Articles

Archive for Cancer

Another Misguided Cancer Testimonial

An economic analyst, Mike “Mish” Shedlock, wrote a blog post to describe how he beat prostate cancer. When laymen and patients write about cancer, they are likely to get some things wrong. Mish’s story is full of typical misunderstandings and misinterpretations.

He interpreted his experience in his own way and did his own research into the medical literature, something he was not qualified to do. Prostate cancer is a very complex subject, and understanding the implications of published studies for treating patients can be difficult even for experts. In typical Dunning-Kruger fashion, he rejected the advice of his doctors, thinking he could do better.
(more…)

Posted in: Cancer, Herbs & Supplements

Leave a Comment (118) →

An aboriginal girl dies of leukemia: Parental “rights” versus the right of a child to medical care

makayla-sault-v2

One topic that keeps recurring and obligating me to write about it consists of critically analyzing stories of children with cancer whose parents, either on their own or at the behest of their child, stop or refuse chemotherapy or other treatment. It is, sadly, a topic that I’ve been discussing for nearly a decade now, starting first on my not-so-super-secret other blog and continuing both there and here. Indeed, the first post I wrote about this problem was in November 2005, a fact that depressed me when I went back through the archives to find it because so little has changed since that time.

I was painfully reminded of this last week when stories started circulating in the media about the death of Makayla Sault, an Ojibwe girl and member of the New Credit First Nation in Ontario:

The entire community of New Credit is in mourning today, following the news of the passing of 11 year old Makayla Sault.

The child suffered a stroke on Sunday morning and was unable to recover. Friends and family from across the province travelled to New Credit First Nation today to offer condolences, share tears and pay their respects.

(more…)

Posted in: Cancer, Public Health, Religion, Science and the Media

Leave a Comment (78) →

Is cancer due mostly to “bad luck”?

One of the more difficult conversations to have with a patient as a cancer doctor occurs when a patient, recently informed of her diagnosis of, for example, breast cancer, asks me, “Why did I get this? What caused it?” What almost inevitably follows is an uncomfortable conversation in which explanations of the multiple known causes of breast cancer do not satisfy the patient. The reason, of course, is because when a patient asks, “What caused it?” she doesn’t mean what causes breast cancer in general or in statistical terms. Rather, she means, what caused my breast cancer? It’s a question that can only occasionally be answered. For instance, if it’s lung cancer and the patient is a smoker, then it was almost certainly smoking that caused the cancer, because lung cancer is a relatively rare cancer in the absence of smoking. In the case of breast cancer, contrary to the prevailing belief that leads women with breast cancer to be puzzled about how they could get it when there’s “no cancer” in their families, only around 5-10% of cases have a familial or genetic component. That means that around 90% of breast cancers are what we call “sporadic,” which means that we can’t identify a specific cause. Or, as I like to say, “We just don’t know.” Worse, in the case of breast cancer, the environmental factors we know about appear to contribute modestly at best to the risk of cancer. (More on this later.)

Understandably, patients hate hearing “We just don’t know,” some vague handwaving about genes, and that there is nothing that we know of that they did that caused their cancer. People—including oncologists—really don’t like the concept of “sporadic” cancer, mainly because humans crave explanation. The default assumption is that everything must happen for a reason and there must be a cause for every disease or cancer. Perhaps the most ridiculously emphatic statement of this that I’ve encountered thus far comes from (who else?) über-quack Mike Adams when he heaped contempt on the idea of sporadic disease as “spontaneous disease.” He did this in the context of a story describing how, after Dr. Mehmet Oz had followed recommended care and undergone screening colonoscopy to look for polyps, he was shocked that he actually had some. This led Adams, in his usual inimitable fashion, to construct a straw man so massive that it could be seen from space when he set it on fire, declaring that “colon polyps, in other words, appear without any cause!” and that “mainstream medicine…believes in the theory of ‘spontaneous disease’ that ‘strikes’ people at random.”

Not exactly.

