The Big Cancer Cover-Up

The big cancer cover-up: WDDTY vol 23 no. 11 (March 2013)
The big cancer cover-up is an op-ed by Bryan Hubbard following the Neon Roberts case. Positioned as highlighting “the shortcomings of conventional cancer treatments and the bias against fair testing of the alternatives”, it is instead a credulous Gish gallop across the landscape of cancer quackery.

The only therapies which get a rough ride, are those supported by reliable evidence. And here Hubbard turns the conspiracy dial up to eleven.

For example, Hubbard states: “Chemotherapy’s true success rate hovers around the 2 per cent mark—the cancer patient has a 2 per cent chance of living a further five years or longer if he has chemotherapy”. This is complete nonsense. Not only is it grotesquely inaccurate in the case of, say, Hodgkin’s lymphoma, where five-year survival with chemo as primary therapy is in excess of 80% and some patients are 40 years and more post chemo, it’s also grotesquely untrue in the aggregate.

The big cancer cover-up

This cartoon sums up WDDTY's agenda on cancer in a nutshell.
This cartoon sums up WDDTY’s agenda on cancer in a nutshell. Thanks to Scott Chambers

The Neon Roberts case highlights the shortcomings of conventional cancer treatments and the bias against fair testing of the alternatives

Bryan Hubbard

The recent controversy over the most effective treatment for Neon Roberts—the seven-year-old with a brain tumour whose mother tried to prevent him having surgery and radiotherapy—has highlighted the myths and half-truths concerning alternative cancer therapies.

Yes it did – and not to the advantage of the bogus claims made by cancer quacks.

Conventional medicine maintains that no alternative to chemotherapy, surgery or radiotherapy has ever been proven to work, and patients who delay treatment in favour of an alternative are endangering their lives and reducing their chances of survival. High Court judge Mr Justice Bodey, who was hearing Neon’s case, agreed and in his summing up commented: “I find it difficult to see that doctors would withhold alternative treatment that would improve survival.”

This is not true. Surgery is the primary therapy for solid tumours, chemotherapy for liquid tumours, radiotherapy is used to reduce solid tumours (neoadjuvant treatment), to slow progression of incurable tumours or to increase the success rate for surgery (adjuvant therapy, for which chemotherapy s also used).

Other therapies used in mainstream oncology include genetic therapies, transplants (primarily bone marrow, but arguably surgery), hyperthermia, photodynamic therapy, cryotherapy and biological therapies.

And for indolent tumours, there’s no rush. More men die with prostate cancer than of it.

And of course the biggie: preventive interventions, ranging from smoking cessation support to the HPV vaccine (against which, of course, WDDTY fulminates with characteristic inaccuracy).

Neon’s mother Sally had challenged the use of surgery and radiotherapy, and had put forward a range of possible alternative therapies that she said were safer and equally effective. Her main concern was the use of radiotherapy, and she cited studies that suggested the treatment could reduce a child’s IQ level by as much as 16 points, putting an average child with a 100 score at the level of ‘dull normal’ and just one point away from mental retardation.

That is what she said, but she comprehensively failed to provide anything like a credible argument to support this. And the case was drawn out by the rhetoric of anti-medicine cranks.

Instead, Mrs Roberts proposed seven possible alternative cancer treatments, including light therapy, boron neutron-capture therapy and immunotherapy, where the protective powers of the immune system are activated to fight cancer cells. However, the hospital trust treating Neon dismissed the therapies as “experimental and unproven” and entering “uncharted waters”.

Correct. There is a long-standing consensus that experimental therapies should only be used when they do not risk the patient: that means they do not replace proven therapies unless the case is truly hopeless or, conversely, the chance of survival is high without any treatment at all.

All this is in the Declaration of HelsinkiW.

It’s an argument that is often cited by oncologists, and it implies that the conventional cancer treatments of chemotherapy, radiotherapy and surgery have been subjected to rigorous testing and have been proven to be highly successful, whereas alternatives have never been properly tested and the inadequate trials that have been carried out show they don’t work.

