public, determine what studies are done. I think you think cancer research is stuck in a rut. I think cancer research is already considering all the things you are asking it to consider.
“The standard mainstream treatments do not consider the health of the immune system, just the opposite. The assumption is that cancer starts because of an accident, a genetic mutation, and eradicating the tumor will cure the disease.”
That is untrue. What is true is that we don’t have enough results in this area, but progress is being made. The treatment of melanoma with vaccines has been in use for some time and progress is being made there.
I said, “That claim was true! The survival rate for treated patients IS 93%. That is documented. You can’t question that. What you are questioning is only how much of that survival rate is actually due to the treatment.”
pec said, “Yes of course. It’s the kind of deception that fools most people.”
It is not deception to say there is a 93% survival rate. It is stating a simple fact.
Patients will most likely assume that the survival rate without treatment is significantly lower, and that assumption will be correct. Even if it was 50% (which I seriously doubt for a 1 cm cancer), I can’t imagine that knowing those numbers would affect a patient’s decision to accept treatment.
pec, you still haven’t answered my question: What do you think the doctors should have told the patient with the 1 cm cancer?
PLEASE ANSWER THIS QUESTION.
http://www.heartzine.com/
695-ChemotherapyforBreastCancerRaises-Heart-Risk.html
Did you know that a drug commonly used in treating breast cancer has absolutely no benefit for over 90% of patients, and is known to cause heart damage?
(I tried and tried to post a link but it seems that some links — maybe if they’re too long? — cannot be posted on this blog)
pec is moving the goalposts. She said,
“Did you know that a drug commonly used in treating breast cancer has absolutely no benefit for over 90% of patients, and is known to cause heart damage?”
We know that some drugs (for breast cancer and for many non-cancer conditions) offer only a small chance of benefit and have side effects. They are also very expensive. It is very difficult to decide when to use them, but some patients WANT to take these drugs. They hope they will be in the 10% and will live longer and they are willing to take the risk.
But what does that have to do with the subject under discussion? The patient in question was not offered risky treatments for advanced metastatic cancer where there were few options left. She was offered surgery and effective treatment with a high chance of success.
pec, What do you think the doctors should have told the patient with the 1 cm cancer?
PLEASE ANSWER THIS QUESTION.
As far as I know at this point, surgery would probably not be harmful and would have been worth trying for this patient, but chemotherapy and radiation should probably be avoided.
No one could have known in advance that she had such an aggressive form of cancer. Of course now we know and we know that the wrong approach was taken. It’s a lot easier looking back than forward.
For other patients, the outcomes may be very different. They might be exposed to damaging treatments when their cancer would never have caused symptoms. They might die from heart disease caused or aggravated by chemo and radiation.
But I was never commenting about this particular case, just Dr. Gorski’s unrealistic claim for his success rate. I have said repeatedly that I am not a health care provider and I do not prescribe or recommend cancer treatments.
But this post was obviously extremely biased. It uses one case as an example, and implies that alternative treatments never work, and mainstream treatments work most of the time. That is not scientific or fair or rational. It is public relations for the mainstream cancer industry.
pec said,
“But I was never commenting about this particular case, just Dr. Gorski’s unrealistic claim for his success rate. ”
But Dr. Gorski’s claim was for this particular case. It did not apply to other breast cancer patients with other types and stages of cancer. And it was not an unrealistic claim for his success rate, it was a simple statement of the fact that 93% of patients in that category were alive 5 years after treatment.
“chemotherapy and radiation should probably be avoided.”
Why do you say that? Do you know the difference in survival between surgery alone and surgery with additional treatment?
You still haven’t answered: What do you think the doctors should have told the patient with the 1 cm cancer?
PLEASE ANSWER THIS QUESTION.
In the case presented, based on what is known of the natural history of the disease, her progression was almost 100% certain. When you say no one knows, you are referring to non-physicians. We do know a few things. Not everything but a few.
pec wrote:
Bona fide cancer researchers have been investigating such questions for decades. And they’ve done so in a far more rigorous way than your ‘alternative medical scientists [sic]‘.
The problem is that so far, none of the attempts to ’strengthen the immune system’ actually work in fighting cancer. (Human cancer, that is; they often work quite impressively in mice.)
And that’s the key here, pec. It doesn’t do today’s patient any good to consider cancer a symptom, or to try to strengthen their immune systems, because NONE OF THOSE DO ANY GOOD! Hopefully that will change one day.
In the meantime, that’s what separates ‘mainstream’ from ‘alternative’ medicine. The former focuses on what works. The latter focuses on what sounds good.
On what basis do you say that? For one thing, if the patient didn’t get radiation she would have needed a mastectomy because the risk of local recurrence would have been unacceptably high without it. As for chemotherapy, even though in a case like this woman it only provides a 2-3% absolute survival benefit, most women will opt for it even when quoted that figure and when the side effects of chemotherapy are explained in gory detail.
Wrong.
The biopsy showed an invasive, ugly-looking cancer in a young woman. Such cancers tend to be aggressive, particularly in young women.
It does not imply that alternative treatments never work. It implies that we do not know of any that can cure early stage breast cancer. Actually, it’s not an implication, it’s a fact. We don’t know of any that can cure cancer. If you know of one that can, by all means share it with us, along with the best evidence supporting it.
As for whether mainstream treatments work most of the time, this post says nothing other than that mainstream treatments do work most of the time for early breast cancer. The evidence is quite clear, your obfuscation and denials notwithstanding.
What “other causes” can result in cancer cells as a “symptom” rather than the disease itself? Please be specific and cite your best evidence.
” As for chemotherapy, even though in a case like this woman it only provides a 2-3% absolute survival benefit, most women will opt for it even when quoted that figure and when the side effects of chemotherapy are explained in gory detail.”
Well they shouldn’t. It can increase their risk for heart disease and who knows what else. I don’t understand why most women make such an irrational choice.
“What “other causes” can result in cancer cells as a “symptom” rather than the disease itself? Please be specific and cite your best evidence.”
I am talking about the hypothesis that cancer cells are sometimes a sign of a more general disorder. The mainstream assumption is that a genetic mutation, for example, results in abnormal cells which become cancer. According to that assumption, eradicating the cancer cells is the essential goal of treatment.
But according to some, or most, alternative approaches, the goal is to determine why the body was not able to destroy or contain the abnormal cells, as it should.
I am not saying that any alternative approaches have succeeded — I don’t know. But I think looking for and treating the cause makes more sense than attacking what may only be a symptom.
You did not answer my question; so I repeat it:
What “other causes” can result in cancer cells as a “symptom” rather than the disease itself? Please be specific and cite your best evidence.
You’re also woefully clueless about cancer research if you don’t think that cancer researchers haven’t already considered the possibility that the body could impact on the development and growth of cancer. It’s a hot area of research. Look up “tumor microenvironment” or “field effect.”
I think pec has a very clear idea of what “other causes” she is thinking about, but doesn’t want to mention them because they will identify the type of woo that she subscribes to. I think the “other causes” she is thinking of are engrams.
pec said,
“But according to some, or most, alternative approaches, the goal is to determine why the body was not able to destroy or contain the abnormal cells, as it should.”
For crying out loud! That’s the goal of medical science too!! Who ever suggested it wasn’t? Clinical medicine, meanwhile, has to do the best it can to treat the existing cancers.
I will ask AGAIN: What do you think the doctors should have told the patient with the 1 cm cancer?
PLEASE ANSWER THIS QUESTION.
That’s certainly one possibility.
Another possibility is that pec is a subscriber to something along the lines of Ryke Geerd Hamer’s German New Medicine and its Iron Rule of Cancer.
