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612 thoughts on “Death by “alternative” medicine: Who’s to blame?

  1. RickK101 says:

    pec,

    You state: “My point is that we should be more afraid of cancer, not less. If someone gets a real case of it there is not much hope. Most Americans are blissfully unaware of this, and think the medical industry has come up with cures (or whatever you want to call a successful outcome).”

    This is an absurd statement. Without exception, my friends and family fear the word “cancer”. I’ve never heard ANYONE (before you) suggest that medical science had beaten cancer, or that malignant cancer was anything other than a dance with death.

    And if this is your point, then your earlier statements make no sense. You’ve been pressing us to admit that some cancers go away on their own. That’s certainly not going to increase people’s fear of cancer.

    You’ve insulted us by saying we don’t get it and that we’re uneducated.

    You’ve ignored the words in the article and repeated comments saying that the 93% applies to the palpable, malignant cancer in this case. Because of the size of this cancer and because it is proven malignant (and has killed or will kill the patient), lead-time bias and over-diagnosis are irrelevant.

    You’ve played fast and loose with the term “early cancer”, apparently applying a definition that doesn’t have meaning in this case.

    And you’ve repeatedly refused to offer any alternatives to the course of action the patient’s doctors took.

    The only conclusion I can draw is that you’re deliberately trying to cast doubt and confusion into this discussion, and to lessen the impact of this story for the next woman who faces this terrible disease.

    Why are you doing this?

  2. RickK101 says:

    Peter Hansen said: “A tragedy. The good that may come from such a horrible case is the feeling amongst physicians and the public that “there ought to be a law..” It is lucky that the surgeon had a chance to see the outcome: most of the time they don’t. The oncologist doesn’t either. Folks like me get to. We in primary care see this more and more, but none so tragic. ”

    Agree completely. If I had a loved one who had a similar diagnosis and was considering false therapies over real medicine, when all gentle arguments had failed, I’d want her oncologist to pull this case, pictures and all, out of a drawer and present it in full glory.

  3. pec says:

    “What do you mean by a “real” case of cancer?”

    Obviously the example you gave was a real case. A real case is when the cancer cells make the person sick.

    But many diagnosed cases of cancer, especially when found early, are not “real,” because they never would have progressed. Yet these are treated and counted as successful.

    I am not saying you should not treat early cases that might never have progressed. I don’t know. It depends on how well your treatments typically work. And that is something we don’t know.

    Palliative treatments are another story. If you can make a dying patient feel better I have no criticism of that.

    But I am trying to get at the reality, which no one here seems to care about.

    You have to compare cancer mortality relative to the general population (not relative to diagnosed cases). If mortality (relative to the population) has decreased for a certain type of cancer, then you have to consider if it might be because of treatments, or something else. For example, if lung cancer decreased over a certain period that could be because of a decrease in cigarette smoking, rather than better treatments.

    Has mortality from breast cancer (relative to the population, not diagnosed cases) decreased over the past 30 years? By how much?

    You still have to interpret the data carefully. If mortality from a certain type of cancer decreased it could be because some other cause of mortality has increased, and some patients who might have died from one are now more likely to die from the other.

    There is no simple way to answer this question.

    But I am pretty certain that your 93% success rate is misleading and wrong.

  4. David Gorski says:

    But I am pretty certain that your 93% success rate is misleading and wrong.

    Be as “pretty certain” as you like based on no data that you can cite. It’s not “misleading” or “wrong” for a 1 cm stage I breast cancer.

    You’re quite good at providing a thin veneer of seeming to understand what you’re talking about, but that’s all it is, a veneer. It doesn’t take much to tell that your “understanding” of the concepts of lead time bias, length bias, cancer staging, and cancer biology, such as they are, are a mile wide and a micrometer deep, not to mention distorted by some very peculiar ideas about “conventional” and “alternative” medicine.

    I and others have patiently tried to educate you regarding these concepts, but you appear to be uneducable. You don’t show any evidence of actually having understood (or even read or looked at) sources cited in answer to your questions.

  5. Fifi says:

    pec – I’m still curious as to what benefit you feel there is to making people more afraid of cancer? And what you feel should have been done in the case in this thread?

    In another thread you insisted that doctors should withhold medication as a means to force/blackmail patients to conform to a healthier lifestyle. (If you don’t remember, it was in the thread where you blamed doctors for the fact that your mother didn’t exercise or eat healthily, and is on medication for emotional issues, and as the reason why you feel burdened with caring for her.) Since you advocate blackmail and the use of force regarding lifestyle changes, what do you advocate when someone refuses cancer treatment?

  6. Fifi says:

    pec – It should also be noted that though you have refrained from promoting CAM in this thread (not surprisingly considering the topic!) you consistently promote the concepts promoted by chiropractors and other “energy healers” (using terminology specific to chiropractors but denying familiarity with chiropractic!).

    I find it odd that you subscribe to the concepts of chiropractic and are apparently – subtly and not so subtly – promoting a chiropractic perspective on cancer in this thread. (I did a little google about chiropractic and cancer and your arguments and information seem lifted wholesale from quite a few sites.)

  7. RickK101 says:

    Pec

    Pec said: “But I am trying to get at the reality, which no one here seems to care about.”

    Please stop statements like that – a whole community here is trying to understand you and is giving you a fair hearing. Because we disagree with you doesn’t mean we don’t care or don’t understand.

    The reality is that the odds are 93% chance of 5-year survival from that point in the cancer (positive biopsy, 1 cm, no evidence of spread) given the recommended treatments.

    You want to know (and want medical science to present) what her survival odds would be without surgery, radiation and chemo. And people here are telling you (and would tell the patient) that they are significantly lower. The historical data and indeed this case itself provide data to support this.

    If you want proof and are willing to read and understand it, I’m sure the doctors in this blog can point you to the research supporting each of the treatments. But we will never see a clinical trial where all care is withheld from a set of patients with palpable malignancies just to see how many MIGHT survive.

    Pec said: “You have to compare cancer mortality relative to the general population (not relative to diagnosed cases). ”

    What possible relevance does this have to this case? This woman’s cancer WAS diagnosed, and the 93% refers to a diagnosed case at this stage of development. I would imagine she couldn’t possibly care less about the rates compared to the general public.

    Pec, there is no evidence in any of your arguments that the patient’s doctors misled her in any way, or that Dr. Gorski’s blog is misleading.

  8. qetzal says:

    pec,

    Why are you talking about breast cancer mortality rates? They are irrelevant to the 93% figure Dr. Gorski cited.

    The overall mortality rate from breast cancer is something completely different from the long-term survival rate in patients already diagnosed with breast cancer.

  9. pec says:

    Shut up Fifi, you have no brain.

  10. weing says:

    Fifi,
    Apparently you struck a nerve. Good work. I never thought her ideas represented a chiropractic perspective. No wonder it doesn’t make sense.

