Questioning chemotherapy

[Guest guest]

http://www.ralphmoss.com/qcpers.html

 

 

Questioning Chemotherapy:

 

A Personal Statement

by Ralph W. Moss, Ph.D.

 

 

 

--

 

" One may hope that in another 10 to 15 years medical progress will make this

edition of the Manual of Oncologic Therapeutics read like an archaic document

for the Middle Ages. " --NCI oncologist Robert E. Wittes, M.D., Manual of

Oncologic Therapeutics (1991)

" Radical chemotherapy? Unbelievable! Sounds like the g-ddamned Spanish

Inquisition to me. " -- " Dr. McCoy " (DeForest Kelley), in Star Trek IV: The Voyage

Home (1986)

 

 

 

--

I began my career as a science writer at Memorial Sloan-Kettering Cancer Center

(MSKCC) in the spring of 1974. I started out as an enthusiastic believer in

chemotherapy. An older relative had inspired me with the progress he himself had

witnessed during his own medical career. He had " rotated through " Memorial when

he was a doctor in training. In the early 1960s, he recalled, New York City's

famous cancer hospital had to offer interns and residents lobster dinners just

to get them to serve.

By the mid-70s, when he came to visit me at my new job, chemo-therapy had made

significant advances against some forms of childhood and adolescent cancer, and

doctors no longer looked on childhood leukemia or a dozen other rare types of

cancer as a death sentence. It was indeed a time of great hope.

 

The implication of all that I heard and read was that adult cancers would be the

next to fall before this chemical assault. I considered myself a rationalist,

and chemotherapy was " rational therapeutics " par excellence (66). At MSKCC I

thought I had a ringside seat on the impending cure for cancer and looked

forward to doing my own small bit in helping to bring it about.

 

As part of my job in the Public Affairs department, I wrote monthly articles on

cancer science for MSKCC's in-house newsletter, Center News. For this, I

interviewed many oncologists, often passing through the hospital's Outpatient

Department. I was repeatedly startled by the sound of unearthly retching coming

from the partitioned cubicles.

 

At first, guided by what these doctors told me, I wrote glowingly about their

triumphs over such rare malignancies as osteogenic sarcoma (bone cancer) and

Hodgkin's disease (lymphoma). But I soon learned about grave reservations that

lurked behind even their most sanguine public pronouncements. Some of the

scientists and administrators I encountered intimated—strictly off the record,

of course—that finding cures for the common solid tumors of adults, such as

breast, colon, and lung, would be an order of magnitude more difficult than

treating the unusual pediatric malignancies. In a memorable phrase, one of them

told me it would be like trying to dissolve a person's left ear while leaving

the right one intact.

 

I was beginning to feel a vague uneasiness about my role as an ardent promoter

of these doctors and their treatments. At the same time, I was proud of my

position at MSKCC and determined to do my job well. I had no idea where these

vague doubts would eventually lead me.

 

Some months after I was hired, our department moved from its temporary quarters

on East 62nd Street to what was then called the " new hospital " at 68th Street

and York Avenue. As part of that move, my boss discarded a collection of

handsome departmental scrapbooks that had been gathering dust in a back room. I

asked if I could take the binders home to my children, seeing them as ideal for

their school reports.

 

As I began to clean out yellowing newspaper and magazine clippings from the

binders, my eye was caught first by one, then another startling story. That

summer, almost every evening, I stayed late, systematically reading and saving

choice bits of the historical record of Memorial Sloan-Kettering's publicity

efforts. I began to augment this with visits to the MSKCC Archives in the

hospital basement and to a college library down the block.

 

A public relations strategy

 

What I eventually discovered was this: I had been hired to help publicize the

latest breakthroughs in the " war on cancer. " But publicizing the imminent cure

for cancer was nothing new. Rather, for decades it had been the stock-in-trade

of newspaper writers, public relations flacks, and " development " (i.e.,

fund-raising) strategists at Memorial and other medical centers.

 

At Sloan-Kettering Institute, despite the obligatory lip service to

humanitarianism, the focus of some researchers seemed to be a high-paced game of

new drug development. The patient, for some of them, was a pawn in the process

of discovering and testing new agents that would boost their own careers, and

the profits of drug companies.