On the other hand, there is a lot of randomness in disease, not just cancer, as hard as it is for Mike Adams, or anyone to accept. Just because there is a varying amount of randomness in who gets a disease does not mean that mainstream medicine claims there is no cause to these diseases. Rather, for diseases like cancer, it’s a stochastic process, meaning that chance can play a role—sometimes a big role—in determining who gets sick. Indeed, just last week there was more evidence supporting this idea published in Science. Unfortunately, much of the mainstream press coverage presented the message of the paper a bit too simplistically. Even more unfortunately, it was the authors who encouraged this, as did the Johns Hopkins University press release about the study, which was entitled “Bad Luck of Random Mutations Plays Predominant Role in Cancer, Study Shows“. Yes, I groaned when I read this title.
(more…)

Posted in: Basic Science, Cancer, Epidemiology, Science and the Media

Leave a Comment (445) →

Risks of CAM Treatments for Cancer

 From the US Food and Drug Association article "6 Tip-offs to Rip-offs: Don’t Fall for Health Fraud Scams

From the US Food and Drug Association article “6 Tip-offs to Rip-offs: Don’t Fall for Health Fraud Scams

“What’s the harm?” is an insidious idea when used as a justification for unscientific medical treatments. The argument is typically put forward with the assumption that direct physical harm is the only type of harm that can result from such treatments, so as long as they aren’t toxic there is no downside to trying them. Harm comes in many forms, however: delayed effective treatment, wasted time and energy, financial harm, the psychological harm of false hope, and the downstream effects of instilling unscientific beliefs regarding health care.

One other form of harm is physical but is not due to direct physical damage or toxicity. Rather, it is caused by CAM treatments interacting with proven therapies. A recent survey, presented at the Clinical Oncology Society of Australia annual scientific meeting, explored the potential for such interactions among oncology patients. Lead researcher Sally Brooks found that, in addition to vitamins and minerals, cancer patients were most interested in fish oil, turmeric, coenzyme Q10, milk thistle, green tea, ginger, lactobacillus, licorice, Astragalus and reishi mushrooms.

As I have written many times before, herbs are drugs, but many patients do not treat them as such because they are regulated and marketed as “supplements,” more like food than drugs. There are concerns that many vitamin and herbal products may interact with chemotherapy or radiation therapy in order to reduce effectiveness or even increase side effects. (more…)

Posted in: Cancer, Science and Medicine

Leave a Comment (100) →

The Central Dogma of Alternative Medicine

Steve still happens to be galavanting about Australia, spreading science, skepticism, and, of course, science-based medicine Down Under. Given that, he has been unable to produce new content for today. Never one to let such an opportunity pass, I decided to take advantage in order to do a little shameless self promotion.

A week and a half ago, I gave a talk at Skepticon 7 in Springfield, MO, entitled “The Central Dogma of Alternative Medicine”. It has now been posted on YouTube:

Because some of the sound didn’t come through as well as one might hope, I’m also including the full video of Kim Tinkham that I used early in the talk to illustrate a point. I only used about two minutes’ worth of it, but here is the whole thing, in case you’re interested:

Let me know what you think! And don’t forget to donate to Skepticon, to keep the skeptical goodness coming next year and beyond.

Posted in: Cancer, Religion, Science and Medicine

Leave a Comment (139) →

Selling “integrative oncology” as a monograph in JNCI

pancreatic-cancer-diagnostics-l

Sometimes, it’s hard not to get the feeling that my fellow bloggers at Science-Based Medicine and I are trying to hold back the tide in terms the infiltration of pseudoscience and quackery into conventional medicine, a term I like to refer to as quackademic medicine. In most cases, this infiltration occurs under the rubric of “complementary and alternative medicine” (CAM), which these days is increasingly referred to as “integrative medicine,” the better to banish any impression of inferior status implied by the name “CAM” and replace it with the implication of a happy, harmonious “integration” of the “best of both worlds.” (As I like to point out, analogies to another “best of both worlds” are hard to resist.) Of course, as my good buddy Mark Crislip has put it, the passionate protestations of CAM advocates otherwise notwithstanding, integrating cow pie with apple pie doesn’t make the cow pie better. Rather, it makes the apple pie worse.