Basically, Hamer postulates that the cancer itself is not a disease but rather the manifestation of a psychological “conflict-shock” that can be identified and that people do not die of cancer itself. (Tell that to some of the cancer patients with whose care I’ve been involved.) Even more outrageously, Hamer claimed that in patients who had never undergone conventional therapy or chemotherapy his success rate is 95-98%. That’s not just for a highly treatable cancer like early stage breast cancer but for all cancers.
The particularly disgusting thing is that the German New Medicine in essence blames the patient if she doesn’t get better because clearly she couldn’t manage to identify and deal with the “conflict-shock” that supposedly caused it.
Or perhaps pec subscribes to Robert O. Young’s idea that cancer is not a disease but rather a liquid manifestation of too much acidity in the blood.
I HAVE NEVER SAID OR SUGGESTED ANYTHING LIKE THAT.
pec said,
“Well they shouldn’t. It can increase their risk for heart disease and who knows what else. I don’t understand why most women make such an irrational choice.”
You can’t tell other people what they should or shouldn’t do. The millions of people who smoke “shouldn’t” but if they choose to take the risk, they have that right. People who gamble “shouldn’t” because the chance of winning is tiny and the risk of losing their money is huge. If a woman is willing to accept a risky treatment for a small chance of a longer life, she has that right. You may not understand their thinking, but if you were in their shoes you might. Maybe if you asked some of them why they made that choice you could gain some insight.
My mother made what I thought at the time was an irrational choice. She accepted chemotherapy for a cancer that had already metastasized, when the chemo had only a small chance of succeeding and large chance of side effects. Her choice turned out to be the right one, because she died of old age a quarter of a century later, with no signs of recurrent cancer. I’m glad now I didn’t try to talk her out of it. You might say I can’t be absolutely sure she wouldn’t have survived without chemo, but it was highly unlikely.
Perhaps you should put more effort into understanding why people make those decisions, and less effort into trying to find fault with the best efforts of intelligent, caring, informed doctors who are doing their best to help people.
I have never said or suggested anything like that. And you know it.
pec,
I will ask AGAIN: What do you think the doctors should have told the patient with the 1 cm cancer?
PLEASE ANSWER THIS QUESTION
“Basically, Hamer postulates that the cancer itself is not a disease but rather the manifestation of a psychological “conflict-shock” that can be identified and that people do not die of cancer itself.”
I HAVE NEVER SAID OR SUGGESTED I BELIEVE ANYTHING LIKE THAT.
“Or perhaps pec subscribes to Robert O. Young’s idea that cancer is not a disease but rather a liquid manifestation of too much acidity in the blood.”
I HAVE NEVER SAID OR SUGGESTED I BELIEVE ANYTHING LIKE THAT.
I don’t think pec subscribes to any alternative cancer theory. She keeps saying she “doesn’t know” about them. She only “knows” that conventional medicine is wrong.
THEN WHAT DO YOU BELIEVE?
Stop dancing around the issue and tell us. What is the “other cause” whose manifestation is cancer cells? As long as you keep dodging that question, we have little choice but to speculate what you are referring to when you say that “other causes” result in cancer cells forming. Hamer’s German New Medicine and Young’s acid-base quackery are simply two forms of “alternative” medicine that postulate that cancer cells themselves do not actually represent disease and that the cause of the cancer cells is not in the cancer cells themselves.
So end the speculation and tell us what you think is the “other cause” whose manifestation is cancer cells!
PEC: “But according to some, or most, alternative approaches, the goal is to determine why the body was not able to destroy or contain the abnormal cells, as it should.”
HALL: “For crying out loud! That’s the goal of medical science too!! Who ever suggested it wasn’t?”
Gorski: “What “other causes” can result in cancer cells as a “symptom” rather than the disease itself? Please be specific and cite your best evidence.”
“As for whether mainstream treatments work most of the time, this post says nothing other than that mainstream treatments do work most of the time for early breast cancer. The evidence is quite clear’
No, the evidence is not clear since the comparison cannot be made, for ethical reasons.
Yes, in the case discussed, it is. Your denying it doesn’t change that.
pec is being obtuse and nonresponsive again.
“THEN WHAT DO YOU BELIEVE?”
I am a skeptical scientist. I am criticizing the belief that the life-threatening diseases we refer to as cancer can be cured, or successfully treated, by eradicating the cancer cells. I am not going to pretend I know what causes all cancer.
Dr. Hall seems to be saying that mainstream science agrees with me, that the cancer cells may at least sometimes be a symptom rather than a cause.
But I get the impression that Dr. Gorski finds this idea to be associated with ridiculous quackery.
I think her woo is Scientology. She is being very careful in her language not to deny it, just to say that she never said it or suggested it.
There was a comment where she did say that she took stuff from multiple different things where each of them made sense, and included Scientology among the things that she thought made enough sense in some areas for her to get “something” from it.
I think the language and thinking structure fits too. Talking in code, but won’t tell what the “code” means.
pec is so entertaining, now she’s trying to claim to be a scientist! Please enlighten us to whether you completed your degree and what it’s in.
Since you’ve expressed a belief in “subluxations” and have made it clear that you have a belief in psychics (in the neurology blog), I think your self proclaimed credentials as a “skeptical scientist” need to be made clear. I mean, if you trained as a chiropractor and believe in subluxations then it’s very relevant to your beliefs about cancer.
pec said “I am a skeptical scientist.”
No you are not. You have shown known evidence that you can think critically, scientifically, and your obtuseness is particularly telling.
Fifi, she claimed to be a computer scientist:
http://www.sciencebasedmedicine.org/?p=87#comment-2869
Which probably means nothing. Her actions and obtuseness speak louder than any her claims of what she things she is.
HCN – Thanks. How strange that she thinks that a degree in computer science translates to medicine! I have quite a few friends who are programmers, developers and on the cutting edge of various theoretical and practical aspects of computer science, some who are even university professors, but none of them think this makes them qualified to give medical advice or gives them special insight into medicine!
pec said,
“Dr. Hall seems to be saying that mainstream science agrees with me, that the cancer cells may at least sometimes be a symptom rather than a cause. But I get the impression that Dr. Gorski finds this idea to be associated with ridiculous quackery.”
You’re misinterpreting and distorting what we said. I said that science is trying to understand what conditions allow cancer to develop, and Dr. Gorski simply asked you if you had any evidence that cancer was a “symptom” of some specific disease. We both recognize that cancer is a disease in its own right once it has developed. A tendency to develop cancer might also be a disease in its own right, and science is looking seriously at that possibility.
No one thinks cancer cells themselves are a “cause” because something had to happen to “cause” those cells to develop in the first place. And the cells themselves are necessary but not sufficient for invasive disease to occur. And “symptom” is not the right word. Cancer is an objective finding, not a subjective symptom.
I will ask AGAIN: What do you think the doctors should have told the patient with the 1 cm cancer?
PLEASE ANSWER THIS QUESTION
You most definitely are not.
“Criticisms” of science tend to be taken more seriously if the person making the criticisms can produce an alternative hypothesis that is testable and could account for current observations at least as well as the current hypothesis or reigning paradigm. Your criticism strikes me as being critical for the sake of being critical because you don’t like “conventional” medicine and don’t “believe” in it. This is especially true since your criticisms are so poorly argued and based on either no data at all or misinterpretations of existing data.
