Ralph Moss Reports
Ralph Moss reports are very relevant to cancer patients. Read it and subscribe. It's about the way chemotherapy and radiation are presented to the public, and the reality, which can be very different. To order a Moss Report, or to schedule a phone consultation with Dr. Ralph Moss, please call 1-800-980-1234 (814-238-3367 from outside the US). You can also order reports through the website, http://www.cancerdecisions.com
In the words of the immortal Mark Twain, there are three kinds of lies - lies, damned lies and statistics.
Once a set of data has been statistically analyzed and the results expressed numerically, we tend to think of these numbers as being bedrock truths. However, this is very far from the case. Two statisticians could take the same set of data and come to startlingly different conclusions as to what the data show. Statistics, in short, do not tell the full story. And when we are told - as we repeatedly are - that progress is being made in the treatment of cancer and that fewer people are dying from cancer than they were ten, twenty or thirty years ago, we need to look at these figures critically, and analyze very carefully how they were arrived at and what they really mean.
In this week's newsletter, Dr. Moss reviews a recent article on progress in the cancer wars and casts a critical eye on the now-familiar mantra of soothing reassurances that form the basis of most journalistic reports on the subject.
For the past thirty years, Dr. Moss has monitored the field of cancer treatment and research, a field replete with opportunities for statistical obfuscation and linguistic double-talk. His observations on the current status of both conventional and alternative medicine have been carefully distilled into the Moss Reports - a series of 200-plus detailed reports on different kinds of cancer. If you or a loved one have been given a cancer diagnosis, a Moss Report on that particular kind of cancer can prove to be a valuable guide and friend through the long and sometimes difficult journey ahead.
Despite an unexpected snowstorm here in the Northeast, spring has definitely arrived. And with spring comes the return of robins to the lawn, the first chartreuse shoots of the daffodils - and the inevitable "Cancer Month" stories on TV and newsstands.
In April, in the United States, we traditionally endure a barrage of propaganda on behalf of the cancer establishment. A long-ago President (I think it was FDR) originally named April "Cancer Month" because that hopeful time was when the giant American Cancer Society (ACS) concentrated its annual fund-raising efforts. Canada followed suit.
Since then many patient interest groups have lobbied for their own causes, and succeeding Presidents have proclaimed "Awareness Months" for colorectal (March), ovarian (September), childhood (October), and prostate (November) cancers. Historically, the major media have always "done the right thing" during the month of April by expanding their favorable coverage of the war on cancer. It has been seen as almost a patriotic duty. (The ACS, said one editor, is no more political than God.)
In the past, this usually meant obligatory stories about the great progress being made through the standard treatments, especially chemotherapy. And this kind of story is still a journalistic mainstay. But clearly times are changing. This year, two major news magazines featured cancer treatment on their front covers, but gave little aid and comfort to cancer fundraisers. I dealt with Fortune's blistering critique of the war on cancer in last week's newsletter. But equally surprising is US News & World Report's cover story on "Cancer: The New Survivors" (April 5, 2004).
Ostensibly, this article is a paean to modern treatment. The subheading reads, "True stories of men and women who beat the odds-and how they did it." The main article is entitled "Beating A Killer," with the tagline: "Cancer was once the end of the line. Today, it can be managed and defeated." Anticipating undiluted optimism, I plunked down my $3.99 for this issue somewhat reluctantly. I figured I was in for another dose of eyewash on the miracles of Erbitux, oxaliplatin and Avastin.
And, as expected, the issue does contain standard bows towards America's long-running war on cancer. "The field of cancer medicine is nothing short of breathtaking," enthused Bernadine Healy, MD, a former National Institutes of Health (NIH) director, who now writes the "On Health" column for the magazine. The caption of a photograph accompanying her column tells us that "investment in basic cancer research has helped create a generation of survivors." But simply repeating this, no matter how often, nor how passionately, does not make it so, as last month's Fortune cover story revealed so trenchantly.
The US News article further claims that "nearly 10 million Americans are living with cancer. Most were diagnosed five or more years ago; many who would have died just 15 or 20 years ago are alive today... " This is highly misleading. As the Fortune article showed, it is METASTATIC cancer that kills the great majority of those who die, and for the most common forms of the disease (such as cancers of the breast, colon, lung, and prostate) metastasis is still the relentless killer it always was. There has been virtually NO change in the survival from metastatic cancer over the last 50 years. The apparent improvement in the survival figures has mainly been due to the earlier detection of illness: people appear to be living longer, whereas in fact what has often happened is that they have received a diagnosis earlier, and have been officially on record for longer before metastasis overtakes them. In other words, many of them are the beneficiaries of a statistical artifact.