 

Money for research was (and continues to be) scarce, no matter how much was

pumped into the war on cancer. Scientists therefore sought out pharmaceutical or

venture-capital financing. This created an inevitable tendency to try to please

their research sponsors.

 

This impression has been confirmed by a more rigorous survey of clinical trials

published in a medical journal. While 61 percent of drug studies in general

reported results favorable to a new treatment, for studies supported by

pharmaceutical companies the number soared to 89 percent (91). In other words,

when the drug company is paying, nine out of ten times scientists find something

positive to say, or say nothing at all.

 

As time went by, I learned that pharmaceutical companies active in the cancer

field had assumed positions of great influence on the Board of Overseers (the

directorship) of Memorial Sloan-Kettering and its subsidiary corporations.

Overseers with fortunes from other sources went into the drug business and

became even wealthier. It was a tightening noose.

 

Bright new minds

 

The director of Sloan-Kettering, Robert A. Good, M.D., Ph.D. was famous for his

speeches extolling the need for fundamental discoveries from " bright new minds. "

But often the best that profit-oriented scientists at his Institute could come

up with were minor modifications of formulas whose patents were running out.

This led to boring, incremental change, masquerading as progress. Other

scientists were indeed seeking ways to understand the chemical environment of

the body (cytokine research, for example). But the practical upshot turned out

to be drugs like filgrastim (Neupogen), which enabled clinicians to give

increasing amounts of standard toxic chemotherapy to their patients, usually

with no appreciable improvement in survival. Cancer was once seen as a dead end

in medicine, and smart doctors hesitated to go into this specialty. But with the

creation of the war on cancer, hundreds of millions of dollars were suddenly up

for grabs. At around the time that I joined Memorial, cancer research became a

smart career move, bringing high salaries, academic prestige, and peer

recognition. For a lucky few, it meant really big bucks in the biotech field.

Cancer had become big business.

 

 

Those vague doubts that I experienced more than 20 years ago have now

crystallized into the book you hold in your hands. To my knowledge, this is the

first book in any language written for the general public that is about the

failures as well as the successes of chemotherapy. But it is certainly not the

first time trenchant criticisms have emerged. From time to time, researchers

have voiced similar reservations within the pages of medical books and journals;

but almost never have their qualms been brought to the attention of the general

public.

 

Why such hesitancy? Perhaps it is a fear of damaging long-nurtured careers by

appearing disloyal to the cancer establishment. Cancer specialists also

sometimes justify their reticence by claiming that a book such as this might

discourage people from getting proper medical attention for life-threatening

conditions. I doubt that will happen, but let me make my position clear from the

start. Namely, there are situations where chemotherapy can be a rational and

life-saving course. These include most cases of Hodgkin's disease, acute

lymphocytic leukemia (ALL), and testicular cancer, as well as certain rare

cancers, such as Burkitt's lymphoma, choriocarcinoma, and lymphosarcoma.

 

It also plays a part, with surgery, in the successful treatment of Wilms' tumor,

Ewing's sarcoma, rhabdomyosarcoma, and retinoblastoma.Among the more common

adenocarcinomas, chemotherapy appears to extend survival in many cases of

ovarian cancer. In small-cell lung cancer (SCLC) there seems to be a survival

gain of several months.

 

Its possible value as an adjuvant treatment in breast cancer patients after

potentially curative surgery is discussed at some length below. Basically, some

chemotherapy has its uses; this message will be repeated throughout the text.

However, even for the above cancers, chemotherapy remains an often grueling

option—medieval, by many doctors' own admission. Even for these kinds of cancer,

effective, less-toxic substitutes are therefore still desperately needed.

 

A reasonable prospect

 

My point of view in this regard is essentially the same as that of New York

cancer specialist, Albert Braverman, M.D., writing in the British medical

journal, The Lancet:

 

" Chemotherapy should be prescribed only when there is a reasonable prospect

either of cure or of benefit in quantity and quality of life. Oncology trainees

should be taught that chemotherapy is not part of the management of every cancer

patient... " (48).

As I shall explain, for solid tumors of adults, such benefit has rarely been

proven and consequently chemotherapy should just as rarely be given.

