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Akavar 20/50 and Truth in Advertising

Over the last few months, I have had a truly surreal experience. It started when I noticed a two-page full color spread in TV Guide magazine advertising a product called Akavar 20/50. It contained the same claims that so many bogus weight loss products do: eat all you want and still lose weight. What attracted my interest was their highlighted statement: “We couldn’t say it in print if it wasn’t true!”

I laughed out loud. Anyone can say anything in print until they get caught. These diet ads all say things that aren’t true, and the FTC can’t begin to catch them all.

The ad describes research results they call “staggering.” They have scientific documentation that 23 out of 24 patients using Akavar’s active ingredient lost weight. They also described a controlled, randomized clinical trial of their actual product in which 23 out of 24 patients lost “a substantial amount of weight.” Two questions immediately came to mind: why were the numbers the same in both studies, and if a single active ingredient worked just as well, why was there any need to develop the Akavar formulation?

There was a toll-free number where I could call for further information. I called and asked for the citations of the two studies they referred to. The man who answered was flummoxed: “No one’s ever asked me that before.” He had to go for help. Finally he came up with the names of two journals and no further information.

I searched PubMed for anything in either of those journals that might even remotely be the studies they described, and I couldn’t find anything. I wrote the company’s customer service representative and asked for more information. And then the real fun began. Here are the actual e-mails for your delectation:

9/30 [Me] Your ad for Akavar describes a high rate of success in clinical studies. I’d like to read those studies for myself. I called your 800 number and the person who answered told me there were two studies published in the Journal of Human Nutrition and Dietetics and in the journal Medical Psychopharmacology. He was unable to give me the full citations, and I have searched PubMed and elsewhere and have been unable to locate the articles. Could you give me the exact citations (date, author, title of article, journal, volume and page number)? Or better yet, could you possibly send me electronic copies of the articles? I would really appreciate it.

10/9 [Akavar] Thank you for your interest in Akavar 20/50. I will be happy to submit a request to our Compliance dept and have these studies prepared for you to send via email or via mail. We request to know as to what use these will be used for and will require a phone # and address. As soon as I have this information I will submit the request and have these prepared for you to save any trouble of having to look these up yourself. Thanks so much.

10/9[Me] I would prefer you send them by e-mail. What they will be used for? To help me decide for myself whether there is adequate evidence to recommend Akavar 20/50 to patients.

10/10 [Akavar] Thank you so much for this.. I will forward this request to compliance and send via email when they have finished preparing the study

10/15 [Me] I’m still waiting. The delay is making me wonder… if you really have legitimate scientific studies to back up your claims, why are they not posted on your website or linked to the PubMed abstracts or at least listed in such a way that they can be located by interested physicians?

10/17 [Akavar] I apologize for the delay. I will follow up with our Compliance/Legal department to see if they have prepared these for you or not. I will let you know shortly.

10/30 [Me] It is now October 30, and I still have not received the studies. If they are not available in electronic format, all I really need is a proper citation: title of article, name of journal, names of authors, date, volume and page. If these studies really exist, and if they really support your product, your company certainly doesn’t seem very proud of them! If you cannot provide me with the citations, I will be forced to assume they do not exist and I will report your company for false advertising.

11/2 [Me] OK. Still no response. I will have to give you a deadline. If you have not sent me the citations by November 5, I will take it as an admission that you are crooks who tell deliberate lies in your advertising and I will report you to the FTC. I will remind you that ALL I’m asking is that you tell me where I can find the clinical studies you advertise as supporting your product.

11/2 [Akavar] I just spoke with our Legal department as I have been out of the office this week. They informed me that they are contacting you via mail as they are requesting more information from you. I can not handle this request other than our legal department. This was sent to the address you provided me below and should receive within normal postal delivery time. [I never received anything by mail.] I apologize sincerely for this delayed response. It should be taken care of now. Thank you,

11/2 [Me] How about you give me the e-mail address of the legal department so you don’t need to act as intermediary? There is no reason for them to request more information from me – that is ridiculous! And even if they are mailing me copies of the studies, there is no reason they can’t also immediately provide me with the citation information via e-mail. Reputable companies usually display that kind of information proudly on their websites, often with a link to the studies.

11/5 [Akavar] Our compliance/legal department has prepared the following for you and are sending via email at your request via the above attachments. Please respond accordingly.Thanks again for your patience. [Attachment] We have received your request to provide you with all studies relating to our Akavar 20/50 product. Due to the confidential nature of these studies, we cannot release these studies without a signed Non-Disclosure Agreement. Our standard Non- Disclosure Agreement is enclosed. Pleases review and sign the Agreement. Upon receipt of the signed Non-Disclosure Agreement, we will happily provide you the information you requested….. [This was accompanied by a complicated multi-page legal document.]

11/5 [Me] You have GOT to be kidding!! I did NOT ask for “all” studies relating to your product. I did NOT ask for any proprietary information. All I asked for was the correct citations for the two published studies referred to in your advertising. This is not anything that requires any signature or agreement. Published studies are in the public domain. This is becoming a surreal experience. Perhaps I’d better start all over again by copying my initial request: [My initial e-mail was copied here.] Let’s make this really simple: (1) Are there two published studies? (2) If so, please provide me with the information I will need to locate and read those studies: Name of author(s), title of article, name of journal, volume, page number and date of publication.

11/7 [Akavar] Any update from MKF?

11/7 [Me] No. Who or what is MKF?

11/13 [Akavar] We regret that you refused to sign the NDA, which would have allowed us to provide you the highly confidential, proprietary data related to Akavar. We are, however, enclosing the citations for the published articles relating to Akavar’s efficacy. [Lieberman, H.R., Tharion, W. J., Shukitt-Hale, B., Speckman, K.L., & Tulley, R. (2002). Psychopharmacology (Berl), 164(3), 250-261. Andersen, T. and J. Fogh (2001). J Hum Nutr Diet 14(3): 243-50.] Any representation on your part that the published studies comprise the full substantiation for Akavar 20/50 or that the substantiation is lacking in any way would be false and intentionally misleading on your part since your were not privy to the full documentation. again because of your refusal to sign a simple NDA. [This letter is signed by a paralegal.]

11/13 [Me] You did not provide the titles of the studies, but I easily found them. I can see why you didn’t provide the titles, and I can see why I didn’t find them when I looked before, because it is obvious that they were not studies of Akavar 20/50.The Lieberman study is titled “Effects of caffeine, sleep loss, and stress on cognitive performance and mood during U.S. Navy SEAL training. Sea-Air-Land.” The Andersen study is “Weight loss and delayed gastric emptying following a South American herbal preparation in overweight patients.” The herbal preparation was a mixture of yerba mate, guarana and damiana. The patients initially lost a few pounds, but those who took the active drug for 12 months “maintained” their weight during that period. The abstract of the study does not say that the study participants were instructed not to alter their eating habits. And the numbers of patients do not correspond to either of the studies described in your ads. Your ad says, “this is scientific fact, documented by published medical findings.” Are you now admitting that there are no published clinical studies of Akavar 20/50 and that the statements in your ads are false?

——–

I never heard back from them.  This interchange only confirmed what I could tell just from reading the ad: they are using deceptive tactics to promote an untested product. They are only one of many. A recent JAMA article reviewed Internet advertising and found that more than half of the diet supplement ads they reviewed were not in compliance with the regulations of DSHEA (the Diet Supplement Health and Education Act of 1994).

I reported them to the FTC for false advertising. I was not the only one to complain. The National Advertising Review Council received an inquiry under the Electronic Retailing Self-Regulation Program (ERSP) and initiated “administrative closure” at the request of the company. There is also a website where lawyers are soliciting clients for a possible class action lawsuit against the company for its false and “shocking” claims.