Sophisticated screening and early detection tests have also succeeded in finding many patients who have conditions that are not life-threatening (for example, some very early precancerous or encapsulated lesions of the breast or prostate). These people are often labeled as cancer patients, thereby weighting the statistics to make it appear that people with cancer are living longer overall. But many if not most of these people would not have died of cancer even if their tumors had not been detected. Of course, none of these statistical irregularities is a secret to the biostatisticians who are the gatekeepers of data analysis in the cancer field. But these are not the sort of facts that it is considered wise to share with the general public, upon whose generosity vast enterprises such as the American Cancer Society depend.
"Beating a Killer" repeats other familiar shibboleths of the cancer establishment. For instance, it defines five-year survival as "the marker of a successful cure." This endlessly-repeated fallacy has been exposed often. For example, here is what I wrote in my 1980 book, The Cancer Industry: "[A] person who is treated for cancer and survives five years is entered into the record books as a 'cure.' What happens, however, if he has a recurrence of this cancer sometime later? What happens if he dies? He will then be in the paradoxical situation of having been officially cured of cancer, and dying of it at the same time" (p. 26).
Even the American Cancer Society, which once vigorously promulgated this five-year benchmark, has quietly modified its position. "While five-year relative survival rates are useful in monitoring progress in the early detection and treatment of cancer," it now writes, "they do not represent the proportion of people who are cured permanently since cancer can affect survival beyond five years after diagnosis" (ACS 2003)
Alas, the word on five-year survival has still not reached some of those who write about cancer in the mass media. There was, and is, no magic that occurs at the five-year survival point. In fact, reliance on such an arbitrary benchmark may engender an unwarranted sense of complacency among patients, who need to remain vigilant against a recurrence of cancer for the rest of their lives.
Rarely Spoken Truths
But don't get me wrong. Overall, this is an excellent article. The magazine's statutory knee-bends to orthodoxy are offset by the main article's refreshing outspokenness. For instance, the authors write, cancer and its treatment "often leave in their wake debilitating physical and emotional scars." The "very therapies that cured [patients, ed.] can also create a whole new set of problems-some, many years later."
"One major source of later problems," the authors state, "is radiation." As early as 1981, they write, scientists at the University of Pennsylvania learned that pediatric leukemia patients whose treatment included head irradiation (as it usually did) later suffered significant drops in their IQ. (The practice of routinely irradiating the brains of such patients went on for years, but has now largely been abandoned. So, in that sense at least, progress is being made.)
The article also reveals that children who were diagnosed with the form of lymphoma known as Hodgkins' disease are now known to have an 18 times greater risk of developing other cancers, mainly of the breast or thyroid, than healthy people. "Again," the article unambiguously states, "radiation was the culprit." Now there's a point of view rarely heard in mainstream publications!
There are also a few exposés of the long-term effects of chemotherapy. "It was once thought that healthy tissue surrounding the tumor would survive a chemical assault, and in some parts of the body that's true. But it turns out the delicate white matter of the brain is not so resilient." It was frequently stated that the "blood-brain barrier," a layer of cells that keep larger molecules from entering the brain, would protect against most such damage. But "this protective barrier," write the authors, "isn't foolproof; it can be broken down by, among other things, radiation and inflammation that many of the chemotherapies cause." So here was another major miscalculation on the part of oncologists. The result, say many observers, is the widespread occurrence of so-called "chemo-brain," which is a highly distressing loss of memory and other cognitive functions often experienced by patients undergoing chemotherapy.
It was a condition that was discovered-and named-by the patients themselves. Conventional doctors are only now beginning to acknowledge and address the psychological needs of such patients. Psychiatrists at Sloan-Kettering Institute, for instance, have found that cancer and its aggressive treatment cause serious depression in 15 to 25 percent of cancer patients. "The depression itself can often be worse than the disease.." they say.
The US News article offers no solutions. But it deserves kudos for highlighting important aspects of the cancer problem that are rarely dealt with in the fluff pieces that usually fill the newsstands during America's original "Cancer Awareness Month."
