Monthly Archives: October 2010

THE TRILLION-DOLLAR CANCER INDUSTRY: QUOT HOMINES TOT FEMINA or QUOT HOMINES TOT CANKERI??

neil.burman@gmail.com

 PREFACE:  the conflict  between common sense, conventional wisdom and vested commercial interests:

Throughout the ages, innovators and believers in truth and freedom of thought  have risked if not attained martyrdom for disputing populist or autocratic wisdom or beliefs, from Socrates to Jesus to objectors against prevailing dogma through the past twenty centuries, Martin Luther, Galileo Galilei and in our time  eg Margaret Sanger, Mahatma Ghandi, Linus Pauling, Jack F Kennedy, Nelson Mandela,  Steven Biko, now even medical leaders like Dr David Graham at the Federal Drug And Food Administration itself.

But despite the eternal fact that truth will out, even now the USA and South African governments are determined to suppress truth, making it a jail offence for whistleblowers and media reporters to publicise evidence that exposes (eg medical) fact let alone corruption and worse. Jose Saramago the late Nobel-winning Portuguese author of “Blindness” and “Seeing”.  will be sadly shaking his heavenly locks.  We should heed Saramago’s modern scepticism  about official truths if not his atheism and communism.

Eleven years ago the emeritus professors Sirs  Stuart Cameron(British)  and Bill Hoffenberg (South African) at London University  dared to publish jtaboo questions for ethical debate – The ethics of organ transplantation reconsidered: paid organ donation and the use of executed prisoners as donors. This was still hotly debated in 2003- and remains so in South Africa -ironically after 16 years of ‘democratic’ majority rule  one of the most violent and corrupt countries in the world – where leading private practice doctors and hospitals are being prosecuted for transplanting kidneys from apparently desperate willing sellers to unrelated paying recipients.

The Case of Disease-Mongering?  Screening the well at average (not high) risk for Possible Future Cancer:

 The classic Latin phrase Quot Homines, Tot Sententiae- so many people, so many opinions – refers to the dilemma of which opinion to follow, what to  vote for. Politics aside, never is this more apposite than about confusing men and women about the grave risks  of the overdiagnosis and overtreatment of screening-detected silent cancers.

So perhaps the title should read: Quot Homines Tot Cankeri: not all adults may get crabs, but the screening disease industry posits that  all adults may get cancer and thus should be regularly invasively internally screened. .

We are not talking about investigation directed at a possible cancer that has already grown big enough to be causing relevant symptoms eg a lump or pain etc. It is indeed surely negligent if a health professional fails to recommend such diagnostic investigations in the appropriate clinical conditions.

SCREENING FOR BREAST AND PROSTATE CANCER: A review last month of the massive ( New Jersey Cancer Institute) study of prostate cancer bears out the futility- in fact grave risks- of screening for silent dormant prostate cancer in men without symptoms. This is reinforced by a broader recent Medscape review. 

Wikipedia usefully sums up the dilemma we face 2500 years after Hippocrates.  While Aulus Cornelius Celsus translated the Greek carcinos into the Latin  – to many of us the foods of the gods – Galen 150 years later used “oncos” to describe all tumours, the root for the word oncology; but the more thoughtful Hippocrates had long before distinguished benign tumours oncos, Greek for swelling, from malignant tumours carcinos.

We can fast-forward this distinction to 2010 in Hippocratic terms of both ethics and pathology:

1.should tumours that are histologically “malignant” but clinically static over a usual lifetime – as most asymptomatic prostate and breast “cancers” are ie “oncos” (eg screening-detected ductal or cervix carcinoma in situ) if not stirred up by eg hormone therapy or biopsy- be labelled, diagnosed to the patient as clinically malignant “carcinos” ie a spreading crab? Hippocrates , and later Celsus , were indeed talking about cancers as tumours that were clinically and macroscopically malignant. Silent preclinical cancers that are discovered on screening are rarely so. And therefore

 2.is it ethical to do cancer screening (by blood, digital, xray, ultrasound, biopsy) of all asymptomatic patients? As Shaughnessy and Slawson (1997) so incisively wrote a decade ago, is such commercially lucrative proactivity Patient-Orientated Evidence that Matters ie POEM to the patient? They continued to publicise this theme relentlessly until their last joint Pubmed-listed essay in 2006, arguing trenchantly for valid evidence-based practice rather than as most doctors seem to do, following ex cathedris views and guidelines by ‘experts’ and committees- who are likely influenced by Big Pharma. They (Shaughnessy and Slawson) individually continue this battle until now.