Yes. Why on earth would they imply this?

Oh, because it’s true.

The truth is far more complicated—and disturbing—than this position suggests as issues of ethics, money, professional standing, data-massaging, sleight of hand and downright fraud all play a part in blurring the information we’re given about cancer treatments.

The truth is always nuanced and complex. Cancer, especially, is a complex set of diseases.

Conventional therapies 

Implicit in the condemnation of alternative cancer therapies is the assumption that conventional treatments are effective. Although there have been many trials involving conventional medicine’s three main cancer therapies, few have met the ‘gold standard’ of a double-blind placebo-controlled study, where the treatment or drug is tested against a placebo or dummy drug or procedure over a period of time. This is because medical ethics do not allow the withholding of treatment to a cancer patient.

Up to a point. Actually any new chemotherapy drug still has to show that it works better than the existing drugs, or as an additional therapy versus placebo, so double-blind controlled studies do exist for these, albeit against standard of care instead of placebo.

There’s a rather more nuanced treatment of this at the US National Cancer Institute.

As usual, attempts to paint anything about cancer as black and white only serve highlight the fact that nothing about cancer is black and white. Unless you determinedly ignore that fact.

However, without this sort of comparative trial, the studies rarely answer such basic questions as: Would the patient have done better on a different therapy? What would have happened if the patient hadn’t had the treatment? Did the treatment actually extend the life of the patient?

Actually that sort of analysis is done all the time, through epidemiological studies, meta-analyses, including analyses of different surgical approaches and so on. There is earnest discussion of how best to collect the data to facilitate this sort of analysis.

Probably the best known source of the detailed comparative information on treatments which doctors don’t tell you doesn’t exist (because, of course, it does) is the NIC’s Surveillance, Epidemiology and End Results (SEER) Program.

I know, it’s a bit much to expect a “health journalist” writing a piece on the efficacy of cancer treatment to be aware of the world’s largest database of cancer statistics.

Chemotherapy

This is medicine’s major answer to cancer. Cytotoxic drugs are either given exclusively or as a follow-up to surgery or radiotherapy, in which case they are called ‘adjuvant treatment’. The aim is either to cure (or put into remission) cancer, or at least alleviate the worst symptoms if a cure is not possible.

False. With my superior analytical skills I have discovered that a large majority of cancer cases in the UK are solid tumours, for which surgery is the primary therapy.

The term “cytotoxic” is a great favourite with the anti-medicine brigade; they love it because it contains the word “toxic”, feeding into their rhetoric of never-identified “toxins”. It means “cell-killing”.

If the cells are cancer cells killing them is a pretty good idea.

Many cytotoxic drugs are used in chemotherapy, including newer agents such as taxanes and anthracyclines, but overall the oncologist often talks about a 50 per cent success rate. In other words, you have a 50–50 chance of living a further five years or longer after chemotherapy. This sounds like an attractive option to a patient who may otherwise be seeing his life expectancy in terms of months rather than years.

False. The success rate depends primarily on the type and stage of cancer. If you have early stage Hodgkin’s lymphoma, your 5-year survival with chemotherapy is likely to be well in excess of 80%

Which patient? What cancer? Which stage? What other risk factors? Which chemotherapy?

But chemotherapy’s real success rate is far, far lower than half: in fact, it hovers around the 2 per cent mark—the cancer patient has a 2 per cent chance of living a further five years or longer if he has chemotherapy.

The 2% figure is a favourite among anti-medicine cranks. Orac calls it the “2% gambit“. It originates in a single study, it’s old and it (intentionally?) omits the types of cancer for which it works best and uses (intentionally?) only five-year survival, ignoring such factors as prevention of late relapse. I’d love to have the full text of this reply, which I am told nails not only these errors but several other glaring omissions.

So how can the two figures be so wildly different? It’s all to do with the way the data are massaged and interpreted. Researchers like to put the best face on study results—often because the trial sponsor happens to be the manufacturer of the drug being tested—and one useful sleight-of-hand trick is to show the results in terms of relative risk rather than absolute risk.

