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Once more into the screening breach: The New York Times did not kill your patient

One of the more depressing things about getting much more interested in the debate over how we should screen for common cancers, particularly breast and prostate cancer, is my increasing realization of just how little physicians themselves understand about the complexities involved in weighing the value of such tests. It’s become increasingly apparent to me that most physicians believe that early detection is always good and that it always saves lives, having little or no conception of lead time or length bias. Sadly, just last week, I saw another example of just this phenomenon in the form of an article written by Dr. George Lombardi entitled My Patient, Killed By The New York Times. The depth of Dr. Lombardi’s misunderstanding of screening tests permeates the entire article, which begins with his recounting a story about a patient of his, whose death he blames on The New York Times. After describing the funeral of this 73-year-old man who died of prostate cancer, Dr. Lombardi then makes an accusation:

This one filled me with a special discomfort as I knew a secret: He didn’t have to die. I knew it and he had known it. Had he told?

About 5 years ago he had just retired and had a lot more time on his hands. He was a careful man, lived alone, considered himself well informed. He got into the habit of clipping articles on medical issues and either mailing them to me or bringing them in. They came from a variety of sources and were on a variety of topics. He wasn’t trying to show me up. He was genuinely curious. I kidded him that maybe he’d like to go to medical school in his retirement. ‘No’ he laughed, ‘I just like to be in the know.’

When he came in for his physical in 2008 he told me he’d agree to the DRE but not the PSA (his medical sophistication extended to the use of acronyms: DRE stands for digital rectal exam where I feel the prostate with my gloved finger for any abnormality and PSA for prostatic [sic] specific antigen which is a blood protein unique to the prostate and often elevated in prostate cancer). He had read that the use of PSA as a screening test was controversial. This was the year that the United States Preventive Services Task Force, a government panel that issues screening guidelines, recommended against routine PSA screens for older men. It was often a false positive (the PSA was elevated but there was no cancer), led to unnecessary biopsies, and besides most prostate cancers at his age were indolent and didn’t need to be treated. I countered that prostate cancer was the second leading cause of cancer deaths in men and that it was better to know than not to know. This way it would be our decision. The patient with his doctor deciding what was best. But no, he wanted to stick to his guns and since the DRE was normal no PSA blood test was sent.

After describing a conversation with the man’s daughter, who said, “My father was killed by The New York Times,” Dr. Lombardi then goes on to anecdotal evidence and a cherry-picked publication to support his view, quoting an oncologist who says he’s “seeing more men presenting with advanced prostate cancer” and then referring to a single paper in the current Annals of Internal Medicine about PSA screening. Before I look at the article and a recently published paper on screening mammography that made the news, I can’t help but point out that I (mostly) agree with Dr. Lombardi when he says:

Public health doctors, policy experts and journalists tend to look at the population as a whole. It is a better story if it is one story. It makes a better headline. Their statistics are people I sit across from everyday trying to figure out what the future holds. We each have our job to do.

The problem is, of course, that Dr. Lombardi takes that observation and draws the wrong conclusion, namely that his patient died because of lack of screening. He attacks a straw man, sidestepping the true argument, namely that evidence shows that PSA screening probably causes more harm than good for men at average risk of prostate cancer. Unfortunately, Dr. Lombardi obviously does not understand some very basic concepts behind cancer screening, nor does he apparently recognize that doctors who deal with the population-level data that we have regarding screening tests and try to apply them to individual patients are actually looking in a very systematic way about what the benefits of screening are to the individual patient. More on that later. In the meantime, although I wouldn’t go quite as far as Dr. John Schumann did in criticizing Dr. Lombardi, I do view his lament as a jumping off point to look at some recent data on screening for the two most common cancers, breast and prostate.

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Posted in: Cancer, Politics and Regulation, Public Health, Science and the Media

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Burzynski: Cancer Is A Serious Business, Part 2: Like the first Burzynski movie, only more so?