Define “symptom” and “cause” for purposes of your argument
In any case, the idea that cancer cells are merely a manifestation of something else or some other “disease” frequently is associated with ridiculous quackery. That’s why, if you’re going to convince me that you’re not a believer in one of the several varieties of ridiculous quackery that make the claim that cancer is not a disease but rather a “symptom” of some other problem (as, for example, the German New Medicine or Robert O. Young’s acid-base quackery do), you’re going to have to give me an idea of what you think the cause that manifests itself as cancer cells may in fact actually be and why.
It’s not at all an unreasonable request, yet when it is made you bob, dodge, and weave like Muhammad Ali–anything to avoid directly answering it.
Dr Gorksi – Isn’t that slightly insulting to Ali? The man really did float like a butterfly and sting like a bee, pec on the other hand shows neither the elegance or strength – or conviction in her beliefs – that Ali did!!! Even after he’d taken all those hits to the head!
Good point. My apologies to Ali.
Pec needs to understand that “alternative” sources confuse matters by not distinguishing the causes of cancer, which can certainly affect the whole body, from the cancer itself, which is always confined to a specific tiisue or organ.
Thus radiation can cause cancer in many tissues but the ca
Apologies, I was about to say that radiation canc caradiation canc
Sorry again. I am not sure what key I press that submits comments prematurely.
Anyway, that is the point — confusing predisposing factors with what is now a well defined disease — cause with effect.
Leukemia can affect the whole body, but it is clearly an irreversible change in one clone of one specific type of bone marrow cell. Exposure to ionising radiation can cause thyroid cancer, but it would be ridiculous to regard the cancerous cells as simply “radiation sickness”. We actually understand a great deal about the causes of cancer and most of them are either not correctable or past history by the time the cancer develops.
Illustrating the problem, there is no consistent example in clinical experience or in experimental cancer in animals where cancer cells have reverted permanently to normal as the result of any change in the body’s environment or any treatment. In order to eliminate cancer the aberrant cancer cell has to be either destroyed or induced to kill itself.
We will almost certainly learn to switch off cancer genes reducing the growth rate of cancers and even possibily inducing a state of dormancy, but even then the cancer cell will almost certainly eventually find ways around such treatments through its ability to mutate further.
“if you’re going to convince me that you’re not a believer in one of the several varieties of ridiculous quackery that make the claim that cancer is not a disease but rather a “symptom” of some other problem … you’re going to have to give me an idea of what you think the cause that manifests itself as cancer cells may in fact actually be and why.”
We know that a healthy body is able to destroy or contain most cancer cells. When the body’s natural defenses fail, it might be because the attack was overwhelming (for example, when the lungs are exposed to carcinogens for decades because of cigarette smoking), but it also might be that the body and its immune system have been weakened by some other cause.
Considering the latter possibility has been more of a priority in alternative medicine than in mainstream medicine.
For example, you often use chemotherapy following surgery for early cancer, even though it is more likely to be harmful than beneficial for over 90% of these patients. The patients who insist on receiving chemotherapy probably think the short term side effects will be worth it, since their chances of long-term health will be improved.
If patients were better informed, and were told that in most cases the chemotherapy is likely to cause permanent heart damage and to weaken the immune system (when a weakened immune system may have actually caused their disease by failing to contain cancer cells), then it is not very likely they would continue to insist on receiving it.
“there is no consistent example in clinical experience or in experimental cancer in animals where cancer cells have reverted permanently to normal as the result of any change in the body’s environment or any treatment. In order to eliminate cancer the aberrant cancer cell has to be either destroyed or induced to kill itself.”
The body has a natural ability to fight cancer. This may become very unlikely once a critical level of disease has been reached. Furthermore, the mainstream treatments may sometimes contribute by weakening the immune system even more.
It is not known how often cancer patients might recover without artificial destruction of cancer cells, since depriving patients of standard treatments is considered unethical.
Maybe there are alternative treatments that help the body fight cancer naturally. I have no opinion on this. There has probably not been enough formal research done, since the huge funding grants go to study synthetic chemicals, not natural alternatives.
This story is about an isolated case, so it does not count as scientific evidence. But this post was also about an isolated case, so you should allow me to do the same.
I had a relative who was diagnosed with deadly skin cancer and advised to have surgery immediately. He ignored the advice because he didn’t want to be disfigured, and went on for decades with no troubling symptoms. One day he had a bad nose bleed and the cancer was somehow ejected. After that he lived to be over 90 without ever being sick from cancer.
Just one example, but we have really no way to know how often this may happen, since most cancer patients aren’t as vain as my relative was!
This happened long ago, when I still had a lot of faith in experts. I thought my relative was crazy to ignore their advice, and I was extremely surprised when his body somehow cured itself.
pec,
Dr. Gorski’s example was a documented medical case; yours is only hearsay, and very unbelievable hearsay at that. How do you know he had deadly skin cancer? Do you have the biopsy report? Where was the cancer? How could a nose bleed “somehow eject” it?
I will ask AGAIN: What do you think the doctors should have told the patient with the 1 cm cancer?
PLEASE ANSWER THIS QUESTION
I’m getting tired of asking.
pec said,
“in most cases the chemotherapy is likely to cause permanent heart damage”
That’s an outright lie.
First of all, there is no alternative medicine. The correct term is quackery. The studies done by quacks are marketing studies to get people to buy their products, whatever they may be, prayer, beads, crystals, herbs, energy therapy, whatever. They hijack terms from real medicine and pretend they have treatment methods, that real medicine is researching, but hasn’t yet come to fruition. People with cancer are desperate. As the saying goes, a drowning person will grab a sharp razor to try to save himself.
“Dr. Gorski’s example was a documented medical case; yours is only hearsay, and very unbelievable hearsay at that.”
It wasn’t hearsay. It was a close relative, and my whole family knew about it. The relative was diagnosed by MDs who were friends of the family, so we knew it was a real diagnosis. It was talked about a lot for a while, since we were all so astounded that someone would ignore expert advice about something that serious.
I saw the relative many times after that and I know he never got sick from cancer. Decades later we heard about the nose bleed. I did not witness it. But I do know for a fact that he lived to well over 90 without ever getting sick from cancer.
pec,
Still hearsay. Where is the biopsy report?
“I’m getting tired of asking.”
I answered you repeatedly. I said the patient should be told the truth, not that the treatment has a 93% cure rate. And she should be told that chemotherapy is only useful for a small minority of patients in her situation, and that it is very likely to cause long-term damage. I also said that, as far as I know, surgery would not be likely to cause harm and might help her body defeat the cancer. But I really don’t know, am just conceding that some aspects of mainstream treatment might be helpful.
PEC: “in most cases the chemotherapy is likely to cause permanent heart damage”
HALL: “That’s an outright lie.”
http://www2.mdanderson.org/depts/oncolog/articles/07/11-nov/11-07-2.html
“Chemotherapy and even newer biological and targeted cancer therapies can weaken a patient’s heart. A study by M. D. Anderson cardiologists, published in the June 29, 2004, issue of the journal Circulation, reviewed the effects of 29 anticancer agents and concluded that every class of cancer drugs can potentially damage the heart.”
Why should the patient be told lies? What are you talking about? Are applying data on estrogen receptor negative post-menopausal patients to a woman in her 30s?
“Still hearsay. Where is the biopsy report?”
Don’t be ridiculous. This story wasn’t all made up. It was such an obvious case of malignant melanoma that one of the MDs spotted it at a social event. And why on earth would I have the biopsy report?
Melanoma is a tumor that is known to undergo spontaneous regression. However, such spontaneous regressions are rare. If your story is accurate (and, given your track record on this blog, I take nothing on just your say-so given how prone you are to misinterpret information and studies; I’d want to see a biopsy report too), then your uncle was one incredibly lucky fellow.