  11. pec says:

    If breast cancer treatments were improving over the past 30 years or so, we would expect a declining mortality rate during that time.

    The mortality rate per incidence has probably declined a lot — because of improved screening and earlier diagnosis. If incidence seems to rise but mortality stays constant, the cure rate seems to rise. That’s an illusion.

    You have to look at the mortality rate relative to the general population. Do you see breast cancer mortality declining very much?

    http://www.cbcrp.org/publications/papers/Mayer/page_08.php

    I haven’t seen that so far, but maybe someone here knows better.

    I see that some of the readers of this blog are incapable of understanding anything at all about research. But I suspect that Dr. Gorski might have some idea what I am saying. He just refuses to get my point, although it should not be so terribly difficult.

    Just show me that breast cancer mortality in the US has been declining to a significant degree. If not, then explain why.

    I am still searching.

  12. Harriet Hall says:

    pec wrote,

    “Shut up Fifi, you have no brain.”

    Speak for yourself, pec. Couldn’t your brain come up with any response but a personal insult? He who first resorts to ad hominems has lost the debate.

    Since pec thinks saying “shut up” is acceptable, I wish I could tell her to shut up, but I’m too polite.

  13. pec says:

    Of course it is possible that treatments are improving even if mortality rates are not decreasing. For example, if heart disease mortality is decreasing then people who might have died from heart disease but didn’t might later die from cancer. Just an example. Or cancer incidence, and death, might increase as the population ages. Or environmental toxins might contribute.

    There are many factors involved. But I am asking for data showing that the treatments work and have been improving.

  14. Harriet Hall says:

    pec said,

    “Just show me that breast cancer mortality in the US has been declining to a significant degree”

    We did that before. Once is enough. Why do you refuse to listen?

  15. Harriet Hall says:

    Criminy, pec, can’t you even cite something that supports your point? That link starts out: “In the United States as a whole, breast cancer mortality rates have declined somewhat in recent years.”

  16. Fifi says:

    Perhaps I hit a subluxation and released some of pec’s toxic thoughts and feelings? Who knows, maybe I’m saving her from breast cancer as we speak by helping her to release her toxic, unloving emotions around her mother and being a caretaker?

  17. pec says:

    I am insulting Fifi because he/she/it is nasty beyond belief. References to my mother are beyond what is reasonable or acceptable, even at an atheist/materialist blog. Fifi, would you like me to make nasty comments about your mother? If you want to start an insult contest I’m sure I will win, since you are not only nasty and cruel but an ignorant moron.

  18. pec says:

    Maybe you should read past the first sentence Harriet.

    “during the twenty years from 1970–1990, death rates showed a small but significant increase for white women of about 0.3 percent per year”

  19. pec says:

    And anyway, as I have been trying to explain, most of these reports are hard to interpret. When they say “death rates” it isn’t always clear what they mean. And a lot of the reports ignore over-diagnosis and lead-time bias, etc.

  20. Fifi says:

    pec – I am only sharing what you yourself have already said yourself previously about your feelings about mother and doctors. Your mother is quite probably a lovely woman, even if you find it frustrating that she relies upon doctors for her medical needs and didn’t choose a lifestyle you approve of. Depression is nothing to be ashamed of and I certainly don’t look down on someone simply because they need some help coping. So, I’m not commenting on your mother who I don’t know but upon you and what you’ve expressed regarding your relationship with your mother and the beliefs you’ve expressed regarding cancer. It seemed quite relevant since you previously expressed a belief that emotional issues regarding mothers and mothering were a cause of breast cancer.

    Feel free to make up insults about my mother, she is a doctor after all so you constantly insult her by extension in your posts here anyway.

  21. Harriet Hall says:

    pec said,

    “Maybe you should read past the first sentence Harriet. “during the twenty years from 1970–1990, death rates showed a small but significant increase for white women of about 0.3 percent per year”

    Maybe you should read past the second sentence, pec:

    “During the 1990s, however, mortality rates fell in white women by 2.5 percent a year, while they declined more slowly in black women, at a rate of 1.0 percent. The decline in mortality has largely been attributed to broader screening leading to earlier stage at diagnosis, so it is understandable that access to and utilization of screening and treatment has been hypothesized as the major reason for these disparities in mortality. However, as we will see, the data on changes in incidence and mortality suggest that changes in treatment, not early detection, may play a more important role in explaining the recent decline in mortality.”

    That sounds to me like it refutes your claim rather than supporting it.

  22. Fifi says:

    pec – Your beliefs about the causes and treatments for breast cancer are, of course, very relevant to this discussion. Particularly since the case being discussed in this thread involved someone seeking “alternative” treatment to EBM with predictably dire results. You’ve yet to explain why you’d want people to be more afraid of cancer? And why you’d want to create further fear about EBM?

    Since you only question EBM and are never skeptical of “alternatives”, your ongoing attempts to misrepresent evidence is cynical not skeptical. This means you’re not seeking “reality” but actually wishfully attempting to create an “alternative” reality (or at least the illusion of one, a pseudo-reality to accompany the pseudoscience of subluxations).

  23. Harriet Hall says:

    pec said,

    “And anyway, as I have been trying to explain, most of these reports are hard to interpret.”

    Maybe for you, but not for some of us; certainly not for Dr. Gorski.

    “When they say “death rates” it isn’t always clear what they mean. ”

    It may not always be clear from secondary sources what “death rates” mean, but they are always carefully defined in the primary sources.

    “And a lot of the reports ignore over-diagnosis and lead-time bias, etc”

    Dr. Gorski understands more about over-diagnosis and lead-time bias than you or I ever will, and he has written about those factors on this blog. He takes all those pitfalls into consideration before he reaches a conclusion. He has read everything worth reading in the literature on the subject. He is a breast cancer surgeon and researcher, and this is his particular field of interest and expertise. He is not just blindly quoting someone’s numbers; he is offering a critically thought-out interpretation of the best available evidence.

    If that’s not good enough for you, I guess nothing could ever be.

  24. Fifi says:

    There’s also a study that indicates that one contributing factor in delaying treatment and mortality for black women with breast cancer is a belief that chiro is a treatment for cancer (along with predictable socio-economic factors).

    http://jama.ama-assn.org/cgi/content/abstract/279/22/1801

  25. pec says:

    Well Harriet I guess I will just have to stop thinking and accept everything Dr. Gorski says on the subject. Who am I to express any skepticism when we have here such an infallible all-knowing expert? Let is remember to always defer to the experts and the authorities. Even if they imply that 93% of cancers can be successfully treated now, thanks to all-knowing and almost godlike doctors and our infallible materialist medical science and all the kind and wonderful drug companies. How could we live for a minute longer without them? In fact, I recommend that MDs such as Dr. Gorski start ruling the world. Maybe they could start a Church of the All-Knowing and Infallible.

    Why think when we have Gorski and others like him. Let us always defer to their greatness. Amen.

