2004 Cancer Convention for 25,000 Oncologists Ignores Complementary and Alternative Medicine

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"The doctor of the future will give no medicine, but will interest his patients in the care of the human frame, in diet and in the cause and prevention of disease."
- Thomas Edison

Cancer is a political problem more than it is a medical problem.

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  "No man is good enough to govern another man without that other's consent." - Abraham Lincoln

 

 

 


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So where can cancer professionals go for reliable training in alternative cancer treatments? Read about the Cancer Guides training program

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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:

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-ą-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.


 

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Ralph W. Moss, Ph.D. Weekly CancerDecisions.com
Newsletter #137 06/21/04
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2004 ASCO MEETING, PART TWO

Last week I began a discussion of the 2004 meeting of the American Society of Clinical Oncology (ASCO). I conclude it this week.


REMISSION ACCOMPLISHED!

On the exhibit floor, huge corporations jostled with one another for control of the best space, each with its two or three-story high triumphalist display. More than once, beautiful young women tried to entice me into their carpeted booths to receive information on their company's products. (A similar thing happened to me in the evening as I strolled with a colleague down the French Quarter's raucous Bourbon Street.)

Overall, the mood was one of unbridled self-congratulation. One drug company display bore the provocative title, "Remission Accomplished!"

Click or go to http://www.cancerdecisions.com/images/ASCO2004_3.jpg

This whole conference was a paean to the surging profitability of the new cancer medicine. As Andrew Pollack of the New York Times made clear in his front page article, the ASCO meeting has become the new trading floor of the biotech industry.  "Analysts, many of them with medical or science degrees, pack the meeting rooms and photograph the presentation posters with digital cameras" (Pollack 2004b).

According to the May 2004 issue of the magazine Hem/Onc Today, there are now over 500 indications being explored in hematology/oncology using new drugs. In five years, says the magazine, hem/onc's pipeline grew by 43 percent. In other words, business is booming.

Yet overall, the actual amount of serious research into CAM presented at ASCO is so small as to be nearly non-existent. Readers can check this for themselves by accessing the ASCO Knowledge Center search engine.

When I entered some popular CAM-related topics in the search engine and here is what I came up with:

Topic Total Abstracts

Antioxidants 3
Ascorbic acid 1
CAM usage 8
Cartilage (any kind) 0
Chronomodulated chemotherapy 5
Herbs 1
Homeopathy 3
Hyperbaric oxygen 0
Hyperthermia 7
Insulin potentiated chemotherapy 0
Licorice 1
Lycopene 0
Melatonin 0
Metronomic chemotherapy 5
Mistletoe 1
Photodynamic therapy 1
Polarity therapy 1
Prayer 4
Radiofrequency ablation 11
Vitamins (in general) 27

As you can see, many popular CAM topics - hyperbaric oxygen, lycopene, melatonin, Coley's toxins, the therapeutic use of cartilage extracts, etc. - are not even mentioned among the 10,000 abstracts. And forget about the more controversial topics of laetrile, Essiac tea, Hoxsey herbs, Rife machines, noni, mangosteen, etc. The public can expect no help from the cancer establishment in making difficult treatment decisions in these areas. It seems that as far as the oncology profession is concerned, such treatments are simply beneath contempt.

And yet, even the numbers on the above list, scanty though they are, give a falsely positive impression of how much work is going on. Many of these citations actually refer to the same few papers. Plus, many of these are not original research but once-over-quickly surveys that mention a treatment only in passing. Thus, the number of genuine, original studies of the safety and effectiveness of CAM treatments is very small.

If we put the term "complementary medicine" into the same search engine (for the body of the text), we come up with the following numbers:

2004 Abstracts 9
2003 Abstracts 6
2002 Abstracts 2
2001 Abstracts 4
2000 Abstracts 0

So I guess we're making some progress. In fact, if this were 30 years ago, I would know exactly how to spin the story on behalf of the cancer establishment. "This year saw a 50 percent increase in CAM-related papers over last year." And technically I would be right! At the rate of an increased three extra papers per year, I can confidently predict that in a mere three hundred years from now CAM will have become a significant minority interest at ASCO meetings.

So, let's see. On the one hand, we know that between 60 to 90 percent of all cancer patients are now using some form of CAM, and interest continues to grow. One paper, reviewed by Dr. Kara Kelly, showed that 86 percent of patients reported satisfaction with their alternative treatments. But on the other hand, we have the painful spectacle of 25,000 oncologists with their heads in the sand, diligently avoiding serious study of those very topics that are of the greatest interest to their patients.

When the public and the Congress rise up against this intolerable situation - and they will - short-sighted oncologists will have no one to blame but themselves.


--Ralph W. Moss, PhD

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ASCO REFERENCES

Barclay, Laura, MD. Many children with ALL deficient in antioxidant vitamins. Medscape Medical News, June 7, 2004. Accessed June 8, 2004 from:
http://www.medscape.com/viewarticle/480092?src=mp

Borden, Bill and Pierson, Ransdell. New drugs chip away at cancer, Reuters, June 6, 2004. Accessed June 8, 2004 from: http://www.reuters.co.uk/newsArticle.jhtml?type=healthNews&storyID=5354434§ion=news

Moss, R. W., PhD  Antioxidants Against Cancer.  Click or go to:
http://www.amazon.com/exec/obidos/ASIN/1881025284/cancerdecisio-20/ref=nosim/104-3796374-0114320

Pollack, Andrew.  Drugs may turn cancer into manageable disease. New York Times, June 6, 2004. Accessed June 8, 2004 from: http://www.nytimes.com/2004/06/06/health/06CANC.html (citedas 2004a)

Pollack, Andrew. Annual cancer conference becomes laboratory for stocks. New York Times,  June 8, 2004. Accessed June 8, 2004 from:
http://www.nytimes.com/2004/06/08/business/08place.html (cited as 2004b).