I think we can agree on it being down to sleight of hand and the massaging and interpretation of data. I suspect we may differ on the identity of the masseur.

Let’s say you have osteoporosis, the brittle-bone disease. Your condition may be at a stage where your risk of suffering a fracture is 4 per cent, but a drug can reduce that risk to 2 per cent. There are two ways of expressing the same thing: as a relative risk, the drug has a 50 per cent rate of effectiveness—it’s reduced your risk from 4 to 2—and that sounds attractive, but in absolute terms its effectiveness is just 2 per cent.

I have osteoporosis. I know this. I know the above because… the doctor told me.

For years, researchers have been presenting the effectiveness of chemotherapy in terms of relative risk, and oncologists have revealed in surveys that this has had a significant effect on the way they have expressed the drugs’ effectiveness to the patient. This has also influenced the media and the way it reports on cancer treatments.

I think you’ll find it’s a bit more complicated than that. People tend to hear what they want to hear. Both ways. This is best exemplified by the oft-repeated claim that 75% of doctors would refuse chemotherapy. Which turns out to be complete bollocks. It’s just another statistic bandied around in the intellectual vacuum of the altmedosphere.

Cancer treatment is as complex as cancer, and every patient views things differently, but chemotherapy works, within the limits of normal scientific uncertainty, and your doctor will tell you these limits.

The media certainly has a case to answer in misleading reporting. Some magazines, for example, devote themselves to little else…

The alarming discrepancy between relative and absolute risk was uncovered a few years ago by some of Australia’s leading oncologists, some of whom influence the country’s medical policies. They even cherry-picked the very best clinical trials, choosing only those showing that chemotherapy had led to a “statistically significant” increase in five-year survival.

Despite this, the researchers found that chemotherapy’s contribution to the five-year survival was only 2.3 per cent in Australia and 2.1 per cent in the US in terms of absolute risk. Similar levels were likely to be seen in every developed country, the researchers said.1

Reference 1: Clin Oncol (R Coll Radiol). 2004 Dec;16(8):549-60. The contribution of cytotoxic chemotherapy to 5-year survival in adult malignancies.

You know where I pointed out that the 2% gambit originates in a single study, it’s old and it (intentionally?) omits the types of cancer for which it works best and uses (intentionally?) only five-year survival, ignoring such factors as prevention of late relapse? That’s the study. Did anyone mention cherry-picking outliers?

Although the gulf between absolute and relative risk was the major cause of the difference in effectiveness claims, the Australian researchers discovered that the studies had also massaged the data for patient survival rates. Although the only measures that matter are meaningful prolongation of life and improved quality of life, researchers had often fudged the survival rates by using vague terms such as “progression-free survival” instead, with no indication of how long the cancer remained in remission. This meant that a patient whose cancer had been “progression-free” for just a matter of months was reported as a success.

Ha! You know when you big up Stanislaw BurzynskiW? Guess which measure he uses for some of his claims?

Reporting of cancer survival has been historically subject to variation. Increasingly, standardised metrics are being applied. This is a normal part of the self-critical system of scientific inqury.

In general, chemotherapy can help to alleviate the worst symptoms and it can be very effective in some rare cancers, but it’s far from being the life-saver against the major cancers that medicine claims, say the researchers.

No, that’s not what they say, and their conclusion is far from robust anyway.

Radiotherapy

The good news is that radiotherapy kills cancer cells. It can shrink tumours and alleviate the worst symptoms. It’s also useful as an adjuvant therapy in the follow-up after surgery. The bad news is that it kills healthy cells too and, despite the claims of its strongest advocates, there is scant evidence to suggest that radiotherapy actually cures cancer.

Really? I think I know your problem with radiotherapy. If it was positioned as channelling the powers nature uses to warm the earth, into cheaply and gently treating cancer without surgery or cytotoxic chemotherapy, we’d be fine.