Biopsies are only needed under two circumstances, when you think you know the diagnosis and when you don’t know the diagnosis. Cancer diagnoses without biopsies are just hearsay.
pec said,
“This story wasn’t all made up. It was such an obvious case of malignant melanoma that one of the MDs spotted it at a social event. And why on earth would I have the biopsy report?”
If you want us to believe you, you have to present evidence such as a biopsy report or a medical record. I don’t think you made up the story. I just think the interpretation of events was wrong. Spotted at a social event? Come on! There are other things that can look like a malignant melanoma. You can’t possibly tell without a biopsy.
My guess: he had a benign skin lesion. Someone thought it looked like a melanoma but the diagnosis was never confirmed by biopsy. The benign skin lesion resolved spontaneously, as they often do.
That is the most likely possibility without hard evidence from a biopsy.
pec,
Learn to read!
“every class of cancer drugs can potentially damage the heart” does not equate to “in most cases the chemotherapy is likely to cause permanent heart damage”
Indeed.
Moreover, it’s all about the risk-benefit ratio and dose. For example, doxorubicin is pretty safe if the overall dose is kept below a certain level. Exceed that level, and that’s when the risk of heart damage goes way up. It’s also why oncologists try very hard to limit the dose.
However, for some adjuvant breast cancer regimens it has been shown that if a patient doesn’t get at least 80% of the recommended target dose, they might as well not get any chemotherapy at all. That’s because if they get less than 80% of the recommended dose, their survival rate falls, approaching that of patients who received no adjuvant chemotherapy at all. Getting the dose right matters, and it is a balancing act between making sure the effective dose is received and avoiding complications.
Pec writes: The body has a natural ability to fight cancer. This may become very unlikely once a critical level of disease has been reached. Furthermore, the mainstream treatments may sometimes contribute by weakening the immune system even more.
____
Efficacious treatments which encourage the body to fight the cancer without any side effects are being pursued by science-based medicine–science-based medicine would embrace any such treatment with great joq.
Your otherwise intelligent grasp of the diseased body needing to have its own resources assisted to recovering equilibrium and health is tainted by your pitting your false dichotomy of alternative medicine against your so-called concept of mainstream medicine–toxic treatments (without juggling the derived benefits), profit/status guo oriented, and resistant to any research that would somehow threaten its perceived and undeserved monopoly.
Many of us are on your side; we just don’t understand why you are so blind to that fact.
It was diagnosed at a *social event*?
And you equate that with a case so well documented it was being discussed at a tumor board?
*sigh*
Okay, I admit, I know a lot of folks with degrees in computer science who aren’t very scientific. So pec would fit right in. Thing is, most of us are really trained as engineers, not scientists, so depending on where you got your degree, it can be a bit of a misnomer. Still it’s embarrassing to learn that pec is in my field.
pec said,
“I answered you repeatedly. I said the patient should be told the truth, not that the treatment has a 93% cure rate.”
That’s not what the patient was told. She was told the truth: that the 5 yr survival rate with treatment was 93%.
” And she should be told that chemotherapy is only useful for a small minority of patients in her situation”
That’s essentially what doctors DO tell patients: that chemo after surgery provides a small increment in survival.
“and that it is very likely to cause long-term damage.”
No, it isn’t “very likely” – there is a small risk, and the risk/benefit ratio is clearly explained to patients so they can make an informed decision.
“as far as I know, surgery would not be likely to cause harm and might help her body defeat the cancer. ”
You don’t know if surgery improves survival?
We know. If you don’t know, it’s only because you refuse to know.
“am just conceding that some aspects of mainstream treatment might be helpful”
How generous of you to make that concession! “Some” aspects “might” be helpful. HA! The fact that you said that in the way you said it makes it very obvious that you are blinded by an irrational, ideological prejudice against mainstream medicine. And yet you have nothing better to offer.
Michelle B.,
I am talking about general differences between the mainstream and alternative approaches. If mainstream medicine is willing to get ideas from CAM I think that’s great. I am not saying they are, or will always be, mortal enemies. I think alternative medicine should become more scientific and skeptical, and I think mainstream medicine should pay more attention to ideas from CAM, some of which make sense.
And that is exactly what seems to be happening, with more research funding going to CAM than previously. But this blog is devoted to blocking CAM from getting any acceptance.
One of Dr. Gorski’s comments was:
“As for chemotherapy, even though in a case like this woman it only provides a 2-3% absolute survival benefit, most women will opt for it even when quoted that figure and when the side effects of chemotherapy are explained in gory detail.”
Even though he knows how damaging chemo can be, and that it is very unlikely to help a patient like this one, he would still administer it to her if she “opts” for it. Now you know most patients would never opt for something with so little chance of benefit and so considerable a potential for harm. If they do opt for it, it’s because they did not get all the information, or did not fully comprehend it. They may have been misled in subtle ways into thinking chemo would improve their health in the long run, while causing only temporary side effects.
That whole attitude is so typical of mainstream cancer medicine. Unnatural drugs are valued for their specific effect, without enough concern for what they do the body in general.
Dr. Hall seemed to be completely unaware of how cancer drugs can damage the heart. There is just too much blind faith in the standard approach, and all I am trying to do is point that out and help make people a little more aware.
The initial diagnosis was at a social event, because it was such an obvious case. Of course that was followed up by a formal diagnosis. I just don’t happen to have a copy of a 40-year-old biopsy report which I never would have needed a copy of in the first place.
“That’s not what the patient was told. She was told the truth: that the 5 yr survival rate with treatment was 93%.”
Come on Harriet. You know perfectly well that implies that 5 year survival with no treatment would be 0%.
And you know perfectly well that statistics like 93% are proudly displayed and that everyone draws the expected inference.
“But this blog is devoted to blocking CAM from getting any acceptance. ”
Absolutely untrue! This blog is devoted to grounding medicine in good science. We treat claims from CAM exactly the way we treat claims from conventional medicine.
“Dr. Hall seemed to be completely unaware of how cancer drugs can damage the heart.”
Absolutely untrue. I’ve made it clear that I’m aware of the adverse effects of chemotherapy and that they need to be considered as a risk/benefit ratio.
“most patients would never opt for something with so little chance of benefit and so considerable a potential for harm”
Absolutely untrue. Most patients DO opt for chemotherapy after being given the most accurate available information about the risk/benefit ratio.
pec said,
“The initial diagnosis was at a social event, because it was such an obvious case”
We’ve told you that what looks like a malignant melanoma may not be, so it was NOT obvious.
“Of course that was followed up by a formal diagnosis.”
How do you know?
I’ve heard so many stories like this that fall apart when you attempt to document them. I don’t believe this story, and if you think we’re going to believe it just on your say-so with no confirmation, you underestimate us.
pec said “But this blog is devoted to blocking CAM from getting any acceptance.”
No, that is the purpose of this other blog:
http://crapbasedmedicine.wordpress.com/
pec said,
“Come on Harriet. You know perfectly well that implies that 5 year survival with no treatment would be 0%. And you know perfectly well that statistics like 93% are proudly displayed and that everyone draws the expected inference.”
It implies no such thing, and if anyone draws that inference, she is not thinking clearly. You may be right that most people don’t stop to ask what their chances would be without surgery. Most people assume that they will be better off with treatment, and that is a valid assumption.
That’s a lie.
This blog is dedicated to applying the best science and evidence to medicine, be it “alternative” or “conventional.” Have you not seen the many other posts here criticizing some aspect or other of “conventional” medicine?
My goodness, you are unbelievably obtuse.