The updated wikipedia review  of xray screening for asympotomatic preclinical cancer including breast cancer, soberly reviews the controversy surrounding the benefits – saving possibly one extra life in 2000 healthy women whose breasts are heavily crushed and irradiated for years for no benefit, for the dozens undergoing recalls and biopsies for lesions found, the handful who may have cancer diagnosed and even surgery and radio/chemotherapy, for mostly early cancers that far more often than not would never have presented during lifetime and death from other causes.

Yet screening breast cancer xray mammography of even millions of asymptomatic women not at familial risk cannot be proven to save even one life let alone lives. The increasing doubts about the costs (both financial and emotional) of such screening versus the benefits of such screening of well persons with low risk factors including family, apply to screening for many relatively common feared cancers eg breast, prostate, testicular, ovary, lung.

SCREENING FOR OTHER CANCERS: So the question may well be asked whether there is overall statistically significant benefit (in lower overall mortality and morbidity) of such invasive screening programs even for the other two commonest cancers of older adults- colon cancer and cervix cancer- in those without significant risk factors- relevant symptoms or infections or family history.

This then extends to the longerm questionable overall benefit versus risk of vaccination especially from preteens against human papilloma virus- again, such vaccination is a trillion-dollar industry when it is decreed compulsory for all children. .  As screening for breast and prostate cancers has shown no clear benefit to individuals or to the population screened – versus the non-screened- on longterm population followup, it will take comparable careful review of results in thousands of initially low-risk well patients for decades to show whether overall mortality and morbidity was indeed lower in average-risk populations that were invasively screened/ vaccinated for eg cervix or colon cancer versus those that were not.

Only such a study will show whether the public has anything to lose by simply being mandated to report to a healthcare professional for relevant investigation when they develop new symptoms eg change in bowel or gynaecological health.   It is damning that on a populist website like Health24, the page on Breast cancer was last updated in 2006, and does not even mention the crucial issue of longterm benefit and risk on those screened. Naturally service providers with vast investments in technology and aggressive management promote screening, as witnessed by national health services, university and private hospitals and high-tech practitioners in all countries. At least the Wikipedia section on breast cancer screening has a lengthy section covering the controversy.  .

 It is now six years since surgery professors Dent and Panieri published an editorial warning about the lack of convincing evidence for population breast cancer screening. And their editorial did not even consider the added risk factor of repeated crushing and irradiation of presumably health breasts.

And a practicing USA radiologist like Dr Jeff Dach argues realistically against all such screening based on the evidence.  .  As he says, just switch off the screening imaging machines, stop calling ductal carcinoma in situ of the breast a cancer. The ongoing argument for and against screening is hotly debated by specialists supporting and opposing the vested interest of the Screening Industry.

 Without more study, it cannot be assumed, proclaimed, taken for granted that the giant resources- costs, risks, and invasion of everyones’ privacy and time,  required for such mass screening and vaccination – are justified. Are they anything more than lucrative disease-mongering? when screening xray mammography alone is already said to  gross almost $10 billion a year in USA (300million people) .

   Extend that to all countries and the five common adult genetically linked cancers,  and the cost of questionable screening (and then managing the discovered cancers) – let alone aging cancer itself) for the whole world of older adults surely  rises to above a trillion dollars a year– a nice coveted annual pot of gold for governments in power and the business moguls, big stakeholders they serve.

As with the spurious decade-long unwinnable invasion of Iraq for fictitious nuclear weapons but in reality for the profits of war and oil,

 and the USA – European Union -WHO declaration of a swine flu pandemic just a year ago so that the NATO business buddies – governments and their funding private megacorporations – could reap billions in immediate rake-off from unproven screening tests and vaccinations and drugs;

and its trillions a year from uncovering and treating all those sleeping cancers, 

 so who cares about the benefits and risks decades down the line for those screened and vaccinated and treated now for disease that is unlikely ever to occur?

Advertisements

update: BISPHOSPHONATES AND MALIGNANT BONE PAIN: REBUTTAL AND COUNTER-REBUTTAL

 neil.burman@gmail.com

update 2 Oct 2010: a practitioner asks what to do for a  white female 58years:
1998 ductal cell. lumpectomy, radiation, 15 nodes removed.  Tamoxifen  5 yrs.
2009  lobular cell. double mastectomy, nodes removed.  Aromasin  for next 5 yrs.
Osteopenia -2.3  found inside  1 yr .    on
Boniva ibandronate  4 yrs, stopped recently. 
 Doesn’t want to take IV drug for osteoporosis. 24 hr urine calcium  normal.  High vitamin d levels.
takes a lot of calcium,  vit d, vit c, vit b complex sups. Takes Prilosec omeprazole for reflux and hiatal hernia. chronic insomnia.
The questioner does not reveal her bodymass index or resting morning cortisol level or insulin resistance- all of which may well be raised; nor give her crucial vitamin D and C  intake or vitamin D  blood level. It is a question of evidence, not opinion – dogma- or laboratory average population ranges , as to what are optimal intakes and blood levels.