Are you wondering what ingredients are in this miracle product? Among many other things, it does contain the three herbs that were used in the Andersen study they cited, but that study is a preliminary one, has not been confirmed elsewhere, and has too many flaws to take seriously. Any effect on weight loss is more likely due to the substantial amounts of caffeine and related xanthines it contains. Drinking lots of coffee is probably just as effective.

A recent issue of the Natural Medicines Comprehensive Database newsletter said: “Akavar 20/50 is a new supplement promoted for weight loss. It contains a long list of ingredients, including large amounts of caffeine from yerba mate, guarana, green tea, and kola nut extracts. It also contains damiana, ginger, schisandra, scutellaria, vitamin B6, magnesium, and other ingredients. Some research suggests that a few of these ingredients might help for weight loss, but this is preliminary. There is no proof that this specific combination of ingredients is effective. Product advertising says, ‘Eat all you want and still lose weight…’ Remind patients that if it sounds too good to be true, it probably is.”

Posted in: Herbs & Supplements

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111 thoughts on “Akavar 20/50 and Truth in Advertising

  1. PalMD says:

    I commend you on your tenacity. I did a little googling, etc and came up with a little something.
    http://whitecoatunderground.com/2007/09/06/eat-as-much-as-you-want-and-still-lose-weight/

  2. ellazimm says:

    Sadly, their website seems to be still making their unfounded claims:

    http://www.akavardirect.com/page2.html

    How long does it take for the process to stop such mis-practice?

  3. pec says:

    Deceptive advertising and fraud gives you a “surreal experience!!” What planet have you lived on until now?

    And what about all the ads for Zytorin, which research now suggests is worthless? Was that a shocker for you also?

  4. Harriet Hall says:

    “How long does it take for the process to stop such mis-practice?”

    Years. And the company usually gets little more than a slap on the wrist. Even if they are required to make restitution, they can declare bankruptcy for the company and the individual culprits keep the personal fortunes they have already made. Then they can move to another state, form a new company, and market another similar product. it’s like a whack-a-mole game where the crooks always win.

  5. Harriet Hall says:

    pec,

    What was surreal was that they asked me to sign a nondisclosure agreement before they would give me a citation for published research. Usually these companies proudly trumpet what turns out to be poor quality or irrelevant research.

    If I’m not mistaken, Vytorin is a combination of two drugs that were previously shown to be effective, and its marketing is based on studies that led to FDA approval. Now a new study does not suggest it is worthless, but “sheds doubt on whether it makes any sense for people battling cholesterol to take Vytorin versus Zocor alone.” No, it doesn’t shock me that drugs are approved based on good research and that the superiority of a combination of drugs over a single drug has been questioned based on other research. That just tells me science is working as intended to hone in on the truth. Any comparison with a product like Akavar that is an irrational mixture and has not been tested at all is ridiculous.

  6. pec says:

    Harriet,

    It’s astounding to me that you think drug research funded by giant companies is fair and scientific, and that you seem to have no doubts.

    And by the way, people battling high cholesterol should increase their exercise and decrease their junk food and get off the drugs if at all possible. Yes, there may be some patients who have lived the American lifestyle so long it’s too late to undo the damage. But MDs are prescribing these drugs for anyone whose cholesterol is even slightly elevated. It is mostly just a marketing scam by the big drug companies. You have been scammed.

    But none of that horrifies you. You probably think cholesterol-lowering drugs should be in the water supply.

    Deception is a fact of life, in mainstream science as in everything else.

  7. Harriet Hall says:

    pec,

    You can’t read, and you are attacking straw men. I didn’t say drug research funded by giant companies is fair, and I didn’t say I had no doubts. I said science is working as intended to hone in on the truth. If you know of any better way to get at the truth, please enlighten us.

    I will be writing about cholesterol and statins in a future blog entry. Why don’t you wait until you see what I think before you try to tell me what I think. It is despicable of you to even suggest that I think drugs should be in the water supply.

  8. Psychotic_Chimp says:

    Dear Dr. Hall (and other blog contributors),

    I’d just like to thank you for your integrity and patience. It isn’t easy to deal with someone making distorted caricatures of you and your opinions (not to mention science) but you’re setting a good example for other skeptics.

    Keep up the good work, checking this blog is one of my top priorities every morning.

  9. pec says:

    Sorry Harriet, maybe you are also skeptical of mainstream medicine. I hope so. The idea of putting statins in the water supply is often repeated by true believers.

    I have said it several times at this blog — science is great, I whole-heartedly believe in the scientific method. But we have to keep in mind that scientific establishments are made up of humans, with all the usual status-seeking and self-interest.

  10. DBonez says:

    pec,

    Why are “big research companies” so evil and underhanded, yet unproven, unscientific magnetic jewelry is a five-billion-dollar-a-year industry somehow all sweet and innocent? I agree that some of the statin claims may have been exaggerated, but I will take their side any day over magic magnetic bracelets. At least drug companies have studies and statistics that can be refuted.

  11. PalMD says:

    Pec, the problem with the whole big pharma conspiracy issue is that they seem to be quite bad at it. Yes, Merck withheld data on Zetia, but it has come out.

    Pfizer withheld data on their HDL drug, but it was published before and the drug basically abandoned.

    Negative studies are published, despite publication bias, and that is one of the glories of modern medicine.

    If the Big Pharma conspiracy actually worked, we’d all be taking 5 or 6 very expensive (but cheap and easy to produce) sugar pills. And before you say “yes, exactly!”, this isn’t the case.

  12. DBonez says:

    “But we have to keep in mind that scientific establishments are made up of humans, with all the usual status-seeking and self-interest.”

    And again, the homeopathic establishment is not? How about the $19,900 EPFX machine made in (fled to) Hungary? Able to cure AIDS and cancer?!? Um, okay.

    See this wonderful device here: http://alternativehopeepfx.com/

    Here is a little background on the machine and the inventor: http://www.randi.org/joom/content/view/141/1/#i10

    pec,

    As you seem comfortable with alternative treatments and have an open mind, please take a moment to enlighten us to the legitimacy and efficacy of this device.

  13. pec says:

    I am NOT an advocate of alternative treatments! I have NO IDEA which of them are frauds!

    Being open-minded does NOT mean accepting anything and everything just because some stupid ad claims it works!

    I practice yoga because I have decades of experience with it and it works for me. It might not work for everyone. I don’t sell yoga, or any kind of treatment.

    I am skeptical of modern medicine, and also of the alternatives. What’s wrong with that?

  14. pec says:

    “Why are “big research companies” so evil and underhanded, yet unproven, unscientific magnetic jewelry is a five-billion-dollar-a-year industry somehow all sweet and innocent?”

    When did I EVER imply that?

    Although, actually, I would rather waste a few dollars on harmless magnetic jewelry than hundreds or thousands on synthetic drugs that weaken and damage the body.

  15. ellazimm says:

    I thought it would be interesting to submit a request similar to the one Dr Hall sent to the Akavar people. Today I sent:

    I am intrigued with your product and would like to find out more about it. Could you give me the reference (i.e. title, author(s) and
    journal) for the published clinical trial so that I can examine the
    research myself?

    To the contact us link on the aforementioned website. Within a few hours I received the following repy:

    Thank you for emailing Customer Service. Akavar 20/50 is an awesome product designed for individuals looking for a completely new approach to effortless weight control. You can find the results on the studies by looking in the Journal of Human Nutrition and Dietetics. The study on the energy component in Akavar was published in the journal Psychopharmacology. I have attached the label for Akavar 20/50 , including the list of ingredients, dosage, warnings, etc. for your reference. Customers are reporting great results so we look forward to hearing of your success.
    If you have any questions, please feel free to call our friendly
    customer service representatives at 1-800-898-5153, Monday thru Friday 6am to 10 pm MST and Saturday 7 am to 6 pm MST.
    We look forward to hearing of your success with Akavar.
    Have a great day,
    Lori
    Customer Service
    1-800-898-5153

    **Be sure to visit our free website, http://www.myfreediet.com/ for
    weight loss tips and ideas for delicious, healthy meals! **

    To which I have replied to the effect that I could not find the papers on the journals’ website, could they please give me issue numbers and/or authors and titles. This effort may be pointless but what if 1000 people sent in the same request . . .