Most adjuvant chemotherapy regimens for breast cancer these days are in fact pretty low risk affairs. True, there are often some unpleasant side effects (loss of hair, nausea, the occasional neutropenic fever), but it’s this horrific, risky treatment that pec likes to portray it as because she clearly hates the concept of chemotherapy for some reason. Indeed, I’ve spoken to a number of my patients after they’ve finished chemotherapy, and they were surprised at how relatively benign the treatment was. pec seems to have in his mind the “altie” stereotype of emaciated chemotherapy patients at death’s door because the patients have end stage cancer. This is not what we’re talking about when we’re talking about adjuvant chemotherapy for breast cancer.
Also, remember that for tumors that are not as early stage as this patient (i.e., stage II and operable stage III patients) the absolute survival benefit from chemotherapy climbs markedly; there is no question that the risk-benefit ratio is in favor of chemotherapy in such cases.
But, bringing it back to the case presented at the tumor board, very clearly she needed at the very minimum a surgical excision of her tumor, along with a sentinel lymph node biopsy and preferably with adjuvant radiation therapy. Chemotherapy would have been icing on the cake, and you can’t worry about icing if you don’t already have the cake. The bottom line is that she chose to eschew all science-based effective therapy and paid a horrific price.
I actually have one more story like this one that’s very instructive (actually, I have more than one more story like this one), except that it not a breast cancer patient and it was a man whom I took care of during my surgical residency. It happened over 12 years ago, and I still remember it. Perhaps I’ll post it in a couple of weeks. Two such stories two weeks in a row would probably not be a good idea.
pec wrote:
Interesting that pec would concede this.
It’s been stipulated that the available data to compare surgery vs. no treatment is quite old. It’s enough to be certain that surgery IS better than no treatment (at least in cases such as in the original post), but not enough to say quantitatively how much better.
So, despite all her protestations, she seems to reluctantly admit surgery is a good idea in such cases.
However, she remains convinced, apparently, that radiation and chemo are BAD! That’s rather ironic, isn’t? IIRC, the data showing that surgery + radiation &/or chemo is better than surgery alone is MUCH more robust and recent. Randomized, prospective, double-blind, placebo controlled trials, stage-matched patients, etc.
If surgery is not likely to cause harm, and “might help,” and if surgery + radiation &/or chemo is proven better than surgery alone, what can we conclude about radiation & chemo in this setting? pec? Anyone?
David Gorski wrote:
pec reminds me of nothing so much as someone with focal brain damage. For example, damage to a certain area of the brain can render a patient unable to consciously perceive objects in one half of their visual field. Put an apple on a table in front of them but to one side, and ask them what color the object is, and they can correctly tell you it’s red. Put it on the other side and ask them what color the object is, and they’ll say “What object?”
Similarly, pec seems literally unable to assimilate information that contradicts certain of her established beliefs. It’s not that she consciously rejects the information. It’s as if her brain refuses to process certain statements.
It’s kind of fascinating, in a morbid sort of way.
[...] David wrote previously about a case he reviewed in which a woman with a very treatable early stage of breast cancer opted for “alternative” treatment rather than the standard treatment, which carries a > 93% good outcome. As a result her cancer progressed horribly – but she clung to belief in CAM despite its obvious failure in her case. This story highlighted the fact that giving patients proper medical advice sometime requires confronting their false beliefs. [...]
Personal insults are so much easier than logical arguments qetzal. Even Gorski admitted that chemotherapy would be extremely unlikely to help this kind of patient. And I linked to an article showing that cancer chemotherapy is very likely to cause heart damage.
And aside from all of that — no one here has been able to answer my original objection, that survival rates for untreated early cancer are not known.
This post used one example to demonstrate that mainstream treatments are good and alternative treatments are bad. That is entirely emotional and unscientific.
My scientific and logical objections are answered with personal insults. Ok if that’s the best you can do, keep insulting. It doesn’t bother me at all, since I know it’s only because of your extremely limited reasoning abilities.
Personal insults are so much easier than logical arguments qetzal. Even Gorski admitted that chemotherapy would be extremely unlikely to help this kind of patient.
You know better than to say something silly like that, pec. The whole point of the story was that surgery and chemo would helped the lady enormously if she’d done it when it was first suggested. By the time the case was presented to the tumor board, it was far too late for *anything* to help. Morphine was probably the only thing left that would even ease her suffering, and that’s tragic.
But you know that already, which makes your comment rather mystifying unless your real intention is to confuse the issue. Not very skeptical or scientific of you, I’m afraid.
I said nothing of the sort. I merely pointed out that the benefits of chemotherapy are quite modest in a patient like this. They are much more significant in patients with stage II or operable stage III breast cancer. However, this patient never got the chance to decide on whether the risk-benefit profile of adjuvant chemotherapy would be appropriate for her because she rejected surgery and radiation therapy, the initial mainstays of treatment for a tumor like this, and let it grow to the point where it was very likely to kill her–and certain to kill her if she didn’t.
So, I echo Harriet’s question, the question that you so assiduously avoid answering: If this patient had asked you for advice when she first presented with a 1 cm invasive breast cancer, what course of action would you have recommended?
pec said,
—
Maybe it’s just me, but I didn’t see Dr. Gorski’s assessment of chemotherapy for that patient as extremey unlikely to help, what I read was that chemotherapy was the icing on the cake offering modest benefits.
And also, I didn’t see that chemotherapy is very likely to cause heart damage, I saw what appeared to be a balancing act between a good enough dosage, and too much that it could cause heart damage. Still, there was a 20% margin to help adjustment, and I believe Dr. Gorski said the dosages were given with that in mind.
Did you not understand that? I find that actually provides evidence for the “obtuse” accusations, even though I don’t like ad hominem. Or worse, it could be that you’re purposefully distorting people’s sayings in order to make your case, which is disingenuous.
Had you used another reference to draw the same conclusion, it could be you’d be relying on different lines of evidence. But since you’re purporting that Dr. Gorski himself said that, it leaves little margin to what could possibly be your motives if my interpretation of Dr. Gorski’s opinion was correct.
gorski: ” As for chemotherapy, even though in a case like this woman it only provides a 2-3% absolute survival benefit,”
pec: “Even Gorski admitted that chemotherapy would be extremely unlikely to help this kind of patient.”
gorski: “I said nothing of the sort. I merely pointed out that the benefits of chemotherapy are quite modest in a patient like this.”
Well if you define “modest” as 2-3%. Definitely worth the permanent heart damage.
” If this patient had asked you for advice when she first presented with a 1 cm invasive breast cancer, what course of action would you have recommended?”
I answered it several times, but there are so many comments here things are getting hard to find.
Just as well, because I should take back my answers anyway. I would not know the best course of action, and fortunately that is not my job. I do not pretend to know how cancer should be treated. I do not think that we have reliable information and statistics about the success of current standard treatments. I do not think cancer is understood well at all and I do not think understanding is progressing very much.
It is perfectly reasonable to have criticisms and objections without claiming to have the answers. My point has been that you don’t have the answers either.
The case described was intended to make us feel that mainstream medicine has cancer figured out and anyone who refuses the standard treatments is a fool. In reality you do not have cancer figured out, and the standard treatments can sometimes be damaging and unhelpful.
You forgot this, pec:
Dr. Gorski said,
I could hardly have asked pec for a better illustration of my point than the last few comments.
I don’t think she’s trying to confuse the issue. I think she is incapable of dealing with data that contradicts her beliefs. Thus her brain obscures it from her conscious consideration by covering it with a mental blindspot.
