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Ralph W. Moss, Ph.D. Weekly CancerDecisions.com Newsletter #137 06/13/04 -------------------------------------------------------
THE MOSS REPORTS
Where do news outlets reporting on the latest medical breakthroughs gather their information? More often than not, they get it from press conferences and publicity materials put forth by the drug companies whose sponsorship has enabled the necessary clinical trials of new drugs to take place. These companies have an obvious vested interest in promoting their new drugs. How are cancer patients to judge the sometimes extravagant claims put forth at such venues? When statistics are skillfully used, they can make the most modest improvement look like a giant leap forward.
For the past thirty years I have been studying and closely monitoring the world of cancer treatment, sorting fact from fiction, and helping cancer patients and their families to understand and weigh the usefulness of the treatments they have been offered.
The Moss Reports represent a comprehensive library of cancer guides. In them, my years of experience in researching cancer treatments have been distilled into a careful assessment of the worth and effectiveness of the conventional and alternative treatments of over two hundred different kinds of cancer.
If you or someone you love has received a diagnosis of cancer, a Moss Report can provide you with the key to understanding the best that conventional and alternative medicine have to offer.
You can order a Moss Report on your specific cancer type by calling Diane at 1-800-980-1234 (814-238-3367 from outside the US), or by visiting our website: http://www.cancerdecisions.com
We look forward to helping you.
2004 ASCO MEETING, PART ONE
I have just returned from the 40th annual meeting of the American Society for Clinical Oncology (ASCO).
The meeting coincided with my 30th anniversary in the cancer field, as I was hired as science writer at Memorial Sloan-Kettering Cancer Center on June 3, 1974. And so this trip was a very good opportunity for me to reflect on the current state of complementary and alternative medicine (CAM) and the changes that I have witnessed in the war on cancer over the past three decades.
The first word that comes to mind in reference to ASCO's meeting is huge. There were over 25,000 participants, mostly medical oncologists, and they took over New Orleans' cavernous 1.1 million square foot convention center. They came to lecture and be lectured to about the latest advances in cancer treatment. In addition to the gargantuan plenary sessions, there were hundreds of smaller sessions, approximately 1,500 poster and oral presentations, and 8,500 other research summaries given as abstracts. Oncologists swarmed around the towering commercial exhibits, read and discussed the latest research and of course schmoozed, dined and did whatever professionals do when they assemble for a collegial good time.
Click on or go to the following link for a scene from ASCO 2004, New Orleans: http://www.cancerdecisions.com/images/ASCO2004_1.jpg
The takeaway message of the meeting, repeated in a thousand stories, was that "little by little, new targeted therapies are helping cancer patients live longer, even if they do not offer miraculous cures…" (Borden 2004). The New York Times, on its front page, featured an anecdote about a single patient who appeared to have benefited from a new Bayer drug in a clinical trial (Pollack 2004a). I guess I have been down this road too many times in the last 30 years to put my faith in such anecdotes until I see the promising results confirmed in rigorous clinical trials. In the meantime the public is kept from seeing the real picture, which is that advanced cancer is no more curable today than it was 30 years ago, a sobering truth that was explored in a memorable Fortune magazine article recently:
Click or go here for a discussion of the Fortune article: http://www.cancerdecisions.com/040404.html
There are a million clever ways to dance around this central fact, but none of them can ultimately obscure the truth about the failure of our war on cancer.
You would think that in the face of this failure the oncology profession would be eager to reach out for new ideas and concepts. As I have shown throughout my career, there are abundant new ideas in the world of CAM. But instead of welcoming CAM, the oncology profession reacts to it as if it were a competitive challenge rather than an opportunity. The majority of presentations at ASCO still concern cytotoxic chemotherapy, but the new twist is to add 'targeted‘ drugs, such as Iressa and Erbitux, to the mix. The existence of these new targeted drugs does raise some interesting possibilities, but one shouldn't put all one's eggs in one basket. The typical treatment protocol used to be based on the question ‘What happens if we add drug A to conventional drugs B and C?' Now the question has become, 'What happens if we add targeted agent A to conventional drugs B, C and D?' The differences in outcome are tiny. Meanwhile, the combinations become more complicated and much more expensive — too expensive, the New York Times even suggested, for society ultimately to bear (Pollack 2004a).