In any case, over the last three months, Steve Novella and I published a solid commentary in Trends in Molecular Medicine decrying the testing in randomized clinical trials of, in essence, magic, while I managed to score a commentary in Nature Reviews Cancer criticizing “integrative oncology.” Pretty good, right? What do I see this month in the Journal of the National Cancer Institute (or JNCI, as we like to call it)? An entire monograph devoted to a the topic, “The Role of Integrative Oncology for Cancer Survivorship”, touting integrative oncology, of course. And where did I find out about this monograph? I found out about it from Josephine Briggs, the director of the National Center for Complementary and Alternative Medicine (NCCAM) herself, on the NCCAM blog in a post entitled “The Evidence Base for Integrative Approaches to Cancer Care“, in which she touts her perspective piece in the JNCI issue entitled “Building the Evidence Base for Integrative Approaches to Care of Cancer Survivors.” In an introductory article, Jun J. Mao and Lorenzo Cohen of the Department of Family Medicine and Community Health, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania and the University of Texas M.D. Anderson Cancer Center, respectively, line up this monograph thusly:
(more…)

Posted in: Cancer, Clinical Trials, Medical Academia

Leave a Comment (77) →

Recent Developments and Recurring Dilemmas in Cancer Screening: Colon, Lung, Thyroid

Cancer screening - lead time bias small

Screen detection and tumor growth rates. Cancers have different growth rates, which determine their potential to be detected by screening. Tumor A remains microscopic and undetectable by current technology (although more sensitive tests in the future might render it detectable). Tumor B eventually becomes detectable by screening (*), but its growth rate is so slow that it will not cause symptoms during the life of the individual; its detection will result in overdiagnosis. Tumor C is capable of metastasizing, but it grows slowly enough that it can be detected by screening (*); for some, this early detection will result in survival. Tumor D grows very quickly and therefore is usually not detected by screening. This will present as an interval cancer (i.e. detected clinically in the interval between screening examinations) and has a particularly poor prognosis. Note that of the four tumor types, only Tumor C has the potential to benefit from screening. Red dashed lines represent the natural history of a tumor in the absence of detection by screening. (Figure 1 from Gates, 2014).

A new stool DNA test was recently approved by the FDA for colon cancer screening. My first reaction was “Yay! I hope it’s good enough to replace all those unpleasant, expensive screening colonoscopies.” But of course, things are never that simple. I wanted to explain the new test for our readers; but before I could start writing, some other issues in cancer screening barged in and demanded to be included. They exemplify the dilemmas we face with every screening test. We have covered these issues before, but mainly in reference to mammography and prostate (PSA) screening. My article morphed into a CLT sandwich: colon, lung, and thyroid cancer screening.

The current issue of American Family Physician has a great article on cancer screening. It uses lucid graphics to illustrate lead time bias, length time bias, and overdiagnosis bias, as well the effect of varying tumor growth rates on screening success rates, all concepts that have been covered by Dr. Gorski here. Briefly, screening may do more harm than good if:

  1. It detects cancerous cells that never would have developed into invasive cancers or harmed the patient in any way;
  2. Early diagnosis and treatment decrease quality of life without reducing death rates; or
  3. The test falsely indicates cancer in patients who don’t have it or fails to indicate cancer in some who do. (more…)

Posted in: Cancer, Diagnostic tests & procedures

Leave a Comment (517) →

Ontario fails to protect the life of a First Nations girl with cancer

First Nations

A few weeks ago, Steve Novella invited me on his podcast, The Skeptics’ Guide to the Universe, to discuss a cancer case that has been in the news for several months now. The case was about an 11-year-old girl with leukemia who is a member of Canada’s largest aboriginal community. Steve wrote about this case nearly a month ago. Basically, the girl’s parents are fighting for the right to use “natural healing” on their daughter after they had stopped her chemotherapy in August because of side effects. It is a profoundly disturbing case, just as all the other cases I’ve discussed in which children’s lives are sacrificed at the altar of belief in alternative medicine, but this one has a twist that I don’t recall having dealt with before: The girl’s status as part of the First Nations. Sadly, on Friday, Ontario Court Justice Gethin Edward has ruled that the parents can let their daughter die.

