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The early detection of cancer and improved survival: More complicated than most people think

“Early detection of cancer saves lives.”

How many times have you heard this statement or something resembling it? It’s a common assumption (indeed, a seemingly common sense assumption) that detecting cancer early is always a good thing. Why wouldn’t it always be a good thing, after all? For many cancers, such as breast cancer and colon cancer, there’s little doubt tha early detection at the very least makes the job of treating the cancer easier. Also, the cancer is detected at an earlier stage almost by definition. But does earlier detection save lives? This question, as you might expect, depends upon the tumor, its biology, and the quality and cost of the screening modality used to detect the cancer. Indeed, it turns out that the question of whether early detection saves lives is a much more complicated question to answer than you probably think, a question that even many doctors have trouble with. It’s also a question that can be argued too far in the other direction. In other words, in the same way that boosters of early detection of various cancers may sometimes oversell the benefits of early detection, there is a contingent that takes a somewhat nihilistic view of the value of screening and argues that it doesn’t save lives.

A corrollary of the latter point is that some boosters of so-called “alternative” medicine take the complexity of evaluating the effect of early screening on cancer mortality and the known trend towards diagnosing earlier and earlier stage tumors as saying that our treatments for cancer are mostly worthless and that the only reason we are apparently doing better against cancer is because of early diagnosis of lesions that would never progress. Here is a typical such comment from a frequent commenter whose hyperbolic style will likely be immediately recognizable to regular readers here:

Most cancer goes away, or never progresses, even with NO medical treatment. Most people who get cancer never know it. At least in the past, before early diagnosis they never knew it.

Now many people are diagnosed and treated, and they never get sick or die from cancer. But this would have also been the case if they were never diagnosed or treated.

Maybe early diagnosis and treatment do save the lives of a small percentage of all who are treated. Maybe not. We don’t know.

As is so often the case with such simplistic black and white statements, there is a grain of truth buried under the absolutist statement but it’s buried so deep that it’s well-nigh unrecognizable. Because we see this sort of statement frequently, I thought it would be worthwhile to discuss some of the issues that make the reduction of mortality from cancer so difficult to achieve through screening. I will do this in two parts, although the next part may not necessarily appear next week

Shortly after I learned that Elizabeth Edwards’ breast cancer had recurred in her bones last spring, meaning that her cancer is now stage IV and incurable, I read for our journal club a rather old article. However, this old article still has a lot of resonance today; indeed it was eerily prescient given the technological leaps that have driven the development of ever more sensitive imaging instruments and other diagnostic tests that have occurred over the last 15 years. The article, written by William C. Black and H. Gilbert Welch and entitled Advances in Diagnostic Imaging and Overestimations of Disease Prevalence and the Benefits of Therapy, appeared in the New England Journal of Medicine in 1993, but could easily have been written today. All you’d have to do is to substitute some of the imaging modalities mentioned in the article, and it would be just as valid now, if not more so. Until someone writes a better one, this article should be required reading for all physicians and medical students.

The article begins by setting the stage with the essential conflict, which is that increasing sensitivity leads to our detecting abnormalities that may never progress to disease:

Over the past two decades a vast new armamentarium of diagnostic techniques has revolutionized the practice of medicine. The entire human body can now be imaged in exquisite anatomical detail. Computed tomography (CT), magnetic resonance imaging (MRI), and ultrasonography routinely “section” patients into slices less than a centimeter thick. Abnormalities can be detected well before they produce any clinical signs or symptoms. Undoubtedly, these technological advances have enhanced the physician’s potential for understanding disease and treating patients.

Unfortunately, these technological advances also create confusion that may ultimately be harmful to patients. Consider the case of prostate cancer. Although the prevalence of clinically apparent prostate cancer in men 60 to 70 years of age is only about 1 percent, over 40 percent of men in their 60s with normal rectal examinations have been found to have histologic evidence of the disease. Consequently, because the prostate is studied increasingly by transrectal ultrasonography and MRI, which can detect tumors too small to palpate, the reported prevalence of prostate cancer increases. In addition, the increased detection afforded by imaging can confuse the evaluation of therapeutic effectiveness. As the spectrum of detected prostate cancer becomes broader with the addition of tumors too small to palpate, the reported survival from the time of diagnosis improves regardless of the actual effect of the new tests and treatments.

In this article, we explain how advances in diagnostic imaging create confusion in two crucial areas of medical decision making: establishing how much disease there is and defining how well treatment works. Although others have described these effects in the narrow context of mass screening6,7 and in a few clinical situations, such as the staging of lung cancer, these consequences of modern imaging increasingly pervade everyday medicine. Besides describing the misperceptions of disease prevalence and therapeutic effectiveness, we explain how the increasing use of sophisticated diagnostic imaging promotes a cycle of increasing intervention that often confers little or no benefit. Finally, we offer suggestions that may minimize these problems.

Since 1993, CT and MRI scans have now become so powerful that they now routinely “section” people into “slices” much thinner than 1 cm, making currently achievable imaging sensitivity considerably higher than it was 14 years ago. What the essential conflict is, at least in the case of cancer, is that far more people have malignant changes in various organs as they get older than the number of people who actually ever develop clinically apparent cancer. The example of prostate cancer is perhaps the best example of this phenomenon. If you look at autopsy series of men who died at an age greater than 80, the vast majority (60-80%) of them will have detectable microscopic areas of prostate cancer if their prostates are examined closely enough. Yet, obviously prostate cancer didn’t kill them. After all, they all lived to a ripe old age and died either of old age or a cause other than prostate cancer. In other words, they died with early stage cancer but not of cancer.

Now, imagine if you will, that a test was invented that was 100% sensitive and specific for detecting prostate cancer cells and that, moreover, it could detect microscopic foci of prostate cancer less than 1 mm in diameter. Now imagine applying this test to every 60 year old man. Somewhere around 40% of them will register a positive result, even though only around only 1/40 of those apparent positives would actually have disease that needs any treatment. Yet, they would all get biopsies. Many of them would get radiation and/or surgery simply because we can’t take the chance, or because, in our medical legal climate, watchful waiting and observation to see if it is going to grow at a rate that would make it clinically apparent in the case of potential cancer are a very hard sell, even when they’re the correct approach. After all, we don’t know which of them has disease that actually will threaten their lives. It may well be that eventually using expression profiling (a.k.a. gene chip) testing, something that did not exist in 1993, will eventually allow us to sort this question out, but in the meantime we have no way of doing so. Even so, I note that there is nonetheless an increasing trend towards “watchful waiting” rather than aggressive surgery or radiation therapy in many cases of prostate cancer with less aggressive histology.

Of the most common diseases, the various forms of cancer are probably the diseases that are most likely to be overdiagnosed as our detection abilities, either through increasingly detailed imaging test or through blood tests, both of which are becoming ever more sensitive. Breast cancer is the other big example other than prostate, but I plan on holding off on that one until Part 2 of this series. So instead I’ll look at another example from the article, namely thyroid cancer. Thyroid cancer is fairly uncommon (although certainly not rare) among cancers, with a prevalence of around 0.1% for clinically apparent cancer in adults between ages 50 and 70. Finnish investigators performed an autopsy study in which they sliced the thyroids at 2.5 mm intervals and found at least one papillary thyroid cancer in 36% of Finnish adults. Doing some calculations, they estimated that, if they were to decrease the width of the “slices,” at a certain point they could “find” papillary cancer in nearly 100% of people between 50-70. This is not such an issue in thyroid cancer, which is uncommon enough that mass screening other than routine physical examination to detect masses is impractical, but for more common tumors it becomes a big consideration, which is why I will turn to breast cancer in the next post.

The bottom line is that the ever-earlier detection of many diseases, particularly cancer, is not necessarily an unalloyed good. As the detection threshold moves ever earlier in the course of a disease or abnormality (in the case of cancer, to ever smaller tumors all the way down to the level of clusters of cells), the apparent prevalence of the disease being screened for increases, and abnormalities that may never turn into the disease start to be detected at an increasing frequency.In other words, the signal-to-noise ratio falls precipitously. This has consequences. It leads, at the very minimum, to more testing and may lead us to treating abnormalities that may never result in disease that affects the patient, which at the very minimum leads to patient anxiety and at the very worst leads to treatments that put the patient at risk of complications and do the patient no good.

This earlier detection can also lead to an overestimation of the efficacy of treatment. That’s the grain of truth in the comment above. The reasons for this are two types of bias in treatment studies known as lead time bias and length bias. In the case of cancer, survival is measured from the time of diagnosis. Consequently, if the tumor is diagnosed at an earlier time in its course through the use of a new advanced screening detection test, the patient’s survival will appear to be longer, even if earlier detection has no real effect on the overall length of survival, as illustrated below:

Unless the rate of progression from the point of a screen-detected abnormality to a clinically detected abnormality is known, it is very difficult to figure out whether a treatment of the screen-detected tumor is actually improving survival when compared to tumors detected later. To do so, the lead time needs to be known and subtracted from the group with the test-based diagnoses. The problem is that the use of the more sensitive detection tests usually precede such knowledge of the true lead time by several years. The adjustment for lead time assumes that the screening test-detected tumors will progress at the same rate as those detected later clinically. However, the lead time is usually stochastic. It will be different for different patients, with some progressing rapidly and some progressing slowly. This variability is responsible for a second type of bias, known as length bias.

Length bias refers to comparisons that are not adjusted for rate of progression of the disease. The probability of detecting a cancer before it becomes clinically detectable is directly proportional to the length of its preclinical phase, which is inversely proportional to its rate of progression. In other words, slower-progressing tumors have a longer preclinical phase and a better chance of being detected by a screening test before reaching clinical detectability, leading to the disproportionate identification of slowly progressing tumors by screening with newer, more sensitive tests. This concept is illustrated below:

Length bias

The length of the arrows above represents the length of the detectable preclinical phase, from the time of detectability by the test to clinical detectability. Of six cases of rapidly progressive disease, testing at any single point in time in this hypothetical example would only detect 2/6 tumors, whereas in the case of the slowly progressive tumors 4/6 would be detected. Worse, the effect of length bias increases as the detection threshold of the test is lowered and disease spectrum is broadened to include the cases that are progressing the most slowly, as shown below:

Cancer Diagnosis
06f4b.jpg

The top image represents an idealized example of disease developing in a cohort of patients by two different hypothetical tests, the first one being the less sensitive standard test and the next one being the “advanced” test, which has a lower threshold of detection. The cases detected by the more sensitive advanced test are represented in the stippled area. The standard test detects only the cases that are rapidly progressive. However, the new test detects all cases, including the ones that are slowly progressive and, if left alone, would not have killed the patient, who would have died from other causes before the tumor became clinically detectable by the “standard” test. These latter two patients would be at risk for medical or surgical interventions that would not prolong their lives and carry the risk of morbidity or even mortality if subjected to the more sensitive test. This is one reason why “screening CT scans” are usually not a good idea.

As the authors state:

Unless one can follow a cohort over time, there is no way of accurately estimating the probability that a subclinically detected abnormality will naturally progress to an adverse outcome. The probability of such an outcome is mathematically constrained, however, by the prevalence of the detected abnormality. The upper limit of this probability can be derived from reasoning that dates to the 17th century, when vital statistics were first collected. If the number of persons dying from a specific disease is fixed, then the probability that a person with the disease will eventually die from it is inversely related to the prevalence of the disease. Therefore, given fixed mortality rates, an increase in the detection of a potentially fatal disease decreases the likelihood that the disease detected in any one person will be fatal.

In other words, early detection makes it appear that fewer people die of the disease, even if treatment has no effect on the progression of the disease. It will also make new treatments introduced after the lower detection threshold takes hold appear more effective:

Lead-time and length biases pertain not only to changes that lower the threshold for detecting disease, but also to new treatments that are applied at the same time. Whether or not new therapy is more effective than old therapy, patients given diagnoses with the use of lower detection thresholds will appear to have better outcomes than their historical controls because of these biases. Consequently, new therapies often appear promising and could even replace older therapies that are more effective or have fewer side effects. Because the decision to treat or to investigate the need for treatment further is increasingly influenced by the results of diagnostic imaging, lead-time and length biases increasingly pervade medical practice.

This month there was a study out of Norway that shows just how variable the growth rate of a tumor can be, a variability that suggests just how difficult it is to optimize a screening strategy that applies to a wide population. Indeed, this study shows that not only are cancers of different organs different diseases, but arguably different cancers in the same organ behave almost like different diseases. In brief, imaging and cancer incidence data were modeled from 395 women and the rates of breast cancer growth thereby estimated. What was found was an enormous variability in tumor doubling times. The mean time for a tumor to double from 1 cm to 2 cm in diameter was 1.7 years. However, 5% of the subjects with breast cancer had tumors whose doubling time was less than 1.2 months. Of course, the doubling of the diameter of a tumor is in actuality an eight-fold increase in tumor volume, which makes this result even more impressive. Not surprisingly, women with such rapidly growing tumors tended to be younger. On the other end of the spectrum, 5% of the women had tumors whose doubling time was greater than 6.3 years. the study also suggested that most breast cancers become detectable on imaging when they reach a diameter of between 0.5 and 1.0 cm. It’s not hard to see how, taken together, this data suggests that no screening regimen is likely to detect a cancer before it reaches 2 cm in diameter except maybe 10% of the time. The converse of this is that women with slow-growing tumors could do just as well with screening every three years. Of course, the problem is that we have no way of knowing who will fall into which category. Such are the complications that have made it difficult to demonstrate a decrease in cancer-specific mortality from mammographic screening. The evidence that it does so in women over 50 is fairly strong; less srong–equivocal, even–is the evidence supporting a decrease in mortality attributable to mammographic screening in women between 40-50.

