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116 thoughts on “How do scientists become cranks and doctors quacks?

  1. pec says:

    Chris Noble,

    When the evidence is ambiguous, the scientific consensus is political. And once a consensus has formed, only researchers who support the consensus are able to get funding or publications. This is not a conspiracy, it’s just the way human society works.

  2. only researchers who support the consensus are able to get funding or publications.

    Simply untrue. Look at all of the excess funding vaccine-autism connection research has received, despite a clear consensus among scientists of no connection.

  3. David Gorski says:

    Which is an excellent example of politics trumping the scientific consensus!

  4. Chris Noble says:

    Pec,

    when the evidence is ambiguous, you get various scientific research groups actively pursuing competing theories. There is a huge difference between a real scientific debate and a manufactroversy.

    Also, if you actually look at the criteria that are used to determine whether research projects are funded and papers published then novelty is right up there near the top. If your research refutes a long held part of science (and the research is done well) then you’ll get it published in one of the big journals.

    Frankly, every time I see one group whining about politics dominating science the shoe is on the other foot. AIDS Denialism was supported by bad politics in South Africa. CAM gets funded through politics, Global warming Denialism is mostly a political movement.

  5. Kiloway says:

    As a biochemist and nutrition scientist I would like to stress that Linus Pauling’s views on cancer treatment and vitamin C (high dose IV) are now being endorsed by more and more scientists and cancer experts. See link : http://www.cmaj.ca/cgi/content/abstract/174/7/937. In effect it took close to 40 years to the scientific community to admit that Pauling’s studies on cancer patients were not flawed and that vitamin C might be a useful option in some cases. I therefore regret to see this great scientist’s name associated with quackery in yet another article.

  6. David Gorski says:

    Not really. I’ve discussed Linus Pauling in detail on this blog twice before:

    High dose vitamin C and cancer: Has Linus Pauling been vindicated?

    Vitamin C strikes (out) again

    Suffice it to say that high dose vitamin C, oral or intravenous, has never shown much (if any) promise in treating cancer. Moreover, there is even evidence that it can be counterproductive in some cases, at least in animal models. Indeed, I discussed the CMAJ article you cite. Even as anecdotal evidence, it’s underwhelming, as I pointed out. Here’s an excerpt from the first post listed above:

    At around the same time, another study was published in the Canadian Medical Association Journal (CMAJ), also by Mark Levine and colleagues in collaboration with a group at McGill University. Based on the concept that only intravenous dosing can produce high enough blood levels of ascorbate and that that is the reason previous trials failed to show a benefit from high dose vitamin C, three cancer cases were reported, all of whom received high dose vitamin C and all of whom, it was claimed, showed much longer than expected survival. The problem is, there was a lot less there than has been reported, especially given that this study was of a type that I particularly detest (but that CAM advocates particularly love), the so-called “best case” series.

    The first patient of the three reported, for instance, had renal cell carcinoma with putative lung metastases and received 65 g vitamin C intravenously twice a week for 10 months. The lung metastases were never biopsy-proven to be renal cell carcinoma, leaving some doubt about them. However, let’s accept that they probably were real lung metastases, even though none of them were ever biopsied. (We don’t always biopsy metastases to prove that they are metastases, particularly if the biopsy would be unduly risky. However, in oncology generally it is always better to have a tissue diagnosis than not.) The problem is that renal cell carcinoma is a tumor type that is one of the more common tumor types to be reported to undergo unexplained spontaneous remissions. It’s uncommon, but it has definitely been documented. Also, the patient received a number of other “alternative therapies,” including thymus protein extract, N-acetylcysteine, niacinamide, and whole thyroid extract. This led me to ask: If the authors believed that alternative therapies like high dose vitamin C can cure certain cancers, why did they automatically assume that it had to be the vitamin C? Why couldn’t it have just as plausibly been one of the other treatments or some combination of them? The fate of this patient was ultimately not good: “Unfortunately, the woman — a long-time smoker — was diagnosed four years later with small-cell lung cancer. She again opted for vitamin C treatment, but the second cancer did not respond.” Was there vitamin C resistance in the second tumor as opposed to the first, or did the first tumor just go into spontaneous remission, or was it something else? It’s impossible to say much of anything from this case.

    The second case presented was of a man who had a primary bladder tumor with multiple satellite tumors. These were all resected with apparently clear margins transurethrally using a cystoscope. Rather than additional conventional therapy, the man chose intravenous vitamin C and was reported alive and well nine years later. Normally, this would be a pretty poor prognosis tumor without more therapy, but, as the accompanying commentary points out, long term survival has been reported with surgical therapy alone. Indeed, this case reminds me a lot of breast cancer patients who undergo excision of their primary tumor, forgo adjuvant therapy for alternative therapy, and then attribute their survival not to the conventional therapy (surgery) but rather to the alternative therapy. In addition, this patient also took a variety of other alternative therapies, leading to the question again: Why did the authors assume that it was the vitamin C? They may be correct, but there are too many confounding factors. It could just as plausibly been the surgery.

