My Malignant Melanoma

Over on my Brandon Bays post, a fan of alternative medicine attempted to post a muddle-headed comment, drawing my attention to an Australian study which concludes that cytotoxic chemotherapy contributes little to five-year survival. He has the mistaken belief that this paper somehow strengthens the case for alternative medicine in general, and the quackery of Brandon Bays in particular. 

I'm afraid that wouldn't follow logically even if this paper claimed (it doesn't) to have proven that chemo made no difference at all. Proof that chemo didn't work at all wouldn't tell us anything about whether magic beans cured cancer. This is the classic alternative medicine technique of muddying the waters.

What the paper actually says is that for adults, only a very modest (2.3%) increase in five year-survival was on average conferred solely by cytotoxic chemotherapy (note that this is not the raw figure, but has been corrected downwards to account for the placebo effect, and the effects of surgery and radiotherapy).

Tell us something we don't know! (Note that cytotoxic chemotherapy is a sub-set of chemotherapy, using simpler, older, drugs highly toxic with a lot of side-effects like cisplatin, and that the placebo effect accounts for 100% of the effect shown by alternative techniques). This sort of chemo is used only as a palliative measure in MM, so only the sickest patients get it, and it's a desperate measure. It's not only MM where this is true, so averaging across all cancers is a bit misleading (especially to non-scientists looking to promote quackery).

The paper says that for MM and a number of other cancers, there is no evidence of improved 5-year survival at all, but admits that for certain cancers, improvements in five year survival of up to 40% are evident. Drawing the blanket conclusion that this sort of chemo is no better than alternative medicine from this paper is unwarranted.

The paper says that some patients are oversold the possible benefits of chemo, and expect too much of it where only very modest improvements are possible. The point of the paper is that overall, this is not great value for the health service, and the cost/benefit profile of individual drugs should be considered in the way NICE does in the UK.

Again, we knew that, but look at the campaigns to allow sick cancer patients access to very expensive drugs that no-one is claiming offer more than a few extra months of life. Cytotoxic drugs are usually pretty easy to make, and consequently cheap. A team of medical researchers made one on top of Snowdon. Whilst it might not be great on average, the 15% response rate of DTIC means that some individuals get a few extra years. This effect is insignificant at the 5-year survival group level, but is significant as hell to those few individuals.

Now this might sound like the sort of arguments advanced by alties, but let us be clear. I am not saying (as they do) that these things really work, but your stupid science just cannot detect it. I am saying that licenced chemotherpaies have been shown to work, but in the case of MM, they are not likely to cure. (Note however that the paper concedes that in the case of some cancers chemo DOES offer a very significant chance of a cure)

So to return to Brandon Bays, does the paper we have been offered to support his claim that all chemotherapy, radiotherapy and surgery is harmful to all cancer patients do so? No, it says that sometimes (taking away those cases attributable to the placebo effect, radiotherapy and surgery) one particular sort of chemotherapy does not CURE some sorts of cancer. It does not give any case where is says that chemo makes cancer worse. It does not say that this sort of chemo is not helpful. This paper does not support the case it is quoted in support of in any way.

If there were a paper with the conclusion our poster thinks this one has, the treatment in question would be withdrawn - the NHS does not knowingly pay for treatments intended to cure which instead kill. There is no conspiracy to suppress the truth. There is no such thing as alternative medicine-there is medicine, and there is quackery. Funny isn't it that they lose their distrust of science when they think they have found a scientist who agrees with them though, isn't it?

Labels: Brandon Bays, Caron Keating, quack