How many times did Dr. Hall ask her question before pec even acknowledged it? And when pec finally responded, note how her response completely misses the point.
The question challenges pec’s beliefs on cancer treatments. Thus, she pushes it out of her conscious consideration. When Dr. Hall’s persistence forces pec to acknowledge it, her blindspot still protects her from dealing with it rationally.
Pec said: “The case described was intended to make us feel that mainstream medicine has cancer figured out and anyone who refuses the standard treatments is a fool. In reality you do not have cancer figured out, and the standard treatments can sometimes be damaging and unhelpful.”
In reality, this case showed that a variety of CAM treatments were completely useless. In reality, this patient would have had pretty good chance of a longer, healthier life by following the recommended treatment.
Pec, you keep applying YOUR interpretations and YOUR generalizations to this case to further muddy the actual facts. YOU assumed the doctors were telling the patient that she had 0% survival without treatment, NOTHING in the case suggests that. NOBODY has said medical science has beaten cancer EXCEPT YOU. YOU created a false strawman argument and then spent hundreds of paragraphs to point out how YOUR interpretation is misleading. Your entire approach has lacked any logical basis.
Nothing you’ve said challenges the basic facts that the patient’s doctors gave – that 93 out of 100 people in her situation live to 5 years if they undergo the recommended treatments. Nothing you’ve said changes the fact that this patient chose CAM and is probably dead now.
But who knows. Maybe you were succesful in your mission. Maybe a cancer patient or two will read this very clear case, then read your comments. Maybe your comments will be enough to confuse some real people with real malignancies.
Maybe your argumentative smokescreen will shorten a life.
pec tries to answer Harriet,
“Just as well, because I should take back my answers anyway. I would not know the best course of action, and fortunately that is not my job. I do not pretend to know how cancer should be treated…
It is perfectly reasonable to have criticisms and objections without claiming to have the answers. My point has been that you don’t have the answers either.”
I agree–it is reasonable to have criticisms and objections without having the answer. But your criticisms have already been considered–and indeed, were first brought up–by those who support the use of surgery and chemotherapy. You are abusing these criticisms and pretending that they invalidate conclusions about the effectiveness of treatment. They don’t. Researchers and doctors are well aware that their treatments have risks, and that their methods of analysis are fallible. No one is pretending that we have the answer to everything.
In addition, your answer to Harriet is simply an argument from ignorance. I think it does demonstrate a strong desire, on your part, to remain ignorant so that you will not have to compromise your beliefs. This is not what a scientist or a skeptic does: they actively seek out the truth to combat ignorance. Label yourself what you want, but do not misuse these labels–you have not, so far, demonstrated that you really are devoted to skepticism or science. You are neither of these things.
Also, I’m pretty sure Harriet addressed the heart damage issue. It can potentially happen–this does not mean that it happens ‘most’ of the time in ‘most’ cases.
“The question challenges pec’s beliefs on cancer treatments.”
I don’t have and fixed beliefs about cancer treatments. I have read claims from the ACA and other mainstream sources that completely contradict other sources of information. The dissenters and doubters are not all fringe wackos — there are many MDs and scientists who feel that meaningful progress against cancer has not been made.
I am someone who cares about science and about accuracy, and that is why I criticize unthinking claims that are easily misinterpreted by the public.
Yes I question the general mainstream approach to treating and understanding cancer (and various other things, such as mental illness, for example). As I learn more about the current drug industry and the adverse effects of some of the most popular drugs, I feel that things have been getting out of control.
pec: “Yes I question the general mainstream approach to treating and understanding cancer (and various other things, such as mental illness, for example)”
The “approach” you refer to is called the scientific method. It was developed over hundreds of years. It involves coming up with a theory, devising ways of objectively testing the theory, rejecting what doesn’t work and building on what does. It focuses on what can be measured and understood and demonstrated and proven. And the community that relies on this method is very highly critical of each other’s findings. Treatments must go through intensive critical review, which is why such a small number of potential drugs/treatments actually ever make it to productive use.
For example, when I toured one of Pfizer’s research sites, they said only a fraction of the interesting compounds make it to clinical trials. And Phase 2 clinical trials alone weed out 75% of the potential products. There is a massive, many-year process to ensure products (1) do something useful and (2) are safe if used correctly.
That’s the “mainstream approach”. Now, what is your alternative approach? What’s the “non-mainstream approach” that ensures treatments actually work? What process weeds out CAM treatments that are proven not to work? Can you name a CAM treatment that has been dropped when proven ineffective?
pec, why don’t you share the non-mainstream sources you’ve been reading that contradict the evidence that’s been presented here?
So far you’ve promoted a belief in subluxations as a cause of disease, which shows you do indeed ascribe to non-mainstream beliefs as promoted by non-EB chiropractors. You’ve shown zero skepticism about any “alternative to medical” treatments and have gone out of your way to misrepresent medical treatments, research and beliefs.
From the most cynical perspective, you’re trying to steer people away from treatments that have proven to be effective by pretending that it’s not know if they are, and trying to steer them towards your profession (website builder for supplement manufacturers perhaps?). From this perspective you’re so greedy you’re willing to kill people for profit.
From the most compassionate perspective, you’ve got some psychological and emotional issues that you’re playing out here and can’t be held totally responsible for your actions or what you say.
I think my irony meter just exploded.
Yes, I, too, would be interested in the non-mainstream sources that pec uses to support her beliefs.
Dr Gorski – Perhaps pec is in need of an irony supplement? I hear that consuming concepts spun of greed and ignorance unbalances the essential humours thereby creating an energy blockage that requires both supplementation and “cleansing” of all the fecal matter than clings so stubborning to the colon walls poisoning one’s thoughts and feelings.
“Yes, I, too, would be interested in the non-mainstream sources that pec uses to support her beliefs.”
I don’t think I said anything about non-mainstream sources. A dissenting opinion does not have to come from a non-mainstream source.
Pec,
You have repeatedly promoted non-material concepts. Mainstream sources are often critical of specific medical practices. They are skeptical, but you are more than a skeptic; you are a denier and an antagonist.
It seems apparent to us that you do not fully accept the scientific approach, or that you think other ways of knowing are equally acceptable. We are clearly not on the same wavelength as you, and we would like to understand where you’re coming from.
The mainstream sources you’ve used thus far to support your beliefs do not, in fact, support them. Whenever I’ve looked one of them up, I’ve found it obvious that you have misinterpreted the source through the prism of your bias against “conventional” medicine. Consequently, I have to wonder whether you’re getting a lot of your information from non-mainstream sources. If you are, why not reveal them, so that we can look at them and see if they support your viewpoint?
“It seems apparent to us that you do not fully accept the scientific approach, or that you think other ways of knowing are equally acceptable.”
Harriet,
I have previously explained to you that I do not equate materialism with science. Materialism is a philosophical perspective and science is a method. I believe in the scientific method, but I am not a follower of the materialist ideology.
No one can define “material” anyway. I have explained that matter is not made out of matter — so matter itself is not material. The whole idea of materialism makes no sense. Yet you deny that science can study anything not currently defined as material. Can scientists study gravity, for example? What sort of matter is gravity made of?
Yes I have said I think there are substances, energies and fields still unknown to science. What reason do you have for assuming science has already discovered and described everything that could possibly exist in this infinite universe?
Pec said: “What reason do you have for assuming science has already discovered and described everything that could possibly exist in this infinite universe?”
Again, nobody said that. You’re setting up a false strawman to knock it down again. We are quite capable of using our own words – you don’t have to put them in our mouths.
You said you question the “mainstream approach” to medicine. The mainstream approach is founded on the scientific method. You now say you believe in the scientific method.