-Ralph W. Moss, PhD
- American Cancer Society, Cancer Facts & Figures 2003. Retrieved April 4, 2004 from: http://health.yahoo.com/health/centers/cancer/7
- Healy, Bernadine. Yes, I am still here! (On Health column), US News and World Report, April 5, 2004, p. 68.
- Szegedy-Maszak, Marianne and Hobson, Katherine. Beating a killer. US News and World Report, April 5, 2004, pp. 56-67. Retrieved April 5, 2004 from: http://www.usnews.com/usnews/issue/040405/health/5cancer.htm
Newsletter #127, 04/04/04
More than thirty years have elapsed since the war on cancer was officially declared by President Nixon. Yet despite the enormous effort expended in terms of manpower, resources and money, we are no closer to winning the war than we were on the day it was declared. New drugs are constantly being approved, but while it is true that many of these drugs can cause a temporary shrinkage in tumor size, very few have yet been found that will eradicate any kind of cancer permanently. When the temporary shrinkage of tumors without any prospect of real prolongation of life can generate so much profit for drug companies there is little incentive for them to investigate different, less toxic approaches that may offer a real chance of influencing the outcome in many cancers.
Dr. Ralph Moss has spent the past thirty years monitoring the field of oncology, investigating the scientific basis of both conventional and alternative cancer treatments. He has written more than 200 reports - the Moss Reports - on various kinds of cancer. Each of these reports offers a thorough analysis not just of the standard treatments for a particular type of cancer but also the full range of useful alternative and complementary treatments that, because they do not promise vast financial rewards to the drug companies, have yet to find a place in mainstream medicine.
LOSING THE WAR ON CANCER
An article of great importance has appeared in Fortune magazine. It is titled "Why We're Losing the War on Cancer." The author, Clifton Leaf, is Executive Editor of the magazine and is himself a survivor of adolescent Hodgkin's disease. So he is no stranger to cancer or to the potential of modern treatment to cure some of its less common manifestations.
Leaf recognizes that he himself was extraordinarily lucky in surviving. But he still has the courage to ask, "Why have we made so little progress in the war on cancer?" He readily acknowledges the flood of recent favorable publicity for drugs such as Gleevec, Herceptin, Iressa, Erbitux and most recently Avastin. "[T]he cure has seemed closer than ever," he says.
"But it's not," he continues. "Hope and optimism, so essential to this fight, have masked some very real systemic problems that have made this complex, elusive, relentless foe even harder to defeat…[W]e are far from winning the war. So far away, in fact, that it looks like losing." Leaf gives some facts about cancer that are well known to insiders but will come as a shock to many readers:
- More Americans will die of cancer in the next 14 months than have died from every war that the US has fought…combined.
- Cancer is about to replace heart disease as the number one US killer. It is already the biggest killer in many age groups.
- Even adjusting for age, the percentage of Americans dying from cancer is about the same as it was in 1971 (when Nixon declared the war on cancer) or even back in 1950! Meanwhile, age-adjusted deaths from heart disease have been slashed by 59 percent and from stroke by 69 percent during that same half-century.
- The much-vaunted improvement in survival from cancer is largely a myth. "Survival gains for the more common forms of cancer are measured in additional months of life," says Leaf, "not years."
- Most of the improvement in longevity of cancer patients can be attributed to life style changes (the promotion of which has not been a conspicuous priority for the National Cancer Institute) and especially to early detection.
- The few dramatic breakthroughs (such as in Hodgkin's disease) mainly occurred in the early days of the war on cancer. There has been little substantial progress in recent decades… despite nearly ubiquitous claims to the contrary.
- According to one biostatistician at M.D. Anderson Cancer Center, long-term survival from common cancers such as prostate, breast, colorectal and lung "has barely budged since the 1970s."
- According to Andy Grove, the chairman of the Intel corporation and a major "player" in funding research, "It's like a Greek tragedy. Everybody plays his individual part to perfection, everybody does what's right by his own life, and the total just doesn't work."
Today, Leaf concludes, the cancer effort is "utterly fragmented - so much so that it's nearly impossible to track down where the money to pay for all this research is coming from." And what money! Leaf estimates that US $14.4 billion is spent each year on cancer research. "When you add it all up, Americans have spent …close to $200 billion, in inflation-adjusted dollars, since 1971." It is certainly justifiable to ask for an accounting of that one-fifth of a trillion dollars.