There is another complication that these more powerful imaging modalities can lead to that wasn’t discussed in the paper, stage migration. This is a phenomenon that occurs when more sophisticated imaging studies or more aggressive surgery leads to the detection of tumor spread that wouldn’t have been noted in an identical patient using previously used tests. This phenomenon is colloquially known in the cancer biz as the Will Rogers effect. The name is based on Will Rogers’ famous joke: “When the Okies left Oklahoma and moved to California, they raised the average intelligence level in both states.” This little joke describes very well what can happen in cancer. What in essence happens is that technology results in a migration of patients from one stage to another that does the same thing for cancer prognosis that Will Rogers’ famous quip did for intelligence. Consider this example. Patients who would formerly have been classified as, for example, stage II cancer (any cancer), thanks to better imaging or more aggressive surgery, have additional disease or metastases detected that wouldn’t have been detected in the past. They are now, under the new conditions and using the new test, classified as stage III, even though in the past they would have been classified as stage II. This leads to the paradoxical statistical effect of making the survival of both groups (stage II and III) appear better, without any actual change in the overall survival of the group as a whole. This paradox comes about because the patients who “migrate” to stage III tend to have a lower volume of disease or less aggressive disease compared to the average stage III patient and thus a better prognosis. Adding them to the stage III patients from before thus improves the apparent survival of stage III patients as a group. The converse is that patients with more disease that was previously undetected, tended to be the stage II patients who would have recurred and done more poorly compared to the average patient with stage II disease; i.e., the worst prognosis stage II patients. But now, they have “migrated” to stage III, leaving behind stage II patients who truly do not have as advanced disease and thus in general have a better prognosis. Thus, the prognosis of the stage II group also ends up appearing to be better with no real change in the overall survival from this cancer.

Does all of this mean that we’re fooling ourselves that we’re doing better in treating cancer? That, after all, is the charge being made. Not at all. It simply means that the question of sorting out “real” effects on cancer survival attributable to new treatments being tested from spurious effects due to these biases is more complicated than it at first seems. For one thing, it points to the importance of carefully matching any experimental groups in clinical trials according to stage as closely as possible using similar tests and imaging modalities to diagnose and measure the disease. These factors are yet another reason why well-controlled clinical trials, with carefully matched groups and clear-cut diagnostic criteria are critical to practicing science-based medicine. It also means that sorting out lead time bias, length bias, and the Will Rogers effect from whether there is actually a better effect from new treatments can be a complex and messy business. If we as clinicians aren’t careful, it can lead to a cycle of increasing intervention for decreasing disease. At some point, if common sense doesn’t prevail (and in the present medical-legal situation, it’s pretty hard to argue against treating any detectable cancerous change), it can reach a point of ever diminishing returns, or even a point where the interventions cause more harm than good to patients. The authors have similarly good advice for dealing with this:

Meanwhile, clinicians can heed the following advice. First, expect the incidence and prevalence of diseases detectable by imaging to increase in the future. Some increases may be predictable on the basis of autopsy studies or other intensive cross-sectional prevalence studies in sample populations. Others may not be so predictable. All types of increases should be expected. The temptation to act aggressively must be tempered by the knowledge that the natural history of a newly detectable disease is unknown. For many diseases, the overall mortality rate has not changed, and the increased prevalence means that the prognosis for any given patient with the diagnosis has actually improved.

Second, expect that advances in imaging will be accompanied by apparent improvements in therapeutic outcomes. The effect of lead-time and length biases may be potent, and clinicians should be skeptical of reported improvements that are based on historical and other comparisons not controlled for the anatomical extent of disease and the rate of progression. Clinicians may even consider that the opposite may be true — i.e., real outcomes may have worsened because of more aggressive interventions.

Finally, consider maintaining conventional clinical thresholds for treating disease until well-controlled trials prove the benefit of doing otherwise. This will require patience. A well-designed randomized clinical trial takes time. So does accumulating enough experience on outcomes from nonexperimental methods that can be used to control for the extent of disease and the rate of progression. From the point of view of both patients and policy, it is time well spent.

These words are just as relevant to day as they were 15 years ago. On the surface, they would appear to support the words of our cranky commenter from the beginning of this post, but they do not. The reason, of course, is that it is quite possible to control for lead time and length bias, the Will Rogers effect, and stage migration, and it’s what clinical investigators do. It’s just difficult, and careful trial design is necessary. Indeed, in carefully controlled studies for a number of cancers the efficacy of our various inteventions against cancer have been demonstrated. In addition, in science-based medicine, unlike the blandishments of “alternative” medicine, we know that there is a cost for every new intervention. The detection of ever-smaller cancers the percentage of which that will endanger the patient’s life we do not know and can only roughtly estimate, leads to increasing numbers of biopsies and treatments that subject the patient to the risk of complications and overtreatment while doing some patients no good even as they may lead to the saving the lives of others. Finding the “sweet spot,” where increased detection reaches a point that maximizes the diagnosis of treatable tumors at an early stage but minimizes the number of “unnecessary” biopsies and therapeutic interventions is a complex business that doesn’t always give the clear-cut answers that our commenter clearly wants.

Compounding the difficulty is that it is very difficult to convince patients and even most physicians that, if we can detect disease at ever lower thresholds that we shouldn’t and that if we can treat cancer at ever earlier time points or ever smaller sizes that we shouldn’t. Moreover, the answer will also not be the same for all tumors. Remember, cancer is not a single disease, but rather a collection dozens, if not hundreds, of diseases. For some tumors (pancreatic cancer, for instance), clearly we need to do better at early detection, but for others (perhaps prostate cancer and breast cancer) spending ever more money and effort to find disease at an earlier time point will yield ever decreasing returns and may even lead to patient harm. It is likely that each individual tumor will have a different “sweet spot,” where the benefits of detection most outweigh the risks of excessive intervention. Similarly, different tumors require different clinical trial designs to rule out the effects of the various biases discussed in this post. Contrary to what our commenter says, it is not only possible to find each sweet spot in terms of early detection versus overtreatment and sorting out the effects of confounding biases, it is imperative that we do so. It’s just that doing so is far more difficult than the frequently simplistic slogans urging more early detection or attacks on “conventional” oncology as not curing anyone because “most cancers don’t progress” would suggest.

To be continued…

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

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228 thoughts on “The early detection of cancer and improved survival: More complicated than most people think

  1. pec says:

    pec: “Maybe early diagnosis and treatment do save the lives of a small percentage of all who are treated. Maybe not. We don’t know.”

    Gorski: “As is so often the case with such simplistic black and white statements, …”

    I said “maybe” and “we don’t know.” How is that simplistic or black and white? It’s an accurate acknowledgment of the fact that we don’t know.

    And I certainly am NOT looking for clear-cut answers. I am just trying to encourage you “skeptics” to be as skeptical of mainstream medicine as you are of alternatives.

    The public and most medical professionals have been convinced that great progress has been made in treating and curing cancer — when it’s diagnosed early. But the reality is that we don’t know how much, if any, progress has been made, and it’s extremely difficult to find out. And you have admitted all of that in this post.

    It’s ironic that you accuse me of being simplistic when I have been exactly the opposite. I have been noticing and explaining the complexity of this problem. It’s the medical profession and the drug companies who have been simplistic.

  2. David Gorski says:

    It’s ironic that you accuse me of being simplistic when I have been exactly the opposite. I have been noticing and explaining the complexity of this problem. It’s the medical profession and the drug companies who have been simplistic.

    No, you’ve been repeatedly very simplistic and just plain wrong. You’ve ranted on and on about how supposedly chemotherapy does no good, doctors want only to poison cancer patients with it, and how most cancer never progresses. You take the uncertainty about how much value early diagnosis has and leap to the unjustified conclusion that “conventional” medicine doesn’t cure any cancers and that any increase in survival is due to earlier diagnosis of tumors that never would have progressed anyway. Controlling for stage shows that you’re wrong.

    You have demonstrated time and time again that you have no idea what you’re talking about in this area, and patient attempts by others to correct you and educate you by myself and others have been to no avail–alas.

  3. Harriet Hall says:

    As I read Dr. Gorski’s post, I knew pec would be saying “I told you so.” But pec has failed to understand the complexities involved. We DO know that cancer treatment saves lives. We DO know that progress has been made. We DO know that early detection improves outcome for some cancers but not for others. Dr. Gorski has tried to explain how to decide just how much we do know, and why early detection is sometimes helpful and sometimes not.

    “I am just trying to encourage you “skeptics” to be as skeptical of mainstream medicine as you are of alternatives.”
    You just don’t get it. It’s not a matter of being skeptical of alternatives or of mainstream; it’s a matter of questioning anything that is not supported by good evidence, whether it’s mainstream or alternative. Dr. Gorski’s excellent post is a great example of questioning things in his own specialty and demanding a high standard of evidence and a rigorous application of the scientific method.

    There is plenty of evidence that modern scientific medicine improves cancer outcome; I know of no evidence that any alternative treatment improves cancer outcome.

  4. wertys says:

    At least when you’re sceptical about ‘mainstream’ medicine the people you criticise don’t roll up into a ball and cry about it, then ignore the criticism and persist in their infantile delusions….

  5. pec says:

    I was NOT wrong or simplistic about this. I did NOT say chemotherapy never works. I said we don’t know if, or how often, it works. You say you know it works — well how exactly do you know?

    It’s true that most early cancer will never progress. There is no debate about that, according to the article you are citing. Are you now disagreeing with the article.

    I NEVER said MDs want to poison their patients with toxic chemicals. But the chemicals ARE toxic, and because of the forms of bias you are talking about here in your post, we DO NOT KNOW their effectiveness or safety.

    Most statements about cancer mortality rates refer to mortality per diagnosis. When diagnoses increase, because of better screening technology, this type of mortality must decrease. But it tells us nothing about the real effectiveness of the treatments.

    You would have to calculate cancer mortality rates relative to the population rather than relative to cancer diagnoses.

    Where exactly is your data that shows mortality relative to population decreasing as a result of a particular treatment?

    You keep saying there are treatments that work, but you do not provide any evidence. How is that science-based medicine? It’s nothing but angry defensive support for the status quo.

  6. pec says:

    “There is plenty of evidence that modern scientific medicine improves cancer outcome”

    Yes Harriet, and most of it is biased and misleading — that is what this post is all about. I would like to see some unbiased evidence.

  7. David Gorski says:

    Yes Harriet, and most of it is biased and misleading — that is what this post is all about. I would like to see some unbiased evidence.

    Tell you what, pec. Show me a study with some “biased and misleading” evidence showing that modern scientific medicine improves cancer survival. A specific example. Explain exactly how it was biased. Then show me some evidence to demonstrate that “most” studies showing a survival benefit from a treatment based on scientific medicine are “biased and misleading.” Show me how you come to that conclusion using science and appropriate citations from the peer-reviewed literature.

    You talk a good game, but you never deliver.

  8. weing says:

    pec,

    Please back up your assertion that ‘most’ early cancers will never progress, otherwise change it to ‘some’ and I’ll agree with you.
    You do realize that life carries a 100% mortality. Are you looking at treatments for cancers as failures because the patients still die?

  9. pec says:

    weing,

    It is well-known that most early cancer will never progress. Read the article linked by this post, for example.

    Cancer treatments are failures when they do nothing to help the patient. Treating someone for cancer that would never have progressed or caused disease is a failure, because it wastes time and money and exposes the person to harmful, unnatural, substances.

    All of that is explained in the article linked by Dr. Gorski. If you don’t believe him, then you certainly won’t believe me.

    How often does it happen that cancer is caught early and treated and the treatment saves the patient’s life? We don’t know. You can’t deprive diagnosed patients of treatments so you can’t do the experiment.

    In areas with good access to modern medicine, there are high rates of diagnosis and high rates of “cures.” In areas with poor access, there are low rates of diagnoses and low cure rates. You can’t draw a conclusion about the treatments from that. So how can you know?

    I am genuinely interested in this subject, partly because of my interest in statistics. Where is evidence that is not confounded by the bias discussed in the article? I have read several similar articles and none of them propose solutions, or give examples of unbiased research.

  10. David Gorski says:

    In other words, pec cannot provide a single peer-reviewed study that is “biased and misleading” and demonstrate why it is “biased and misleading,” much less provide a whit of evidence that “most” studies that show a treatment benefit from a science-based treatment are “biased and misleading.”

    The rest of his post is one massive exercise in the logical fallacy known as the appeal to ignorance, not to mention his ability to ignore the fact that it is possible to match for cancer stage and generate a true treatment effect and that this is done all the time. That it is difficult does not make it impossible.