  26. pec says:

    And don’t worry about getting cancer. The wonderful mainstream treatments work 93% of the time! Do not doubt that figure for one second. Do not dare doubt anything proclaimed by the great, the infallible, Dr. Gorski.

    Thank you Harriet for setting me straight. I thought Dr. Gorski was human. Oh how could I ever have thought such a thing?

  27. Fifi says:

    pec – No one is suggesting Dr Gorski is god as far as I can see, it’s just being pointed out why he’s considered an expert (due experience, training, ability to understand those studies or articles you find so confusing, etc). Does recognizing someone else’s expertise in an area that you’re not an expert in feel like supplicating yourself to a god to you? Is your ego so bound up in your beliefs that it feels like complete surrender of body and soul to admit that an idea you hold is misguided? Or is this really all about religion for you and you see EBM and science as a threat to your faith?

    Once again, though you keep claiming skepticism, you’re actually expressing cynicism. (Your assertions are based upon no evidence and you continue to hold tightly to cynicism DESPITE the evidence you’ve admitted you don’t know how to interpret and find confusing – this makes you quite distinctly not a skeptic or your assertions skeptical in nature. It does make them cynical and predicated upon a strongly held belief that is apparently impervious to evidence and reason).

    There’s no point in worrying about getting cancer – or being terrified of getting cancer for that matter – since that does nothing to prevent or treat cancer. One should simply take the practical preventative steps (eat well, exercise, don’t smoke or whatever health/debauchery trade off one chooses, etc), be aware of family history and take the appropriate actions, and get on with living and enjoying life (something which being chronically fearful tends to inhibit). If there’s no afterlife then this is the only one you get, so you might as well enjoy it as much as you can. If one gets diagnosed with cancer, then it’s about being able to make an informed choice about treatment options and being thankful for the friends and family who love you and support your through the process of healing (or if the cancer is fatal, dying).

    Once again, what good do you think promoting fear of both cancer and EBM does? And how do you balance that action with the idea that you hold that negative and unloving thoughts cause cancer?

  28. Fifi says:

    As noted before, the 93% figure was in relationship to the particular type of breast cancer being discussed in the case presented here (once again you’re misrepresenting things to create hyperbolic assertions). Why do you keep trying to pretend 93% applies to all cancer? And why does it bother you so much that women may be less afraid of some forms of breast cancer because the survival rate has risen? I though you were advocating for reality and being realistic? Doesn’t your advocating fear of breast cancer conflict with your beliefs that women should be sending loving messages and feelings to their breasts to prevent cancer? Aren’t you now, according to your own beliefs, attempting to sow the energy seeds of cancer in women’s breasts by trying to make them afraid of breast cancer and that their breasts will kill them?

  29. Zetetic says:

    Does pec have anything meaningful to do with her/his life?

    My wife is a retired military officer and she devotes 40-50 hrs a week to charitable and public benefit causes.

    “GET A LIFE!!!!!!!!!!!!!”

  30. Hermano says:

    Bravo, pec.
    Hang in there.

  31. Harriet Hall says:

    pec sais, “Well Harriet I guess I will just have to stop thinking and accept everything Dr. Gorski says on the subject.”

    No, pec, you will have to think even harder to understand what Dr. Gorski says and why he says it and then present credible evidence to show us why you think he got it wrong.

  32. weing says:

    pec,
    So you are pissed off because sCAM treatments have a 0% cure rate for cancers. This bothers you to no end, as it’s not fair. Therefore those damned EBM practitioners just have to be wrong. You will show them. You will not go down without a fight. Materialism and atheism just has to be wrong because… it’s just so wrong.

  33. qetzal says:

    There are many factors involved. But I am asking for data showing that the treatments work and have been improving.

    Yes, you are. Over and over and over again.

    And you’ve been given such data over and over and over again. It’s clear that you can’t understand it, and wouldn’t accept it even if you could.

    I see that some of the readers of this blog are incapable of understanding anything at all about research.

    Well, one certainly is.

  34. HCN says:

    pec said “Well Harriet I guess I will just have to stop thinking and accept everything Dr. Gorski says on the subject. …”

    Immediately followed by: “And don’t worry about getting cancer. The wonderful mainstream treatments work 93% of the time!”

    You are not thinking very well if you believe that is for all types of cancer. It was noted that statistic was for a very specific size, type and stage of breast cancer. Actually, you were told that multiple times.

    But somehow, you cannot get it to your head that there is an improvement in breast cancer survival over the last 30 years.

    Also, you seem to have forgotten that the woman’s chances for survival declined substantially in the three years of other kinds of treatments. Can you honestly sit there and tell how great and wonderful non-mainstream medicine is without any evidence presented other than this woman’s story?

    What are the long term survival rates for Gerson’s treatment? What are they for Hoxley’s method? Where are those numbers? Tell us why that woman was better off going to those folks than the oncologist.

    Also, a small sidestep in the “real cause of cancer”… which one? The one that includes being born with the BRCA1 or BRCA2 gene? Or the one that includes having been infected with hepatitis B or human papillomavirus microbes? Or the ones that involved ingesting tobacco for years? Or, and this actually happened to someone I know — she got a minor mouth cancer which she thought was from her habit of constantly sucking on a mint. Or the cancers that hit children who have not done much more than just live a couple of years, like leukemia? Or the ones from being exposed to radon?

  35. Hermano says:

    weing ridicules pec and says “Materialism and atheism just has to be wrong because… it’s just so wrong.”
    The problem with materialism and atheism is its being so “right”.
    If I remember correctly “scientific” materialism and atheism amounted to something like state religion in the Soviet Union.
    Still having fun conducting show trials and purges, Comrades?

  36. weing says:

    Hermano,
    She’s the one who considers us materialists and atheists. That is her ad hominem label for us, not ours. Now you want to call us commies? That’s ad hominem not ad Hahnemann.

  37. RickK101 says:

    Pec cites articles that refute his/her own assertions, and both he/she and Hermano insult us.

    There is a difference between argument and debate. Pec and Hermano are here to argue and are avoiding any real debate, and pec is clearly here to obfuscate the discussion and confuse anyone reading the followup to Dr. Gorski’s sobering and informative blog posting.

    If someone is reading this to help with their own difficult decisions, please don’t let pec influence you any more than you would let the guy on the street corner with the tinfoil wrapped around his head influence you with his leaflets. If you have cancer, don’t let people like Pec succeed in their mission to shorten your life to promote their own confused agendas.

  38. Hermano says:

    Rick0,
    You have a nice science based medical AND argument clinic here.
    Which reminds me http://youtube.com/watch?v=uLlv_aZjHXc

  39. HCN says:

    weing said “She’s the one who considers us materialists and atheists. That is her ad hominem label for us, not ours. Now you want to call us commies?”

    I’d love to see her call Michael Shermer that! (note: he is very libertarian)

  40. Hermano says:

    hydrogen cyanide,

    Which authority figure are you kowtowing to now?