Film producer Eric Merola seems to think that there is a conspiracy of skeptics (whom he calls The Skeptics) who are fanatically hell-bent on harassing his hero, Brave Maverick Doctor Stanislaw Burzynski. According to his latest film Burzynski: Cancer Is A Serious Business, Part 2 (henceforth referred to as Burzynski II, to distinguish it from part 1, to which I will refer as Burzynski I), there is a shadowy cabal of Skeptics out there just waiting to swoop down on any Burzynski supporter who has the temerity to Tweet support for him, any cancer patient being treated by Burzynski who Tweets or blogs about it, and any cancer patient even thinking about going to the Burzynski Clinic. I know this because he’s made it very clear in the promotional materials of his movie that that’s what he thinks and that skeptics were going to be the main target of his “film making” in his latest hagiography devoted to Stanislaw Burzynski. Very clear indeed. And, given how ham-fisted he was in his conspiracy mongering in Burzynski I, I’d be lying if I didn’t admit that I was at least a little concerned, because Merola made an explicit promise to “name names.” So were some other skeptics. After all, Merola isn’t exactly known for intellectual honesty (or even talent) in film making. We expected a heavy duty sliming, and curiosity (not to mention concern over our reputations) made us very—shall we say?—curious about what Merola was going to say about us.

So it was with great interest that I learned that Burzynski II was going to be screened at a film festival in San Luis Obispo last weekend. Its DVD release having been delayed from March 5 to July 1, I had thought that my curiosity about the contents of the movie would probably have to wait, and it will, at least as far as seeing the movie. A review of the movie suggested dark insinuations about Burzynski critics abounded, but that was not enough. Fortunately, a small posse of skeptics, lead by the intrepid Brian Thompson, made posthaste for San Luis Obispo. When the reports and copious handwritten notes in perfect encoded reptilian script came back, however, I was faced with a problem. How does one review or discuss a movie second-hand? How does one report on a movie that one hasn’t seen, about which one has to trust the powers of observation (and not to mention the note taking capabilities) of someone else, no matter how well briefed beforehand about what to look for? I decided that there was only one thing to do, and that’s just to go ahead and do it. I realize that there are likely huge swaths of information missing, but I definitely got a flavor of the movie from Brian’s detailed account plus discussions, and a definite idea of how it is going to be promoted from what was reported to have been said during the Q&A. Then I’ll discuss each of these points, thus inflating the rather thin observations I have from our Skeptics into a real post. Unfortunately, more detail from me will have to wait until the official release of the movie, or until such a time as Merola tries to bring the movie to somewhere in my neck of the woods. (Wouldn’t that be amusing?)

So here are the five things I learned (secondhand) from the Burzynski II screening, thanks to The Skeptics.
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Posted in: Cancer, Clinical Trials, Science and the Media

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Three myths about Stanislaw Burzynski and The Skeptics

As I finished last week’s post, I promised myself that I wouldn’t write about Stanislaw Burzynski again this week. After all, counting this post I will have done 13 posts so far in 2013, and, counting this one, four of them will have been about Burzynski, and three out of the last five posts (three out of four, really, if we eliminate my blatant self-promotion for the talk I gave to the National Capital Area Skeptics over the weekend). It’s the same sort of thing that I sometimes comment about over at my not-so-super-secret other blog when seemingly all my posts are about the antivaccine movement for days at a time. Still, as Michael Corleone said in The Godfather, Part III (admittedly the weakest of the Godfather movies), “Just when I thought I was out…they pull me back in.” Except, I guess, that I never really was out and, as long as Burzynski’s propagandist is coming after skeptics, myself included, I’ve come to the reluctant conclusion that I can’t be out for a long time.

Besides, with the first screening of the Burzynski sequel, Burzynski: Cancer Is Serious Business, Part II (which I’ll simply call Burzynski II, given Eric Merola’s penchant for long titles with multiple subtitles) at the San Luis Obispo International Film Festival yesterday, it looks as though I will find myself on the receiving end of what, from what I can gather, will be a withering and deceptive campaign of personal attack directed against myself and other skeptics who are critical of Burzynski’s treatments and methods. Like Josephine Jones, I can’t help but admit to feeling a little trepidation over this. Meanwhile, given that the Burzynski movie is now finding its way out into the wild, I thought it would be worthwhile to compare the myth-making about Burzynski in the movie with reality. There are so many myths being perpetuated by Merola and Burzynski, so I thought I’d take on three of the most flagrant ones. At some point, once I know the nature of the attacks against me, I will have to respond to specific allegations. Unfortunately, that might not be possible until after the DVD release in July. However, for now, I hope to make this post a resource that takes on the most blatant examples of exaggeration, cherry picking, and spin likely to be in the movie. Hopefully after that I can leave this topic alone for a while and explore more of the big wide world of science-based medicine and offenses against it.
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Posted in: Cancer, Science and the Media

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Dr. Stanislaw Burzynski’s cancer “success” stories update: Why is the release of the Burzynski sequel being delayed?