  11. pec says:

    Everything I have read so far about cancer research is biased, in the ways we are discussing here. You have not provided a single unbiased study to back up your claim that cancer treatments work. I do not have access to subscriber-only medical journals, so please give us something the public is allowed to see.

  12. Harriet Hall says:

    pec,

    “In areas with good access to modern medicine, there are high rates of diagnosis and high rates of “cures.” In areas with poor access, there are low rates of diagnoses and low cure rates. You can’t draw a conclusion about the treatments from that. So how can you know?”

    Well, duh! By doing high-quality controlled studies, of course!

    You are looking for answers, and there are no easy black and white answers. The best we can do is to look at each individual cancer and evaluate all the available evidence with a critical eye. Dr. Gorski is teaching us how to do that.

    We don’t have the kind of evidence that we would ideally like to have, but we do have good enough evidence to give patients some rough numbers. Something like “There is an x percent chance this screening test will prolong your life but a y percent chance you will have a false positive result and a z percent chance you will be treated unnecessarily.” We can share the uncertainty with the patient and involve him in the decision.

    Mammograms do save lives, but they also cause harm. The answer is not to stop using mammography; it’s to learn how to use mammography more judiciously. For one thing, we must consider the risk factors of the individual patient. Mammography might be life-saving for a high risk patient but worthless for a low risk patient. The article I posted today on the art of clinical decision-making addresses some of these issues.

  13. pec says:

    Harriet,

    Please explain how you know that mammograms save lives. Please give a scientific answer, not a “common sense” answer. There is no way to know whether or not an early cancer found on a mammagram would have progressed and become dangerous if untreated.

    I am not getting any straight answers to my question. How do you know?

  14. weing says:

    pec,

    I still haven’t found proof of your claim that most cancers will never progress, sorry.

    That is the reason for staging and stratifying lesions based on size in controlled studies. This helps to eliminate lead-time and length bias. Then you can see if and how your treatments are working compared to others. I am not an oncologist but I am sure they are well aware of what good and lousy studies are.

    You can volunteer to be in the control group if you are ever found to have cancer on a screening test.

  15. DBonez says:

    Pec said:

    “In areas with good access to modern medicine, there are high rates of diagnosis and high rates of “cures.” In areas with poor access, there are low rates of diagnoses and low cure rates. You can’t draw a conclusion about the treatments from that. So how can you know?”

    How about life expectancy figures? Why is it that “indigenous people” without modern medicine and without accurate diagnostic procedures who “live simplistically and are one-with-nature” (one-with-nature = herbs, medicine men, and all natural living) have such short life spans? Why do all modern, industrialized nations have significantly longer life expectancies? Sure there are a ton of variables blended in, but so is cancer and I think this list pretty well sums up most peoples’ views on this website.

    http://geography.about.com/library/weekly/aa042000b.htm

    This is also my argument about “traditional Chinese medicine” (TCM) and any other forms of non-science-based medicine that are hundreds or thousands of years old. Sure, TCM is thousands of years old, but their life expectancy was 35 years. Modernized countries utilizing science-based medicine has life expectancies pushing 80 years with excellent quality of life.

    Sorry, but I can draw a conclusion from this evidence and I am living a great, long, happy life with modern medicine, and statistically will continue to do so for another 40 + years.

  16. pec says:

    DBonez,

    What a ton of nonsense. Yes, lifespan is often included in the pro-cancer drug propaganda.

    We know very little about prehistoric longevity, and average lifespan is utterly misleading. All species in nature produce more offspring than can be expected to survive — this is nature’s “cruel” way of keeping species healthy, since the less fit are weeded out.

    Modern humans have disabled the mechanism, since we (understandably enough) have focused on preventing infants from dying.

    Pre-modern humans had high infant mortality rates, which resulted in a low average lifespan.

    Pre-modern humans also lived under a wide variety of conditions. In the middle ages, for example, many lived in filthy cities, which led to early deaths from infectious disease.

    Pre-moderns of all times and places died from infections and injuries that we now survive easily thanks to antibiotics and advanced surgical technology.

    If you factor out deaths from infection and injury, and infant mortality, and you consider whether or not the environment was clean or not, then you might wind up with a reasonable estimate of pre-modern typical lifespan. It would certainly not be 35 — people living in clean natural conditions with plenty of food and exercise did not drop dead of old age at 35. That is a complete misconception. It’s exactly what the drug companies hope you will believe, but it is BS.

    And pre-moderns did not get cancer. Cancer is a modern western disease. This may be partly because we survive many other causes of death. But more likely, I think, it’s because of our horrendously unnatural and unhealthy lifestyle.

    This is a hard thing to prove, but it is wrong wrong wrong to assume current cancer treatments are effective just because we are more likely than pre-moderns to reach old age.

    There have been studies of contemporary traditional societies where old people are MUCH healthier than old people here. We have no reason to assume contemporary traditional societies are all that different from prehistoric traditional societies.

    Yes we have the advantage of being able to survive certain kinds of infections, diseases and injuries. But in almost every other respect, we are less healthy now.

  17. Harriet Hall says:

    “There is no way to know whether or not an early cancer found on a mammagram would have progressed and become dangerous if untreated.”

    You’re right. There is no way to know whether an individual early cancer would have progressed. Science doesn’t have crystal balls to predict the outcome for an individual.

    What science CAN do is show statistically that a group of women who get mammograms will have a better survival rate than a group of women who don’t. Lives are saved; we just don’t know which ones.

    As Dr. Gorski says, Patience! He has more to say in part 2. Meanwhile, here are just two of the many recent studies that support my claim that mammography saves lives:

    http://www.ncbi.nlm.nih.gov/pubmed/18351455?ordinalpos=12&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    http://www.ncbi.nlm.nih.gov/pubmed/16434585?ordinalpos=22&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    These studies were of unselected patients. The benefit of mammography is even greater for women at higher risk.

  18. Harriet Hall says:

    “And pre-moderns did not get cancer.”

    Wrong.

  19. Harriet Hall says:

    “There have been studies of contemporary traditional societies where old people are MUCH healthier than old people here.”

    Sure. In those societies only the healthy people live to old age. Modern medicine keeps some of the unhealthy ones alive longer.

  20. weing says:

    “pre-moderns did not get cancer.”
    OMG, I nearly wet myself when I read that.

  21. David Gorski says:

    And pre-moderns did not get cancer.

    Bullshit.

    I’m sorry; I know Steve likes to maintain more decorum than that here, but that statement is such a big, stinky, dripping turd that there is no other response to it. (Sometimes bullshit just has to be called for what it is, even here.) I just finished reading a very good chapter on the history of breast cancer going back to before ancient Egypt; there were lots of descriptions of how, for example, ancient Egyptians thought about and treated breast cancer. Ever hear of Nabby Adams? (Watch HBO?) Pre-moderns most definitely did get cancer.

    It is true that life expectancy in the preindustrial age was such that many fewer people as a percentage of the population lived to a sufficiently old age to reach the years when humans are most susceptible to the most common cancers that people get today, most of which are diseases of the elderly. It is not true that pre-moderns did not get cancer.

  22. weing says:

    I think it was Hippocrates that came up with the name ‘cancer’ as it had the appearance of a crab on a woman’s breast.

  23. daedalus2u says:

    Those pre-moderns had quite sensitive stomachs too. Quite a few of them died of acute indigestion. Good thing modern medicine has virtually eliminated deaths from acute indigestion, what with antacids and the like.

  24. pec says:

    “that statement is such a big, stinky, dripping turd that there is no other response to it”

    Ok Gorski, don’t have a stroke. The rate of cancer now is MUCH MUCH MUCH higher than in pre-modern times.

    As I said, this could be partly because we are more likely to reach old age. But anyone who denies the possible importance of lifestyle and exposure to pollution is a big stinky dumb turd.

  25. pec says:

    Sorry, I meant to say “big stinky dripping dumb turd.”

  26. apteryx says:

    In little over a century, life expectancy has increased by about 25 years. I have read an estimate that over 21 years of this should be attributed to better public health (clean water, ventilation, improved food) and only a couple of years apiece to active medical treatment and prophylactic medical treatment. In prehistoric times, most people died of accident (eaten by cave lions…) or infectious disease. Western treatments for diseases such as typhoid and cholera are more potent than traditional treatments, until resistance evolves, but the primary reason why few American children die of those diseases is not that we have pharmaceuticals instead of traditional (or worse, horrors, Chinese!!) medicine; it’s that we have sewer systems and chlorination. Or just soap and water. It’s possible to avoid most disease cheaply in the field if you know what to do and why, but if you have no idea that germs exist, you won’t wash your hands very often or care if flies land on your food.

    Daedalus quips that “premoderns” died of “acute indigestion” – well, it’s probably true that the later-era European diet was not good for people, but you folks don’t accept any other “premodern” opinion as fact; they might have diagnosed heart attacks as indigestion. Was the point here to mock them for not having had fully equipped labs with which to make modern diagnoses?

    As for the cancer rates, good grief, can’t people talk about cancer without calling each other names? Given that rates of some cancers are far lower in modern non-Western peoples who eat traditional diets and are less sedentary, it’s reasonable to assume that our ancestors also had lower cancer rates than we do. The stated health concerns of people at the time also seem to support that. But of course some people got cancer; there is such a thing as genetic bad luck.

  27. Joe says:

    Spec wrote “The rate of cancer now is MUCH MUCH MUCH higher than in pre-modern times.

    As I said, this could be partly because we are more likely to reach old age.”

    You did not say that, you wrote “Yes, lifespan is often included in the pro-cancer drug propaganda.” You are trying to horn in on the bread and butter of priests and politicians (words), and you are inept at it. What is “pro-cancer drug propaganda”?

    So we know you are wrong about the antiquity of cancer. However, you wrote a long dissertation with many more assertions. Are any of them supported by reliable publications?

    I have experience that allows me to infallibly spot an anonymous chiropractor; in this case, I suspect you are a naturopath, or an acolyte. How am I doing?

    @Weing, your ability to deal with spec’s posts Depends on proper preparation. Also, Wikipedia supports your claim about Hippocrates; nonetheless, I think you are correct.

  28. pec says:

    Thank you apteryx. At least I’m not the only person here who has ever read a book outside their immediate field.

    Joe you can’t read; this is what I said:

    “Cancer is a modern western disease. This may be partly because we survive many other causes of death”

  29. pec says:

    I almost never call anyone names and I admit it’s stupid. But Gorski is such a filthy-mouthed you-know-what, sometimes you just have to fight back.

    Saying pre-modern people didn’t get cancer is a tiny bit inaccurate, since they probably did get it, very rarely. Notice how insane he went over that tiny inaccuracy. It doesn’t matter than almost everything I say is qualified and careful and seldom inaccurate or exaggerated. He’s ready to pounce on small errors so you don’t notice how wrong he is about so many important things.

    But of course, he makes a living “curing” people with toxic unnatural substances, so he must never question the wisdom and compasssion of his beloved drug companies.

  30. Harriet Hall says:

    pec, You’re contradicting yourself. First you said “pre-moderns did not get cancer.” Then you said, “The rate of cancer now is MUCH MUCH MUCH higher than in pre-modern times.”

    Those two statements are not logically compatible.

    We know the rate of cancer is higher today, but I don’t know if we have enough comparison data to say it is MUCH MUCH MUCH MUCH higher. And how much of the increase is due to better diagnosis and to people surviving to older ages? And didn’t pre-modern people have exposure to other factors that might contribute to cancer, like close contact with open fires? Their world wasn’t so pristine.

    “But anyone who denies the possible importance of lifestyle and exposure to pollution is a big stinky dumb turd.”

    Yes, I agree with you completely. I wouldn’t even qualify it with “possible.” We KNOW lifestyle and pollution contribute to cancer, especially lung pollution from smoking. But why are you bothering to say something so obvious? I doubt if a single person reading this blog denies that. The references I gave you about cancer prevention all agreed. Do you know of ANYONE who ever denied the possible importance of lifestyle and exposure to pollution, or are you just indulging in indiscriminate fantasy?
    .

  31. David Gorski says:

    I almost never call anyone names and I admit it’s stupid. But Gorski is such a filthy-mouthed you-know-what, sometimes you just have to fight back.

    Ah, yes, the old “skeptics are mean” trope.

    I didn’t insult you. I simply said that what you said was a load of B.S., so much so that there was no reason to sugarcoat it or show more respect to your claim that “pre-moderns did not get cancer,” which you neither qualified nor equivocated on, than the claim deserved. There’s a difference. Trust me, I’ve had far worse “insults” in far more colorful language directed at things I’ve argued or said in medicine or science. I didn’t take it personally (well, most of the time, anyway); I knew it was what I said that was being ridiculed, not me personally. Scientists (and surgeons even more so) tend to have little patience for repeated bad arguments and to be fairly ruthless when it comes to deconstructing each other’s hypotheses and contentions; it’s the intellectual war of ideas, with the person who can best support his or her arguments with data the winner. The best way to deal with it is to come up with the evidence to show why one’s argument is not “bullshit,” as I had politely asked you to do several times before I gave up and lost my patience. As Thomas Jefferson famously said (and was quoted by fellow SBM blogger Mark Crislip):

    “Ridicule is the only weapon which can be used against unintelligible propositions. Ideas must be distinct before reason can act on them…”

    Moreover, it was appropriate in your case. You were clearly making an unsupported statement, and now that you’ve been called to task for it by more commenters than just me, you’re retreating to one of the lamest defenses in the book by claiming you didn’t really mean what you said. In any case, attacking something you said vigorously is not the same thing as attacking you. Confusing the two, however, is a frequent sign of someone who has a hard time separating ideas from people.