    Perhaps if we could stop arguing we could spend more time holding such charlatans’ feet to the fire and do something about this travesty.

  16. DBonez says:

    “I had not realized that CAM had been infiltrating to this extent. Very encouraging to learn!”

    “Life energy is real.”

    Well if you’re encouraged about faith-based “science” infiltrating universities and medical practices, then you are implying support. Certainly magnetic bracelets and the EPFX machine are CAMs, right? And from a number of your posts, it appears you support non-science-based medicine and generally distrust the scientific establishment, therefore supporting homeopathy, life energy, and sCAM in general. Just my observation.

  17. rjstan@together.net says:

    If I remember correctly, several years ago when I requested citations to the studies reporting on the clinical trials that a supplement ad claimed showed that their product was effective, I was told that the FDA does not permit them to give out such information because the agency thinks that if they cite such studies they are “making drug claims” which of course is illegal for supplements.

  18. Harriet Hall says:

    rjstan,

    That doesn’t make a bit of sense, because the ad already made an illegal drug claim. I don’t think the FDA even has any jurisdiction in the matter: they are responsible for labelling claims, and the FTC handles advertising claims. I think they were just trying to foist you off with a convenient but stupid excuse. Kind of like saying you can’t borrow my lawnmower today because I have to paint the roof.

    My experience has been that supplement vendors often provide lots of citations, but those citations don’t actually support the use of the product. They don’t expect anyone is actually going to read them. They just want to make it look superficially like science.

  19. BlazingDragon says:

    Pec… you said:

    “Although, actually, I would rather waste a few dollars on harmless magnetic jewelry than hundreds or thousands on synthetic drugs that weaken and damage the body.”

    This shows your incredible ignorance on the idea of “synthetic” vs. “natural.” I work as a synthetic chemist. I make stuff like this every day. If something I make will end up in people, even just to test on a few people, it requires massive toxicity studies that take a year or more to complete at doses FAR higher than will ever be used in clinical practice.

    Ricin is all-natural … strychnine is all natural… and both are lethal. Aflatoxin is found on moldy grains (among other places) and is carcinogenic and can lead to liver damage.

    As many mistakes as have been made by the FDA of late, these are directly traceable to the gutting of the FDA by political leaders and NOT an indictment of the pharmaceutical industry as a whole or “synthetic” drugs. If proper FDA protocols are followed with good enforcement, very few things that are dangerous get through to the US consumer (see the story of how thalidomide was kept out of the US markets).

    I expect, however, that you will continue to throw up clouds of straw.

  20. pec says:

    I NEVER said that every natural substance is good for us. Obviously, we were meant to ingest some things and not others. The synthetic substances that you make should be avoided if at all possible, however. I don’t care how much you tested them — they are not meant to be inside our bodies and sooner or later they will cause damage.

    Of course we are all ingesting unnatural chemicals all the time and this can’t be avoided in an industrial civilization. But MDs COULD try to use a little restraint, and in my experience they don’t.

    For example, I know someone whose husband died, so her doctor prescribed anti-depressants for her and her 14-year-old son.

    Healthy people are given cholesterol and blood pressure lowering drugs because their levels are considered a little too high.

    People with advanced, incurable, cancer, are given toxic chemotherapy for months, just in case it might work.

    Young boys who, after sitting still for hours at school and at home, and eating processed high-carbohydrate junk, naturally become agitated and unable to concentrate. They are put on Ritalin for years.

    Oh there are so many more examples of this kind of thing, unfortunately.

  21. PalMD says:

    “The synthetic substances that you make should be avoided if at all possible, however. I don’t care how much you tested them — they are not meant to be inside our bodies and sooner or later they will cause damage.”

    Unfounded assertions like that really aren’t useful…the point was that there is no real difference between “natural” and “synthetic”. There are lots of substances we weren’t “meant” to ingest, whatever that means. Take for example, aspirin. If you are having a heart attack, it can save your life. Same goes for metoprolol.

    “Healthy people are given cholesterol and blood pressure lowering drugs because their levels are considered a little too high.”

    Evidence-based medicine has shown that certain combinations of patient and cholesterol, or patient and blood pressure lead to problems, and that treating these problems saves lives and disability.

    A healthy person with no cardiac risk factors might be just fine with an LDL level of 130. A diabetic would not be based on evidence.

  22. Roy Niles says:

    Pec said about synthetic substances that “they are not meant to be inside our bodies and sooner or later they will cause damage.”

    How does one decide what was meant for what, unless one can determine the source of any purposefulness implicit in its creation?

    And does one such purpose automatically preclude its use for any other?

  23. pec says:

    “A healthy person with no cardiac risk factors might be just fine with an LDL level of 130. A diabetic would not be based on evidence.”

    Type 2 diabetes would almost never occur in a person who follows does a reasonable amount of exercise and avoids high-carbohydrate junk food. The drugs would simply not be needed if MDs would educate their patients rather than write prescriptions.

    The scientific research said that 20 minutes of aerobic exercise, three times a week, helps prevent heart disease. MDs, ignoring common sense, recommended that amount of exercise to their patients. There was no research saying that 20 minutes three times a week is ENOUGH aerobic exercise. Our species has never been that inactive, except recently.

    Most of the drugs being taken now would be completely unnecessary if only MDs were less infatuated with drugs and more in touch with reality and common sense.

    There are people I love who were saved from death or disability by the amazing accomplishments of recent medical technology. And there are also people I love whose lives are being wrecked by avoidable lifestyle diseases treated with toxic “medications.” They are depressed, tired, sick, demented. It could all have been prevented if their MDs had used some common sense decades earlier.

  24. pec says:

    Mainstream medicine should concentrate on what it does well — emergency surgery, anesthesia, antibiotics, vaccines, diagnostic technology.

    It should hand over what it does poorly — treatment of heart disease, type 2 diabetes, chronic degenerative diseases, auto-immune diseases, cancer, AIDS, for example — to CAM.

    There does not have to be any conflict. We don’t recommend yoga for someone who just feel off the roof. If CAM is funded and encouraged to advanced it can take over ONLY the areas where mainstream medicine has failed.

    Mainstream medicine could stop pretending that a cure for cancer is just around the corner. It isn’t, not within the current mainstream scientific framework. It could stop prescribing drugs for artery disease that may slow progression and stave off death for a while, but that erode quality of life and well-being.

    Give CAM a chance and focus on doing what you can be successful at. Aren’t you getting tired of failing?

  25. PalMD says:

    “Type 2 diabetes would almost never occur in a person who follows does a reasonable amount of exercise and avoids high-carbohydrate junk food. The drugs would simply not be needed if MDs would educate their patients rather than write prescriptions”

    I’m sorry, pec, but that is a completely false assertion. Many type II diabetics are obese, but many are not. You have a bit of an education gap. DM II is often partially behavior-related, but not exclusively.

    Many of my type II diabetics, were they to follow your advice, would have to avoid food until they starved.

  26. BlazingDragon says:

    So much straw…. so many assertions based on “what we humans used to do and don’t do now.” Reminds me of the “Eat Right for Your Type” craze, among others.

    Pec, you are dead wrong about cancer, among other things. Modern medicine works miracles with cancer (surgical excision, followed by a dose of chemo or radiation therapy) knocks out most localized tumors with relatively little recurrence. These courses of chemo or radiation are usually uncomfortable, but not intolerable and they have evidence they work. My wife had lupus nephritis many years ago. As horrible as the chemo was, it saved her kidneys and saved her life. Again, there is evidence that this horrible treatment works, while other therapies for lupus nephritis, especially herbal/acupuncture/etc., don’t work better than random chance.