This column  has regularly reviewed the conflicting views and evidence  on osteoporosis;  BNP and breast cancer; and the safe multisystemic efficacy of using the score of natural supplements- including appropriate combined hormone replacement therapy – that safely oppose both osteoporosis – bone and muscle frailty-  and the associated chronic major involutionary diseases of aging especially vascular disease, dementia  and cancer. .

 The antireflux proton pump inhibitors PPI drugs notoriously aggravate osteoporosis; and for average reflux are not necessary with use of slippery elm, apple cider vinegar, simple calmag  and sensible diet and lifestyle.  It has been known for years that PPIs  more than double risk of osteoporosis, so why take them?. 

On the other hand, the pluripotential hormones of darkness and light –  vitamin D3 and  Melatonin – combined with the other mulibeneficial natural supplements that synergistically relieve/ reduce insomnia,  reflux pain,  cancer, depression, memory loss  and all other significant major chronic degenerative diseases of aging.

As this column regularly updates, Metformin too is a natural supplement (plant) co-hormone- a veritable panacea-  that reduces all major chronic disease and mortality by about a third- including cancer; and  dementia perhaps via reducing serum amyloid levels.let alone tissue oxidation, glycation, vasculopathy. BPN has none of these extraosseous benefits, only deadly risks.  

 Similarly, appropriate transdermal human estrogen but not oral xenoestrogen- CEE-  reduces serum amyloid in postmenopausal women,  while low testosterone raises serum amyloid in men.

So middleaged patients are at terrible risk of anxiety depression hypercortisolemia, frailty fractures, vascular disease , cancer and dementia after cancer, especially with sex hormone suppression or blockade. They do not need the myriad risky designer drugs touted for prevention of more cancer etc, all they need urgently and permanently is the scores of appropriate natural balanced supplements as this column regularly reviews- most of which supplements can simply be mixed in a tub of customized powder blend to be drunk twice daily. .

:Feb 13, 2009    In response to  Death-knell-for-bisphosphonates-for-osteoporosis-breast-cancer-time-for-class-action-against-bisphosphonate-damage last week,  a world-renown emeritus professor of radio-oncology comments:

“the action of the bisphosponates BPN is to inhibit osteoclastic action and thus reduces bone resorption; the patients tell the story- they get immediate and sustained relief from bone pain; if they  are on opiates the need is much reduced. Of course palliative RT is valuable, but often if pain recurs after RT the BPN give welcome relief, at least in my experience.

The  IV BPNs are also very useful in the oft-times encountered hypercalcemia often threatening myeloma- and other cancer patients. I am not however, too conversant with D3 in this setting!” But the first reference links are the latest in the clinical field of BPN and cancer.

Other than  in terminal cancer cases- when it doesn’t matter what convenient pain relief is used-  the problem with bone pain in cancer always is, what is the cause? either bone resorption from the catabolic effect of cancer (via eg high parathyroid hormone PTH);  OR cancer eating away at bone itself, OR something else common OP  unrelated to the cancer.?

But FOR CANCER-RELATED bone pain lesions – whether directly from cancer there, or from remote metabolic effect –  where are the trials comparing BPN with other antiresorptive antineoplastic ANTIINFLAMMATORY ANALGESIC ANABOLICS ie testosterone (or occasionally estrogen/ other antiandrogen)  and vitamin D3?

Obviously bone metastases are attacked with appropriate chemo-/ xray XRT, cortisone, testosterone AND if deficient, vitamin D3.

To put it the other way round: where is the evidence that BPN – at cumulative cost and risk-  adds benefit to the multiple attack? where the evidence that- unlike testosterone and vitamin D3- BPN has any benefit except on bone pain? Hypotheses based on in vitro and animal and human cell culture studies have  not translated into even good observational comparative evidence favouring BPN as good benefit:cost ratio for osteoporosis or cancer.

The oncologist answers in the traditional mode, by experience that BPN works. But evidence-based medicine EBM asks where is the comparative evidence for BPN to challenge the evidence that we have better multi-attack without BPN – when these supplements are not equally commercially promoted and tested in controlled trials for the usual commercial  reason ?

The dream of drug manufacturers is eternal, that their raincheque designer drug- statin or BPN or antihypertensive- will prove to be a safe multisystem panacea as is metformin and many  other supplements like vitamin D3 or testosterone. But after more than 30 years of BPN and statins, no trial in humans has yet shown this for BPN or  statin or any other original designer drug.