  41. HCN says:

    Well, definitely not you!

    Why do you care?

    Oh, and communism and libertarianism are economic ideas.

    The system that the Panama Canal Zone was run under would have been considered “communism” because everything was owned by and run by the Panama Canal Company (from its beginning to about 1990). If one needed a light bulb changed in your housing quarters, you called the PanCan maintenance for that service (see stories here: http://www.czbrats.com/Menus/Story_Menu.htm ). The Panama Canal Company was actually part of the US Army Corps of Engineers. So that means that the entire Canal Zone, from the civilians operating under the umbrella of the Panama Canal Company, and the military personnel on the multiple military bases (like Ft. Kobbe, Ft. Sherman, Howard Air Force Base, Ft. Amador, Ft. Clayton and others) were operated under a communistic system administered by the Pentagon in the USA!

    Basically, they have nothing to do with science.

    Now, answer my question!

    What are the numbers, statistics and data for the survival rate of cancer for Gerson, Hoxley, Reiki and the other “alternative” methods used by the woman that Dr. Gorski wrote about?

  42. pec says:

    “the evidence you’ve admitted you don’t know how to interpret and find confusing”

    Shut up Fifi, you’re a moron. The evidence is confusing to EVERYONE, including the great Gorski. You steadfastly miss every single point and you are incapable of anything resembling rational thought. I am not reading or answering any more of your comments.

  43. pec says:

    “Once again, what good do you think promoting fear of both cancer and EBM does? And how do you balance that action with the idea that you hold that negative and unloving thoughts cause cancer?”

    Oh I couldn’t resist. You’re such a dope. I have been trying to make a point about statistics. I don’t hold any idea about unloving thoughts causing cancer. And I don’t promote fear of cancer and EBM.

    You are incredibly stupid.

  44. pec says:

    “you will have to think even harder to understand what Dr. Gorski says”

    He has not said anything that explains how he “knows” the success rates of his treatments. He won’t even admit it’s a hard problem with no simple answers.

  45. pec says:

    “you cannot get it to your head that there is an improvement in breast cancer survival over the last 30 years.”

    No I can’t get that into my head because it is bs. They can’t do experiments to show treatment vs no treatment, so inferences are made based on data which is influenced by many variables. If you compare breast cancer mortality relative to all cause mortality, or relative to the population, or relative to incidence, you get different answers.

    I explained a lot of that before. A complete waste of time because no one here wants to question the medical science they adore so passionately.

  46. spurge says:

    Wow pec.

    The amount of projection you do is astounding.

    It is not surprising you have fallen back on name calling.

    You should be ignored.

    You bring nothing and learn nothing.

  47. Skip says:

    Pec scares me.

    How can science based medicine even hope to help people who are true believers when we cannot even convey to true believers a basic understand of statistics and physiology?

  48. weing says:

    Skip,
    In order to understand statistics and physiology you have to want to learn them. Then you have to make the effort. If you don’t want to learn them, you will not make the effort. Those are the blind that will not see. Notice also how convinced pec is of her beliefs. I wonder if it’s ever been tested how conviction correlates with knowledge? I recall reading somewhere that it doesn’t. I wonder if there is an inverse relationship.

  49. Joe says:

    Someone I know likes to say “If you can’t understand; maybe it’s you:”
    http://www.apa.org/journals/features/psp7761121.pdf
    The article is titled Unskilled and Unaware of It: How Difficulties in Recognizing One’s Own Incompetence Lead to Inflated Self-Assessments

  50. Fifi says:

    I find it quite amusing that pec is accusing people who advocate for EBM of being uncritical of medicine (not the alternative to medicine but medicine itself).

    Firstly because the statistics she’s having a hard time understanding (and keeps randomly and inappropriately attributing) are all generated by EBM and she only knows about them because Dr Gorski brought them up for discussion.

    Secondly, this blog’s archives (and yesterday’s post about heart scans) are full of critiques of practices in medicine that aren’t evidence based. There are also plenty of critical posts by people who advocate EBM – granted they’re usually discussions about evidence and ideas, not hysterical posts calling people “stupid doodyheads” (but when one lacks evidence or a coherent idea, I guess this is the best that can be done).

    One thing pec seems to fail to understand when she tries to cast EBM as a religion and doctors as priests, is that because EBM isn’t based on faith, it’s not destroyed by being criticized. It is, in fact, strengthened and improved.

    And, I’m curious what being an atheist has to do with any of this…unless, of course, pec is advocating a religious perspective based on faith and faith healing? Pec and others are, of course, free to refuse treatment with EBM (as some religious organizations and many cults require of adherents – and as was the case with the woman in the case discussed in this blog who put her faith in energy healers). I don’t take issue with people making personal choices about their health (sad thought it may be) or how they live their life – what I take issue with is people being scammed when they’re sick and vulnerable (by anyone).

    I take issue with is people who try to pretend their faith is science or evidence based, fear mongering about cancer and EBM while promoting energy medicine (particularly in light of the story above), and attempts to spread pseudoscience as a means to dress up faith as science.

  51. nwtk2007 says:

    This EBM movement is, of course , driven by insurance companies trying to get out of paying for what they agree to pay for.

    This trend has been increasing in the past ten or twelve years and the only thing I can see is that it prevents injured people from getting the care they need. (One factor that also drives people to the Alt provider)

    In the workers comp arena, for example, “treatment guidelines” are generated, which are “apparently” based upon “evidence”. They continue to reduce recommended treatment for everyhting and are used as “law” by insurnace companies to deny payment for services. In Texas, it is EBM that has driven so many doctors, MD’s, DO’dsand DC’s out of the system, leaving injured workers unable to provide for their families and stranded with inadequate treatment and no where to go.

    The only ones benefiting from this EBM movement are the insurance companies and that is a fact.

    I read all these pseudo-intelectuals posts about EBM and I can see, between the lines, that they are not involved in treating people who are being depribed of care because of it.

    The insurance companies are just like the oil companies in that they increase their profits continually but continue to provide less. (Poor analogy but it is early).

    Ask the doctor who gets half or a third of what they bill for paid and most will tell you that it is insurance companies who drive the wagon and it is them who want this EBM bandwagon to contiue down the rosd it is on.

  52. Fifi says:

    I just went back and read the thread about the belief that “unloving” thoughts and maternal issues cause breast cancer and I now realize that it was Hermano and antivax who were defending that idea in that thread, not pec. Much as I suspect that pec’s belief in energy medicine and subluxations that she’s expressed do lead her to share their faith in that idea (subluxation being a chiropractic concept and terminology), I consider it a matter of personal integrity to be open and honest when I discover I’ve made an error or a false attribution. (Plus, my interest and motivation for engaging here isn’t to be “right”.) It’s also quite possible that pec’s faith is of a different denomination than Hermano or antivax’s since different religions and faith based CAM concepts can be very different from each other and, though most may talk about various forms of life or divine healing energy, what they believe about that energy and where it comes from can be entirely at odds at times.