    PalMd is correct about your education gap. You are spouting off things that are stupid to anyone who knows medicine.

    Can you read a medical journal article and understand the study design, the treatments, and the results? If you can’t, you cannot put evidence-based medicine in the trash bin like you seem to want to (for many treatments at least) because you are not reading the evidence.

    I read awhile back that people who did not arrive at a conclusion using logic will never be persuaded by facts and reason to give up that conclusion. Seems to apply here.

  27. David Gorski says:

    It should hand over what it does poorly — treatment of heart disease, type 2 diabetes, chronic degenerative diseases, auto-immune diseases, cancer, AIDS, for example — to CAM.

    Let’s see. Forty years ago, childhood cancers were a death sentence. Now, they are 80-90% survivable, and adult cancers are showing significant decreases in mortality. Fifteen years ago, AIDS was a death sentence. Now, thanks to multidrug cocktails, it is a chronic, manageable disease. Indeed, I recently saw an article about how early HIV and AIDS patients are now reaching the age at which they are eligible for Social Security. Heart disease? You’ve got to be kidding.

    But the more important question is: Do you have a single shred of scientific evidence that CAM can do better against any of the diseases above for which you tout it?

  28. David Gorski says:

    I’m sorry, pec, but that is a completely false assertion. Many type II diabetics are obese, but many are not. You have a bit of an education gap. DM II is often partially behavior-related, but not exclusively.

    Indeed, I have two male relatives with type II diabetes. Neither of them are obese. One might even be characterized as skinny. Where pec pulls his assertions about Type II DM from, I suspect I know.

  29. qetzal says:

    Harriet Hall,

    Actually, FDA does have jurisdiction. For example, see http://www.fda.gov/bbs/topics/news/2004/NEW01045.html.

  30. Harriet Hall says:

    At 4:23 pec said, “I am NOT an advocate of alternative treatments!”

    At 8:33 he said mainstream medicine “should hand over what it does poorly — treatment of heart disease, type 2 diabetes, chronic degenerative diseases, auto-immune diseases, cancer, AIDS, for example — to CAM.”

    pec, this only demonstrates an ignorance of the facts and an inability to think clearly. You are making a fool of yourself and you might want to desist before you dig yourself in any deeper.

  31. Harriet Hall says:

    qetzal’s link didn’t work for me.

    According to Wikipedia, “The FDA reviews and regulates prescription drug advertising and promotion. (Other kinds of advertising, including for over-the- counter drugs, are regulated by the Federal Trade Commission). ”

    I thought the FDA determined what claims and product labels were acceptable for a diet supplement (“supports the pancreas” might be OK; but “effectively treats diabetes” would not). I thought the FTC was responsible for enforcing claims in advertising that were not acceptable to the FDA.

    If this is wrong, please correct me.

  32. Liam says:

    Great blog Dr Hall. Pec’s a bit off the wall, I’m not convinced he’s not a troll.

    L

  33. ellazimm says:

    I’m sure my following Dr Hall down the rabbit hole is pointless but at least the Akavar people know someone is paying attention. I have received the following request:

    Hi Jerad,
    Thank you for contacting the customer service department once again
    regarding the study information. We would be more than happy to mail
    you a copy of the entire study if you would provide us the following
    information;

    Your Full Name

    Mailing Address

    Phone (including area code)

    Purpose of use (how/what the study will be used for)

    Once we have received this information we will forward your information
    to our study request team. They will then mail you a copy of the
    complete study.
    Again thank you for taking the time to contact us.

    Lori

    I replied that I didn’t know why they needed that information if the trials were published but I gave it to them anyway. I wonder what the next weasel-words will be?

  34. pec says:

    Type 2 diabetes is only found in Western industrialized cultures. It is now becoming an epidemic. Do you think that’s because of lifestyle, or something else?

    I did NOT say every patient with type 2 diabetes is obese. It is possible to have an unnatural lifestyle and not be obese.

    All of our lifestyles our unnatural to some degree, in this civilization. It’s a matter of degree.

    You all know very well — although you pretend not to — that the diabetes epidemic is caused by lifestyle, and that drugs are not the answer.

  35. pec says:

    “Fifteen years ago, AIDS was a death sentence. Now, thanks to multidrug cocktails, it is a chronic, manageable disease. ”

    Oh come on. That’s your typical approach to disease — manage it with expensive drugs that may prolong life, while destroying health.

    It’s a wonderful approach for the drug and medical industry. And as long as you completely fail to understand AIDS and cancer, it’s the best you can do.

    I am NOT saying CAM has the understanding or the cures for AIDS, cancer etc. I AM saying you could allow it to try, instead of doing your best to block its funding.

    You DON’T have answers or cures for some of the worst diseases. Everyone knows that progress in cancer has been minimal, yet you still manage to brag about it.

  36. pec says:

    And the statistics showing progress in cancer are very often deceptive. For example, you say that thanks to better techniques for early detection, survival times have increased.

    Did you ever think that earlier detection automatically results in longer survival, even if the treatment does absolutely nothing? That doesn’t stop the cancer industry from proclaiming great success.

    If you want to show that your treatments work, you have to adjust for earlier detection.

    In case you don’t get it: If two patients had exactly the same kind and degree of cancer, but one was diagnosed a year earlier, then survival time will be one year longer for that patient.

    So your statistics show great improvements in survival! It fools everyone!

  37. David Gorski says:

    I am NOT saying CAM has the understanding or the cures for AIDS, cancer etc. I AM saying you could allow it to try, instead of doing your best to block its funding.

    Without even minimal evidence of its efficacy against HIV, it would be highly unethical to “allow it to try.” You need evidence that it does something to treat HIV before you ethically “try it out” on a larger scale. And, before you attack an obvious straw man, that evidence doesn’t have to be randomized clinical trials. It does, however, have to be of considerably better quality than the usual anecdotes produced by CAM advocates. At the minimum, high quality retrospective studies, along with some modicum of physiological plausibility greater than that of homeopathy, would be needed to justify larger randomized trials.

  38. PalMD says:

    “Type 2 diabetes is only found in Western industrialized cultures. ”

    Step lightly with those assertions…

  39. David Gorski says:

    Did you ever think that earlier detection automatically results in longer survival, even if the treatment does absolutely nothing? That doesn’t stop the cancer industry from proclaiming great success.

    If you want to show that your treatments work, you have to adjust for earlier detection.

    Now you’re stating the bleedingly obvious. Really, do you think cancer physicians are so ignorant that they don’t realize this and try to account for it in the statistics as best as can be done? These sorts of issues are discussed in the early chapters of oncology textbooks, usually right after the chapters on what cancer is. They’re also frequent topics of conversation and criticism at oncology meetings and in journals. What you’re describing is a well known phenomenon described decades ago. In fact, it’s a set of related phenomena, of which you missed at least one. They even have names. Effects due to early detection are known as lead time bias, and every attempt is made to adjust for that in cancer research. That’s why effects on survival rates mean little if they are not adjusted for cancer stage. The effect in which occult disease that wouldn’t have been detected before but is now detected because of better imaging, leading to “upstaging” of a tumor with a better prognosis and producing an apparently but not really better survival for a higher stage is known as stage migration, and the effect on prognosis is known as the Will Rogers effect.

    Detailed discussions of these issues can be found here:

    1. Early detection of cancer, part 1: More complex than you think
    2. Early detection of cancer, part 2: Breast cancer and the never-ending confusion over screening
  40. qetzal says:

    Sorry about the bad link. I don’t know why it doesn’t work, since that is the URL that appears when I’m on that page.

    Anway, go to FDA’s home page at http://www.fda.gov. Search for “weight loss” in the search box (upper left of the page). Click on the ninth result, titled “FDA Warns Distributors of Dietary Supplements…”

    I recommend following the link at the bottom and reading some of the specific warning letters. They give more information, including the specific laws involved.