It’s no secret that I happen to be on several mailing lists of groups or doctors whose dedication to science is—shall we say?—questionable. Of course, the reason I join such mailing lists is to keep my finger on the pulse of pseudoscience, so to speak. Between such lists and strategically selected Google Alerts (the latter of which appear to be failing me these days), I’m usually aware of potential blogging material fast on selected topics that have become my bailiwick on this blog. So it was that I became aware on Saturday of a development regarding the movie about Stanislaw Burzynski that was going to be released direct to DVD this week.

I wrote about this “documentary” a couple of weeks ago, because it had become pretty clear that a significant part of the movie will be dedicated to a PR counterattack (more like a smear job) on skeptics who have been critical of Burzynski, criticism that apparently goaded him to use a rather unhinged individual by the name of Marc Stephens to threaten skeptical bloggers who had written posts critical of Burzynski’s science (more appropriately, his lack of science), and his proclivity for charging patients huge amounts of money to be in clinical trials, a practice that is in general considered at best questionable. The brouhaha in the blogosphere led me to pay attention to Burzynski in a way that I hadn’t before. Sure, I had heard of him, but I hadn’t really delved deeply into his claims. That situation was rectified in late 2011, as I reviewed the first propaganda movie made about Burzynski by Eric Merola, Burzynski The Movie: Cancer Is Serious Business. As I delved deeper, I learned that Burzynski’s evidence for the anticancer efficacy of his “antineoplaston therapy” doesn’t hold up; that his “personalized gene-targeted cancer therapy” is anything but personalized or gene-targeted; and that he’s using an orphan drug now in what appears to me to be a strategy to bypass restrictions on his use of antineoplastons that he agreed to in a consent agreement with the Texas Attorney General back in 1998 that allow him only to use these drugs as part of a valid clinical trial.

So I awaited the approach of this week with a mixture of anticipation and trepidation; anticipation because I wanted to see what sort of bizarre new conspiracy theories (or new twists on old conspiracy theories) that Merola could weave, and trepidation because I don’t know how badly Merola will trash me (and people I know) in his movie and such attacks could cause me difficulties. Suffice to say, it looked very much as though Merola was going to resurrect Jake Crosby’s scurrilous attacks against me from three years ago. So it was with great surprise that I read this e-mail on Saturday morning, sent to the Burzynski Movie mailing list:

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Posted in: Cancer, Clinical Trials, Science and the Media

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Kudos to a Journalist

Many SBM readers will remember the late, great Barry Beyerstein,  a luminary of the skeptical movement and author of a classic article that has been cited many times on SBM, an explanation of why bogus therapies seem to work.

One of his greatest personal accomplishments is not as well known: he produced an exceptional daughter, Lindsay Beyerstein, a freelance writer, philosopher, and polymath who stepped into her father’s shoes as a faculty member of the annual Skeptic’s Toolbox workshop after his death and has done a truly admirable job there.

Among Lindsay’s many other activities, she works for the Sidney Hillman Foundation, a nonprofit that honors excellence in socially conscious journalism. One of her goals has been to reward excellence in science journalism. Bob Ortega has just received a Sidney Award for his exposé of a widely used HPV (human papillomavirus) test that is not FDA approved and has an unacceptably high rate of false negative results. Her interview with him was published on the Hillman Foundation website.  On SBM, we frequently criticize journalists who get the science wrong. For a change, I’d like to congratulate Mr. Ortega for not only getting the science right, but for accomplishing something that could potentially save lives.