It’s a branding issue, obviously.

Essentially, radiotherapy is the use of high-energy radiation to kill cancer cells by damaging their DNA, which stops them from dividing and spreading. The radiation can either come from an external device, or radioactive material can be placed in the body close to the site of the cancer in a form of treatment known as ‘brachytherapy’, or ‘internal radiation therapy’.

Very good. did you look that up in a brachyosaurus?

For any good that it does, however, radiotherapy also seems to do an equivalent amount of harm. One study of 470,000 cancer patients found that 27 per cent hadn’t died of the cancer, but from the conventional treatment. In many cases chemotherapy and radiotherapy had fatally damaged the heart and respiratory system.2

Reference 2: J Natl Cancer Inst. 1993 Jun 16;85(12):979-87. Noncancer deaths in white adult cancer patients.

Again, this doesn’t say what you represent it as saying. What the study shows is that the odds ratioW for non-cancer death in recently-diagnosed cancer patients was 1.37 – i.e. there were a third more likely to die from all causes than the general population. The period studied was diagnosis between 1973 and 1987, and the authors acknowledge that a more detailed analysis is merited.

It is plausible that a significant (in the statistical sense) number of cancer patients may die of non-cancer causes – anything from car crashes to suicide to heart attack to simply giving up – but we’re a long way form having any solid evidential foundation for the implication made.

And radiotherapy appears to reverse the good work achieved by chemotherapy in women with breast cancer. One study found that the number of lives saved by chemotherapy was matched by the number of deaths caused by the radiotherapy.3

Reference 3: J Clin Oncol, 1994; 12: 447–53. Cause-specific mortality in long-term survivors of breast cancer who participated in trials of radiotherapy.

We studied all available information from randomized trials initiated before 1975 in which radiotherapy was the randomized option and surgery was the same for both treatment arms.

Do you think there is any small possibility we might have got slightly better at it since the trials in the early 70s?

We’re done here.

The concerns of Neon’s mother are also well founded. Studies support her fears that radiotherapy given to children with brain tumours affects their cognitive development and IQ (intelligence quotient). An analysis of 29 studies concluded that the children’s verbal and performance IQ levels, and their intellectual functioning and attentiveness, were “seriously impaired”. Children who had both chemotherapy and radiotherapy and longer times since diagnosis were reported to have even lower IQ scores.4

Reference 4: Dev Med Child Neurol, 2012; doi:10.1111/dmcn.12020  Neurocognitive consequences of a paediatric brain tumour and its treatment: a meta-analysis.

I think the clue is in the fact that it’s a brain tumour. In the absence of a magic bullet (outside the fertile imagination of cancer quacks, anyway) this is, sadly, the truth. Some of it will be due to time out from education during treatment, much of it probably due to the treatment. It takes time for the brain to make new neural paths, if it ever does, as any stroke victim knows.

So, would you prefer a normal-range IQ or certain death?

Surgery

An operation to cut away the tumour is medicine’s oldest intervention and has been in regular use since the 16th century. Although it is the least harmful of the conventional treatments—and can even be a life-saver—it can also aggravate the problem. Surgery is also limited to the less malignant tumours.

There was no significant use of surgery for brain tumour in the 16th Century. They barely understood the role of oxygen back then (Robert HookeW was lampooned for experiments on dogs showing that they could be kept alive by blowing air through the lungs).

Surgery is not limited to less malignant tumours, and the idea that it can “aggravate the problem” is contentious to say the least.

Although an operation can ease the worst symptoms of cancer, it doesn’t appear to prolong life, a fact that was established back in 1844 in a study that is still the most comprehensive ever undertaken. Dr Leroy d’Etoilles of Paris, France, studied the case histories of 2,781 cancer patients over a 30-year period who had undergone either surgery or caustics—the chemotherapy of the day—or had done nothing.

Obviously representative of modern surgical oncology.
Obviously representative of modern surgical oncology.

1844? A great year. The year that Whitworth introduced the thou, Morse sent his first message, Fox Talbot published the first book illustrated with photographs.