  41. Harriet Hall says:

    qetzal,

    Now I’m even more confused. What is the difference between the FDA’s and the FTC’s enforcement powers? If I want to report false advertising of a diet supplement, should I report it to the FDA, the FTC, or both? If the jurisdictions overlap, does that create a problem for enforcement? Do the two agencies coordinate?

  42. pec says:

    “You need evidence that it does something to treat HIV before you ethically “try it out” on a larger scale. ”

    Dr. Gorski,

    That is exactly my point. If you stop funding for CAM they will never have a chance to demonstrate anything.

    And there are some things you may not have found so obvious about cancer and AIDS statistics:

    Extremely early detection of cancer means patients will be treated whose cancer was never going to progress anyway. These patients are declared cured, and the treatment is given credit.

    Similarly, patients who are HIV-positive are treated with drugs, which are credited with preventing or delaying the development of AIDS. But you have no idea how many of these patients would have developed AIDS or how long it might have taken.

    And it is not possible to actually study the effectiveness of cancer and AIDS treatments, since they are given to all patients. You cannot ethically deprive some patients of a treatment that is thought to work.

    In short, you really don’t know if your cancer and AIDS treatments are doing more good than harm. You are sticking with an approach and assuming it’s the right way to go, that it will lead to continued improvement.

    It is very possible that your approach will not lead anywhere.

  43. pec says:

    And I am glad to hear that oncologists are aware of lead time bias. But that is definitely NOT the story presented to the public.

    And exactly how do you figure out if your treatments are helpful or not? There is no way to know whether an early cancer would have progressed, or whether it would ever have become lethal. There is no cure for advanced cancer, so you have no way to know if you are curing anything.

    If you can point me to anything that actually sorts this out I would appreciate it.

  44. David Gorski says:

    Extremely early detection of cancer means patients will be treated whose cancer was never going to progress anyway. These patients are declared cured, and the treatment is given credit.

    I feel as though I’m talking to Ferrous Cranus here. My attempts at explanation fall on apparently deaf ears, given that you have just repeated once again the same canard that I addressed. Once again, I just provided links to show that oncological doctors and scientists are very much aware of this issue and do try to correct for it in doing studies. It’s a complicated issue, but early detection alone does not account for the improved survival from cancer. Indeed, there are examples where it does not. For example, if I recall correctly, despite early suggestive results, more recent studies of attempts at even earlier detection (using routine CT scans to detect lung cancer in smokers earlier than it would show up through symptoms or on a chest X-ray) have failed to result in improved survival rates, to the point where this approach has largely been abandoned. Moreover, there has always been a lot of discussion over whether mammography has resulted in lead time bias effects. This discussion has been resurrected now that the more sensitive modality of MRI has become more widespread. In other words, you are, quite simply, wrong when you keep saying we don’t know whether all of this decrease in mortality is due to early detection.

    Take another example, which addresses your fallacious claim that we do not know if our treatments do more good than harm. Fifty years ago, leukemia was largely a guaranteed death sentence, with almost zero long term survivors. Now, thanks to combination chemotherapy and sometimes stem cell transplant, leukemia is a survivable disease. Childhood leukemia is as high as 90% survivable, although the number gets smaller as we look at leukemia in older and older adults. Another consideration is quality of life. For example, although breast cancer mortality has decreased modestly in the last two decades, the surgery has become progressively less invasive, from modified radical mastectomy, to lumpectomy with axillary dissection with radiation, to lumpectomy and sentinel lymph node biopsy and radiation. This produces equivalent or better survival with less pain, faster healing, and less disfigurement.

    If CAM could do anywhere near as good, it would not be difficult to show. In fact, here’s a question for you: Show us a single CAM modality that can result in long time survival in a specific cancer at a rate equivalent to that of conventional medicine.

  45. Joe says:

    pec wrote “I am glad to hear that oncologists are aware of lead time bias.”

    Ah, more of the arrogance of ignorance; I have directed you to this before
    http://photoninthedarkness.com/?p=140

    pec wrote “If you can point me to anything that actually sorts this out I would appreciate it.”

    Okay, this is beyond the pale- he did.

  46. pec says:

    I did NOT say CAM treatments are better (I keep having to repeat this). However, I think some of their theories are better and should be pursued. You keep battering away with the same old theory of cancer that does not result in better understanding. You have some improved treatments because of better technology — I have never doubted that medical technology improves and advances. What does NOT advance is theories of certain diseases such as cancer.

  47. pec says:

    “It’s a complicated issue, but early detection alone does not account for the improved survival from cancer. ”

    Ok, then I would like to see how you can determine that breast cancer treatment, for example, is benefitting patients. How do you decide how much of the increased survival results from earlier detection? How do you determine if you have cured a cancer that would have progressed. How do you know your treatment made a difference?

    I would just like to see an explanation of this. I have not seen any mention of it in any cancer or AIDS research I have read. Where is it mentioned and how is this determined? It would have to be animal research, since there is no ethical way to answer this question with humans.

  48. PalMD says:

    That sounds suspiciously like “other ways of knowing”.

    We know an enormous amount about cancer biology—you, however, do not. In fact, you don’t know what you don’t know.

    Cancer is not the big, mysterious “C” it once was.

  49. Harriet Hall says:

    And as for AIDS, even if you aren’t aware of the science, you should have noticed that all those stories of AIDS patients dying that were so common a few years ago are much less common now. We have a very good idea how many HIV positive patients would have developed AIDS without treatment because we used to watch a percentage of them develop AIDS and die. We are still watching it happen in Africa when drugs are not available.

    Your statement that “you really don’t know if your cancer and AIDS treatments are doing more good than harm” could only be said by someone who has no concept of how science asks and answers those questions, yet you say you have a PhD in psychology.

    Some of what you write is so silly I have wondered if it is a spoof. Are you playing a joke on us? If so, I’m afraid it has fallen flat.

  50. qetzal says:

    Dr. Hall,

    Re FDA, FTC, jurisdictions, etc. – my apologies, but I’m close to the limit of my knowledge on this topic.

    My guess: in certain cases, false advertising claims about supplements or drugs violate both FDA and FTC regulations. If you claim your product promotes weight loss, but you can’t back up your claim, it’s probably both false advertising (FTC) and misbranding (FDA).

    I found this document that appears to be jointly issued by FDA and FTC. Among other things, it says:

    The Federal Trade Commission has jurisdiction over advertising and marketing of foods, non-prescription drugs, medical devices, and health care services. The FTC can seek federal court injunctions to halt fraudulent claims and obtain redress for injured consumers.

    The Food and Drug Administration has jurisdiction over the content and labeling of foods, drugs, and medical devices. The FDA can take law enforcement action to seize and prohibit the sale of products that are falsely labeled.

    Pragmatically, if you want to report a suspected violation, I’d report it to both agencies.

  51. pec says:

    No Harriet, I am not kidding. I have spent a lot of time reading about cancer and AIDS and was surprised to see how many of the assumptions have such a weak basis in evidence.

    For example, new AIDS drugs are judged by comparing them to AZT, on the assumption that AZT works well. But the original evidence for AZT was weak.

    A decrease in AIDS deaths cannot necessarily be attributed to the drugs, and the death rate might have fallen off naturally without the drugs. It’s possible that the most vulnerable individuals died from AIDS early in the epidemic — this is not unusual for an epidemic.

    The desire to believe in mainstream medicine is so powerful it sometimes makes it hard to see the reality.

    I am not claiming AIDS drugs never do any good. I just don’t think there is nearly enough skepticism, especially considering the enormous fortunes being made.