What have we gotten for that huge sum? In fact, research has become increasingly irrelevant to the real-life problems faced by cancer patients. "The narrower the research niche," says Leaf, "the greater the rewards the researcher is likely to attain." Particularly thought-provoking is his assertion that cancer research is fundamentally flawed in its orientation. Cancer scientists have self-confidently created "animal models" and artificial cell lines that supposedly mimic an equivalent human disease, such as breast, colon or lung cancer. These scientists then triumphantly "cure" cancer in these laboratory models. But cell lines and tumors growing in mice are drastically different from spontaneous human tumors, the kind that afflict us and our loved ones. A flawed model is not likely to yield useful results. Those who closely follow the cancer field have become inured to an endless series of "breakthroughs" in mice that almost never pan out when tried in the clinic.
According to one of America's most celebrated cancer researchers, Dr. Robert Weinberg of the Massachusetts Institute of Technology (MIT), "a fundamental problem which remains to be solved in the whole cancer research effort, in terms of therapies, is that the pre-clinical models of human cancer, in large part, stink."
Prof. Bruce Chabner of Harvard University expressed similar frustration: "Cancer researchers say, 'I've got a model for lung cancer!' Well," says Chabner, "it ain't a model for lung cancer, because lung cancer in humans has a hundred mutations. It looks like the most complicated thing you've ever seen genetically."
Why then are these artificial and intrinsically misleading systems still being used? The answer is simple. These artificial models are "…very convenient, easily manipulated," says Vishva Dixit of the Genentech company. "You can assess tumor size just by looking at [them, ed.]." There's no thought, still less acknowledgement, given to the fact that shrinking a tumor, especially in a mouse, has little to say about human survival or well-being.
"Hundreds of millions of dollars are being wasted every year by drug companies using these models," says Weinberg. But with the huge profits to be made from tumor-shrinking drugs like Avastin, Erbitux and oxaliplatin, what incentive do they have to stop?
Leaf also tackles the subject of cancer regression, or shrinkage of tumors, pointing out that it is a totally inadequate measure of the effectiveness of a drug. (This is a theme I dealt with in depth in my book, Questioning Chemotherapy, and many times since then.) "It is exciting to see a tumor shrink in mouse or man and know that a drug is doing that, "says Leaf. "It is a measurable goal." But, he adds, "tumor regression by itself is actually a lousy predictor for the progression of disease." The sad truth is that "regression is not likely to improve a person's chances of survival." Read those words over carefully - you do not encounter such ideas often in mainstream publications.
By contrast, what really matters, says Leaf, is stopping metastases (secondary growths), which kill the great majority of cancer patients. "So you'd think that cancer researchers would have been bearing down on this insidious phenomenon for years," he says. In reality quite the opposite is true. Fortune magazine's examination of NCI grants, going back to 1972, revealed that less than 0.5 percent of study proposals focused primarily on metastases. Half of one percent! Of nearly 8,900 grant proposals awarded last year, 92 percent didn't even mention the word metastasis.
According to I.J. (Josh) Fidler of M.D. Anderson, the study of metastases is avoided by cancer researchers because it is a tough and so far unfruitful field, and not likely to yield quick and easy results. Instead, researchers focus on techniques and avenues that they know will produce measurable results in the laboratory. The attitude, Fidler says, is "Here's an antibody I will use, and here's blah-blah-blah-blah, and then I get the money." (Fidler, to his great credit, has published over 250 scientific articles on combatting metastases.)
The current crop of new drugs comes in for scathing criticism as well. A study done in Europe showed that twelve new anticancer drugs approved in Europe between 1995 and 2000 were no better in terms of improving survival, quality of life, or safety than those they replaced. But as far as the drug companies were concerned they had one big advantage: they were several times more expensive to purchase than the old drugs. "In one case," says Leaf, "the price was 350 times higher."
Leaf points out that two new blockbuster drugs, Avastin and Erbitux, are lacking in substantial effectiveness. Avastin, he says, "managed to extend the lives of some 400 patients with terminal colorectal cancer by 4.7 months." And Erbitux? "Although it did indeed shrink tumors, it has not been shown to prolong patients' lives at all." Still, a weekly dose costs $2,400.