Positively vintage, in fact. Chloroform was over a dozen years old by then and just four years later, John Snow published his first treatise “On Narcotism by the Inhalation of Vapours”.

Practically modern era.

 

The average survival after surgery was one year and five months—similar to today’s rates—although in absolute terms, caustics and surgery prolonged life by only two months in men and six months in women. However, those who survived the first two years after diagnosis and did not receive either treatment had the best survival rates by around 50 per cent.5

Currently, 51% of newly diagnosed patient are still alive five years after diagnosis.

You do not appear to be checking your facts.

This uncomfortable fact has been amplified more recently by researchers who have observed prostate cancer patients who had either submitted to localized surgery or a radical prostatectomy, or did nothing. They discovered that those who underwent surgery didn’t live any longer than those who did nothing. Absolute differences between the three groups—which involved a total of 731 men with an average age of 67 years—were less than 3 per cent, say researchers in the PIVOT (Prostate Cancer Intervention versus Observation Trial) study group.6

Why don’t doctors tell you that radical prostatectomy is a bad choice for non-aggressive prostate cancer?

They do. And have done for years.

Reference 6: N Engl J Med, 2012; 367: 203–13 Radical prostatectomy versus observation for localized prostate cancer

Here’s the thing about prostate cancer: as far as we can tell, 100% of men who live long enough, will get it. Most prostate cancers are indolent, many more men die with prostate cancer than of it. The standard of care for non-aggressive prostate cancer is “watchful waiting”.

Which is precisely what this study indicates.

Any alternatives?

Poor as the conventional therapies may be, they are the only approaches that have any evidence that they might help, according to the doctors who testified at Sally Roberts’ High Court hearing.

Sadly true, in this case (though as noted above, other therapies, including simply doing nothing, are certainly on the menu).

Researcher Andrew Vickers at the Memorial Sloan-Kettering Cancer Center in New York put it more emphatically. Alternatives aren’t just unproven—they’re disproven, he says.7

Reference 7: CA Cancer J Clin. 2004 Mar-Apr;54(2):110-8. Alternative cancer cures: “unproven” or “disproven”?

Excellent reference.

Vickers’ statement suggests there have been numerous trials that have demonstrated that alternative treatments have been thoroughly tested, but found wanting. But this isn’t the case, as America’s National Cancer Institute (NCI), which researches various cancer therapies, confirms. There are several reasons for this, it says.

The article addresses several therapies which have been tested. The test do not support the claims made by proponents.

The first is probably the main reason: a lack of funding. Pharmaceutical companies almost exclusively pay for medical research, and there aren’t enough institutes or interested individuals prepared to foot the enormous bill for a full-blown study into alternative therapies.

Why is this? It turns out that vendors of supplements and other “alternative” products typically spend between 0.5% and 1% of revenue on R&D, compared to 15%-20% for pharmaceutical companies. The US National Council for Complementary and Alternative Medicines has spent $1.7bn of US taxpayers’ money since its foundation as the Office of Alternative Medicine in 1992, it has yet to validate a single alternative therapy.

The field of quackademic medicine is awash with money, the problem is not lack of funding, it’s that the SCAM promoters know that objective tests do not say what they want them to say so they are perfectly happy to carry on pretending their therapies are “suppressed” by the “cancer industry” and coining it hand over fist.

The second reason is that very few academics would be prepared to undertake the research anyway.
Worried about their own prestige and standing, few would want to be associated with what might be viewed as some maverick therapy.

False. MC Anderson, Memorial Sloan-Kettering and several other high-profile cancer research centres have quackademic “integrative” faculties.

The third reason is a Catch-22: if doctors and researchers don’t really believe that an alternative therapy is effective, should they ethically be using it in favour of a conventional treatment they believe might work better?

Why is that a catch 22? Minchin’s Law: the term for alternative medicine that can be shown to work, is medicine

We already saw this with Marshall and Warren. Their “heretical” ideas earned them a Nobel prize because instead of going the alt-med route and selling an unproven therapy while muttering suppression, they did proper science.