    Saying pre-modern people didn’t get cancer is a tiny bit inaccurate, since they probably did get it, very rarely. Notice how insane he went over that tiny inaccuracy. It doesn’t matter than almost everything I say is qualified and careful and seldom inaccurate or exaggerated. He’s ready to pounce on small errors so you don’t notice how wrong he is about so many important things.

    Pot. Kettle. Black. Of course, you could provide evidence other than your say-so that your argument is correct. You could provide scientific evidence from the peer-reviewed literature to support your contention that most trials supporting the efficacy of science-based medicine against cancer are “biased and misleading.” But you don’t.

    Why is that?

    But of course, he makes a living “curing” people with toxic unnatural substances, so he must never question the wisdom and compasssion of his beloved drug companies.

    Actually, I make my living cutting cancers out of the body with cold steel and electrocautery. Big pharma means little to me, because the vast majority of drugs that I prescribe are either narcotics for the relief of postoperative pain or the the occasional odd antibiotic for wound infections. I don’t prescribe chemotherapy. Oh, and I also do research looking for better ways to treat cancer. As for “unnatural substances,” did you know that one of the mainstays of breast cancer treatment is taxol? Do you know how Taxol was discovered? It was isolated from the bark of the Pacific Yew tree, that’s how.

  32. Harriet Hall says:

    pec said, ” he makes a living “curing” people with toxic unnatural substances, so he must never question the wisdom and compasssion of his beloved drug companies.”

    Do you know of anyone who makes a living curing people with nontoxic natural substances?

    Did you even notice that he is questioning the wisdom of drug treatment for some cancers?

  33. David Gorski says:

    “But anyone who denies the possible importance of lifestyle and exposure to pollution is a big stinky dumb turd.”

    I’m curious: Who denied the importance of lifestyle or environmental pollution to the development of cancer? I assure you, it wasn’t me.

  34. David Gorski says:

    Did you even notice that he is questioning the wisdom of drug treatment for some cancers?

    pec can’t make up his mind. First, my article is cited as validation of his whole “early stage cancers rarely progress” and “scientific medicine cures almost no one of cancer” thesis, but then when it is pointed out to him that it is not and that all it says is that science can sort these confounding factors out but that it’s difficult and requires rigorous controlled clinical trials, he starts attacking.

  35. pmoran says:

    Pec, it is not “extremely difficult” to show that current medical approaches are having an impact. What do you make of these statistics for breast cancer? There is a similar trend with colorectal cancer, although some of the decline in deaths from that is due to declining incidence.

    http://www.statistics.gov.uk/cci/nugget.asp?id=575

  36. apteryx says:

    I think the comment about “people who deny the possible effects of lifestyle and pollution” derives from the apparent belief held by some people – not Dr. Gorski – that if our ancestors were less likely to get cancer, that was just because they almost all died too young to get it. If you tell yourself that age-corrected cancer rates would have been unchanging throughout history, then you will not be able to acknowledge intercultural differences in current age-corrected cancer rates, or discuss what environmental factors may cause them. That can be a touchy subject. Dr. Hall was quick to point out that smoking has greatly increased age-adjusted lung cancer rates. Nobody, these days, will be annoyed with a doctor who criticizes smoking, and the entrenched interests encouraging smoking are relatively small and on the defensive. If you started seriously scrutinizing the beef-and-HFCS-based diet, say, or diesel exhaust, or bisphenol A, then that would be a whole different can of worms.

    Suppose you (the MDs among us) treated cancer like infectious disease? You all support mandatory vaccination, even for diseases that are generally harmless, like chickenpox. If someone comes to you severely sick with chickenpox or measles, you will treat them, but you would rather prevent as many such cases as possible even if that takes costly, society-wide efforts. Some people will always get cancer, diabetes, etc., and you will treat them as best you know how – but why not try first to minimize their number by investing intensively in prevention and healthy lifestyles?

  37. Joe says:

    pec wrote “Joe you can’t read; this is what I said:

    “Cancer is a modern western disease. This may be partly because we survive many other causes of death”

    Mea culpa. You wrote so much unsubstantiated nonsense that I lost track. I guess you are not going to support any of your statements, or deny that you are a naturopath.

  38. Thank you Peter. You for providing the evidence about the effectiveness of the treatment of breast cancer.
    http://www.statistics.gov.uk/cci/nugget.asp?id=575

    Pec, do you have evidence showing that the statistics reported there are incorrect or that the reporting is biased?

    I haven’t looked further at the site but would expect that they have similar statistics showing the number of deaths for each specific type of cancer over a period of many years. I also suspect that the cancer specialists here could give references showing that many cancers which 20, 30 or 40 years ago were almost always fatal are rarely so today and I suspect that many of the childhood cancers would be among them.

    Pec, you stated, “I am genuinely interested in this subject, partly because of my interest in statistics.” The fact that you are genuinely interested in the subject is very obvious. What is not obvious is the reasons or where your ideas on the subject come from. I asked you before where you got your ideas from and whether or not they are from personal experience that you or a loved one had or from reading stories about people with cancer. Unless I have missed it, I have not seen your response.

    You sound like cancer terrifies you, but you don’t provide a way of knowing what your fears are based on. Without knowing that, I think it is impossible to have a rational discussion with you because i don’t know if you really had or observed a terrible experience yourself, have imagined something that never happened, believed horror stories quacks tell to scare people into buying their “therapies” or are a quack trying to scare people into buying yours.

    Now please don’t tell me how horrible cancer is or that everyone should know how dreadful it is because as I’ve already told you, I have had cancer myself and it doesn’t frighten me anywhere near the way it appears to frighten you. I have also known others who have been successfully treated for cancer and I’ve helped care for others who have died from it.

  39. David Gorski says:

    I have also known others who have been successfully treated for cancer and I’ve helped care for others who have died from it.

    Recent cancer victims in my family include an aunt and an uncle (within less than three years of each other), both of whom died, and my mother-in-law, who is doing well so far, although her tumor was not early stage–not to mention cancer scares recently with my mother and father. Add that to seeing some pretty young patients recur with stage IV disease, and I know just how horrible cancer can be. That’s why I always get annoyed when told that I just don’t care or understand.

  40. pec says:

    “You sound like cancer terrifies you”

    That is such an absurd statement. There was nothing in anything I said that expressed emotions about cancer, or any other disease.

    No one likes diseases, but why waste effort saying something so obvious? I am interested in how people come to believe things that are just not supported by any clear scientific evidence.

    We are always being told that people now live longer healthier lives thanks to recent medical advances. Well it’s true that more of us are getting old, but not because of the new drugs. That is a complete misconception. And we’re getting sicker as we get older.

    The drug companies are happy to take credit for our longer average lifespan, but they probably don’t deserve much of it. And the people whose lives are extended by the new drugs suffer greatly. That is because these drugs, in general, work against the system, not with it.

    We need a more holistic and prevention-oriented approach to health. We can’t possibly avoid all the carcinogenic substances in the air, water and food, but there is still a lot we can do.

    And it was actually very helpful and open-minded of Dr. Gorski to post about this article. Most people have never thought about overdiagnosis, lead-time bias, etc., and it is very important that the public becomes aware. Too many Americans are careless about their lifestyle, assuming that there are, or will soon be, drugs that cure cancer and the other lifestyle diseases that plague our society.

  41. I said, “You sound like cancer terrifies you”

    Pec, responded, “That is such an absurd statement. There was nothing in anything I said that expressed emotions about cancer, or any other disease.”

    I know that I may have been incorrect about you actually being terrified of cancer, but all your statements have certainly given me the impression that you are. The question is do most people reading what you have written here have the same impression as I have or not? If not, then my statement is absurd. If they do, then you haven’t got the slightest idea of how you sound to others.

    Getting objective evidence to determine if my impression is that of the majority of readers would be rather simple. We could take a poll to see how many readers think you sound as if cancer terrifies you and how many think that nothing you have ever written here about cancer is emotional.

    Actually, I don’t expect the forum to go to the trouble of conducting such a poll. My point is that your response that my statement about how I believe you sound is absurd tells me a great deal about you. It tells me that you haven’t bothered to sit back and say to yourself, Well look how I sound to this person and what makes her think such a thing? Could I really sound to others the way I sound to her, and if so, could they possibly be right?

    I also note that you have once more refused to answer the questions I asked you about how you have arrived at the ideas you continually express here and you have once more preached to us about the horrors of scientific medicine and the marvelous of the alternative unscientific kind. From that i conclude, and will continue to conclude until presented with evidence to the contrary, that you either are not facing your irrational fears or that you sell unscientific medicine.

  42. Harriet Hall says:

    “I am interested in how people come to believe things that are just not supported by any clear scientific evidence.”

    We are interested in how you come to disbelieve things that are supported by clear scientific evidence.

    “Well it’s true that more of us are getting old, but not because of the new drugs. That is a complete misconception”

    No one here has the misconception that drugs are “the” reason. There are many reasons more of us are getting old. Hygiene and vaccines are major reasons; drugs may be of lesser importance than those, but there is clear evidence that some drugs save lives. Other drugs don’t save lives but do improve symptoms and quality of life.

    “we’re getting sicker as we get older” It is a truism that the longer we live, the more chance we have of developing illnesses. Do you think there is some way to prevent that beyond the preventive measures recommended by scientific medicine?

    “people whose lives are extended by the new drugs suffer greatly” That’s just silly, pec. It’s like saying people who drive cars are injured in terrible automobile accidents. Maybe SOME people suffer; maybe a few ever suffer greatly; the majority don’t. And many of those who suffer side effects are quite willing to accept those side effects to get the benefit of extended life.

    We are all in favor of more prevention. What makes you think we aren’t? We are talking about what to do when prevention fails.

    You are constantly criticizing drug treatments but you haven’t offered any safe and effective alternatives. Do you think there are any? What would be your approach if you were diagnosed with, say, breast cancer?

  43. HCN says:

    pec said “And pre-moderns did not get cancer. Cancer is a modern western disease”

    So Ada, Countess of Lovelace did NOT die of uterine cancer at the age of 36? (and her hypochondriac mother out lived her! — sorry, recently read a biography)

    pec said “We need a more holistic and prevention-oriented approach to health. ”

    Prevention is also why vaccines are important. Even for chicken pox, which does kill… and makes a person eligible for shingles later in life. Some of the vaccines even help prevent cancer, not just HepB and HPV:
    http://www.sciencedaily.com/releases/2008/04/080425082125.htm …. “In another paper, Israeli researchers suggest that measles virus may also be a factor in some lung cancers. Their study included 65 patients with non-small-cell lung cancer, of whom more than half had evidence of measles virus in tissue samples taken from their cancer.”

    Wait… um, i got a bit lost here: who said prevention was not important?

  44. Harriet Hall says:

    rjstan,

    My impression is not that cancer scares pec, but that she is terrified by chemotherapy. She seems to be under the misconception that it always causes great suffering, which it clearly does not. It also seems to me that she is averse to the idea of taking medications and would prefer some unspecified “natural” approach.

    My impression is that she subscribes to some nonscientific world view and is letting her preconceptions interfere with understanding our arguments and accepting the facts.

  45. Pec, is Harriet’s impression that you are terrified of chemo correct or is it also absurd? If it is correct, where have you gotten the idea that it is always horrible?

    You specifially stated, “I did NOT say chemotherapy never works,” but in your anti-scientific rants you sound as if you don’t think it works often. Could you please clarify that.

  46. qetzal says:

    pec said:

    It doesn’t matter than almost everything I say is qualified and careful and seldom inaccurate or exaggerated.

    I’ve no doubt you think so, but what does the evidence say? Let’s ignore all the counter-examples from past threads, and look only at this one.

    At 6:37 am, pec wrote:

    I NEVER said MDs want to poison their patients with toxic chemicals. But the chemicals ARE toxic, and because of the forms of bias you are talking about here in your post, we DO NOT KNOW their effectiveness or safety.

    Really? Not even the ones that have been tested in double blind, placebo-controlled studies? Or did you neglect to qualify that statement?

    At at 6:39 am, pec wrote:

    “There is plenty of evidence that modern scientific medicine improves cancer outcome”

    Yes Harriet, and most of it is biased and misleading — that is what this post is all about. I would like to see some unbiased evidence.

    I note that you did NOT qualify this careful statement by saying “most of it may be biased….” I also note the careful way you ignored requests to support this claim with actual evidence.

    At 3:08 pm, pec wrote:

    The rate of cancer now is MUCH MUCH MUCH higher than in pre-modern times.