    So, your claims that insurance companies are fans of EBM is just patently untrue and yet another attempt to hide just what a profit driven industry CAM actually is, how much government lobbying goes on in the US by the CAM industry as they attempt to remain unregulated and avoid being responsible for maintaining ethical and evidence based practices and claims.

    Actually medical insurance companies have accepted CAM because it’s cheaper to provide than EBM. Insurance companies aren’t doctors, they’re the same people who insure your home and so on. They routinely refuse EBM treatments and make the practice of medicine more difficult. For instance, most insurance companies don’t cover psychotherapy even though the evidence points to it being more effective than medication alone. Why? Because psychotherapy tends to be a long process. They’re corrupt and all about making profit – which is why they endorse CAM treatments since EBM can be much more expensive.

    Medical insurance companies aren’t EBM or even medicine, they’re insurance companies. They’re just as connected to CAM as they are to EBM, if not more so and are just another profit driven arm of the health care and “wellness” industry that doesn’t actually have much to do with the practice of medicine. In Canada, which has universal health care, medical insurance covers non-cosmetic dental work, glasses/contact lenses, and CAM. Not surprisingly, these same insurance companies have been vigorously lobbying for the privatization of medicine in Canada. Not that universal healthcare doesn’t have its problems and challenges but clearly the drive for profit is behind unethical behavior by all kinds of people/groups associated with medical insurance, clinics that put profit before patients, supplement manufacturers and naturopaths, and other people who play with people’s lives for profit.

  53. mdarby says:

    Question for the moderator of this excellent blog: at what point is a poster deemed sufficiently disruptive, troll-like, and incapable of enhancing the mission of this site to be banned?

    On another special interest site I used to frequent, the moderators revoked the rights to post of a person who had made 10,000 posts (!) because he was deemed disruptive.

    I used to find pec’s comments entertaining but now they are simply cloying and repetitive.

    I realize I am an active reader but not an active poster, so I don’t suggest that my vote have much weight, but was curious what the point of view was here. It’s a tough question because most who frequent presumably believe, like I do, in free speech and inquiry. But it is seemingly hard for the regular posters to ignore a troll.

  54. tgbarton says:

    I agree with the assertion that the medical system failed in this case, not at the time of the initial diagnosis of the cancer, but well before that when the woman decided to place her trust in alternative practitioners over medical ones. It was at that point she obviously found something lacking in the medical; find that “something”, combine it with the empirical efficacy of SBM, and it will be the alternative health industry that dies rather than curable cases like this one.

  55. nwtk2007 wrote: “The only ones benefiting from this EBM movement are the insurance companies and that is a fact.”

    Can you provide a reference for this fact?

    This is at direct odds with documented recent history. The EBM movement is an academic movement. While I have quibbles with it – it has nothing to do with the insurance companies. That is just made up anti-scientific propaganda.

    Insurance companies try to limit what they pay for. Sometimes they are a restraint on overuse (see Harriet’s excellent post on CT angiograms). Sometimes they hamper good care. The current situation is very problematic – and I am not defending insurance companies. My point is – they are just using what’s out there for their own ends. They also refuse to cover drugs for non-FDA approved uses – even when they are evidence-based. So should we argue that insurance companies are the only ones driving and benefiting from the FDA? That would be equally absurd.

    No one likes to be told “no.” The reality is we cannot offord all the healthcare that everyone wants and that we have the technology to deliver. This means we have to make decision about what to cover and what not to cover. Science is the only way to objectively make those tough choices. What’s the alternative?

  56. daedalus2u says:

    I think that leaving posts up that obviously demonstrate ignorance and even trollish behavior is useful.

    People need to be able to see such posts and decide for themselves if the poster is real and if the ideas expressed in it make sense or not. When such posts are taken apart by those who do know what they are talking about, it becomes more obvious for the readers who are less sure of their science to become more aware of how science works.

    The eventual goal of those who run this blog is for the people who read it to become informed and to be able to think for themselves and be able to analyze quackery and recognize it when they see it.

    Leaving up obvious examples of quackery, showing the false arguments that quacks use, showing that quacks have no special knowledge, and can be mean and vindictive a$$holes when their pet woo is gored is a useful demonstration.

  57. pec says:

    Oh yes I must be an ignorant troll if I ask for evidence about how often your treatments work. I should know better than to ask a question when I already know you don’t have an answer. It’s very disruptive to be asked a question you can’t answer when you are supposedly an exalted authority. Just think, Gorski knows more than I could ever possibly know about cancer research and statistics, and yet he doesn’t have an answer. Now that is terribly disruptive. I didn’t even realize medical school teaches research and statistics. How disruptive of me to think I might also know something about that, when I didn’t even go to medical school.

  58. Hermano says:

    http://jama.ama-assn.org/cgi/content/full/300/2/173 might be apropos of nothing or pertinent to this discussion.
    Apparently, under some circumstances, “conservative management” beats conventional drug treatment for surviving cancer.
    Here is the WSJ take http://blogs.wsj.com/health/2008/07/09/drugs-give-no-advantage-to-older-men-with-early-prostate-cancer/.

  59. weing says:

    Hermano,
    What that study illustrates is EBM in action. Now elderly men with prostate cancer will not be subjected to chemical castration, and if they have the poorly differentiated type, they can decide based on the evidence available.

  60. Fifi says:

    Hermano – Yes, “watchful waiting” is one of the methods employed by medicine for certain cancers in certain people at certain early stages. Clearly it doesn’t apply to the case this blog details, which quite graphically illustrates how resorting to alternative therapies – and not watching or waiting, just choosing treatments that aren’t based on evidence – may even be worse than doing nothing in some cases. Since you’ve proven yourself to be a vocal supporter of CAM and unproven “alternative” cancer treatments, and it’s already been established that different kinds of cancer require different treatment, what’s the point that you’re trying to make? That EBM works and is constantly self critical and looking to minimize useless treatments and maximize non-invasive ones based upon weighing the evidence and the cost/benefit ratio?

    From the article
    “The standard options for men with prostate cancer that hasn’t spread to other parts of the body are radiation, surgery or “watchful waiting” — doing nothing, and keeping an eye on the cancer. Watchful waiting can be a good option for older men, because prostate cancer often grows so slowly that it doesn’t wind up causing major problems.”

  61. HCN says:

    pec said ” It’s very disruptive to be asked a question you can’t answer when you are supposedly an exalted authority. ”

    Which is why I keep asking you for the documented survival rate for Gerson’s, Hoxsey and the other therapies for the woman’s breast cancer! What are they, please?