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Posted in: Cancer, Obstetrics & gynecology, Science and the Media

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Blame and magical thinking: The consequences of the autism “biomed” movement

That the myth that vaccines cause autism is indeed nothing more than a myth, a phantom, a delusion unsupported by science is no longer in doubt. In fact, it’s been many years now since it was last taken seriously by real scientists and physicians, as opposed to crank scientists and physicians, who are still selling the myth.  Thanks to them, and a dedicated cadre of antivaccine activists, the myth is like Jason Voorhees, Michael Myers, or Freddy Krueger at the end of one of their slasher flicks. The slasher or monster appears to be dead, but we know that he isn’t because we know that he’ll eventually return in another movie to kill and terrorize a new batch of unlucky and invariably not so bright teenagers. And he always does, eventually.

Unfortunately, the myth has a price, and autistic children pay it when they are unlucky enough to have parents who have latched on to this particular myth as an explanation for why their child is autistic. One price is blame. Parents who come to believe the myth that vaccines cause autism also express extreme guilt that they “did this” to their children, that it’s their fault that their children are autistic. At the same time, they have people and entities to blame: Paul Offit, big pharma, the FDA, the scientific community, pediatricians. As a result, the second price is paid: Their children are subjected to pure quackery, such as “stem cell” injections (which almost certainly aren’t actually stem cells, given the provenance of the clinics that offer such “therapies”) into their cerebrospinal fluid, and what in essence constitutes unethical human experimentation at the hands of “autism biomed” quacks. Meanwhile these same quacks reap the financial benefits of this belief by offering a cornucopia of treatments to “recover” autistic children that range from the ineffective and usually harmless (such as homeopathy) to the ineffective and downright dangerous (dubious “stem cell” injections by lumbar puncture into a child’s cerebrospinal fluid). These treatments drain the parents’ pocketbook and do nothing other than potential harm to the children. These prices are intertwined, and just last week I saw examples of both prices on full display at various antivaccine blogs. Worse, the concept appears to be metastasizing beyond vaccines. As more and more scientific evidence fails to find even a whiff of a hint of a correlation between vaccines and autism, the One True Cause of Autism, which was once vaccines or mercury in vaccines, has become the Many True Causes of Autism, in which vaccines (it’s always the vaccines) mix with pharmaceuticals, pollution, diet, and chemicals to produce autism in a manner that is a lot harder to falsify than the older, all too scientifically testable hypothesis that vaccines cause autism.
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Posted in: Health Fraud, Neuroscience/Mental Health, Science and the Media, Vaccines

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Dr. Stanislaw Burzynski’s cancer “success” stories

The year 2012 was rung out and the year 2013 will be rung in by news that Eric Merola, propagandist for “brave maverick doctor” Stanislaw Burzynski who claims to have developed a cancer treatment far superior to current conventional science- and evidence-based cancer treatments, is releasing releasing a sequel to his wildly successful documentary (in the “alternative cancer” underground, that is) Burzynski The Movie: Cancer Is Serious Business. In fact, the sequel is coming out on DVD on March 5, and you can even preorder it now. I somehow doubt that Eric Merola will send me a screener DVD to review, but I did review the first movie because it easily falls into a genre that I like to refer to as medical propaganda movies, which are almost always made in support of dubious medical treatments. My mostly lame jokes about proposed titles aside (e.g., Burzynski II: Electric Boogaloo, Burzynski II: This Time It’s Peer-Reviewed, or even Burzynski II: Quack Harder), it’s very clear that in the wake of the Texas Medical Board’s decision to drop its case against Burzynski on a technicality, Burzynski and his very own Leni Riefenstahl named Eric Merola are planning on a huge publicity blitz, in which Burzynski will be portrayed as, yes, a “brave maverick doctor” whom “They” (as in the FDA, drug companies, and the Texas Medical Board, a.k.a “The Man”) tried to keep down but failed because he has The Natural Cure For Cancer “They” Don’t Want You Sheeple To Know About.

I come back to this again because Merola’s strategy for Burzynski II, as I pointed out, is going to involve “conversion stories” of oncologists who didn’t believe in Burzynski’s magic antineoplastons but do now, attacks on skeptics who have been critical of his work (like me), and, of course, testimonials for success stories. I don’t know how I missed this before, but what exactly that will mean in practice is actually spelled out pretty well in an installment of a video blog by a Burzynski patient named Hannah Bradley. Bradley became famous for her battle against a malignant brain tumor, her decision to go to the Burzynski Clinic, and the prodigious fundraising efforts of her partner Pete Cohen through their Team Hannah website and vlog. In this vlog, recorded on September 7, 2012, Pete and Hannah are happy because in their previous vlog of July 27, 2012, they reported that, after having received Dr. Burzynski’s antineoplaston treatment Hannah has had a “complete response,” and indeed the MRI scans shown in their movie, Hannah’s Anecdote, do appear to show just that (more on that later).