    This is my personal favorite (on this thread). You insist we can’t know if cancer death rates are getting better today, even though we’re aware of various biases and try to account for them. Then you turn around and claim that cancer rates are MUCH MUCH MUCH higher today!

    How did you adjust for longevity biases in arriving at that careful, qualified, accurate conclusion?

    At 6:37 pm, pec wrote:

    I am interested in how people come to believe things that are just not supported by any clear scientific evidence.

    Irony, thy name is pec.

    In all sincerity, pec, if you would apply the same skepticism and rigor to your own beliefs that you demand from conventional medicine, I’m certain you could make meaningful contributions to these discussions. Sadly, the evidence to date suggests you’re unable or unwilling to do so. I hope that changes some day.

  47. pec says:

    Harriet: It also seems to me that she is averse to the idea of taking medications and would prefer some unspecified “natural” approach.

    I have said, very explicitly, that the American lifestyle is the cause of many of the supposedly age-related diseases. The longer you practice this lifestyle, the more likely you will get these diseases. Therefore, many or most older Americans get sick and are put on unnatural, often toxic, drugs.

    The drug companies have convinced many or most medical professionals, and the general public, that taking pills is as good, or better, than improving your lifestyle.

    The public has also been convinced that there are excellent treatments for cancer. Rather than change their deadly lifestyle, they count on these treatments to save them.

    Yes, increasing numbers of Americans are starting to think about lifestyle. But as long as MDs believe, and convince their patients, that unnatural medical treatments are as good or better than living more naturally (exercising, eating natural food, sleeping enough), this change will be slow.

    Another medical blogger, PalMD, recently said that osteoporosis drugs are better than exercise. So that’s what he must be telling his trusting patients — these drugs will help you more than natural lifestyle changes. And I’m sure he isn’t the only one.

    So I definitely have alternatives to drugs, for the diseases that are caused by our unnatural lifestyle. A healthy lifestyle will not prevent all disease, but it will make a tremendous difference. And there is plenty of scientific research to confirm my opinion.

  48. PalMD says:

    Another medical blogger, PalMD, recently said that osteoporosis drugs are better than exercise. So that’s what he must be telling his trusting patients — these drugs will help you more than natural lifestyle changes. And I’m sure he isn’t the only one.

    That is quite similar to what I said, if not an exact quote. The exact quote is:

    the data from randomized controlled trials are actually quite clear. The effect of bisphosphanates is significantly better in increasing bone density and decreasing significant fractures than non-medical interventions. That doesn’t mean exercise etc isn’t important—it is, but it is only one tool, and unfortunately not the most powerful one.

    Once someone has significant osteopenia or osteoporosis, bisphosphonates are currently the best intervention to prevent fractures. Of course, exercise is a great thing, and we all encourage it.

    Oh, and pec, you’re still an idiot. You have never backed a single claim of yours with any actual data, and when you are asked you always change the subject. Perhaps you need a new hobby.

  49. weing says:

    I really think these SCAM practitioners should be held to the same standard as we are. Imagine telling a post-menopausal woman with a T score < -2.5 that she doesn’t need the osteoporosis medication and that life style changes are enough. Ridiculous. The life style changes had to have been made when she was younger, not now. And who says MDs don’t advise lifestyle changes? Half my time is spent drumming that need into my patients heads.

  50. pec says:

    Lifestyle changes are to prevent disease, not cure it. Although some conditions can be greatly improved even if you start late.

    I don’t think PalMD is an idiot, but I do think he is dogmatic, narrow-minded and unscientific. And he is also an insecure, immature name-caller.

    The osteoporosis drug ads target older women in general, not just the ones who are already sick. PalMD is intensely pro-drug (does he own a lot of shares of Merck or Vioxx, by any chance?) I suspect his patients are told more about the glories of synthetic drugs than about simple, boring, lifestyle changes.

    I know a woman whose MD got her on anti-depressants (she doesn’t have enough will power to exercise) and now she can’t stop, since the withdrawal from these drugs is so intensely unpleasant. But, amazingly, she is letting him put her young daughter (who smokes and won’t exercise either) on the same drugs. She trusts MDs more than she trusts here own direct experience and common sense.

    That is just one example, but there are millions of Americans going on addictive and harmful drugs, mostly for problems caused by an unnatural lifestyle. It can’t all be blamed on MDs. The TV ads — about one every 5 minutes — are also to blame.

  51. PalMD says:

    Once again, you descend into idiocy. You make many unfounded assertions with no data.

    If you have a point, bring the data, otherwise, get a life.

  52. David Gorski says:

    pec is nothing, if not consistent. I’ve been asking for hard evidence and data to support her contention that the clinical trials showing efficacy of various science-based treatments for cancer are “biased and misleading.”

    I’m still waiting.

  53. apteryx says:

    Look on the bright side, Requip has just been approved as a generic. This means no more TV ads about the horror of RLS and a lot fewer patients coming in to get their brain chemistry scrambled.

    You guys who keep piling on pec — for those of you who are actually experts, is your purpose in writing to take pleasure in bashing opponents, or is it to educate the public? Pec does strike me as being too broadly negative towards conventional medicine while being too credulous towards some other practices, and she’s not always accurately informed. However, it’s clear from her writing that she’s not a moron. In short, she is representative of millions of American consumers. I’m sure you find it frustrating when people less educated than you don’t seem to respond to what you see as well-reasoned arguments. However, when you start saying not just that they are wrong about one subject but that they are idiots, irrational, liars, or quacks, you make it impossible for them to consider moving closer toward your viewpoint; to do so would imply also accepting your negative views of themselves. Maybe pec has irritated you enough that you don’t care, but this blog may have dozens or hundreds of readers who hold some similar beliefs. They will take those insults as directed at them too, and the message they will take away is that MDs are hostile to and contemptuous of patients who have unconventional opinions. Is that really what you want? I have adopted new opinions in response to Web discussions before, and the writers I found convincing were not people who treated me with disrespect because I did not already agree with them.

  54. Pec said, “I have said, very explicitly, that the American lifestyle is the cause of many of the supposedly age-related diseases. The longer you practice this lifestyle, the more likely you will get these diseases. Therefore, many or most older Americans get sick and are put on unnatural, often toxic, drugs.”

    First, where did you get that from? Second, I don’t have statistics but I sure have a lot of anecdotes. Of course i know anecdotes don’t prove anything, but I will throw out a few on the off chance they may make you realize how silly you sound.

    I live in an area where a lot of people are “locavoirs” (sp?). They produce their own food both animal and plant. They exercise and only eat “organic, whole foods”. Several are seriously overweight. One is quite thin but had breast cancer in her early thirties and none stands out as being healthier than others with bad lifestyles. The lady with breast CA didn’t expect to live. The MDs gave her horribly toxic drugs and she survived quite well both the cancer and the toxins. They told her not to get pregnant again so she quickly proceeded to do just that. Her sister thought it was her way of “defying the disease”. She had a recurrence, got more toxins and got better again. That was over 10 years ago. She is still doing fine.

    Pec said, “The drug companies have convinced many or most medical professionals, and the general public, that taking pills is as good, or better, than improving your lifestyle.”

    Once more where did you get that from? Haven’t you seen any of the brochures medical professionals leave out in waiting rooms telling people how to live healthy lifestyles? Haven’t you seen the programs many medical institutions offer to help people do just that? Haven’t you heard anyone say that his doctor told him to loose weight, exercise, stop smoking or eat more fruit and vegetables. How about cutting down on cholesterol? No one has ever told you his doctor told him to do that? Ever had to drive over the middle line in the road to avoid hitting a very skinny MD jogging by, one who jogs habitually? What do you think he tells couch potatoes?

    Pec said, “The public has also been convinced that there are excellent treatments for cancer. Rather than change their deadly lifestyle, they count on these treatments to save them.”

    You’ve apparently have never tried to convince anyone with a “vice” to try to change his ways. If you had, you’d know that a lot of people either won’t or can’t change. I’ve known several people who decided to continue smoking because they enjoyed it and prefered to live short enjoyable lives rather than long unpleasant ones. They assumed sometimes erroneously that those where the two choicses life had given them.

    I don’t think the public is anywhere near as dumb or as impressed with authority as you seem to believe. I still think that you are terrified of cancer and perhaps all disease and are trying desperately to convince yourself that there is a magic wand you can wave to live a happy, healthy life until you are 90 when you can die peacefully in your sleep and I think that is the delusion that makes unscientific medicine so appealing to true believing alts.

    I can just imagine the pain listening to such nonsense as you preach causes caring doctors who practice scientific medicine and caring scientists do everything rationally within their power to find cures that actually work. It is painful to me to listen to knowing that if you preach such nonsense to others, especially if they are strangers on the Internet, that some may actually become as terrified as you are of drugs and therapies that can improve and save their lives.

  55. pec says:

    apteryx,

    Hey why did you suddenly decide I’m less educated than these guys, and that I represent a typical consumer? Is it by any chance because you got the idea that I am female???

    I am not less educated, just not an MD. I have a Ph.D. and pretty good undertanding of statistics.

    “Pec does strike me as being too broadly negative towards conventional medicine while being too credulous towards some other practices, and she’s not always accurately informed.”

    Anyone who has read any of my comments should know that I REPEATEDLY state that mainstream medicine is great if you need emergency surgery or antibiotics, or painkillers. And you would also know that I REPEATEDLY state that I have no opinion on alternative treatments I have not tried or seen scientific evidence for. I am not very interested in alternative treatments and I assume most of them are rip-offs.

    In short, you have mistaken me for some other stereotype.

  56. Apteryx, without good studies showing the contrary, I will continue to believe that one of the reasons that snake oil and quacks are now a multibillion $ industry which has even “integrated” itself into scientific institutions is that doctors and scientists have for too long been intimidated by your “be nice bad bigoted white men” argument and been silent when confronted with nonsense and false claims that can cause injury and death. They have been trained to be rational and unemotional which in most situations is a very good thing, but not when they have marketing professionals feeding lies to the public to get them to waste money on useless remedies and therapies as well as outright dangerous ones and when the marketers are trying to replace science with nonsense and delusions. It isn’t about arguments. It is about life and death. It is emotional. Quacks know that only to well and use it to sell product. It is about time that MDs and scientists learned it too.

  57. Harriet Hall says:

    OK, I think I’m beginning to understand where pec is coming from. She’s comparing medical treatment to prevention. She’s against taking pills because she thinks the disease should have been prevented in the first place.

    All of scientific medicine AGREES with her that prevention is much more effective than treatment. Treatment is for when prevention has failed.

    So yes, let’s continue to do as much as possible to prevent disease. But when a healthy lifestyle doesn’t work (and even pec has admitted that it doesn’t prevent all disease), or when a patient has been given good preventive advice and for whatever reason has failed to follow it, then what? The drugs that pec keeps calling “unnatural” and “toxic” DO help people. I hope she’s not suggesting that we tell these people “You’re screwed. You didn’t live right, and now you have to suffer the consequences and you shouldn’t take pills.”

    “as long as MDs believe, and convince their patients, that unnatural medical treatments are as good or better than living more naturally (exercising, eating natural food, sleeping enough), this change will be slow.”

    pec, this is a ridiculous straw man argument. MDs don’t believe any such thing. I bet you can’t find a single example anywhere of a doctor telling a patient that pills are as good as or better than prevention.

    And you keep using the word “natural.” A scientist doesn’t ask whether any individual diet or lifestyle measure is “natural” – he asks whether there is evidence that it improves outcome.

  58. David Gorski says:

    However, when you start saying not just that they are wrong about one subject but that they are idiots, irrational, liars, or quacks, you make it impossible for them to consider moving closer toward your viewpoint; to do so would imply also accepting your negative views of themselves.

    Ineducability is the problem. pec has been corrected many, many times and shown where to look at the evidence for herself by not just SBM bloggers but by several other regular commenters. It has been water off a duck’s back, and she keeps repeating the same misinformation again and again and again. She has also been repeatedly asked by me and others to back up her assertions with more than just her own assertions and posturing. So far, she has steadfastly ignored such requests.

    We here at SBM have in fact been very, very patient with pec until recently, far more so than her behavior and comments have warranted. We do this because of our dedication to free and open debate, even though no amount of evidence or anything we write seems likely ever to persuade her and trying to do so, I have reluctantly concluded, is almost certainly a waste of time. Countering her misinformation, however, is not, although the sheer volume of misinformation that must be countered is daunting. Remember, too: On a number of other blogs, pec would have been banned long ago as a disruptive troll, but not here; we have as yet banned no one, and I would be opposed to banning her.

    Even so, given her extreme persistence and apparent ineducability, however, I have concluded that there is no longer any compelling reason to be gentle or patient with pec when she goes off the rails. How many times do I have to read the same old canards and fallacious broadsides against science- and evidence-based medicine again and again and still remain “nice”? In terms of debating, it’s the proverbial bringing a knife to a gunfight. There comes a limit, and sometimes, as I pointed out before, you just have to take the gloves off and call an assertion bullshit, when it is, in fact, bullshit. No, it’s not necessarily “nice,” but it is accurate, and it’s not as though I, at least, haven’t waited a long time before doing it.