This is only a catch-22 if you believe that medicine is a sinister conspiracy to make money at the expense of patients.

Evidence, evidence

Despite these impediments, many alternative therapies have more evidence than the sceptics claim, although it may not be to the rigorous standards of a proper clinical trial. Yet the fact that the data from studies of conventional therapies are widely manipulated seems never to be raised as a concern by the critics of alternative therapies.

Ah, so they have “evidence” not evidence. Otherwise known as hype.

Over the years, many alternatives to conventional therapies have been tried, and some have garnered many hundreds of case reports describing successful outcomes. These include high-dose intravenous vitamin C, hydrogen-peroxide treatment, bovine cartilage treatment, Essiac, Coley’s toxins and Hoxsey therapy. The following are five such therapies and their supportive evidence.

See how many red flags you can spot
See how many red flags you can spot

The plural of anecdote is anecdotes, not evidence.

Gerson therapy

This is one of the most promising therapies. It’s a natural treatment that activates the body’s own healing system through an organic vegetarian diet that also includes raw juices, coffee enemas and supplements.

If this is one of the most promising, then pack up and go home now.

Max GersonW promoted his therapy with testimonials, promised a cure, advertised widely and was unable to provide either theoretical or clinical proof that his therapy worked.

His malpractice insurance was terminated in 1953, his medical license was finally suspended in 1958, and he died in 1959.

He dreamed up his therapy as a treatment for migraine and tuberculosis (which are obviously completely the same as cancer).

Although there have been no controlled studies published in a peer-reviewed scientific journal, there have been numerous trials of the therapy on its own or comparing it with no intervention. In one such trial, 18 patients with colorectal cancer and 38 with breast cancer were divided into those who used the therapy after surgery and those who didn’t. Both groups also carried on with any conventional treatment they were receiving.

Three of the nine patients in the Gerson diet group increased their survival time after surgery up to 28.6 months compared with 16.2 months in the non-diet group.8

Reference 8: Aktuel Ernahrungsmed 2 (15): 72-8, 1990. Experiences with the use of diet therapy in surgical oncology. (Not PubMed indexed).

This is “a non-controlled, self-selected, matched-pairs study conducted in Austria used a diet regimen based on the Gerson therapy to evaluate diet as an adjuvant to surgery.” (source).

In another study carried out by the Gerson Research Organization in San Diego, California, 153 patients with stage I to IV melanoma skin cancer were assessed; all 14 patients with stage I or II were disease-free 17 years after the Gerson treatment, while 70 per cent of patients with stage III melanoma were still alive five years later compared with averages of between 27 per cent and 42 per cent in the general population. Most impressively, 39 per cent of patients with stage IV, or end-stage, cancer were still alive five years later, whereas the average at that stage is just 6 per cent for people receiving conventional treatment.9

Reference 9: Altern Ther Health Med, 1995; 1: 29–37 Five-year survival rates of melanoma patients treated by diet therapy after the manner of Gerson: a retrospective review.

So a team from the Gerson Institute published a paper in an alternative medicine specific journal that regards cranio-sacral therapyW and reikiW as “emerging therapies”. Oh, and it was nearly two decades ago.

Maybe not.

Antineoplastons

More than 60 clinical trials have been carried out with this alternative therapy pioneered by Dr Stanislaw Burzynski, who works out of a clinic in Houston, Texas. The therapy uses synthetic chemicals called ‘antineoplastons’—mostly made up of peptides and amino acids—to help the body fight cancer.

False. Stanislaw Burzynski has registered 60 phase II trials and one phase III trial, only one phase II trial has been completed, that has not been published. Most of the trials are not publishable, several have been terminated with no recruitment due to the third successive adverse inspection of his Institutional Review Board.