Here are some papers on the use of CAM presented at ASCO this year:

Comparison of complementary medicine use at genetic testing program enrollment and one-year following results disclosure.
Meeting: 2004 ASCO Annual Meeting   Abstract No: 1013   First Author: L. Digianni

Does the perceived risk of breast cancer recurrence and death affect the use of complementary medicines by cancer patients?
Meeting: 2004 ASCO Annual Meeting   Abstract No: 8152   First Author: S. Verma

Licorice in prevention of radiation induced mucositis.
Meeting: 2004 ASCO Annual Meeting   Abstract No: 8268   First Author: A. A. Ismail

Out-of-pocket costs (OPC) and time costs (TC) for patients with stage IV non-small cell lung cancer (NSCLC) and their caregivers.
Meeting: 2004 ASCO Annual Meeting   Abstract No: 6021   First Author: D. Romanus

Polarity therapy and cancer-related fatigue.
Meeting: 2004 ASCO Annual Meeting   Abstract No: 8147   First Author: J. A. Rosco

Prevalence of CAM in a cohort of breast cancer patients and controls.
Meeting: 2004 ASCO Annual Meeting   Abstract No: 8131   First Author: K. N. Anderson

Use of complementary/alternative medicine by Brazilian oncologists.
Meeting: 2004 ASCO Annual Meeting   Abstract No: 8196   First Author: E. S. Tibana Samano

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

Newsletter #168 01/23/05

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THE MOSS REPORTS

Studies have shown that at least 70 percent of cancer patients are using some form of complementary and alternative medicine in addition to their standard cancer treatment.  Yet the medical profession remains appallingly badly informed about the alternative treatments their patients are increasingly using.

This week I announce a meeting that aims to change this unfortunate situation.

For thirty years I have been writing about cancer treatments, both conventional and alternative.  The fruit of my long career in this field is The Moss Reports, a comprehensive library of more than two hundred individual reports on specific cancer diagnoses.  For a cancer patient, a Moss Report represents an invaluable guide and handbook for the journey ahead. 

If you would like to order a Moss Report for yourself or someone you love, you can do so from our website, www.cancerdecisions.com, or by calling Diane at 1-800-980-1234 (814-238-3367 from outside the US).

We look forward to helping you.
 

IMPORTANT MEETING ANNOUNCEMENT

The fourth weeklong CancerGuides® training program is scheduled to begin on March 13, 2005, at the Claremont Hotel in Berkeley, CA.  This program is the most comprehensive training in integrative cancer treatment in the United States.  It is specifically designed to help oncology and other health professionals to guide their patients in creating individualized programs of comprehensive care.  I will be addressing the meeting on the subject of alternative cancer clinics in Europe and Mexico.

CancerGuides® provides scientific information on, and guidance in using safe and effective complementary approaches, including proper nutrition, stress management, massage, exercise, group support and Chinese medicine.  It teaches the professionals who come how to help their patients to discriminate among the bewildering array of complementary therapies that so many are already using. 

The CancerGuides® training is attended by a full spectrum of health professionals, including oncologists and other physicians, oncology nurses, social workers, psychologists, and patient advocates.  The content of CancerGuides® is based on the Center for Mind-Body Medicine's Comprehensive Cancer Care Conference, which was called "the most important alternative medicine meeting in America" by The New Yorker. 

Studies demonstrate that up to 70 percent of all US cancer patients are using alternative or complementary therapies, and that the majority of professionals they consult possess little knowledge about these practices.  Thus, patients are generally left to figure out what to do on their own, at times leading them to try ineffective - or even harmful - treatments.  CancerGuides® aims to fill the knowledge gap in the professional community.  As one oncologist who attended the program said, "The CancerGuides® training is the best way for physicians and other health professional to learn to bring truly integrative care to their patients.  We use what we've learnt every day."

CancerGuides® was created by the Center for Mind-Body Medicine (CMBM), which is led by Founder and Director James S. Gordon, MD.  Dr. Gordon, who is the former Chair of the White House Commission on Complementary and Alternative Medicine Policy, and the author of Comprehensive Cancer Care and Manifesto for a New Medicine, among other books, is also a clinical professor at Georgetown Medical School.  He founded the CMBM in 1991 in an effort to bring a humane, integrative approach to medical care. 

The CancerGuides® training is co-sponsored by the Susan G. Komen Foundation, the George Family Foundation, Cancer Treatment Centers of America, and the Center for Spirituality and Healing at the University of Minnesota.  National and local cancer organizations, including the Association of Northern California Oncologists (ANCO), and the Oncology Nursing Society (ONS), are actively participating.  Almost 400 people have attended the training in its first three years. 

To participate, register, or to learn more about this important meeting, please contact the Center for Mind-Body Medicine at 202-966-7338 or visit www.cmbm.org.

--Ralph W. Moss, PhD

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