  62. Fifi says:

    Actually pec, you’ve been given answers to the questions you’ve asked numerous times but continually dodge questions you’re asked. You’re apparently unwilling or unable to understand that different forms of cancer require different treatments. I understand that you like simple, absolute answers – such as provided by faith healers. Apparently you prefer absolute answers even if they’re untrue – I suspect this has something to do with your vividly apparent resentment of the expertize of others and the respect they’ve earned. It seems that you’re the one clinging to the god-like expectations and vision of doctors (and science), and being bitterly disappointed when they aren’t gods who are capable of making your mother exercise and eat well (against her will) or her emotional issues magically disappear.

  63. pec says:

    Shut up Fifi. I have merely asked for sources that indicate something about how well the current standard treatments are working. The only answers I have gotten are that it’s hard to say. Ok well, these experts must have some reason to believe in their treatments.

    This post is about one unfortunate case. Is that EBM? No, but it is supposed to horrify us into thinking the standard treatments are just wonderful.

    All I am asking for is scientific and logical thinking. Instead we have hysteria and emotion and reverence for the medical industry.

    A lot of the supposed progress in treating cancer is illusion. Many of the research reports neglect to mention the common sources of bias. And they often don’t specify what mortality rates are being compared to.

    It is very hard to know how well cancer treatments work. That is my main point. I have not seen anyone try to respond, except with hysterical insults.

  64. Hermano says:

    weing wrote “What that study illustrates is EBM in action. Now elderly men with prostate cancer will not be subjected to chemical castration, and if they have the poorly differentiated type, they can decide based on the evidence available.”

    Presumably the chemical castration treatment had been approved by the FDA and had received the imprimatur of the science based medicine prior to this recent study.

    I guess the patients would have been better off taking a homeopathic in this case.

  65. Fifi says:

    Um, did you just decry hysteria and emotion but start your post with “shut up”? Seriously, you should think twice about just repeating back to me my observations about yourself if you’re just going to confirm I was right about you being hysterical (in this case hysterically funny!) and emotional in the process of doing so!

    I always find it odd when someone says “scientific thinking” simply because it reveals a lack of understanding of what science is – as well as being an indicator that someone is probably a proponent of “magical thinking” but feels insulted by having their magical thinking pointed out as such. Science is a methodology, a discipline. Plus, using “scientific thinking” just reveals (again) that your main tactic is an attempt to present science as a religion (followed by an attempt to present their religion as science). Religious belief is a personal matter, science isn’t.

  66. HCN says:

    pec said “All I am asking for is scientific and logical thinking.”

    So am I… Tell us exactly what the survival rate is for that woman’s cancer is using Gerson’s, Hoxseys and the other treatments. Be sure to include the back up documentation.

  67. Fifi says:

    Hermano – Actually no. Granted “a homeopathic” (I suspect you mean a homeopathic remedy) wouldn’t do anything but, as the example in this blog illustrates, the watching part is absent (the watching is a very important part of “watching and waiting”). And why would one spend money taking “a homeopathic” when it does nothing? The men in question would not only be subjecting themselves to a useless treatment that had nothing to do with their cancer, but they’d also be wasting time and money in the process – ultimately they’d be worse off in a number of ways.

  68. nwtk2007 says:

    nwtk2007 wrote: “The only ones benefiting from this EBM movement are the insurance companies and that is a fact.”

    Steven Novelle wrote – “Can you provide a reference for this fact? ”

    Steven Novella also wrote – “This is at direct odds with documented recent history. The EBM movement is an academic movement. While I have quibbles with it – it has nothing to do with the insurance companies. That is just made up anti-scientific propaganda. ”

    First of all, just make a few calls to providers in Texas and see if they take workers comp cases and if not why.

    Also get a hold of the “Official Treatment Guidelines” used in Texas.

    This is how it works: A patient injures their back, is unable to work and their is no light duty available. The doctor prescribes three weeks of PT at three times per week. The guidelines, supposedly EBM, say that only six sessions are needed and thus will not preauthorize more than six. Many times they will just deny the pre-auth and wait for the doctor to resubmit or appeal, an additional 10 – 15 days wait in addition to the three days wait for the initial pre-auth and subsequent allowance for six sessions or flat out denial

    The patient is limited to the six because the insurance companies use the guidelines as law and they are supposed to be based upon evidence. Tell me, how could their be evidence to be applied across the board to all back injuries.

    The ortho wants to get an MRI of the low back but the guidelines, evidence based (horse crap), say it is not needed until four weeks of conservative treatment has been done, but the pre-auth is only for six sessions or two weeks worth, which they later deny payment for because a whore, peer review doctor who they have now hired will say it was all not medically necesssary, based upon the EBM official treatment guidelines which he will quote, again, as if they were law.

    The MRI is done anyway because the ortho says it was needed, and initial MRI’s do not need pre-auth. The MRI shows a large HNP with nerve root impengement but the insurance co denies payment for it because the evidence based guidelines say it was not needed and should not have been done in the first place.

    See my point. Very typical in well over 80% of the cases.

    The guidelines say on average a worker should only be out of full duty work for, say, six days for an injury such as this. But the treating doctor knows the patient is at risk of further injury and exacerbation if he goes back to work so he keeps the patient off work until he can be sure it is safe for the patient to go back to work. The insurance company denies payment of income benefits based upon the EBM guidelines. The patient is forced to try to go back to work or go hungry because he can’t work and then has to wait for months for a hearing, not to mention the eventual cost of an attorney, to find out that he might or might not win in the hearing. Throw in a company who won’t allow a worker back to work with out a full release without restrictions and it really gets stupid.

    It goes on and on almost ad infinum.

    So you see, that is how insurance companies are using EBM to their advantage. And who is really the ones to say what is evidence based and what is not? There is such variance in anything evidence based because evidence exists to the contrary of everything under the sun, both for and against any aspect of care or treatment.

    The guidelines even say that they are not to be used in the way they are being used but even the legal system goes along with it.

    Also, it appears that injured workers cannot sue workers comp insurance companies for bad faith and employers most certainly won’t.

    Shall I go on?

  69. David Gorski says:

    EBM does not necessarily mean the most inexpensive medicine. Often it does, but often it doesn’t as well. For example, breast MRI is increasingly being covered by insurance companies because studies have supported its use in many clinical circumstances. In the old days, a woman would have gotten just mammography and ultrasound, but now most women with breast cancer also get an MRI at more than $1,000 a pop before surgery because there is evidence to support its use. Insurance companies used to fight it when MRIs were ordered, but now for the most part they routinely approve them..

  70. Fifi says:

    nwtk – All you’ve done is point out why private medical insurance and corporate medicine is a bad idea (again) and that medical insurance companies aren’t interested in appropriate, evidence based, medical treatment because they’re trying to limit how much they pay out and create one-size-fits-all standards. Certainly insurance companies may claim they’re creating evidence based standards but, as the evidence constantly proves, one size does not fit all when it comes to medical treatment, which just goes to show that like the supplement manufacturers and some non-evidence based CAM practitioners people appeal to EBM for authority even when what they’re doing is antithetical to EBM.

  71. Zetetic says:

    (s)CAM = “Faith Based”… I like the analogy!