It’s your contradiction – so which is it? You either agree that the scientific method of modern science leads to actual solutions (effective treatments) or you don’t.
If you still question the “mainstream approach”, what part do you question?
We would very much like to know on what basis you accept some data and reject other. Most of the people in this forum use the principles of the scientific method to accept or reject certain medical conclusions. We’d like to understand what criteria you use. If you have a better approach to treating cancer, then PLEASE TELL US! Even if you have just have a suggestion to improve existing methods, please tell us.
Repeating “science misleads people” isn’t actually offering any useful suggestions.
And by the way, the “why do you assume science has discovered everything…” is a really old and tired argument tactic. It’s just like the creationists who say “not all transitional forms have been found, therefore the Theory of Evolution doesn’t work.” That’s like saying “my kid didn’t learn everything she needed to know in her first year of school, therefore education is useless.” Just because a process isn’t complete doesn’t mean it’s a bad process.
Please try to refrain from such argument tactics and attempt to answer the questions. They are sincerely meant from people who are in fact open minded to other, better ways of solving health problems.
“you think other ways of knowing are equally acceptable”
The only acceptable way of knowing in formal science is the scientific method. I have never said or suggested otherwise.
In other areas of life, of course, we use other ways of knowing. We can’t conduct formal research every time we make an ordinary decision. Many of the things we care about and must deal with every day have never been studied by science.
So yes, there are acceptable ways of knowing other than the scientific method, and no these other ways are not acceptable for scientific publication.
But scientists should not close their minds to everything not already studied formally by science. We get new ideas by considering what might be true, not by looking at what is already established.
Science is an approach that involves guessing, wondering, trial and error, as well as formal methods of analysis. It is a serious mistake to believe scientists can think only about what has already been discovered. You are wrong when you tell people their experiences are illusions and hallucinations, if those experiences have not already been verified by science.
pec,
Materialism does not mean that science can only study things made of matter! Obviously, that would be nonsensical. Perhaps that should have given you a clue that your concept of materialism was faulty?
(Also, you would do well to learn the different between Philosophical Materialism and Methodological Materialism.)
pec wrote:
No scientist I have ever met assumes that. Every single one thinks there are many many things still unknown to science. (Otherwise, why be a scientist?)
The critical question is this: do you think there are any substances, energies, and fields unknown to scientists that ARE known to anyone else? If so, can you please name one such substance/energy/field, and who knows of it?
No one can define “material” anyway. I have explained that matter is not made out of matter — so matter itself is not material. The whole idea of materialism makes no sense. Yet you deny that science can study anything not currently defined as material. Can scientists study gravity, for example? What sort of matter is gravity made of?
You do realize, don’t you, that in this context “materialism” is like “allopathy” in that it is nothing more a term used to denigrate the mainstream? The scientists you consider materialistic only use the word “materialism” in the context Madonna was singing about (wanting stuff). I have yet to meet a scientist (or physician) who describes himself or herself as a “materialist” in any sense other than being a aficionado of Mercedes Benz and Ralph Lauren.
Of course mainstream scientists can and *do* study gravity. Newton’s Laws, including his law of gravitation, remain some of the great triumphs of physics. Things don’t have to be made of matter to be studied.
And of course matter is material. That’s what the word literally means. If you don’t consider matter to be material, then your use of the word “material” is so far away from common usage as to make discussion on the subject rather pointless. Either that or you misunderstand some rather critical basics of physics. If that is the case, don’t worry. You’re in good company. Right up there with Alexander Abian and Archimedes Plutonium.
pec said,
“I have previously explained to you that I do not equate materialism with science.”
I don’t have the patience to go back through all your comments, but I distinctly remember you saying science was materialist.
“Materialism is a philosophical perspective and science is a method.”
If I remember correctly, I was the one who told you that when you seemed to have confused the two.
“matter is not made out of matter”
I think you are confused. Matter and energy are interconvertible.
Gravity is a property of matter and is measurable and we have developed a theory that predicts things well enough to get us to the Moon.
“I think there are substances, energies and fields still unknown to science”
Why do you think that?
“It is a serious mistake to believe scientists can think only about what has already been discovered.”
It would be a serious mistake if anyone believed that. We certainly don’t. Do you know of anyone who does?
“You are wrong when you tell people their experiences are illusions and hallucinations, if those experiences have not already been verified by science.”
We would be wrong if we said that, but we don’t. I don’t believe I’ve ever suggested anything of the kind. I have said that you have not ruled out the possibility that your experiences were illusory or hallucinatory, and that illusions could explain them without any need to posit the immaterial.
pec said,
“In other areas of life, of course, we use other ways of knowing. We can’t conduct formal research every time we make an ordinary decision. Many of the things we care about and must deal with every day have never been studied by science.”
Of course! When we don’t have adequate data and we have to make a practical decision, we can make an informed guess. That’s very different from making a truth claiim without adequate evidence.
Example: if you tried untested treatment X and you felt better, it would be entirely reasonable to try X again. It would not be acceptable to claim that you know X is effective.
pec said,
“scientists should not close their minds to everything not already studied formally by science”
When you think about it, that statement is truly idiotic. If the first scientist had closed his mind, science would have been over before it started. All scientific advances have been made precisely by scientists having open minds about things that have not yet been studied.
Scientists must have open minds, but if their minds are so open their brains fall out, they can’t accomplish anything.
“Materialism does not mean that science can only study things made of matter! Obviously, that would be nonsensical. Perhaps that should have given you a clue that your concept of materialism was faulty?”
qetzal,
I was talking to Harriet and she says science must be restricted to studying the material. I know it’s nonsensical.
“as a profession we have sat on the sidelines while antiscientific ideology has infiltrated medicine at every level. Every physician who is not outraged and actively working against the rise of CAM is to blame.”
Steve Novella’s comment. In case anyone doubts that this blog tends to be more about politics than science.
Pec: “But scientists should not close their minds to everything not already studied formally by science.”
And there it is… It was only a matter of time before “scientists” were labelled “close-minded”.
Scientists and believers in the scientific method are the most open-minded thinkers there are. Show us evidence, some actual valid proof, and we’ll believe ANYTHING. Now, if you ask us to believe something that potentially invalidates a bunch of other things we thought were true, then the burden of proof is higher. Your proof must be tangible, significant, re-creatable. But if you meet that burden of proof, we’ll change our minds.
But as I said before, I can’t think of a CAM treatment that has been tested, rejected and dropped. Most of the CAM supporters I’ve met would not change their minds regardless of the evidence was presented.
People have been unable to prove spiritual healing / UFOs / auras / young-earth creationism / chi / psychics / etc meet the scientific burden of proof. And believers in these things tend to ignore all evidence that indicates they don’t work. THOSE people, who continue to believe in spite of a wealth of evidence to the contrary, are the most closed-minded people on our pretty blue planet.
“I don’t have the patience to go back through all your comments, but I distinctly remember you saying science was materialist.”
NEVER NEVER NEVER NEVER. That was not me!!! I always say, and have said repeatedly here, that science IS NOT inherently materialist. NOT AT ALL.
I am astounded that I could be misunderstood to that degree.
Actually, you got exactly the opposite of my intended message.
pec said,
“I was talking to Harriet and she says science must be restricted to studying the material. I know it’s nonsensical.”
Pec, PLEASE stop misquoting me!!!
I never said any such thing! In fact, I asked you for suggestions about how science might study the immaterial.