    Maybe pec has irritated you enough that you don’t care, but this blog may have dozens or hundreds of readers who hold some similar beliefs. They will take those insults as directed at them too, and the message they will take away is that MDs are hostile to and contemptuous of patients who have unconventional opinions.

    Have you ever heard of the term “concern troll”? Please look it up, because it describes your statement to a T, although it’s usually used in politics, usually in liberal politics. Its use, however, has become more generalized recently. I understand where you’re coming from, but it’s gotten to the point where I disagree, at least in this case.

    In any case, respect is earned, at least after the initial default of showing courtesy to a new commenter. Indeed, I try to treat new commenters with courtesy, even when they say something that is obviously incorrect, on the default assumption that they just don’t know better and can be shown why what they said was wrong. This blog has been in existence for four and a half months, and pec showed up pretty early on. I think that’s enough time to have figured out whether or not there is any hope of getting through to her. In any case, rjstan put it very well, having to be “nice” and “rational” all the time is good to a point, but in some cases it just isn’t enough.

  59. apteryx says:

    My apologies if I offended you, Pec – I was trying to discourage others from insulting you, not to insult you myself. When I referred to “people less educated than [the MDs on this site]” I meant specifically education in medical science. Sorry that that was not clear; it certainly was not meant to be sexist! I too have a PhD and am more educated in my own field (and on botanicals research, I think) than the MDs here. But I will happily concede that they are more educated than I when it comes to anatomy and pharmacology. I think that does make us reasonably typical CAM consumers, who tend to be more educated (in a general sense) and well-read than average, but usually not medical experts. As for your opinions, though I do not follow rjstan’s lead in trying to imagine irrational motivations for them, I do think they are too extreme. You tend to paint with a broad brush. Most MDs are basically well-meaning, and they will not take any more kindly to being told their treatments are worthless and toxic than you or I take to being told all CAM/TM is similarly evil.

    David, maybe instead of seeing Pec as “that person who keeps arguing with me,” you can try to envision her argument in each thread as coming from a different random health care consumer. (I really don’t like that word….) Don’t argue to a single writer; argue to the multiple consumers who read the blog and share that writer’s opinions. If you have facts on your side and you argue politely, I’m sure that you will make an impression on some of them. I have not heard the term “concern troll,” but will go look it up in the Font of All Knowledge (i.e. Wikipedia ;) )

  60. pec says:

    “I bet you can’t find a single example anywhere of a doctor telling a patient that pills are as good as or better than prevention.”

    I already gave the example of PalMD. And I personally know of examples.

    “And you keep using the word “natural.”"

    By “natural” I mean substances in a state that our bodies evolved over millions of years to deal with.

    And Harriet I have never said or implied that patients should be left to die if they became sick in spite of a healthy lifestyle, or if they became sick because they failed to practice a healthy lifestyle.

    I am saying that we have no good treatments for the chronic diseases associated with aging, such as type 2 diabetes, cancer, heart disease, etc. And these diseases can largely be prevented by avoiding the typical American lifestyle. This is well known because people from non-Western cultures do not get type 2 diabetes, for example, until they start eating processed food and stop getting exercise.

    When Americans are led to believe that there is, or will soon be, a pill for these diseases they are less likely to worry about lifestyle. For example, if they knew that the “cure” rate for cancer is so much lower than it seems, they would be less complacent. Everyone knows someone who was “cured” of cancer — but all of those patients were diagnosed early and only a tiny percent would have become sick without the treatment.

    This is terribly misleading, and it’s dangerous because it gives people much more faith in mainstream medicine than is warranted.

    As I keep saying, if you fall off the roof and land on your head your life may be saved by mainstream surgery. In the past, you would have died. Mainstream medicine is also great at diagnosing certain diseases with blood tests.

    I have very little use for mainstream medicine, or alternative medicine, outside of certain limited areas. Everyone keeps saying how wonderful most MDs are but people I know have been given very bad advice and have become addicted to these wonderful drugs.

    Another example is a guy I knew who had RLS. I advised him to try stretching or yoga, because I could see that he had bad posture and I suspected his RLS was related to subluxations. He tried that and it worked, but he decided to consult a specialist anyway. Now he is completely addicted to one of the RLS drugs — if he misses one does his RLS becomes unbearable, much worse than it ever was before the drug.

    I could go on and describe more and more examples. I know people whose lives were saved by emergency surgery, and others whose lives have been seriously damaged by unnecessary drugs.

  61. PalMD says:

    “I bet you can’t find a single example anywhere of a doctor telling a patient that pills are as good as or better than prevention.”

    I already gave the example of PalMD. And I personally know of examples.

    That is a fairly crappy mischaracterization. Pevention is extremely important, but when an 80 year old woman comes to me with a T-score of -3.0 and vertebral compression fractures, offering exercise rather than fosamax would be pretty close to malpractice.

  62. Fifi says:

    People shouldn’t have faith in medicine of any kind, it’s not a religion and treating it as such will only lead to disappointment. Just like treating doctors like shaman will ultimately be disappointing when it’s discovered they’re just humans with some training and access to specialized knowledge. Rather than relying on faith, people should ask their doctor to explain to them the things they don’t understand so that faith isn’t required. Naturally if one has built up trust in a doctor then one can trust them as one would anyone else who’s earned your trust.

    Having actually faced the challenge of helping chronic pain patients make lifestyle changes, I can tell you that some people are resistant to changing their diet or exercising even when their current lifestyle is clearly hurting them. I have seen many yoga teachers do things that are patently dangerous and likely to create damage in the long term. There are great ones’ too but putting faith and unwarranted trust in yoga – particularly if someone has a physical problem that may contraindicate practicing certain asanas – is not only foolish but potentially dangerous. Which, of course, is not to say that yoga can’t be practiced safely or be beneficial, just that it’s actually a rather dangerous thing to proscribe in some cases.

    Pec, since you’re diagnosing subluxations are you a chiropath?

  63. apteryx says:

    “This is well known because people from non-Western cultures do not get type 2 diabetes, for example, until they start eating processed food and stop getting exercise.”

    That’s not always true. Studies have found that diabetic indigenous people who return to traditional wild-food diets and lifeways have their blood sugar and lipids normalize rapidly. However, many traditional ethnic diets have enough carbs that it is possible for susceptible people to have type 2 diabetes. Among agricultural peoples, diabetes has been common enough that many traditional pharmacopoeias have at least semi-effective herbal treatments for diabetes; I believe these are not likely to work well for people with type 1 diabetes, so they were probably developed by observation of their benefits in people with type 2 diabetes. (No, I am NOT saying that people should give up their metformin in favor of the plant from which metformin was derived. I’m saying the plant was significantly better than nothing.)

  64. HCN says:

    No, from:
    http://www.sciencebasedmedicine.org/?p=87#comment-2869

    She says “I am a woman in computer science and we are very very scarce. I never had any natural love of machines, so I’m not sure how I got into this field. I think it was my typically female love of language and logic.”

  65. PalMD says:

    As has been written here recently, EBM is hard—it requires applying data to actual people. I have a wonderful patient (actually he’s a wonderful guy, not a great patient) who just won’t quit smoking. He has several severe complications of smoking.

    It would seem that the pecs of this world would rather I didn’t offer evidence-based therapy to this guy, despite that fact that I can help him a lot. It’s a terribly punative viewpoint, and full of wishful thinking.

  66. pec says:

    PalMD,

    The drug ads do not show 80-year-old women with severe osteoporosis. They show attractive actesses or models who obviously do exercise. But they take the bone drug anyway and the implication is the drug is healthy and wholesome and good for you. It is not. Maybe it’s ok for someone whose life is endangered by severe disease. I am not even convinced it’s good for that, since dense bones are not necessarily healthy.

    And when you first made that statement no one was talking about 80-year-olds with fractures. The commenter was a not-very-old woman who said she would rather exercise than take pills, and was scolded, by “oldfart” I think, for not following her doctor’s advice. Your comment followed that. I know I should go look it up and quote it exactly but I don’t have time right now.

  67. pec says:

    And by the way, in that same conversation you said your patients don’t always follow lifestyle advice so you have to give them drugs. I do not believe a patient would ignore lifestyle advice if they thought there were no easier alternatives.

    When you tell patients to change their lifestyle, and then say “but don’t worry I’ll give you a pill if that doesn’t work,” you know very well they would rather have the pill.

    People who have never tried a healthy lifestyle do not know that it feels good to be healthy. They assume exercise is boring and painful and therefore drugs are the more attractive choice. So they will take the pill every time, if you offer it and they trust you.

  68. PalMD says:

    The drug ads do not show 80-year-old women with severe osteoporosis.

    Pec, this particular logical fallacy is called “moving the goalposts”. When you get trapped, you change your objectives to continue the argument.

    You haven’t fooled anyone—your objections aren’t based on science, they are based on your own prejudices. That’s it.

  69. pec says:

    Oh and we were talking about drugs for PREVENTING osteoporosis, not curing it. Jane was advised to take it for prevention.

  70. PalMD says:

    Um, I’m not sure of Jane’s exact story, but bisphosponates are only indicated for prevention in certain situations (like chronic steroid use). That’s the science. If I were to offer fosamax to a woman with normal bone density and not on chronic steroids, I would be ignoring the medical evidence.

    Pec, you don’t actually have some rare insight that medicine has missed. We really do think about these things.

  71. weing says:

    pe,
    There are so many errors and ridiculous blanket statements in your post that one doesn’t know where to begin to correct them. Diabetes mellitus was known in ancient Rome and was recognized by the sweet urine of the patients. Hence its name.
    I think we can do quite a lot to help patients despite themselves. It would be ideal if they adhered to lifestyle modifications. “Natural” is a bogus term. Everything is natural. Try eating a “natural” amanita phalloides, drink some “natural” hemlock. Eat some unripe seeds of the “natural” akee fruit. Spend enough time outside in “natural” sunshine in non-western countries and see if you don’t develop natural skin cancers. The trouble with your statements is that there is a tiny grain of truth that is twisted to come up with bizarre conclusions.

  72. Joe says:

    Pec wrote “And by the way, in that same conversation you said your patients don’t always follow lifestyle advice so you have to give them drugs. I do not believe a patient would ignore lifestyle advice if they thought there were no easier alternatives.”

    What you ‘do not believe’ is worth less than the electrons that convey your message (updating “the paper it is printed on” trope).

    Pec wrote “When you tell patients to change their lifestyle, and then say “but don’t worry I’ll give you a pill if that doesn’t work,” you know very well they would rather have the pill.”

    Haven’t you worked out what “straw man” means?

    Pec wrote “People who have never tried a healthy lifestyle do not know that it feels good to be healthy. They assume exercise is boring and painful and therefore drugs are the more attractive choice. So they will take the pill every time, if you offer it and they trust you.”

    More, worthless, rumination.

  73. pec says:

    weing,

    You’re the ignoramus. Diabetes mellitus can result from lack of insulin (type 1) or insulin resistance (type 20). You don’t know which type occured in ancient Rome. Probably type 1, since almost everyone had to walk then.

    And I KNOW that natural substances can be toxic. I defined “natural,” in this context, as substances we evolved to deal with. And I KNOW that not everything natural is good for us. But substances cooked up in a laboratory are very unlikely to be something we ought to take into our bodies every day.

    If you think evolution has done a lousy job — and many materialists do believe that — then maybe you don’t think natural is generally better.

  74. pec says:

    “type 20″ should be “type 2.”

  75. PalMD says:

    You’re the ignoramus. Diabetes mellitus can result from lack of insulin (type 1) or insulin resistance (type 20). You don’t know which type occured in ancient Rome. Probably type 1, since almost everyone had to walk then.

    ZOMG! The unsupported assertions continue!

  76. weing says:

    pec,
    Based on that statement, it’s obvious you haven’t studied history and don’t really know what people are like. You are romanticizing the non-western lifestyles and demonizing science based approaches. As I said, there is a tiny grain of truth in what you say that you manage to totally twist to suit your fantasy. I guess a little knowledge is a dangerous thing.

  77. Harriet Hall says:

    Pec, you are hard to pin down, and people are responding to you in a scattershot pattern. I’m going to offer you a chance to redeem yourself and carry on a sustained focused discussion. I’m responding to your last comment responding to my comments. Please respond to each numbered point.

    (1) I said, “I bet you can’t find a single example anywhere of a doctor telling a patient that pills are as good as or better than prevention.” pec said “I already gave the example of PalMD.”

    No, pec; PalMD is not at all an example of that. He was talking about treating a woman who already had a problem. He never suggested that primary prevention wouldn’t have been a better idea when this woman was younger. If he had seen her in her youth, I’m sure he would have suggested preventive measures like exercise and adequate calcium in the diet.

    (2) “By “natural” I mean substances in a state that our bodies evolved over millions of years to deal with.”

    Our bodies evolved to deal with a lot of different things in their environment. In our present state of evolution our bodies are quite capable of dealing with things that were not present in prehistoric times. Biochemical mechanisms that evolved for one purpose may also work quite well for another purpose. It is not logical to reject something just because it wasn’t present 1000 years ago.