So, if a pharmaceutical company had been selling a treatment for four decades without publishing any credible evidence, had started registering trials only when forced to by a court, had failed in nearly two decades to complete and publish a single trial, had charged hundreds of thousands of dollars in “case management fees” to trial participants, and had sold itself aggressively direct tot he most desperate patients – parents of children with incurable brain tumours – using flashy propaganda techniques, how happy exactly would WDDTY be?

This is quackery of a truly obscene kind. And any responsible health journalist would e repelled by it.

According to Burzynski, antineoplastons are part of the body’s “natural biochemical defence system” that acts independently of the immune system and protects the body against diseases such as cancer. This means that, according to the theory, cancer patients are depleted in antineoplastons, and the therapy involves a course of injections or tablets of antineoplastons, taken from human blood and urine, to restore their levels. People who want the therapy can do so only as a participant in one of Burzynski’s clinical trials, which are restricted to cancer sufferers whose tumours continue to grow despite conventional treatment.

And he’s had 40 years to prove it, and failed. All he has to show for it is a rather nice mansion, a big glass office block, and a cult of personality that rivals Jim JonesW.

But you have missed a trick. The trials were closed to new participants before this article was published.

How come you missed that?

Burzynski claims to have successfully treated more than 8,000 people with cancer, but detractors say his trials have never been successfully repeated by doctors not associated with his clinic.

Oh it’s just those detractors. As in: anybody who is not for him, is against him.

Before you go to bat for Burzynski, it’s probably worth checking these “8,000 people”. Bob Blaskiewicz started checking them and found out some pretty gruesome stuff.

Nonetheless, results have been impressive, including one trial of 21 patients, of whom four had a “complete tumour response”—indicating that the tumour had shrunk and completely disappeared—while four had partial tumour responses (the tumours had shrunk by more than half); in six participants who were still taking the treatment, their cancer continued to regress but had not yet reached the stage of complete remission at the time of the report.10 

Reference 10: Physiol Chem Phys, 1977; 9: 485–500 Burzynski SR: Antineoplastons: biochemical defense against cancer.

A 35-year-old paper by Burzynski himself, in a journal outside its area of expertise, is the best he can do?

No wonder the NCI say:

And those “mild” side effects? Watch this space. Mild as in death, is the current status.

In another trial of 14 men with prostate cancer, 13 of whom had tumours at stage IV, two achieved complete remission and three had partial remission, while the cancer had stabilized in seven of the participants and progressed in two cases.

All of the men were still alive two years after the trial had come to an end.11

Reference 11: Drugs Exp Clin Res, 1990; 16: 361–9  Toxicology studies on antineoplaston AS2-5 injections in cancer patients. Burzynski SR.

Do you understand the importance of independent replication? Do you understand why a publication by the inventor of a treatment, in a journal with no impact factor, that is publishing outside its core expertise, is unlikely to be Noble prize material?

Have you ever heard of N-raysW?

Coenzyme Q10

There are impressive case reports and a few clinical trials showing the effectiveness of coenzyme Q10 in reversing cancer, although a full controlled study has never been undertaken. In one case report, three women with breast cancer were given 390 mg of coenzyme Q10 a day—the usual dose is around 90 mg—and after five years, one showed complete remission of a tumour in the liver that had spread from the breast (and no signs of tumour elsewhere), another had complete regression of tumour that had spread throughout the chest cavity and the third had no signs of any tumour or metastases (spreading).12 

Reference 12: Biochem Biophys Res Common, 1995; 212: 172–7 (IF2.5) Progress on therapy of breast cancer with vitamin Q10 and the regression of metastases

Coenzyme Q10W, also known as ubiquinone or ubidecarenone, is an important biochemical compound, a part of the electron transport chainW.

It has been proposed for conditions including heart disease, migraine, cancer, cardiac arrest, hypertension, periodontal disease, radiation injury and Parkinson’s disease. Oh, and for extending lifespan. Because elixirs of youth are so not quackery.

The study is nearly 20 years old and does not appear to have been independently replicated.

The great tragedy of science: the slaying of a beautiful hypothesis by ugly fact.