  52. pec says:

    “the vast majority of women from 40-49 with microscopic evidence of breast cancer or DCIS will never die of cancer, because either does not progress or progresses so slowly that, even in the 30-40 year remaining life expectancy for women in this age range, it does not manifest itself as clinical cancer. … The problem, of course, is that we have no way of identifying which of these lesions will turn into clinically apparent cancer and thus have little choice but to treat all detected cancer, even tiny microscopic lesions, as though they will.”

    Yes, and all will be counted as cures attributed to the treatments!

    I am failing to see why it was so stupid of me to bring this up. If it’s so “bleedingly” obvious, why did someone bother explaining it in such detail?

  53. PalMD says:

    OMGz! My brain is going to explode from the stupid!

    Did it ever occur to you, ever, that maybe, just maybe, all of these experts might be right and you, the lone Galileo in the wilderness, might be wrong????

  54. pec says:

    “Did it ever occur to you, ever, that maybe, just maybe, all of these experts might be right and you, the lone Galileo in the wilderness, might be wrong????”

    Yes, it has. But it has also occurred to me that I, and many thousands of other skeptics, could be right about some things, and you indoctrinated “experts” might not be as all-knowing and infallible as you claim to be.

  55. Harriet Hall says:

    pec,

    Yes, you are kidding. You’ve got to be! You read about “assumptions” with a weak basis in evidence and that makes you doubt something that is not an assumption but an obvious fact: that cancer and AIDS patients survive better with treatment.

    The death rate “might” have fallen off naturally without the drugs, but it hasn’t. It hasn’t fallen off naturally among patients who do not get the drugs. There is plenty of evidence from Africa, where so many patients lack access to modern medicine.

    I already said this: “We have a very good idea how many HIV positive patients would have developed AIDS without treatment because we used to watch a percentage of them develop AIDS and die. We are still watching it happen in Africa when drugs are not available. ” But I have to say it again because you are pretending you can’t read. Very funny! Shall I say it 3 or 4 more times?

    Guess what, pec? Scientists have already thought of all these questions you keep bringing up and they have figured out ways of answering those questions! And believe it or not, they keep asking questions about everything and they keep changing clinical recommendations as they hone in more precisely on the truth. It’s not a perfect system, but it eventually corrects its mistakes and it’s far better than any alternative.

    I’m not intimately familiar with the quality of research on the original AZT, but there is no doubt whatsoever that anti-AIDS drugs are saving lives. I think you are just pretending to think otherwise so you can harass those of us who are seriously trying to carry on a rational discussion.

    You say “The desire to believe in mainstream medicine is so powerful it sometimes makes it hard to see the reality.” Yes, that’s true, and that’s why mainstream medicine needs to be based on the most rigorous science and that is what this blog is all about. You are so busy finding silly things to pick on that you can’t even recognize what we are trying to do. Your desire “not” to believe in mainstream medicine is so powerful it makes it hard for you to see the reality.

    Come on, fess up! You really just want to pull our chains, don’t you?

    In another thread you said you could “see” life energy. That was a pretty good one! I’m still waiting to hear your description of what seeing energy is like. I expect to be heartily amused. I don’t expect you to even consider demonstrating your ability to James Randi and trying to win his million dollars.

    I’ll say one thing, pec – you really stand out among the rest of the commenters on this blog!

  56. Roy Niles says:

    Methinks he has mistaken your chain for the hoist on his own petard.

  57. slausvonhagen says:

    You guys, I figured it out. pec has GOT to be the Novella brothers! They are having the best time with you. Oh man, I can finally go to sleep now.

  58. David Gorski says:

    “I am failing to see why it was so stupid of me to bring this up. If it’s so “bleedingly” obvious, why did someone bother explaining it in such detail?”

    Because it’s not bleedingly obvious to non-oncologists, pec, just as it’s not obvious to you. However, to those who have devoted their lives to the specialty of cancer, it is obvious. It’s considered part of the basic fund of knowledge you must have to be an oncologist.

    Once again, repeat after me: That’s why taking tumorstage into account is so important in comparing survival statistics and that’s why we as cancer doctors do it when figuring out survival. I would also point out that alternative medicine cancer cure testimonials nearly always credit the alternative medical therapy when the patient also received conventional therapy; so spare me the “taking credit” blather.

    Really, I’m beginning to agree with Wally about you. You appear to have deep and unshakable biases against conventional medicine that make you in essence unteachable. I note that even Harriet, who is much more patient than I with people like you, appears to be losing her patience and that Steve Novella, who is even more patient still, has simply given up responding to you for the most part.

  59. pec says:

    “it’s not bleedingly obvious to non-oncologists, pec, just as it’s not obvious to you.”

    It was always obvious to me. It is never mentioned in any media reports for the public. So you oncologists have been keeping it as your secret? And I have to keep asking — HOW do you figure out the effects of your treatments?

    As I have always thought, and the article you linked confirms (but non-oncologists seldom realize), most early cancer will never progress. Before early detection technology, most people who had “cancer” never even knew it.

    So what prevents you from claiming all these early treatments as cures? Are you saying they are not counted as cures? I am very skeptical.

    And as for all the accusations saying I believe any kind of nonsense if it’s non-mainstream and have no use for the scientific method — that is complete garbage.

    The fact that I can see life energy disqualifies me as a serious scientist? You have absolutely no idea how many other scientists can see life energy — they just wouldn’t mention it to you. I only mentioned it to illustrate a point, but of course you hard-core materialists love to ridicule anyone who perceives anything that doesn’t fit your little definition of “matter.”

    And I patiently explained to Harriet (you think SHE’s losing patience, what about me!) that you can’t win Randi’s prize because of personal experience. You have to prove it scientifically.

    I have important things to say, and have been studying these questions for a lifetime. Your ridicule is nothing but a symptom of your fear. My question about cancer cure rates is important and deserves an answer. Non-oncologists should know what you have for some reason avoided telling them.

  60. pec says:

    And Harriet ignored my comments, on another post, about cholesterol. Mainstream medicine has been pushing cholesterol-lowering drugs even to healthy people, even though there is no scientific reason to think cholesterol levels are related to artery disease. Artery disease is related to inflammation, and statins have an anti-inflammatory effect.

    So why have you been promoting the myth that everyone has to keep their cholesterol down? Since most older people have cholesterol levels above your limit, that means all of them can be put on drugs. This is terrific for the drug companies, but it’s complete nonsense from a scientific perspective.

    And people should NOT be given unnecessary drugs. Why aren’t you skeptical about that?

  61. David Gorski says:

    “The fact that I can see life energy disqualifies me as a serious scientist?”

    If you keep making the claim but either can’t or won’t validate your claim in a well-controlled scientific experiment, well, yes, I do.

  62. Joe says:

    pec wrote “I have important things to say …”

    Then stop writing drivel and get to it.

  63. pec says:

    “If you keep making the claim but either can’t or won’t validate your claim in a well-controlled scientific experiment, well, yes, I do.”

    That’s ridiculous. I never said my seeing life energy proves that it’s real. I said my perceptions, added to the perceptions of countless millions in all times and places, should count for something. I also said that direct personal experience DOES NOT count as scientific evidence. We cannot prove that our perceptions are “real” with controlled experiments.

    I would love to see more controlled experiments on life energy. I am very happy that CAM is getting increasing attention.

  64. pec says:

    “stop writing drivel and get to it.”

    I got to it Joe. I asked how oncologists can determine how often their treatments have any benefit, given that most early “cancer” will never progress and cause illness. When you treat a patient for early cancer and they survive, do you credit the treatment? Or do you admit that you have no way of knowing if they would have become sick and/or died without your treatment?

    How is this problem addressed? David Gorski assured me that it is dealt with, but never said how. The article he linked explained the problem very well, but never mentioned any solutions.

    I think this is extremely important. The claims about great advances in early detection and treatment are at least partly deception. Aren’t they? If you think I’m wrong, why don’t you try to explain your opinion?

    It’s easy to insult and ridicule — a very common tactic among uncritical believers in mainstream medicine and science.