 

For reasons of space, our focus shall be only on those drugs that have been

approved by the U.S. Food and Drug Administration (FDA), used either singly or

in combinations of what are rather flippantly called " chemo cocktails. "

 

Naturally, this book deals with chemotherapy's record up to this point. Although

I personally doubt that cytotoxic drugs (i.e., those that are detrimental or

destructive to cells) are about to make any big breakthroughs, admittedly I

cannot predict the future. Every new treatment idea certainly deserves to be

considered on its own merits, and not rejected because of other drugs' failures.

 

I am also aware that some doctors use chemotherapy in innovative ways. For

example, some doctors use drugs unapproved in their own countries. Others use

standard drugs " off-label, " for purposes or in dosages that have not been

approved by the FDA. This may involve massive doses of conventional drugs. Some

patient advocates, desperate for cures, encourage doctors to pursue even

seemingly remote possibilities, such as administering chemotherapy in situations

that are unjustified by any scientific results. Even ardent enthusiasts must

admit that there is no way to know if such unapproved treatments are really

effective. And usually, one doctor's or clinic's astonishing claims of success

evaporate when their results are subjected to larger, multi-center studies.

 

But if such treatments are not subjected to more definitive trials, then these

" successes " remain essentially in the realm of anecdote.

 

It amazes me how much of what passes for knowledge in cancer therapy turns out

to be incomplete, inadequate, and anecdotal.

 

A bitter pill

 

Early successes with Hodgkin's disease and childhood leukemia stirred up great

hopes. As Dr. Braverman points out, some chemotherapists now find it hard to

accept the fact that their even greater dreams of curing the common forms of

cancer have not come true, and probably never will. That must be a bitter pill

indeed. Patients are angry and doctors are defensive; tempers are bound to flair

in such a situation. I disagree with almost all the current dogmas of oncology,

but do not need to personally attack my opponents in order to build up my own

position. Those looking for ad hominem attacks will have to look elsewhere.

 

Chemotherapy's use is now rampant not just in the United States, where it began,

but in Canada, Chile, Denmark, France, Germany, Italy, South Africa—actually

throughout most of the industrialized, and some of the developing, world. In

fact, in Great Britain, 60 different cytotoxic drugs—more than in the United

States—are now licensed for use in cancer therapy (61).

 

With Questioning Chemotherapy, I hope to spark an international debate on the

value of toxic drugs in the treatment of cancer.

 

There is much discussion of the meaning of the word " epidemic " in relation to

cancer. However, consider this: in 1962, 278,000 Americans died of cancer. By

1982 that figure had risen to over 433,000. By 1995, cancer deaths were

estimated at 547,000. Certainly, part of this increase is due to the growth and

aging of the population. But even when one adjusts for these, the overall U.S.

mortality rate had increased by 10.1 percent from 1950 to 1991 (323). Incidence

during that time had increased 49.3 percent. While the occurrence of some

cancers declined, many of them were on the rise, sometimes dramatically:

 

 

a.. A 548.7 percent increase in lung cancer among women;

b.. A 346.7 percent increase in melanoma;

c.. A 205.4 percent increase in multiple myeloma;

d.. A 189.9 percent increase in prostate cancer (323).

A sweeping reform of the " war on cancer " is needed, with new leadership focused

on prevention, non-invasive forms of early diagnosis, and the exploration of

non-toxic and substantially less toxic treatments. A discussion of 102 such

approaches is given in my book, Cancer Therapy (271).

 

For the 1.2 million Americans and the 9 million people worldwide (192) who will

develop cancer this year, such a reform cannot come too soon.

 

--Ralph W. Moss, Ph.D.

 

###

 

 

 

--

Ralph W. Moss, Ph.D. is the author of eight books and three documentaries on

cancer-related topics. He is an advisor on alternative cancer treatments to the

National Institutes of Health, Columbia University, and the University of Texas.

He researches and writes individualized " Healing Choices " reports for people

with cancer. For information on Healing Choices, you can contact coordinator

Anne Beattie @ 144 St. John's Place, Brooklyn, NY 11217; Phone 718-636-4433; Fax

718-636-0186.

Web site: www.ralphmoss.com.

Email: mail.

 

 

*§ §* Pulse On World Health Conspiracies!

 

Subscribe:......... -