    (3) “I have never said or implied that patients should be left to die if they became sick in spite of a healthy lifestyle, or if they became sick because they failed to practice a healthy lifestyle.”

    I never said you said that. I said I hoped that wasn’t what you meant. I wanted to know what you did mean. You did say that telling people that treatments exist interferes with their motivation to follow a healthy lifestyle. What would you do? Censor information? Keep all treatment options secret until the patient is sick?

    (4)”we have no good treatments for the chronic diseases associated with aging, such as type 2 diabetes, cancer, heart disease, etc.”

    FALSE. The only way you can try to justify that statement is by making up your own idiosyncratic definition of “good.”

    (5) “people from non-Western cultures do not get type 2 diabetes, for example, until they start eating processed food and stop getting exercise.”

    FALSE. Where did you get your information?

    (6) “Everyone knows someone who was “cured” of cancer — but all of those patients were diagnosed early and only a tiny percent would have become sick without the treatment.”

    FALSE. A lot of those patients were diagnosed when their cancer was advanced and had already metastasized and they were already sick. And still treatment was able to prolong their lives and in some cases actually cure the cancer.

    (7) “people I know have been given very bad advice and have become addicted to these wonderful drugs ”

    Individual experiences are not enough to counteract the general reality. The majority of scientific doctors do not give bad advice and very few patients become addicted to drugs. It is not scientific to let personal experiences influence your opinions.

    (8) “I suspected his RLS was related to subluxations.”

    Why on earth would you suspect that? Do you have any evidence that indicates the cause of restless legs? Do you have any evidence that the “subluxations” chiropractors talk about really exist?

    (9) “others whose lives have been seriously damaged by unnecessary drugs.”

    We all know of people like that. That’s why it’s so important to only prescribe drugs when they are clearly indicated and when there is scientific evidence to support their use. That’s what good doctors try to do, and that’s what this list is all about. Don’t you know of anyone who was ever helped by necessary drugs?

  78. David Gorski says:

    A lot of those patients were diagnosed when their cancer was advanced and had already metastasized and they were already sick. And still treatment was able to prolong their lives and in some cases actually cure the cancer.

    A good example that Harriet is correct is a famous one: Lance Armstrong. In 1996, he was diagnosed with testicular cancer that had metastasized to his brain and lungs, described as over forty tumors in his lungs and two in his brain. He underwent brain surgery and chemotherapy for them and survived. It’s hard to argue that he isn’t thriving, and there’s no way it can be argued that he had “early stage” cancer. Indeed, if I staged him correctly, nowadays he’d be staged as IIIC, and brain metastases are generally among the poorest of prognostic factors for most solid tumors. Lance Armstrong, and many patients like him, are strong evidence that scientific medicine can cure more than just early stage cancers. Moreover, his primary treatment was chemotherapy. And he wasn’t elderly, either. He’s only 36 now. Of course, testicular cancer is a disease primarily of younger men, usually in their 20′s and 30′s.

    Not unexpectedly, scientific medicine doesn’t do as well with advanced cancers as with early stage cancers, and there are cancers that are incurable once they’ve metastasized distantly (pancreatic cancer and breast cancer, for instance). There are also others that are potentially curable after they’ve metastasized (testicular cancer, sarcomas, and colon cancer metastatic to the liver, for example). In other words, pec is being simplistic to the point of being just plain wrong when she says that scientific medicine can’t successfully treat anything other than early stage cancers. She’s also wrong when she implies that “natural” cures could do any better or even equal what scientific medicine can accomplish.

  79. Fifi says:

    pec – “The drug ads do not show 80-year-old women with severe osteoporosis. They show attractive actesses or models who obviously do exercise.”

    Ads for drugs are made by pharmaceutical companies not doctors – like all ads they’re made to get people to buy things they don’t need. For a long time it was illegal to advertise drugs to the public, you’re a prime example of why it’s essentially an unethical thing to do since advertising isn’t about distributing information but about creating a demand to sell more product. I’ve yet to meet a doctor who thinks advertising prescription drugs to the general public is a good idea.

    pec – “People who have never tried a healthy lifestyle do not know that it feels good to be healthy. They assume exercise is boring and painful and therefore drugs are the more attractive choice. So they will take the pill every time, if you offer it and they trust you.”

    You could insert “magic CAM cures” in place of “drugs” as the attractive choice. Some people just don’t want to give up their unhealthy habits or create healthy ones – they want to be magically “cured” of all that ails them while continuing to do what hurt them in the first place (including the minor aches and pains that are just a part of life). There are a wide variety of reasons for this, but ultimately it’s people selling things (Big Vita/Sup and Big Pharma) try to sell the public magic cures, not doctors. Eat less and exercise more is obviously less attractive than magic, no matter who’s conjuring up fantasies that involve getting what we want with no effort.

  80. pec says:

    (1) >“I bet you can’t find a single example anywhere of a doctor telling >a patient that pills are as good as or better than prevention.” pec >said “I already gave the example of PalMD.”

    >No, pec; PalMD is not at all an example of that. He was talking >about treating a woman who already had a problem.

    Harriet,

    The conversation at PalMD’s blog was about preventing osteoporosis. He changed it at this blog so you would think it was about 80-year-olds in bad shape, but it wasn’t.

    http://scienceblogs.com/denialism/2008/05/about_that_crank.php#comments

    (2) “Our bodies evolved to deal with a lot of different things in their environment. … It is not logical to reject something just because it wasn’t present 1000 years ago.”

    A lot of these drugs weren’t even present 5 years ago. It IS logical to see a difference between substances our species has been eating for tens of thousands of years, and newly concocted concocted.

    Even natural substances, such as vitamins, often can’t be used by our bodies when they have been separated from their natural context in food(. Evolution does matter.

    (3) “You did say that telling people that treatments exist interferes with their motivation to follow a healthy lifestyle.”

    I would not hide information. But I would tell them the drugs should be avoided if at all possible, because they do not restore health. For example, I know people who were told that the new anti-depressants restore brain chemicals to their correct balance. This kind of statement is very misleading, and gives patients false confidence in the drugs. Notice that I don’t call them “medicine,” since medicine is supposed to help the body heal itself. Many of these drugs throw complex systems further out of balance — exactly the opposite of what you want.

    (4) ”we have no good treatments for the chronic diseases”

    No, we don’t. A “good” treatment helps the body heal itself. I would define emergency surgery as a good treatment, since it allows the patient to survive an recover. Antibiotics are sometimes good, although of course they have been over-used and misused. I don’t think the drugs used for heart disease and cancer are very good.

    Yes there are exceptional cases where they do allow patients to survive and recover. But citing exceptional examples, like Armstrong, is not scientific. If I cite a particular example — even if it is representative and typical — you all shout “unscientific!” Well an atypical example is even worse.

    (5) “people from non-Western cultures do not get type 2 diabetes”

    “FALSE. Where did you get your information?”

    I have read it many times in many places, would have to search. Native Americans are one example — they had no refined sugar or alcohol before the Europeans came, so they were extremely vulnerable to alcoholism and diabetes. Just look at pictures of people in traditional cultures — they are not obese. And obesity is the main cause of type 2 diabetes.

    (6) “FALSE. A lot of those patients were diagnosed when their cancer was advanced and had already metastasized and they were already sick. And still treatment was able to prolong their lives and in some cases actually cure the cancer.”

    You always want citations — where is the evidence for that statement? What is implied by “in some cases actually cure the cancer?” One in a billion cases were cured? It could mean anything. And when a treatment very rarely results in a cure, you have to wonder if factors other than the treatment were involved. Sometimes cancer just goes away, with or without treatment, and no one knows why.

    (7) “The majority of scientific doctors do not give bad advice and very few patients become addicted to drugs.”

    From what I have read the new psychiatric drugs can have severe withdrawal symptoms. Therefore, they are addictive.

    (8) “I suspected his RLS was related to subluxations.”

    “Why on earth would you suspect that?”

    I have decades of experience with subluxations. No, I have not run clinical trials, I am talking about direct personal experience. It won’t convince you. But the guy I was talking about saw for himself that I was right — it was just easier to take the pills and he trusted the MD. When he complained to the doctor about being much worse off than before, the doctor said “You asked me for medicine, so I gave it. It’s not my fault.”

    “Don’t you know of anyone who was ever helped by necessary drugs?”

    Yes, especially antibiotics. Before antibiotics minor injuries could be fatal. I also am grateful that we have better painkillers now, in case anyone needs them temporarily. And sometimes I need allergy medicine, even though I hate it. There is always a week in the fall when I can’t stop sneezing.

    I can’t think of any other drugs right now that are worthwhile. But to have a thriving drug industry you have to constantly invent new products, and you have to invent needs for those products.

  81. PalMD says:

    Based on this bizarre response, I’d say it’s time to stop feeding the troll.

  82. Harriet Hall says:

    (1) Thanks for the link, pec. It says, “Jane, the data from randomized controlled trials are actually quite clear. The effect of bisphosphanates is significantly better in increasing bone density and decreasing significant fractures than non-medical interventions. That doesn’t mean exercise etc isn’t important—it is, but it is only one tool, and unfortunately not the most powerful one.”

    You misinterpreted what he wrote. Any discussion that mentions biophosphanates is clearly about SECONDARY prevention, i.e. preventing fractures in patients who already have decreased bone density. He is not talking about PRIMARY prevention, which is what you are talking about, preventing osteoporosis in the first place. He says exercise has not been shown as effective as the drugs once the condition has developed. He absolutely does not say what you think he said. You still have not given me a valid example of a doctor who thinks drugs are equal or better than lifestyle measures for preventing disease in the first place.

    (2) “It IS logical to see a difference between substances our species has been eating for tens of thousands of years, and newly concocted concocted.”

    The ONLY difference is that they are newly concocted. They are all chemical substances. There is no reason to assume that a new chemical is any worse for the body than a previously existing chemical. Some of the things that our species has been eating might be bad for us, and some new things might be good for us. The only way to find out is to test them.

    (2a) “Even natural substances, such as vitamins, often can’t be used by our bodies when they have been separated from their natural context in food.”

    I can’t think of an example. What are you talking about?

    (3) “I would tell them the drugs should be avoided if at all possible, because they do not restore health.”

    I agree that drugs should be avoided if at all possible, but you’re wrong that they do not restore health. Sometimes they DO restore health. Sometimes nothing can really restore health but the drugs can help the patient function and live with suboptimum health.

    (4) “Yes there are exceptional cases where they do allow patients to survive and recover. But citing exceptional examples, like Armstrong, is not scientific.”

    In some cancers, survival and recovery are not exceptional, but routine. Armstrong’s case was not so exceptional. You can look up the survival rates for various cancers with and without treatment. One case like Armstrong proves nothing, and Dr. Gorski did not intend to “prove” anything by citing him; he was just trying to get you to question your convictions by providing a well-known example that strikingly refuted them. The statistics DO prove the benefits of cancer treatments. Do some research.

    (5) “I have read it many times in many places.”

    Well, I’ve read many times in many places that the Tooth Fairy brings money to children. That’s not good enough.

    (5a) “Just look at pictures of people in traditional cultures — they are not obese. And obesity is the main cause of type 2 diabetes.”

    I’ve seen lots of pictures of people in traditional cultures who were obese. Type 2 diabetes is complex, and it is simplistic and inaccurate to say it is “caused” by refined sugar and/or obesity. In fact, Type 2 diabetes can itself CAUSE obesity and can make it extremely difficult to control weight, and thin people can develop diabetes too. For a discussion of causal and risk factors, see http://www.umm.edu/ency/article/000313.htm

    (6) “One in a billion cases were cured?”

    Your estimate is truly laughable. At least half of invasive cancers can be cured today.

    See:
    http://rex.nci.nih.gov/NCI_Pub_Interface/raterisk/rates28.html
    http://www.users.on.net/~pmoran/cancer/cancercure.htm
    and many other sources of accurate statistics.

    Even those that can’t be cured can be treated to prolong life and improve symptoms.

    (7) “From what I have read the new psychiatric drugs can have severe withdrawal symptoms. Therefore, they are addictive.”

    Some psychiatric drugs do cause withdrawal symptoms; some more than others. Most do not. This is not “addiction” in the common sense of the word, and patients can easily be tapered off these medications. Once they are off the drug, their body chemistry returns to normal and they do not have any craving for the drug or any need for it. Addictions to drugs used in scientific medical treatment are rare.

    (8) “I have decades of experience with subluxations.”

    You have decades of experience with what you thought were subluxations. Since chiropractic has been trying to demonstrate subluxations to the scientific community for a century and has never been able to do so, can you admit at least a tiny possibility that your experience might have misled you? Do you realize many chiropractors have admitted their training misled them and have given up the subluxation myth? Do you understand why? If you trust your personal experience more than scientific evidence, I wonder what attracts you to science blogs.

    You didn’t answer this question: “Do you have any evidence that indicates the cause of restless legs?”

    (8a) “I can’t think of any other drugs right now that are worthwhile.”