    But it’s hard to explain logically and scientifically why you think I’m wrong.

    If you diagnose patients with early cancer and they are fine after receiving the standard treatments — how do you know it was because of the treatments?

    The article David Gorski linked explained why you cannot know. Don’t you see that as a problem? And if not, why not?

  65. David Gorski says:

    The article David Gorski linked explained why you cannot know. Don’t you see that as a problem? And if not, why not?

    No it didn’t. It explained why determining the benefits of early screening scientifically is more complex than is apparent to the average person. It also explained factors that have to be taken into account when evaluating cancer therapies and screening programs. That you apparently did not understand that says a lot about the pointlessness of trying to explain things to you.

  66. qetzal says:

    ped wrote:

    Mainstream medicine has been pushing cholesterol-lowering drugs even to healthy people, even though there is no scientific reason to think cholesterol levels are related to artery disease.

    What an astonishing, not to mention revealing, statement!

    pec, ever heard of familial hypercholesterolemia? You know, that inherited genetic disease whose primary defect leads to elevated LDL, and whose sufferers have a very high level of artery disease and heart attack? That sounds to me like a damn good scientific reason to think cholesterol levels are related to artery disease. (Far from the only one, of course.)

    For example, new AIDS drugs are judged by comparing them to AZT, on the assumption that AZT works well. But the original evidence for AZT was weak.

    This is irrational. If AZT plus a second drug like lamivudine works better than AZT alone (which has been shown; see Table 2), then even if AZT has no efficacy at all, lamivudine still works.

    Ok, then I would like to see how you can determine that breast cancer treatment, for example, is benefitting patients.

    Surely you’re familiar with a methodology called a randomized controlled prospective clinical trial? Take a homogenous group of patients with breast cancer. Divide randomly into two comparable groups. One group gets current standard of care, the other gets current standard of care plus New Treatment X. Follow both groups for 1 or more years and see which group does better.

    It’s done all the time, and I seriously doubt you’re unaware of that. You’re not being a skeptic, pec. You’re being a denialist.

  67. qetzal says:

    Sorry for misspelling pec at the beginning of my previoius comment.

    Also, I should have clarified that emphasis was added to pec’s first quote.

    This site could use a preview feature for comments.

  68. PalMD says:

    Don’t make Gorski angry….you wouldn’t like him when he’s angry…

    Anyway, in all due respect to you, Pec, I think I really do know where you are coming from.

    As an intelligent human being, you are naturally inquisitive and use human logic to try to understand large problems.

    Others have done this as well, and have formed a large body of scientific evidence and method to deal with these issues.

    When you are alone and contemplating these problems, it can seem as if, like Galileo, you have stumbled upon a great truth (or at least, a great skepticism), but, to be like Galileo, one must be not just dis-believed, but also correct.

    There is a whole wonderful world of science for you out there. Read a bit in the science blogosphere, learn, enjoy, then discuss.

  69. David Gorski says:

    Don’t make Gorski angry….you wouldn’t like him when he’s angry…

    Whatever are you referring to? ;-)

    Actually, when I joined up with this skeptical crew, I promised to be on my best behavior on this blog. If I let my alter-ego come out to play, Steve Novella might decide to kick me off, and I can’t have that. I will admit that pec’s acting like Ferrous Cranus is seriously straining the self control that is keeping the Bruce Banner half of me in charge.

  70. pec says:

    PalMD,

    I realize condescension comes naturally to the educated elite, but you are completely wrong about me. I have been reading about health all my life, and I am a scientist. I just have not been programmed into mainstream ideas.

    I do NOT think I alone see the great truths. Millions of people see defects in scientific materialism and mainstream science. Why do you think CAM is gaining acceptance?

  71. pec says:

    “It explained why determining the benefits of early screening scientifically is more complex than is apparent to the average person. It also explained factors that have to be taken into account when evaluating cancer therapies and screening programs. ”

    You think you’re smart enough to confuse me and avoid answering. I know what the point of the article was. But it inadvertantly revealed another serious problem — that very often you cannot know if your cancer treatment worked or not.

    You have not said anything that would contradict this. If I am wrong, you could simply explain why. But since I am not wrong, all you can do is insult me.

  72. Joe says:

    Harriet Hall,

    When pec refers to the initial evidence for efficacy of AZT being weak, he is parroting a faulty, AIDS-denialist notion. They claim (correctly) that the initial clinical trial (1986) was never completed. However, the trial was stopped because the drug was so obviously effective that it was not ethical to continue treating patients with placebo. A full-text review is available, free.

    http://www.ncbi.nlm.nih.gov/pubmed/3304154?ordinalpos=23&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    The mode of action, pharmacodynamics, and clinical efficacy of AZT were well established more than 20 years ago.

  73. Harriet Hall says:

    pec says I ignored his comments on another post about cholesterol. I did not. Anyone who is interested can go to comments section of the blog entry previous to this one and find my answer. Also, I will be writing about cholesterol in a future entry about the errors of the International Network of Cholesterol Skeptics (who pec cites).

    pec has exhausted my patience. I think it will be obvious to readers why I am not going to respond to any more of his comments.

  74. pec says:

    There is a similar problem with AIDS treatment as with cancer — you do not know when or if HIV-positive patients will get AIDS. You do not know how many HIV-positive individuals have never been diagnosed or treated because they have no symptoms. This makes determining the efficacy of AIDS treatments difficult to asses. Or should make it difficult.

    But right now I am much more interested in how you determine the effectiveness of cancer treatments. AIDS is extremely controversial and anyone who expresses the slightest skepticism is labeled an HIV denier.

  75. pec says:

    “asses” should be “assess.” It would be nice to have a preview function on this blog.

  76. Roy Niles says:

    No, you were right the first time. Determining efficacy of anything IS difficult to asses.

  77. Simon says:

    “You do not know how many HIV-positive individuals have never been diagnosed or treated because they have no symptoms.”

    Pec, this is a common mistake that people make when assessing the prevalence of a disease in a population- you are ignoring serological studies of the population in general. For example: Blood donors are regularly screened for HIV antibodies as a matter of course, thus we can use them as a sample to extrapolate the prevalence in the population at large.

    By the way, Pec, you have stated that you are a scientist- excuse me if I have missed this in a different thread but what kind of scientist exactly? Please don’t mistake this for an attack on your credibility, I am merely interested to know more about you so I do not end up either patronising or arguing over your level.

  78. pec says:

    I want to forget about AIDS right now and I would like to get an answer to my question about cancer. I have asked it several times but no one seems to be able to answer it.

  79. qetzal says:

    pec asks:

    If you diagnose patients with early cancer and they are fine after receiving the standard treatments — how do you know it was because of the treatments?

    I’ll say it again. Controlled, randomized, prospective clinical trials.

    Want to read some? Go here, type “breast cancer” in the search box, click the Limits tab, check the Randomized Controlled Trial box under Type of Article, and click Go.

    Voila! 3748 references for your learning pleasure.

    If you like, you can even limit to references that have links to free full text (second check box on the Limits tab).

  80. Joe says:

    pec, why do you want to forget about AIDS right now? Is it because you are so miserably uninformed?

  81. pec says:

    qetzal,

    You did not understand the question. No one would do controlled experiments that deprive cancer patients of standard accepted treatments. There is no way to compare two groups of patients with early cancer, one treated and the other not treated, because it would not be considered ethical.

    And MDs cannot answer the question based on their own clinical experience, since they cannot deprive patients of treatment. And they cannot predict which early cancer patients would have actually become sick or died. Many of them, most of them, as the article linked by Dr. Gorski explained, would have never experienced any cancer symptoms, and would have died of other causes.

    And this problem increases as early detection technology improves. I guess you didn’t follow this discussion at all.

  82. pec says:

    “pec, why do you want to forget about AIDS right now?”

