THE MOSS REPORTS Newsletter (06/13/04)

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14 Jun 2004 04:00:27 -0000

" Cancer Decisions "

THE MOSS REPORTS Newsletter (06/13/04)

 

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Ralph W. Moss, Ph.D. Weekly CancerDecisions.com

Newsletter #137 06/13/04

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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).

 

 

Meager Findings

 

 

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

 

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IMPORTANT DISCLAIMER

 

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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