  72. Hermano says:

    Could someone differentiate EvidenceBM and ScienceBM?

  73. Hermano says:

    Would it be accurate to say that EBM aims to find the most effective treatment available, whereas SBM concerns with whether or not treatments are consistent with current sciences?
    Are SBM sciences restricted to biological, or physical, does it also include social sciences such as economics and anthropology?

  74. pmoran says:

    Pec >”I have merely asked for sources that indicate something about how well the current standard treatments are working. The only answers I have gotten are that it’s hard to say. Ok well, these experts must have some reason to believe in their treatments.”

    This again! What is your precise question? We know from vast experience that without treatment patients with a biopsy diagnosis of invasive cancer nearly always fare badly, with relentlessly advancing local disease and the devopment of progressive metastastic disease in many cases. Even every “alternative” testimonial assumes this to be the case.

    Yet you have been offered statistics showing that, with conventional treatments, a varying number of such patients, depending on stage and cancer type (>90% in some instances), will live on for twenty years or more without further evidence of cancer.

    What, then, might modify the conclusion that our treatments are “working”? Let us consider this.

    Well, we admit that rarely some kinds of cancer (breast and melanoma) can recur even after twenty years, but this is very rare, and available statistics give an approximation of how often that might occur (2-3% at most).

    We also know that occasional cancers of some types can stay stationary for long periods, and may even never progress at all. But remember that most cancers are already symptomatic — a sign of probable cancer progression — when we treat them. We also don’t yet have the capacity to sift out the cases discovered prior to the onset of symptoms that might do equally well without treatment, so this is of no practical importance outside of the design of screening programs intended to detect cancers before they cause symptoms.

    It is also true that even after efficacious treatments the biological properties of the cancer is the dominant determinant of outcomes, i.e. whether the patient surtvives cancer-free or not. Are you deducing from this that we should NOT treat the cancer, when we know what usually happens if we don’t treat them?

    Or are you frustrated that we cannot give you concrete survival figures to within the nearest percentage point? What, precisely, are you worried about?

  75. nwtk2007 says:

    Pec, give it up. The’ve got you. Given a condition that has a 93% chance of long term survival with medical care, you would also go for the medical care. Sure you might do some concurrent Alt treatment, but you would do the medical. If you didn’t then you would be getting exactly what you wanted, no matter what the out come.

    And FiFi, what a name, you are right about what this shows about the insuance companies. I am just showing you that EBM is going to be used in this fashion in any arena that it can be.

    As to the MRI’s being approved by the insurance company for breast cancer evaluation, I would first ask why an insurance company gets to determine medical necessity in any case? I have seen an insurance adjuster, under oath in a deposition, state that she has denied payment for medical services be cause of the lack of medical necessity but then in the same deposition could not define medical necessity. Second, I would point out that on health insurance plans, the facilities on contract have agreed to accept sometimes less than a third of the billed amount from the insurance company and thus the insurance company is much more apt to go along with the study.

    With insurance companies it is definitely about bucks baby, nothing more. You ain’t in their good hands. According to the McKenzie reports they are now boxing gloves.

    My main point is that EBM will be “used” like this but when it starts costing someone more money, they will turn against it, who ever they may be. They use the EBM line just as anti Alts and anti-chiro’s will use the Nette case.

  76. Fifi says:

    nwtk – The fact that someone misuses or misrepresents something doesn’t invalidate it, it just means it’s been misused or faultily applied. EBM is about the practice of medicine. Medical insurance is about making money via gambling on the odds (and making sure those odds are in the insurance industry’s favor – all the same criticisms of the many other arms of the insurance industry apply). How you get from there to proposing that people who favor evidence based medicine over faith based “alternatives” to medicine are “using” Sandy Nette’s horrific paralysis at the hands of a non-evidence based chiropractor who clings to ideas like subluxations seems like a leap. They are not “using” Sandy Nette, they are supporting her in her battle to prevent other people from being injured as she was by faith based alternatives to medicine.

  77. Fifi says:

    I highly suggest checking out the interview with Sandy Nette

    http://www.youtube.com/watch?v=SHX7m09OZ8E

  78. Harriet Hall says:

    Hermano asked,
    “Would it be accurate to say that EBM aims to find the most effective treatment available, whereas SBM concerns with whether or not treatments are consistent with current sciences?”

    No it would not. My formula is SBM=EBM + CT.
    Science-based medicine is evidence based medicine plus critical thinking about what the evidence really means.

  79. Hermano says:

    Are chiropractors more likely to paralyze their patients than surgeons to remove a wrong organ?
    http://news.postbulletin.com/newsmanager/templates/localnews_story.asp?z=2&a=349993

  80. Hermano says:

    H. Hall,
    Thank you for clarifying this.
    I had an impression that the opposite was the case,
    EBM = SBM + CT

  81. Fifi says:

    It’s well worth reading the article Hermano links to because it shows how the doctor in this particular incident admitted and took responsibility for his mistake immediately, figured out how it happened and voluntarily stopped practicing while the incident was investigated. It also shows how the hospital apologized to the patient and investigated the mistake and just generally treated the person who the mistake harmed with compassion and respect. This serves as a stark contrast to how the faith based chiropractor who paralyzed Sandy Nette, and professional chiropractic organizations and supporters, have responded to her. Once again this highlights the difference in professional ethics and honesty between EB practitioners and faith based practitioners.

  82. Hermano says:

    Fifi writes “doctor in this particular incident admitted and took responsibility for his mistake immediately”.
    I am admittedly naive but I suspect that there was a critical time
    interval when the surgeon met with his personal and hospital legal teams and was advised on how to best deal with this situation.

  83. Fifi says:

    Hermano, you can try to diminish the differences in response as much as you like through non-evidence based conjecture but it doesn’t diminish the difference in the responses at all. There’s no reason to believe that the faith based chiropractor who paralyzed Sandy Nette didn’t call his lawyer immediately with the intention of avoiding responsibility for his actions. Speculation aside, I think this is a fantastic illustration of the ethical divide between medicine and faith based chiropractors. Interestingly, Sandy Nette isn’t out to stop all chiropractors from practicing, just those whose practice is based on faith not evidence.

  84. Fifi says:

    It should also be pointed out that the doctor in the linked article probably is unlikely to make the same mistake again because he’s taken responsibility for it and figured out why it happened. The chiropractor who paralyzed Sandy Nette refuses responsibility despite the evidence so clearly intends to keep on doing exactly the same thing over and over again, knowingly risking paralyzing other clients. As do all faith based chiropractors who do neck adjustments to correct “subluxations” and who refuse to acknowledge the risks of neck adjustments or inform their patients of the risks.

  85. Harriet Hall says:

    “Are chiropractors more likely to paralyze their patients than surgeons to remove a wrong organ?”

    Are surgeons more likely to save a patient’s life by removing the right organ than chiropractors are to save a patient’s life by manipulating their spine?