    I can. Insulin, anti-convulsants, corticosteroids, anti-hypertensives, gout medications, low molecular weight heparins, anti-HIV agents, diuretics, disease-modifying agents for rheumatoid arthritis…. the list goes on and on. How can you not know about any of these or think they’re not worthwhile?

  83. PalMD says:

    Well, I’ve read many times in many places that the Tooth Fairy brings money to children.

    What are you trying to say? That she isn’t real? Because that would really suck.

  84. Harriet Hall says:

    PalMD,
    Don’t let me disillusion you. I was just kidding. The Tooth Fairy is real but her vibrations exist on a quantum energetic plane which does not lend itself to scientific testing. Prejudiced and closed-minded scientists reject her, but science is only another belief system. There are other ways of knowing. There is more than just the material world that we see and touch.
    I have personal experience with the Tooth Fairy – she brought me money many times in my childhood. So many other people believe: there must be something to it. I know what I know, so don’t try to talk me out of it. :-)

  85. qetzal says:

    Also, the Tooth Fairy cured my subluxations. Great gal!

  86. HCN says:

    Fifi said “You could insert “magic CAM cures” in place of “drugs” as the attractive choice. Some people just don’t want to give up their unhealthy habits or create healthy ones – they want to be magically “cured” of all that ails them while continuing to do what hurt them in the first place (including the minor aches and pains that are just a part of life). There are a wide variety of reasons for this, but ultimately it’s people selling things (Big Vita/Sup and Big Pharma) try to sell the public magic cures, not doctors. Eat less and exercise more is obviously less attractive than magic, no matter who’s conjuring up fantasies that involve getting what we want with no effort.”

    You have essentially described a member of our extended family. She has several health issues. She has been told over and over and over again by regular doctors to leave her house and walk, to eat a balanced diet. But no, she does not like those answers. Especially since the only vegetable she will eat is corn.

    So she goes to a naturopath and gets several expensive compounded nostrums to help her. But she refuses to exercise, refuses to eat a balanced diet and then complains that she cannot lose weight and she is constipated.

    At a family gathering years and years ago she was complaining about her constipation. I piped in that I found walking very helpful, along with eating whole wheat bread, salads and whole fruit instead of juice for fiber. All I got was a deadly glare.

    Later I was informed that those were activities she was trying to avoid.

    Oh, by the way… after three years of trying to control my cholesterol through exercise and diet (up to swimming 2000 yards, and lost over 20 pounds) my genetics have fought back. While I initially brought my levels down, my liver has decided that I need more LDL to accompany my very high HDL (it was over 70 at one point!)… and I need to schedule an appointment to talk about my options. While my half-Dutch hubby gets to eat all the cheese, butter and sausage he wants and his levels are very low (his grandparents cooked everything in butter, I actually had a steak in their little house in a town outside Amsterdam that was cooked in a half-inch of butter!).

    Anyway, I have read:
    http://www.amazon.com/Survival-Sickest-Medical-Maverick-Discovers/dp/0060889659/ … which says that some genetic characteristics that are fatal at a certain age (like over 50) had advantages for survival in an era where the life expectancy was much lower. Like the author’s own genetic blood iron disorder, and sickle cell anemia.

    All I can conclude is that somewhere in my very Northern European heritage their is an advantage to making so much blood cholesterol (British Isles and Scandinavia). Something like getting most of their protein from fish instead of pigs or other meats with fats. Along with the fair skin for better getting more Vitamin D from sunlight.

    It sucks, but I might have to go on medication to keep my liver from trying to do its evolutionary job.

    Much like my oldest son who is on medication to keep the blood pressure across his mitral valve from causing any more damage. He has a genetic heart condition that has been known to cause “sudden death”: hypertrophic cardiomyopathy with obstruction.

    I did the whole exercise and diet bit… which I will continue to do (on the bright side, my back no longer goes out, something that started with child #3… now I have no problem filling a wheelbarrow with a pea gravel and pushing it up an incline to fill in under a porch). I don’t like it, but at least I was given a few years to attempt to bring the levels down with changes to lifestyle. What am I supposed to do? Increase my swimming to 4000 yards? Become a reluctant vegan?

    My son was exercising and eating a balanced diet when his heart murmur was found when he was fourteen. Now he has to limit his exercise, or his abnormal heart muscle will block his mitral valve and kill him. What miracle natural cure do you have for http://4hcm.org/WCMS/index.php?overview ?

  87. HCN says:

    Let me bring this back to early detection of cancer and genetics:
    What miracle natural treatment do you suggest for those born with either the BRCA1 or BRCA2 gene?

    The reason I ask is because I went to this lecture:
    http://www.gs.washington.edu/wednesdays/speakers/king.html

    Since I come from a family that put “fun” into dysfunctional, which includes familial non-communication and a possible adoption (or two, I just found out that the grandmother who may have carried the hypertrophic cardiomyopathy gene was adopted… something out of an Old West “the mom died, gotta give the babe to a young family to care for her ‘coz the dad had a hard job on the range” story… I am not joking). I am the one in the video (which I have not watched, well, because I was there) that asked about cloudy family history.

    After the talk I was cornered by a pair of young ladies. They were identical twins who had been adopted out as infants, fortunately together. It turns out that when they were both in their early 30s they were diagnosed with breast cancer. They hired a detective to find their birth mother (the adoption papers out here in the far west are usually very murky, and some are under the table… I actually met someone in college who was part of an illegal adoption in the late 1950s, even stranger family dynamics than mine!). The detective was able to find the records, and both the birth mom and her sister were already dead: from breast cancer. The twins both tested positive for one of the BRCA genes.

    And no, I am not sure this experience contributes much to this discussion, but I thought it was interesting. This genetics stuff is very interesting. I started to study my genealogy just for fun, but I have only found it to be very murky and my ancestry is not what I thought (found out some secrets, and created more… turns out my great-grandfather left my great-grandmother because she decided to live openly as a lesbian with her girlfriend in the 1930s, now I know why he moved diagonally across the country to Georgia! — my dad was actually laughing when he told me about “the part of the family we don’t talk about”). I am actually tempted to pay for one of those tests that take a guess at where a person’s ancestors come from, but they are expensive (but could be worth a sciencebasedmedicine article?).

  88. pec says:

    http://rex.nci.nih.gov/NCI_Pub_Interface/raterisk/rates28.html

    You must be kidding Harriet. Or you missed the entire point of Gorski’s post. Those data are for 5-year survival, and do not correct for lead-time bias.

  89. pec says:

    “If you trust your personal experience more than scientific evidence,”

    Many things have never been studied by science. And for heaven’s sake why should I doubt my own experiences anyway? And most of what you call “science” is really based on a materialist ideology and has nothing to do with objective observations.

    Yes I trust my own experiences more than the dictates of a materialist pseudo-scientific establishment.

    On the other hand I love science and I do care about evidence. There is NOTHING in your brand of pseudosience, however, to demonstrate the non-existence of subluxations.

    “Some chiropractors” have decided subluxations aren’t real? So I should go along with that group of ex-chiropractors because they agree with you?

    Most things are unknown to science (I mean real science, not materialist ideological pseudoscience). Some things have been demonstrated by careful observation and data collection — evolution for example. But many of the things we need to know haven’t been studied, and of those that have been studied no clear answers have yet been found. As our knowledge grows, our ignorance remains infinite.

    I know a lot about subluxations, and about yoga. Harriet you are wrong but I don’t have millions of dollars to prove it with research.

    I am very grateful for what I have learned during my life and I wish everyone could benefit. But closed-minded MDs like yourself want to prevent your suffering patients from ever knowing.

  90. pec says:

    Correction:

    “But many of the things we need to know haven’t been studied, and of those that have been studied no clear answers have yet been found.”

    But many of the things we need to know haven’t been studied, and of those that have been studied no clear answers have yet been found, in many cases.

  91. Michelle B says:

    I am quite late to this v interesting thread, but here’s my two cents: Pec is insulated from terror by cocooning herself (and I will now refer to Pec by that gender since she has identified herself) in a nature-knows-best chrysalis. We have certainly evolved within nature, and we continue to have a very close relationship with it (How can we not?). Evidence-based medicine does not usurp nature–it does not violate any true natural laws.

    But, recognizing and trying to understand the natural world does not mean we suspend reality or attribute to it characteristics it does not have–like it knowing what is best for us, cares about us, fills us with a force of ‘life energy’, etc. For Pec, I think, nature is intuitive while drug-based medicine is not, and she, despite her intelligence, skills, and above-average knowledge base, remains mired in her ‘intuitive’ distrust of ‘un-natural’ drugs. Within this blinkered perspective, she then gloms onto valid criticisms of how some doctors adversely practice medicine and makes it the centerpiece of why one must defer to/trust Mother Nature.

    Just like a drunk or a druggie or a believer in irrational religious superstitions comes up for air from time to time, so does Pec. It would be great if she did it more though and not just flounder temporarily–taking nice, big drafts of reality–on the surface of her murky, ‘intuitive’ pond.

    Some education experts focus on what students are already familiar with and also with what they do right. So, I am guessing that since intuition plays a prominent role in Pec’s decision making, perhaps a post on that angle, how some true concepts can appear counter-intuitive would make a nice addition to this blog.

  92. David Gorski says:

    Yes I trust my own experiences more than the dictates of a materialist pseudo-scientific establishment.

    As I had been beginning to suspect, Pec’s inability to deal with science appears to have a religious or “spiritual” basis more than anything else, which is perhaps why she is so resistant to data that conflicts with her world view. Whenever I hear anyone refer to science as “materialist” in such a tone, I can be pretty sure I’m right in concluding that they are not coming from a scientific viewpoint.

  93. Fifi says:

    It occurs to me (and please excuse me for stating the obvious but it is a bit like trying to ignore the elephant in the room) that anyone who truly defers to mother nature and think nature knows best would just let people die. Disease is natural. Death is natural. Whether one’s using CAM or pills, both are intervene with the natural progression of disease and a natural death (using tools and systems created by humans).

    I’m curious as to whether pec’s resistance to science and fear/fear mongering comes from a professional involvement with CAM or is purely personal. I doubt we’ll get a straight answer, since I suspect she doesn’t want to reveal her motivation since she keeps dodging these kinds of questions. People who have spent their whole life playing CAM “doctor” – who took people’s money and told them not to get tested or treated for cancer, high blood pressure, diabetes, etc – would start to realize how much blood they have on their hands if they admitted that science had shown their beliefs (and consequently actions) to be wrong. As most CAM philosophies blame the patient for their disease/illness – it’s a spiritual imbalance, an evil act in a past life, etc – CAM practitioners tend to blame the patient (via karma, bad vibes or whatever) when treatments don’t work. I can see how some people would deny the evidence in this kind of situation – particularly if they had a religious need to see themselves as “good” or some sort of superiorly evolved spirit being and they realize on some level that their actions and advice actually caused more harm than good. I can certainly see how someone could irrationally cling to their beliefs in this kind of situation.

    That pec claims to know about yoga but doesn’t even seem to understand that certain asanas are very ill advised with certain injuries or conditions, and that some yoga teachers are actively dangerous in their ignorance of the body and basic exercise safety. Any yoga teacher with experience and adequate training recognizes and understand this – yoga teachers who specifically work with people with injuries most of all.

  94. daedalus2u says:

    The only way we can think about things is to use the cognitive structures we have in our brains. If those cognitive structures are “tuned” to work best at understanding human relationships, they may be ill suited for use in thinking about reality.

    In other words, if the only tool you have is a hammer, every problem looks like a nail. If the only cognitive structures you have relate to human interactions, everything you try to think about will appear anthropomorphic. I think this is why people attribute human motivations to non-human objects. It lets them use their very well developed brain structures for interacting with other humans to think about physical reality involving those non-human objects (even if that thinking is muddled). To understand other humans and interact with them successfully, you need to attribute motivations to them and model them as autonomous actors with human motivations that you can understand. There is no reason to suppose that any non-human aspect of reality corresponds to any matching human behaviors.

    It is very easy for humans to get sucked into that mindset. I am reminded of an incident I once read about where a mother found a wild bear cub, and smeared peanut butter on her child’s face so the bear cub would lick it off so the mother could get “cute pictures” of the bear cub licking her child’s face. Bears of all ages are wild animals, not “child-like” organisms that our anthropomorphic oriented senses “see”, because infants of all mammalian species are “cute” because they invoke parenting behaviors.

  95. pec says:

    “she is so resistant to data that conflicts with her world view. ”

    What data am I resisting? I believe objective scientific data, and i believe my own direct experiences. I have not seen any conflict between them.
    I DO see conflicts between my experiences and materialist dogma, which has nothing to do with scientific evidence.

    “Whenever I hear anyone refer to science as “materialist” in such a tone, I can be pretty sure I’m right in concluding that they are not coming from a scientific viewpoint.”

    I am a real scientist, because I look at the evidence, whether from my own experiences, or scientific research, or the experiences of others.

  96. pec says:

    Materialism DOES NOT EQUAL science.

  97. weing says:

    “I am a real scientist, because I look at the evidence, whether from my own experiences, or scientific research, or the experiences of others.”
    That is your definition of scientist? Someone who just looks at evidence?

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