Science can study any immaterial thing through its effect on the material. If it doesn’t have any detectable effect, its existence becomes a moot point.
pec: “I think there are substances, energies and fields still unknown to science”
hall: “Why do you think that?”
pec: “It is a serious mistake to believe scientists can think only about what has already been discovered.”
hall: “It would be a serious mistake if anyone believed that. We certainly don’t. Do you know of anyone who does?”
Harriet, your comments strongly suggest that you think the forms of matter and energy already described by physics are all that will ever be discovered, or hypothesized. Then you say you DON’T believe everything has already been discovered.
You have been contradicting yourself.
“Science can study any immaterial thing through its effect on the material. If it doesn’t have any detectable effect, its existence becomes a moot point.”
NO NO NO NO. How can you say that? Things only have detectable effects if our senses or the instruments we already have developed are able to detect them.
How can you think that no other senses or instruments could conceivably exist?
pec said, “as a profession we have sat on the sidelines while antiscientific ideology has infiltrated medicine at every level. Every physician who is not outraged and actively working against the rise of CAM is to blame.” Steve Novella’s comment. In case anyone doubts that this blog tends to be more about politics than science.”
The only politics involved is about the struggle to keep science honest. It’s about science; it’s not about politics.
“Of course mainstream scientists can and *do* study gravity.”
That was my point. They study gravity, even though there is nothing “material” about gravity.
Pec: “there is nothing “material” about gravity.”
Pec – are you proud of your ignorance? Do you wear a t-shirt that says “Don’t even TRY to teach me!”
Harriet did not mean material as in solid matter. Materialsm as Harriet meant is a philosophical definition similar to Naturalism. In other words, science only works in the natural or material world. In other words, if it is SUPERNATURAL then it cannot be proven or disproven by science.
Fortunately, our bodies and the electrical impulses in our brains work in the natural world, so science works for medicine. No supernatural is needed.
“In case anyone doubts that this blog tends to be more about politics than science.”
You consider promotion of science to be political because you fundamentally dislike science and/or scientists. Yet you live and bask in the very comfort that science has provided you. The only reason you’re sitting at your computer criticizing scientists and not out gathering firewood or repairing your hut is because of the steady advancement of the science you seem to despise.
“The only politics involved is about the struggle to keep science honest. It’s about science; it’s not about politics.”
No, he’s against CAM in general, as a whole. He doesn’t want any alternative approaches to be studied. That is NOT an open-minded scientific attitude.
“The only reason you’re sitting at your computer criticizing scientists …”
I have NOT been criticizing scientists. I AM a scientist, and I am sitting at a computer that I know how to program. I am criticizing the narrow-mindedness of SOME scientists. If you think criticizing some scientists means criticizing science in general then you need a logic course.
pec said,
“NO NO NO NO. How can you say that? Things only have detectable effects if our senses or the instruments we already have developed are able to detect them. How can you think that no other senses or instruments could conceivably exist?”
Obtusely refusing to understand me again!
Other senses or instruments could conceivably exist, and immaterial things could conceivably be detected by their effects on material things. We ought to be able to detect such things by finding measurable phenomena that are unexplained by our current theories. We know there is conservation of matter and energy, and we have never found any data that don’t fit. If we can’t currently detect any anomalies, what are we to do?
Our provisional conclusion is that there is currently no evidence that unmeasurable, undetectable immaterial things exist. The burden of proof is on you. You believe they exist, but you have offered no way to test that belief. You have offered no proposals for research that might lead to detection, and you have given us no reason to think one immaterial idea superior to another.
“An idea that is not ruthlessly questioned and put to the test does not deserve to be taken seriously.” – Lewis Jones
pec said,
“he’s against CAM in general, as a whole. He doesn’t want any alternative approaches to be studied.”
There is no such thing as CAM. There is only one medicine, and decisions of what to study should be based on one standard, no matter where the idea originates. He’s not “against CAM” but “for” scientific medicine. Can’t you see the difference?
pec said,
“You have been contradicting yourself.”
No I have not. You have been deliberately misunderstanding me in every way you possibly can.
pec said,
” NEVER NEVER NEVER NEVER. That was not me!!! I always say, and have said repeatedly here, that science IS NOT inherently materialist. NOT AT ALL.”
You said several things that sure sounded to me like you thought science was materialist. OK, then what exactly was it you said that made me respond to you explaining that science was not materialist?
I agree. pec has been deliberately misunderstanding.
If understanding threatens to invalidate her beliefs, she will deliberately misunderstand without even being consciously aware of it!
You sure haven’t been sounding like a scientist.
Is it possible that pec is a chatbot and we are just wasting time with it. How could anyone be so obtuse?
That we are wasting our time is beyond question.
That Pec is a scientist however, is very much open to question and requires a large burden of proof.
pec quotes me and sez:
“Of course mainstream scientists can and *do* study gravity.”
That was my point. They study gravity, even though there is nothing “material” about gravity.
I think Newton would have a few things to say about that.
Gravity is a property of matter. Seriously. Gravitational force between two bodies (ignoring any other bodies in the universe for the sake of simplicity) is directly proportional to the product of their masses (gravity relates to the quantity of matter) and inversely proportional to the square of the distance between them (the inverse square rule). Without matter, there is no gravity.
It has long been a mystery why matter produces gravity. Einstein moved us a bit forward by proposing that gravity isn’t really a force but is the effect of spacetime being warped by matter. This still leaves some questions unanswered, but it has proven bizarrely accurate — spacetime really does seem to be warped around massive objects, as demonstrated by gravitational lensing and by frame-dragging. The latter effect explains why Newton’s formulas don’t quite work for predicting the motion of Mercury — it’s so close to the Sun that frame-dragging becomes significant.
So, if it can be observed, it’s worth investing science in it. Gravity moves matter around, so you can observe it even though it is force and not a thing. It’s like the wind; you can’t see it, but you can see it’s effect, and so you can be certain that it is really there. But sometimes science proposes things which ultimately cannot be observed in any way. If they exist, they must have no influence whatsoever on the observable cosmos. Therefore, it is a waste of time to consider them, at least until somebody figures out a way of observing them. A good example of this is the ether. Ever since it was proven that light travels in a wave, it was assumed that light must be traveling in some sort of medium, just like any wave. It can travel through a vacuum, so the medium must not be normal matter, at least not the kind we’re used to dealing with. The ether was proposed as a sort of placeholder for whatever it was that light waves propagated within. Yearning for an absolute frame of reference, scientists realized that the ether itself must be one. The Earth must be passing through the ether as it moves around the Sun. This would produce an “ether wind”, and light would seem to travel much faster at one time of the year (when Earth is traveling with the ether) than six months later.
The Michelson-Morley experiment was conceived not to disprove the ether but to measure the speed of the ether wind and thus establish the universal frame of reference. The experiment was sufficiently sensitive that it would detect the ether wind due to the Earth’s rotation — so, two measurements 12 hours apart should show a difference. But the scientists were shocked. They found something completely unexpected — no difference whatsoever. The speed of light was constant. There was no ether. Science did not readily accept this; it was so extraordinary and so implausible (light *had* to have a medium!) that it took a lot of experiments of increasing accuracy before consensus was reached. It ended up being very important to Einstein’s theory of relativity — the strange fact that the speed of light in a vacuum is constant no matter what speed you are going. That was how Einstein deduced time dilation, an effect later experimentally proven by spacecraft. Today’s GPS constellation proves it all the time.
So the ether was found to be totally undetectable. Like God Himself, really. Whether it exists or not is thus irrelevant from a scientific perspective, because science cannot do anything with the idea if there is no way to test it. Science thus discarded the ether concept. Today, we talk of photons, not ether.
I’m serious. Is it possible that pec is an artifici