    Finally, the third patient had a large paraspinous mass that turned out to be diffuse B-cell lymphoma. She agreed to radiation therapy but refused chemotherapy, opting instead for intravenous vitamin C. She, too, used a variety of other alternative therapies, including beta-carotene, bioflavonoids, chondroitin sulfate, coenzyme Q10, dehydroepiandrosterone, a multiple vitamin supplement, N-acetylcysteine, a botanical supplement, and bismuth tablets. It’s utterly ridiculous to include this case as “evidence” for the efficacy of vitamin C. Besides the confounding factor of using multiple alternative therapies, the patient reported only had, as far as can be told from the case report, a Stage I diffuse B cell lymphoma. Radiation therapy alone used to be a common treatment for such tumors and is well known to be able to produce long term survival in such cases. To try to show that this was something other than Stage I disease, the authors made much of the observation that the patient subsequently developed enlarged lymph nodes in numerous other nodal basins over ten years. However, nowhere did they report that any of these enlarged lymph nodes were ever biopsied to prove conclusively that they were recurrent lymphoma, and the only pathology result reported was from the biopsy of the paraspinous mass. One thing oncologists that I’ve worked with damned near always insist upon before diagnosing a recurrence of lymphoma is proof by tissue diagnosis, and it is very puzzling why such a simple procedure was not done at some point over the ten year case history reported. It would have been very easy to do biopsies of any of the superficial lymph nodes that were reported to have become enlarged. Another point I noticed was that, looking at the authors’ descriptions, only one of these nodes would I have even considered particularly suspicious (a 3 cm supraclavicular node). The majority of the nodes reported were merely described as merely “palpable” or as measuring 1.0 or 1.5 cm, which is within the normal range for lymph nodes in those basins.

    This study is one reason why I really, really detest “best case” series. CAM advocates love such series, though, because they allow them to cherry pick patients. The problem is this: Even if these three cases do represent legitimate tumor responses to vitamin C, we have no idea what the denominator is. These cases were collected over many years, and it’s impossible to know how many thousands of patients underwent similar vitamin C regimens with no response at all. In fact, I find it hard not to point out that these were the very best cases the authors could come up with over a span of many years, and yet they are only marginally more convincing than the anecdotes. The bottom line: as of 2006, the evidence supporting the use of vitamin C in cancer, either intravenous or oral, was not compelling. Considering that even in theory very high ascorbate concentrations would be needed, meaning very high doses, for an effect that in vitro was fairly weak, made the whole thing seem like a long run for a short slide.

    Finally, as I’ve said time and time again, even the most favorable studies of high dose vitamin C show at best a very, very modest–even questionable–benefit. Given that achieving those blood levels takes gram upon gram of vitamin C and provide no benefit–or, at best, a very tiny benefit–the persistence of vitamin C strikes me as a long run for a short slide.

    Any other pharmaceutical agent requiring such massive doses and such high blood levels for such a tiny possible benefit would have been abandoned long ago. But not vitamin C.

    No, high dose vitamin C for cancer is dubious at best, quackery at worst. In addition, Linus Pauling was instrumental in pushing the quackery that is “orthomolecular medicine.”

  7. Kiloway says:

    I disagree. Making such definitive statements in nutritional medicine is a tricky game. As scientists we all express opinions based on our knowledge of limited data. Even “consensus” statements based on scores and scores of studies can be easily challenged. That would be the case for the “cholesterol and heart disease” theory – a theory recently shaken by some disappointing results with cholesterol-lowering drugs and challenged by a group in France led by Dr Michel de Lorgeril. Another example would be the type of diet currently advocated by diabetologists in type-II diabetes (experimentations under way with a paleo diet-type show exciting results). Or the benefits of high calcium diets and dairy for the prevention of fractures. The list is long… In the case of vitamin C and cancer, the data at hand is scarce yet intriguing. I confirm that more and more scientists now show interest and support for Pauling’s views. Our own review of the studies to date was convincing enough to get european funding for animal studies that should begin next year. We all may be wrong, vitamin C for cancer may be “quackery” but that represents merely an opinion.

  8. David Gorski says:

    In the case of vitamin C and cancer, the data at hand is scarce yet intriguing.

    Not really. This has been studied to death since the 1970s, and there is really no evidence that vitamin C does much, if anything, for cancer.

    I bet you didn’t even read my detailed critiques of Linus Pauling’s ideas and of the whole “vitamin C cures cancer” thing. Instead, you lapsed into an argument from ignorance.

    As for “more and more” scientists being interested in vitamin C, that may or may not be true, but one thing that is true: Scientists are becoming a bit concerned that antioxidants like vitamin C can actually interfere with chemotherapy.

  9. weing says:

    I devoured the Nature of the Chemical Bond by Linus Pauling when I was in college. The guy was a genius. However, with Vitamin C he was off base. It reminds me of Michael Jordan trying to play baseball.

    re
    “That would be the case for the “cholesterol and heart disease” theory – a theory recently shaken by some disappointing results with cholesterol-lowering drugs and challenged by a group in France led by Dr Michel de Lorgeril.”
    Could you please elaborate? All I know about Lorgeril relates to Omega-3s.