I attended ASCO as a reporter for several CAM-oriented publications and although I was aware of the featured papers I was more interested in gathering information on unusual, unconventional and out-of-the mainstream treatments than on those that grabbed the headlines. I must say that I came away disappointed. Something radically new is needed. But, once again, the number of presentations on non-toxic or alternative treatments was meager. First, a word of caution. Like the three blind men studying the elephant, everyone comes away from a meeting this huge with their own distinct impression. Although I spent three days at the meeting I readily admit that I might have missed a few relevant presentations. (The Meeting Program itself runs to 341 pages and the Proceedings total over 1,000.)
Nevertheless, the absence of CAM was conspicuous – and somewhat mystifying, also, in view of the fact that CAM treatments for cancer are generally acknowledged to be extremely important to patients and to society as a whole. For instance, a study presented at this year's ASCO meeting showed that fully "91 percent of patients surveyed reported using at least one CT [complementary therapy, ed.] since diagnosis" (Yates 2004). Ninety-one percent! Yet despite this, I found only a single lecture (out of many hundreds) that featured a discussion of CAM. This was the Saturday (June 5th) presentation on "Complementary and Palliative Care for the Treatment of Pediatric Cancer."
Two speakers talked at length about palliative care, which is really a separate issue. Only one speaker, Kara Kelly, MD, an Assistant Professor of Pediatrics at Columbia University, New York, and co-chair of the Complementary Therapies Committee of the Children's Oncology Group (COG), then spoke about complementary medicine. Although Dr. Kelly is a reasonable voice in the field of academic CAM studies, I found her presentation downbeat.
She emphasized the negative aspects of the topic, such as potentially adverse interactions of herbs and conventional drugs, while de-emphasizing the positive impact that vitamins and herbs might have for patients. At the end, however, she did concede that CAM could be useful to mitigate the side effects of conventional treatment. She cited research done at Columbia showing that lower blood levels of antioxidants were associated with increased adverse affects of chemotherapy (Barclay 2004). I felt like a single crumb had fallen off the vast ASCO banquet table.
In the Question and Answer session that followed one angry doctor assailed parents who expressed a desire to use CAM for their children. These people, he claimed, were actually suffering from a psychopathology (a fancy word for mental disease), and had what he called "control issues" vis-à-vis their doctors. (The topic is sensitive since doctors in the US have the legal ability to force pediatric patients to submit to chemo and other conventional treatments.) He also said that doctors who offered alternative treatments were motivated by greed (a charge I considered hypocritical considering the intimate ties of ASCO and many of its members with the pharmaceutical industry). There was embarrassed silence at the podium, and none of the three speakers—good people all—saw fit to challenge these intemperate remarks.
Posters No Better
The poster sessions filled one section of the vast convention hall. I thought for sure I would find some interesting and unusual presentations there. But this was not the case. On two consecutive days I squeezed my way through the throngs around most of the posters. Click on or go to the following link for a scene from the poster presentations at ASCO: http://www.cancerdecisions.com/images/ASCO2004_2.jpg
One of the first presenters I spoke to was Catriona McNeil, MD, a young doctor from New South Wales, Australia, whose poster presentation warned against the "delay in conventional breast cancer treatment associated with alternative therapy usage" (Abstract #593). This poster contained some of the most grisly pictures of untreated breast cancers I have ever seen. Really in-your-face stuff. Her presentation concerned six patients who had been treated at two Sydney hospitals, and who had delayed conventional treatment in order to try alternatives. Three of them died while the other three were still alive, and possibly cured by conventional means.
Now, I happen to believe that women who have curable breast cancers should accept conventional treatment and use alternative treatments only as adjuncts. And I certainly have known a few women over the years who I think made tragic choices in this regard, some of whom lost their lives in the process. So I would be the last person to say that this is not a potential problem. But exactly how big a problem is it? The impression given by these Australian doctors is that it is a huge one. "Alternative therapies," the presentation cautioned, "are used by between 28 percent and 83 percent of women with breast cancer, but their impact is causing deleterious delay in commencing empirically validated conventional therapies…."