  86. Harriet Hall says:

    Hermano thought it was EBM=SBM+CT. It should be, but it isn’t. EBM has been hijacked and improperly applied. He should read a few of the so-called “evidence-based” books out there. I’ve reviewed one on the evidence for energy medicine and I own a copy of “Somatovisceral Chiropractic: An Evidence-Based Approach.” There is nothing I would call credible scientific evidence in either book. EBM has become a buzzword and an excuse to use any “evidence” from testimonials to junk science to support a belief.

  87. nwtk2007 says:

    I love the way FiFi uses the term “faith based’ chiropractic, as if the belief in medical science has no faith component to it.

    EBM is just a better gamble and you believe in it because you get better odds than Alt treatment, even though there are really no odds in Alt treatment as I see it.

    If there is a 93% chance of long term survival and you take it then you see that as better odds but you accept it on faith. EBM seems more credible to you so you have faith in it and thus you believe it is the better choice.

    The so called “faith based” chiropractors are not relying on a persons faith and beliefs any more than the allopath, one just, in your view, has better odds of things happening the way you want it than the other.

    And my previous point FiFi was that anti chiro groups do not morn for what happened to Ms Nette, they are lapping it up like a thirsty dog. They don’t give a rats a$$ about her any more than medical science truly gives one about the thousands of deaths they cause each year thru mistakes.

    You FiFi said, “this highlights the difference in professional ethics and honesty between EBM practitioners and faith based practitioners.” in reference to the way the hospital handled the doctors mistake as opposed to the way the chiropractor has alledgedly handled his. What a joke. Events like this just don’t happen very often in chiropractic and thus we are not a astute as the medical profession in handling them, mistakes that harm, I mean.

    I still have a tough time understanding how so many have become so self righteous about this case in the face of the daily harm medical science does.

  88. Hermano says:

    H. Hall,

    I am not suggesting that chiropractic has any value and you have not answered my question.

  89. Harriet Hall says:

    nwtk2007 – We don’t need to depend solely on ”belief” in medical treatments; we can test them. We can have justified “faith” in science-based treatments because they have been tested. If a treatment has not been adequately tested, then all we have is belief. If it has not been tested, we have no way of knowing the odds.

    “anti chiro groups do not morn for what happened to Ms Nette, they are lapping it up like a thirsty dog. They don’t give a rats a$$ about her any more than medical science truly gives one about the thousands of deaths they cause each year thru mistakes. ”

    This is malicious and untrue. It is despicable for you to even suggest such a thing. If anyone doesn’t give a rat’s posterior, it’s the chiropractors who continue giving treatments that are not known to have any benefit and that have a chance of creating “locked in” quadriplegics, and who don’t even want their patients to know that such disasters have happened.

    “I still have a tough time understanding how so many have become so self righteous about this case in the face of the daily harm medical science does.”

    Please read my blog post on “Death by Medicine.” Medicine does good as well as harm. It is irrational to look at the harm without putting it into perspective with the good. It is irrational of you to question our criticism of a tragic, avoidable disaster by invoking the tu quoque fallacy.

  90. Harriet Hall says:

    Hermano insists that I answer his question: “Are chiropractors more likely to paralyze their patients than surgeons to remove a wrong organ?”

    I don’t have accurate statistics, but I have never heard of a surgeon removing a stomach instead of a gallbladder. The case mentioned was of a paired organ, a kidney. I would guess that such errors are somewhat less common than chiropractic strokes. But I don’t see what that has to do with the price of spaghetti.

    Why do you ask?

  91. pec says:

    pmoran,

    “you have been offered statistics showing that, with conventional treatments, a varying number of such patients, depending on stage and cancer type (>90% in some instances), will live on for twenty years or more without further evidence of cancer.”

    You are claiming to have found effective treatments for certain kinds of cancer, specifically breast cancer in this post. But I believe that is inaccurate, since I have been searching for data showing a significant decline in cancer mortality, relative to population, and did not find it.

    I have found articles saying that cancer remains undefeated, and I have made sure to ignore all alternative medicine sources, since they are likely to be biased against mainstream medicine.

    All of the information I have read lately on cancer (none of it non-mainstream) says the only progress has been in diagnosing and treating early cancer (of course that progress could be mostly an illusion, because of lead-time bias and over-diagnosis), and certain childhood cancers.

    I have not seen any claims for invasive breast cancer treatments with a high level of success. Yet that is what you are claiming.

    There is a discrepancy. I just want to understand this, because this is important and I don’t like deception.

    I do not practice or promote any form of alternate cancer therapy.

  92. spurge says:

    pec

    Care to link to any of the information you are talking about?

  93. weing says:

    pec,
    I don’t recall them claiming a high level of success for invasive breast cancer. This was a tumor less than 1 cm and no lymph node involovement. This was not an invasive tumor at the time of diagnosis. Please define your terms. When you say invasive, what do you mean?

  94. weing says:

    involvement

  95. Fifi says:

    pec – If you don’t like deception, why do you engage in it routinely? This is just a repeat of you telling me to “shut up” before decrying the very kinds of hysterical and emotionality you claim to not be into (not to mention that you’ve been trying to promote both fear of cancer and EB cancer treatments, you know, whip up a bit of hysteria). Once again, you’ve clearly been being deceptive in your attempts to fudge numbers, apply them to things they don’t apply to, pretend that you aren’t an advocate of faith-based alternatives to medicine, and in saying you have evidence but never presenting any and on and on.

  96. pec says:

    weing,

    You can go back and read their claims in the comments on this post. They are claiming high rates of success with invasive breast cancer.

    With early cancer, it’s hard to estimate the success rate because of over-diagnosis and lead-time bias. If, let’s say, 90% of diagnosed early cases would never have progressed, then a 90% success rate would mean the treatment is useless (I am NOT saying those are the rates, just trying to illustrate my point).

    This is a hard question, and no one here seems willing to tackle it.

    Gorski has written about over-diagnosis, but only in the context of questioning the value of certain screening technologies. He never ties that in with questions about treatment efficacy.

  97. weing says:

    pec,
    This was a palpable mass that on biopsy was confirmed to be an adenocarcinoma. My understanding of lead time bias is apparently different from yours. Lead time bias wouldn’t apply in this case. The natural history of the disease from this point, as illustrated by this patient, is pretty much guaranteed.

  98. vinny says:

    I knew that hermano was back when I saw over 190 comments to this post. Surprisingly, he asked some interesting questions. Harriet, his point about bashing chiropractors when the number of severe injuries they caused may favorably compare to the number of severe injuries a surgeon causes is valid. On the other hand, Harriet’s point about the number of lives saved or improved by surgeons compared to the benefit chiropractors brought with that particularly nasty manipulation is a valid response.

    Hermano, it goes back to this issue with homeopathy and other techniques that have no benefit compared with tested and efficacious medical practice. When these alternative methods hurt people, the benefit/harm ratio is too low.

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