The First Nations consist of various Aboriginal peoples in Canada who are neither Inuit nor Métis. There are currently more than 630 recognized First Nations governments or bands in Canada, half of which are located in Ontario and British Columbia. This girl lives in Ontario, which is basically just next door to Detroit, just across the Detroit River. Unlike previous cases of minors who refuse chemotherapy or whose parents refuse chemotherapy for them that I’ve discussed, such as Sarah Hershberger, an Amish girl whose parents were taken to court by authorities in Medina County, Ohio at the behest of Akron General Hospital, where she had been treated because they stopped her chemotherapy for lymphoblastic lymphoma in favor of “natural healing,” or Daniel Hauser, a 13-year-old boy from Minnesota with Hodgkin’s lymphoma whose parents, in particular his mother, refused chemotherapy after starting his chemotherapy and suffering side effects, there’s very little information about this girl because of Canadian privacy laws. I do not know her name. I do not know anything about her case except that she has acute lymphoblastic leukemia, that she started treatment but her parents withdrew her because of side effects.
(more…)

Posted in: Cancer, Faith Healing & Spirituality, Politics and Regulation, Religion

Leave a Comment (177) →

Eminent Harvard psychologist, mother of positive psychology, New Age quack?

Eminent Harvard psychologist, mother of positive psychology, New Age quack?

Be less curious about people and more curious about ideas.
– Marie Curie’s advice to journalists

langer cbs this

Harvard psychologist Ellen Langer was on CBS This Morning News explaining plans for a psychosocial intervention study with women with Stage IV metastatic breast cancer. The project would attempt to shrink women’s tumors by shifting their mental perspective back to before they were diagnosed.
Seeing her on TV unsettled me because I had just supplied a journalist with quotes for his article in the New York Times about Langer. I hadn’t been following her recently. Instead I focused on her now-famous study from the 70s. Langer had claimed that giving nursing home residents a plant for which they were responsible cut their mortality by half (the nursing home residents, not the plant), compared to residents whose plants were attended by staff. The paper continues to get uncritical coverage in the media and in introductory psychology texts.

I looked up the Timesarticle after seeing CBS This Morning News, and it accurately quoted me:
(more…)

Posted in: Cancer, Clinical Trials, Medical Ethics

Leave a Comment (64) →

Blaming breast cancer on autism

From the Wikimedia Commons, originally posted by Flickr user Alex E. Proimos (link)

From the Wikimedia Commons, originally posted by Flickr user Alex E. Proimos (link)

Gayle DeLong has been diagnosed with what she refers to as “autism-induced breast cancer”. She’s even given it an abbreviation, AIBC. Unfortunately, as you might be able to tell by the name she’s given her breast cancer, she is also showing signs of falling into the same errors in thinking with respect to her breast cancer as she clearly has with respect to autism. As a breast cancer surgeon, regardless of my personal opinion of DeLong’s anti-vaccine beliefs, I can only hope that she comes to her senses and undergoes science-based treatment, but I fear she will not, as you will see. Her brief post announcing her diagnosis and blaming it on autism, however, does provide what I like to call a “teachable moment” about cancer.

We’ve met DeLong before on this blog. For instance, she published an execrably bad study that—of course!—tried to link vaccine to autism and failed miserably, despite doing some amazing contortions of analysis, combining diagnoses willy-nilly, all in the service of the discredited vaccine-autism hypothesis. As I said at the time, it just goes to show that someone who is an associate professor of economics and finance shouldn’t be doing epidemiological research. As I also described at the time, if the sorts of analytical techniques she used in her study are acceptable in the world of economics and finance, no wonder our economy has been so screwed up for so long. Another time, DeLong wrote a broadside against the regulatory machinery that oversees vaccine development and safety that was full of the usual antivaccine misinformation, tropes, and pseudoscience and hugely exaggerated perceived “conflicts of interest” among the various parties.
(more…)

Posted in: Cancer, Neuroscience/Mental Health, Vaccines

Leave a Comment (22) →
Page 1 of 24 12345...»