This young doctor, thinking I was a fellow oncologist, began to confide in me concerning what she presumed to be our shared desire to limit the use of CAM treatments! I quickly corrected her misunderstanding and explained my position. I then asked how frequently this problem actually occurred. She didn't know, but volunteered that there were 6 oncologists involved in the study cited in her presentation, and each of them saw about 200 new patients per year, making a total of about 1,200 new patients per year. Since the study ranged over a four-year period, the patient base from which these six cases were drawn was approximately 4,800 patients. Thus, the "deleterious delay" affected 0.125 percent of the total patient population. This is obviously a miniscule proportion of the total number of women treated, a fact not pointed out in the presentation. Quite the opposite: the authors drew global conclusions about "a medico-political climate that favors accommodation of non-traditional adjuncts to cancer therapy."
Dr. McNeil indicated that alternative medicine was so popular that many oncologists feared to criticize it. What amazed me was that Dr. McNeil and her colleagues considered this problem serious enough to do a study, create a grisly poster, and then travel 10,000 miles to warn their American and international colleagues about this imminent danger. This more or less set the tone for the other CAM-related presentations that I saw and read.
One researcher at Massachusetts General Hospital, Brian D. Lawenda, MD, did present an interesting and objective poster (Abstract #9601) on how vitamin E and EGCG (an antioxidant compound in green tea) might modify the effects of radiation. The premise of the study was, however, a negative one, i.e. that "dietary antioxidants may play an antagonistic role during radiation treatment (RT)" In fact, the opposite is true. As I explained in my book, "Antioxidants Against Cancer," most studies show not an antagonistic but a harmless or synergistic interaction when antioxidants are given concurrently with conventional treatment. Be that as it may, Dr. Lawenda and his Boston colleagues implanted cancer cells into the legs of mice, and then gave them either vitamin E or EGCG. There was a small and statistically non-significant 4 percent increase in the radiation dose necessary to control 50 percent of the tumors locally (the so-called TCD50). But EGCG by itself significantly decreased the tumor growth rate by 10 percent. There was also less general toxicity when animals were administered these nutrients: less than half of the EGCG-treated mice had to have their limbs removed after radiation treatment (9.8 percent vs. 23.8 percent in the control animals). For patients, this could translate into a rather significant benefit from a simple and non-toxic regimen involving taking the equivalent of 2-3 cups of green tea per day. (This was an animal study and so the usual limitations of such studies apply.) The paper concluded that "adverse [radiation therapy]-related soft tissue reactions occurred less frequently with antioxidant supplementation…."
Although Dr. Lawenda seemed especially eager to explore the issue of antioxidants' possibly negative impact on the TCD50, he was clear that the takeaway message was the dramatic lowering of the toxicity of the treatment.
This was the most positive thing I heard about any CAM treatment at the convention. Sadly, while some of the ‘targeted' treatment posters were so crowded that you had to fight your way, New York subway-style, just to read them, Lawenda's study was completely unattended during the time I visited it.
TO BE COMPLETED (WITH REFERENCES) NEXT WEEK
"DEPARTMENT OF CORRECTIONS ":
In last week's newsletter I stated that Dr. Stanislaw Burzynski was prosecuted (unsuccessfully) by the US government for health fraud. Thanks to a sharp-eyed reader it has been brought to my attention that this statement was incorrect. Dr. Burzynski was prosecuted not for health fraud but rather for insurance fraud, and also for introducing a new drug into interstate commerce and violating a judge's order. As our correspondent (Dean M.) points out, this difference is significant because the government never alleged that Burzynski's treatment was ineffective. To the contrary: the government fought hard – and successfully – to prevent the question of whether or not the treatment actually worked from being introduced at the trial.
--Ralph W. Moss, PhD
The news and other items in this newsletter are intended for informational purposes only. Nothing in this newsletter is intended to be a substitute for professional medical advice.
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