The article then features a list of "Miracle Cures That Weren't," including radiation therapy, interferon, interleukin-2, endostatin and Gleevec. As Leaf himself admits, Fortune itself once featured Interleukin-2 on its cover with a huge headline reading: "Cancer Breakthrough."
Yet despite the profound importance of what Leaf has to say in this article, you are unlikely to see the article cited as front-page news. I was dismayed to find that, this morning, for example, the total number of citations at Google News for this article was three (out of 4,500 news sources). By comparison, at the time of its announcement Erbitux was generating over 1,000 articles per day in the same search engine.
Leaf's article can be ordered online at www.fortune.com (The March 2004 issue of Fortune). However, excellent though this article is, and delighted though I am to see this subject aired so prominently, I do regret the fact that Leaf did not take his arguments quite far enough. For instance, he includes a section on "how to win the war," but this seems anemic and hard to follow compared to his previous incisive analysis. In my opinion, he doesn't deal with the basic economic and political underpinnings of the war on cancer. The emphasis on ever-more-profitable drugs is dictated by the very nature of Big Pharma and its unhealthy influence on the whole research and approval apparatus.
Also, Leaf fails to cite the most prominent critics of the war on cancer, especially those with an orientation towards complementary and alternative medicine (CAM). Thus, while he hits the nail squarely on the head in many instances (as, for example, when he discusses the danger of equating temporary tumor shrinkages with increased survival), he also misses many other important aspects of the problem that are well known to people who have followed this field for decades.
When he quotes a scientist as saying, "We have a shortage of good ideas," this is likely to elicit incredulity from the CAM community. There are scores of excellent researchers who have proposed exciting new ideas for treating cancer over the last few decades. Most of them have been ignored or dismissed out of hand. Some have even been persecuted. My 1980 book, Cancer Industry, discussed eight such cases. A dozen years later I published Cancer Therapy, which contains reviews of over a hundred unconventional treatments, most of which could still be usefully pursued. Many treatments discussed in my book Antioxidants Against Cancer have still not been examined, much less acted upon.
Let me give one example of an original idea that has been studiously ignored by the mainstream. I recently received a reprint from my colleagues Eva and Laszlo Csatary, MD, of their latest results using MTH-68. This treatment is based on the non-toxic Newcastle disease virus vaccine and is seemingly quite beneficial in select cases, especially in brain cancer. The article appears in the most recent issue of the Journal of Neuro-Oncology, with co-authors from respected institutions in Germany, Hungary and California. It is not the first such article that Dr. Csatary has published. I myself co-authored a best case series with him on this topic in 1999, which appeared in a respected peer-reviewed journal. Admittedly, this is not exactly a "new" idea, simply an unrecognized one. In fact, the name of the compound, MTH-68, refers to the date of its discovery...1968, three years before the war on cancer was launched, and before many of today's cancer researchers were even born. Despite repeated articles and letters, press releases, news conferences and appeals to governmental authorities, this promising treatment has made little progress in the world of conventional medicine. The response from the American "cancer establishment" to the Csatarys' work has been a thundering silence.
But this June, 25,000 oncologists will once again gather at the American Society of Clinical Oncology (ASCO) meeting for their annual four-day convention. Don't expect any center-stage attention, though, for promising non-toxic treatments, such as MTH-68, which could provide true departures from the quagmire of the stalled war on cancer. Even Mr. Leaf, for all his trenchant criticism, seems unaware or unconcerned that there are many other treatments that are potentially valuable, yet are being systematically ignored. And they will continue to be ignored until the public, Congress and scientific community wake up to the fact that the most powerful force driving cancer research is Big Pharma's need for a hefty bottom line and a quick return on its investments.
It is enough to make the angels weep.
Ralph W. Moss, PhD
- Csatary LK, Moss RW, Beuth J, et al. Beneficial treatment of patients with advanced cancer using a Newcastle disease virus vaccine (MTH-68/H). Anticancer Res. 1999 Jan-Feb;19(1B):635-8.
- Csatary LK, Gosztonyi G, Szeberenyi J, et al. MTH-68/H Oncolytic viral treatment in human high-grade gliomas. Journal of Neuro-Oncology 2004;67:83-93.
- Leaf, Clifford. Why we're losing the war on cancer. Fortune 2004;149(6):76-97.