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Posted in: Cancer, Clinical Trials, Science and the Media

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An open letter to Penn & Teller about their appearance on The Dr. Oz Show

An open letter to Penn & Teller about their appearance on <em>The Dr. Oz Show</em>
OzPT

 

Dear Penn & Teller,

I really don’t want to say this, but I feel obligated to. I’m afraid you screwed up. Big time. (Of course, if this weren’t a generally family-friendly blog, where we rarely go beyond PG-13 language, I’d use a term more like one that Penn would use to describe a massive fail, which, as you might guess, also starts with the letter “f”; I think he’d appreciate that.)

I’m referring, of course, to your appearance on The Dr. Oz Show one week ago (video: part 1, part 2, part 3, part 4). Before I begin the criticism, let me just take care of the obligatory but honest statement that I am a fan. I’ve been a fan for a long time. Indeed, I remember seeing you guys perform in Chicago back in the late 1990s when I was doing my fellowship at the University of Chicago. I’ve also seen you in Las Vegas a couple of times, most recently a couple of years ago (see pictures below) at TAM. The two of you have become skeptical icons, through your association with James Randi and over the last several years through your Showtime series Bullshit!, which is advertised with the tagline, “Sacred cows get slaughtered here.” And so they did for the eight seasons Bullshit! was on TV. When you guys were on, it was a thing of beauty to behold, both from the standpoint of entertainment and skepticism.
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Posted in: Faith Healing & Spirituality, Homeopathy, Public Health, Science and the Media

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Are You Ready For the Oz Manifesto

“Medicine is a very religious experience. I have my religion and you have yours. It becomes difficult for us to agree on what we think works, since so much of it is in the eye of the beholder. Data is rarely clean. You find the arguments that support your data, and it’s my fact versus your fact.”

- Mehmet Oz

The above quote is from a recent article for the New Yorker by Michael Specter about Dr. Oz, the most currently popular TV doctor. Specter described this sentiment as “chilling.” To me it sounds like a manifesto – a postmodernist attack on the scientific basic of modern medicine.

In my experience, this sentiment is often at the core of belief in so-called complementary and alternative medicine (CAM). In order to seem respectable and infiltrate the institutions of medical academia, proponents of CAM will say that their treatments are evidence-based and that they are scientific. They have a serious problem, however – their treatments are not evidence-based and are often grossly unscientific. Whenever someone bothers to look at their evidence and examine their science, therefore, they start to backtrack, eventually arriving at their true position, a postmodernist dismissal of science resembling Oz’s statement above. I have heard a hundred versions of the Oz manifesto from CAM supporters.

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Posted in: Homeopathy, Science and the Media

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One Flu Into the Cuckoo’s Nest*

“I don’t seem able to get it straight in my mind….”
― Ken Kesey, One Flew Over the Cuckoo’s Nest

Influenza is going gangbusters at the moment. I like going to Google Flu trends as well as the CDC flu site to see what flu is doing. Using Google searches as a surrogate for infections is an interesting technique that public health officials have tried with less success in other illnesses but is not without utility. Behaviors of populations can presage a problem, my favorite example is the first hint of the 1993 massive Cryptosporidia diarrhea outbreak in Milwaukee was a sudden shortage of Kaopectate and Peptobismol. It appears there are more patients with flu like symptoms this year than  at the height of the H1N1 epidemic of 2009. We have lots of flu like illness, and per the CDC there are buckets of confirmed influenzaflu, but so far the season, while probably having more cases than 2009, the outbreak is clinically not the same.

Compare and contrast, the two words that defined undergraduate liberal arts essay assignments. Get out your blue books and compare and contrast influenza outbreaks from 2009 and 2013. You have one hour. (more…)

Posted in: Clinical Trials, Epidemiology, Public Health, Science and Medicine, Science and the Media, Vaccines

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