    It’s extremely complicated and controversial. I do not think AIDS is at all well understood and I do not think the new drugs are the answer. I am not an HIV denier, but I am a skeptic.

    But I did not want to get side-tracked onto a highly emotional insult session. I want to see if anyone will try to give a sensible answer to my question about early cancer treatment.

  83. Simon says:

    Pec, to answer your question I will simply quote qetzel answering it earlier when you were still happy to talk about AIDS.

    “This is irrational. If AZT plus a second drug like lamivudine works better than AZT alone (which has been shown; see Table 2), then even if AZT has no efficacy at all, lamivudine still works.”

    Once upon a time there were no drugs to treat cancer. The first one worked better than nothing. The second worked better than the first. Now, drug n is tested against n-1. Thus we can test efficacy without endangering patient care.

  84. PalMD says:

    I’m “feeding the troll” because I think it sharpens us all.

    “Millions of people see defects in scientific materialism and mainstream science. ”

    1) Scientific materialism: is this Egnor-type turn toward “non-materialist science”, whatever that might be?

    2) Mainstream science: what distinguishes mainstream from other? I’ve been involved with science since my first chemistry set, have worked in a few labs, and, despite not being involved in research as a career, read quite a bit. Still, I’ve never heard of non-mainstream science.

  85. Roy Niles says:

    Trolls are identified by their propensity to bite the hand instead of the food.

  86. pec says:

    “I’ve never heard of non-mainstream science.”

    Of course not. It is usually excluded from mainstream journals and you would not learn it in mainstream colleges or graduate programs.

    But it can be found in public libraries and all over the internet. There are many organizations and institutions dedicated to alternative science and medicine. You would not look for it if you had no idea it exists, or had been indoctrinated into thinking it’s all pseudoscience.

    Non-mainstream science is full of nonsense, but so is mainstream science. That’s the nature of the human quest for knowledge — full of obstacles and dead ends, but ultimately groping its way forward.

  87. qetzal says:

    pec,

    I’ve followed the discussion, but I don’t think you understand the process. How do you think treatments get to be standard and accepted?

    Example:

    The National Comprehensive Cancer Network recommends lumpectomy plus radiation as a standard treatment for DCIS (early stage breast cancer; see p.6). Note that of the three ‘standard’ treatments, this one has the highest category of evidence rating (Category 1).

    Here is a study that asked whether lumpectomy plus radiation was better than lumpectomy alone. They followed 1010 women for a median of 10.5 years and found that yes, lumpectomy plus radiation significantly reduces recurrence (p < 0.01).

    You wanted to know how we can be ‘sure’ that standard treatments work. That’s how. They don’t become standard unless there’s evidence to show they work. Once they are standard, we compare new experimental treatments to the standard (often by adding the new treatment to the standard, but not always).

  88. Joe says:

    “pec, why do you want to forget about AIDS right now?” {snip}

    pec replied “… I did not want to get side-tracked onto a highly emotional insult session.”

    Why am I so honored? You are willing to insult the doctors here; but you shy away from disputing me. Do you see something in my life-energy that intimidates you?

    If a black cat walked across your path, it was not my doing. I don’t wish you ill, I wish you an education.

  89. Psychotic_Chimp says:

    Roy Niles, you’ve successfully made me laugh several times now, keep it up.

    “No, you were right the first time. Determining efficacy of anything IS difficult to asses”

  90. pec says:

    qetzal,

    Your example just made my point.

    http://www.ncbi.nlm.nih.gov/pubmed/16801628

    Local recurrence was lower in the experimental group, but
    “Both groups had similar low risks of metastases and death.”

    That was exactly my point — cancer that is detected early is unlikely to ever cause the patient any trouble.

    It’s strange that the best example you could provide only reinforces my criticism. The cancer industry is claiming great success at early detection and treatment of early cancer, but it seems that no one knows if there been much, or any, real success.

  91. Simon says:

    “Cancer that is detected early is unlikely to ever cause the patient any trouble.”

    Surely it is only significant if cancer is caught early if treatment is going to follow? If cancer rarely progresses to cause a problem, as you suggest, why should it matter if it’s detected early, late or not at all?

  92. PalMD says:

    I’m really struggling to understand pec’s reasoning.

    Let’s take an example of a single case, even though RCT data is more valid.

    My mother had a local breast cancer. She received lumpectomy, sentinel node biopsy, local radiation therapy, and tamoxifen. Many years later she is still apparently cancer-free.

    In pec’s world, we will be so “skeptical” that my mom would have waited to see if her cancer grew and metastasized, rather than subject her to the un-hearing medical establishment.

  93. Simon says:

    PalMD- I agree, I find it extremely hard to understand where Pec is coming from. Perhaps that is because I am a “mainstream scientist” and so request evidence to back up his (her?) claims.

  94. PalMD says:

    When I was in medical school, some of the surgeons I worked with were stuying sentinel node biopsy…it had not yet become standard. It is physician-scientists such as Dr. Gorski and many others who, among other things, allowed my mother to live a longer, unmutilated life.

    People who think there is some other type of “science” to help make these types of decisions infuriate me. What has this “science” ever done for me?

  95. pec says:

    According to the article linked by David Gorski, most cancerous tumors will never result in disease or death. I am NOT saying that therefore they should not be treated. I AM saying that we DO NOT KNOW how effective the treatments are.

    The claim is frequently made that cancer treatments are improving and cure rates are increasing. However, I cannot see how this can be demonstrated, and no one here has been able to answer.

    Sure, your mother should have had the treatment and it’s great that now she’s fine. But we do not know if she was really cured of a deadly disease caught early. That is always the assumption — but given that the odds are very small that her cancer would have ever progressed (according to that article I keep mentioning), we do not know if the treatment should be credited.

    Does it matter? Well yes. Everyone, or nearly everyone, is assuming that we have great treatments for cancer, as long as they are applied early. So cancer research tends to focus on improving the tried and true techniques, since we “know” they work.

    But do they work? Don’t you wonder about that?

    Detection occurs earlier and earlier, cure rates (and incidence rates) continue increasing. Everyone is happy with the progress.

    But is there any progress, and if so exactly how much? I am saying that, quite possibly, no one knows. And maybe this question deserves more thought than it’s getting in mainstream medicine.

  96. Simon says:

    Pec, I’m really sorry but one of us here is being very silly (it could easily be me, I’m horifically drunk at this moment)- I really do not understand your position. How exactly do you propose measuring progress unequivocally?

  97. Simon says:

    Pec, PalMD, qetzel, everybody- I’m sorry but reading the last few posts, including my own, I believe that we have exhausted this topic (which was tangential to begin with) and have resorted to tit-for-tat arguments where we will never satisfy the opposition however hard we may try. This is not a chatroom, it is the comments page of an interesting and insightful article about advertising a dietary supplement, an issue that we have barely discussed at all. If we want to continue this believer Vs. sceptic argument I am sure there is a another forum somewhere else in this internet to do so, but let us work to keep this blog on topic and relevant.

    Also, it is 2am and I need sleep. Let us stick to commenting on the issues raised in the article and not the issues that touch us personally- perhaps we could establish a forum for fans of this blog to continue personal arguments? Nonetheless, I feel that this topic is exhausted, so good night and let us look forward to another excting post tomorrow, with a whole new set of questions to answer. A bientot,
    Simon

  98. PalMD says:

    Agreed. Sorry for stealing the bandwidth.

  99. pec says:

    Right, of course, no one has an answer. No one knows if progress is being made in cancer treatment. Fortunes are being made though, that we do know. And maybe that’s all that really matters? That oncologists and cancer researchers have their jobs, and that drugs are being sold.

    And, of course, the patients are “cured” and the public is happy to know that cancer is not a death sentence any more. So what if it’s an illusion? At least it’s an illusion that makes people happy and rich. Let’s not mess with it.

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