The compound has also been used successfully as a complementary therapy alongside chemotherapy. In one study, 32 women with breast cancer were followed for 18 months, during which time they took antioxidant supplements and 90 mg/day of coenzyme Q10. All of the women were alive at the end of the trial, although four deaths had been anticipated, and six showed signs of partial remission.

All of the women also reported using fewer painkillers, a good quality of life and no weight loss.13

Reference 13: Mol Aspects Med, 1994; 15 Suppl: s231–40 Apparent partial remission of breast cancer in ‘high risk’ patients supplemented with nutritional antioxidants, essential fatty acids and coenzyme Q10.

A promising early result. But quite likely to be wrong.

Hyperthermia 

(see Don’t tell the president, below). This alternative—which exposes cancer to high temperatures—is beginning to attract interest from researchers. One study involved 105 rectal cancer patients, 61 of whom had heat therapy after receiving conventional cancer care. They were given as many as four one-hour sessions, and the target temperature was 40.5 degrees C (104.9 degrees F). Overall the positive response rate—defined as having no spread of the cancer while showing some signs of tumour shrinkage—was three times greater with the heat therapy than in those who only had the conventional treatment.

This study underscores the success of hyperthermia, which has also been seen in the treatment of soft-tissue sarcoma and late-stage cervical cancer.14

Reference 14:  Int J Hyperthermia, 2012; 28: 707–14. Pathological complete response and sphincter-sparing surgery after neoadjuvant radiochemotherapy with regional hyperthermia for locally advanced rectal cancer compared with radiochemotherapy alone.

Hyperthermia is being tested in mainstream cancer treatment. It won’t become “alternative” unless the results are negative and it continues to be sold anyway. the paper is very specific and in a journal devoted to hyperthermia (a red flag).

Avemar.

This liquid solution made up of fermented wheat-germ extract—which is mixed with water—has been the subject of around 30 peer-reviewed studies so far. It’s mainly been used as an adjuvant treatment with chemotherapy or radiotherapy, and patients have generally fared better with it than without it.

The study count is valid. Some journals are useless SCAM-specific dumping grounds for pseudoscience, some are decent journals.

The website selling it says it’s not available to US citizens. Another red flag, indicating FDA enforcement action.

In one study of melanoma skin cancer patients who had been treated with chemotherapy, those who were also given Avemar survived for nearly 59 months on average compared with the chemotherapy-only group, who survived on average for around 30 months.15

Reference 15: Cancer Biother Radiopharm, 2008; 23: 477–82 Adjuvant fermented wheat germ extract (Avemar) nutraceutical improves survival of high-risk skin melanoma patients: a randomized, pilot, phase II clinical study with a 7-year follow-up.

Another early study in another journal with no traceable impact factor. As with so many studies, it is additive (i.e. not replacing any proven therapy) making it hard to unpick the effects.

Broadly, if this worked it is unlikely it would have taken this long to produce so few studies, but as  yet it appears to be neither confirmed nor refuted. It’s unlikely to work for all the conditions for which it’s promoted, and the independent coverage is remarkably thin.

The jury appears still to be out.

Who cares?

Despite the constant complaints that alternative cancer therapies don’t have any evidence, there are plenty of people like Sally Roberts who are looking for alternatives to standard medical treatment.

Yes. and the job of those who follow science, is to help them make the right choice: trust the doctor.

One survey of 394 breast cancer survivors found that 51 per cent were using some kind of alternative medicine. Around 80 per cent of these survivors were taking vitamins or other dietary supplements, mainly to make their everyday activities easier and to improve their immune system and emotional well-being.

Although the most popular source of information about alternatives was family and friends, around 25 per cent said their doctor had told them about these treatments—so perhaps doctors aren’t quite so convinced about the standard cancer treatments after all.16

Reference 16: Asian Pac J Cancer Prev. 2012;13(8):4081-6. Use of complementary and alternative medicine among breast cancer survivors.

Looks to be an opinion survey. Useless as a source.

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