  10. David Gorski says:

    I devoured the Nature of the Chemical Bond by Linus Pauling when I was in college. The guy was a genius. However, with Vitamin C he was off base. It reminds me of Michael Jordan trying to play baseball.

    Except that Michael Jordan was not too shabby as a baseball player. He just wasn’t anywhere near major league material.

    The analogy for Linus Pauling doing cancer research was that he wasn’t even at the Little League level.

  11. Even if it did turn out that there was something to the vitamin C and cancer thing,

    It’s possible to be a crank (or engage in crank science) and end up being right (by dumb luck) without being “vindicated”.

    Anybody can come up with a theory, hypothesis, conjecture, or speculation. Gather enough speculations on a subject, and there’s a good chance one of them ends up being correct.

  12. Kiloway says:

    David Gorski states “one thing that is true: Scientists are becoming a bit concerned that antioxidants like vitamin C can actually interfere with chemotherapy.” I guess you refer mostly to the Heaney study. In this study vitamin C was applied to cancer cells, both human and mouse. But its meaning for humans is very limited. First, the researchers used an oxidized form of vitamin C (dehydroascorbic acid) instead of ascorbic acid and they used high doses of it. We just do not know how the concentrations of dehydroascorbic acid used in this study relate to those that are achieved by taking ascorbic acid supplements. Also, vitamin C was applied directly to tumour cells, and this may not represent the way vitamin C is used by our cells. Also, vitamin C was given two hours before treatment. What would the effects be if the time before treatment was increased or if the vitamin C was given after the drugs ? To my knowledge this study has not been replicated. A 2007 review by Keith Block on antioxidant and chemotherapeutic agents concluded that antioxidant supplementation did not blunt cancer drugs. Although preliminary, a recent study using bortezomib and vitamin C in newly diagnosed multiple myeloma concludes that the combination is “effective and well-tolerated”. See also the review by Ohno in the March issue of Anticancer Research. It is therefore true that “scientists are concerned that antioxidants can interfere with chemotherapy” just as it is probably true that just as many scientists are interested in using antioxidants along with anti-cancer drugs. We are.
    Weing asks about Michel de Lorgeril, a French researcher and cardiologist famous for his work with Serge Renaud on alpha-linolenic acid (Lyon Diet Heart Study) and the so-called “French paradox” (chronic, moderate wine consumption may protect from heart disease). In recent years De Lorgeril and his team have been extensively looking at the relationships between blood cholesterol and atherosclerosis and the impact of cholesterol-lowering on mortality. Their conclusions : cholesterol is not the “bad guy” we have been taught to believe; cholesterol-lowering does not reduce mortality; moderate wine-drinking and/or getting enough omega-3s in the diet is more effective at reducing mortality than cholesterol-lowering drugs. Very intriguing. See this article : de Lorgeril M, Salen P. Cholesterol lowering, sudden cardiac death and mortality. Scand Cardiovasc J. 2008 Aug;42(4):264-7. Review. PubMed PMID:18615354.

  13. weing says:

    It looks like their analysis was a failure. Many reasons could be responsible for that. Sorry, not convinced. Take a look at the JUPITER study, which did show a decrease in overall mortality also, in men and in women. Also, from the same issue you cited check out the following:

    The causal role of blood lipids in the aetiology of coronary heart disease – an epidemiologist’s perspective
    Dag S. Thelle
    Pages 274 – 278

  14. Kiloway says:

    Well, discussing this Jupiter/cholesterol issue is clearly out of my field. I know not everyone buys the Jupiter conclusions. See
    http://www.bmj.com/cgi/content/extract/337/dec10_1/a2921 See also Michel De Lorgeril’s own analysis of the Jupîter results (in French but if you scroll down to the readers’ comments, one reader (groutchmeuh) has posted a tentative translation of De Lorgeril’s text. http://michel.delorgeril.info/index.php/2008/12/09/19-que-penser-de-jupiter-mensonges-et-propagande-encore-baroud-dhonneur-avant-banqueroute

  15. David Gorski says:

    See also the review by Ohno in the March issue of Anticancer Research. It is therefore true that “scientists are concerned that antioxidants can interfere with chemotherapy” just as it is probably true that just as many scientists are interested in using antioxidants along with anti-cancer drugs. We are.

    You’ll note that I said for some cancers and some chemotherapies. Whether antioxidants are additive, neutral, or antagonistic to chemotherapy likely depends upon the chemotherapy drug and the tumor. What I have not seen is any research that changes my mind from my conclusion that vitamin C for cancer is, as we put it in the U.S., a really long run for a really short slide; i.e., far more trouble and less effect than it’s probably worth. Indeed, I’m quite sure that, were it not for the fact that it was Linus Pauling who popularized the idea of using vitamin C to treat cancer, scientists would have abandoned vitamin C as a cancer treatment long ago as impractical, requiring too high a dose for too small of an effect, if effect there even is.

    Truly, a cult of personality.

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