Cancer cures and the evil of false hope

This dicholoroacetate (DCA) story keeps dogging me. A cheap drug which kills all cancers! But Big Pharma won’t let the cat out of the bag, because it’ll kill their billion-dollar profits! Does a story get any sexier than that? Think about it: cancer fears; a discovery that would spark hope in millions of patients and their loved ones; and a great whopping conspiracy theory to top it all off. Wow.

The other day, I spent at least an hour reading reading Randula's diary (with comments), and this morning, a good friend asked me about it, too. What follows is my response to my friend.

But first, my credentials, such as they are: I am an ear, nose, and throat doctor. I have an MD/PhD, and the PhD is in cancer biology. Full disclosure, though: I've never been involved in cancer research and my PhD was awarded in 1990. A lot changes in 17 years, believe me, and at best I've been only an armchair cancer biologist. What follows is my modestly informed opinion, something I trot out when the latest "cure for all cancer" is announced. I've cross-posted this 'dichloroacetate cures cancer' business at my place, too.

You know the line, "If it sounds too good to be true, it probably is"? With respect to DCA, that's almost certainly the case. We're talking about a drug which has not seen a single cancer-related clinical trial. Is the preliminary data exciting? Sure it is. But there are a number of factors which  should temper anyone's enthusiasm:

1. There is no single disease, "cancer". Every type of cancer is  genetically and behaviorally unique. Within a single type of cancer,  every patient's cancer is genetically and behaviorally unique. And  within a single patient, that cancer's genetics and behavior changes  over time. That's why very few types of cancers are cured with chemo alone, by  the way. And it's also why the only chance a patient has with some  cancers (like pancreatic) is surgical. If you can physically remove the  cancer, you have a shot at cure. But with pancreatic CA, one of the most  lethal of all cancers, I think the 5-year survival is still only 22%  even if you're in the lucky minority who can have surgery.

2. In medical research, there's a long history of diseases cured in  tissue culture, cured in animal models, etc. Tissue culture and animal  models are important, but they are no substitute for human studies. I'm  particularly sensitive about this point. If my wife were a mouse, her multiple sclerosis  would have been cured back in the 80s. LOTS of drugs have worked  dramatically for animal cancer models -- I'm thinking back to the 90s,  when we thought the anti-angiogenesis drugs were going to be the next  cure-all, based on mouse (or rat?) studies. Ten years later, these drugs  are seeing limited use, but they're far from being panaceas.

3. In any given tumor, you have a population of cells with genetic  variability within the population. Think of it as evolution on a small  scale. When you radiate or give chemo to the patient, you're applying  selective pressure to that population. Many die, but the ones who resist  are left behind to continue their cell division. Only now you have a new  population, don't you? Newer, tougher. Point is, DCA (this new wonder  drug) might have some efficacy against cancer, but until we hold human  clinical trials, we have no way of knowing how readily human tumors can  'outwit' (if you'll forgive the anthropomorphism) the drug.

4. I think this particular story has legs because of the "Big Pharma is  Baaad" meme. Since it's a simple molecule (dichloroacetate -- doesn't  get much simpler) and it's out there in common usage (to treat lactic acidosis,  apparently, although I couldn't find it in the Physician's Desk  Reference), the pharmaceutical companies can't make a profit off of it.  And since it's this big panacea, it would cost them billions in lost  profits, yatta yatta.

My point (buried in the comments to Randula's diary): if this drug is as great as everyone says it is, Big Pharma will FIND a way to make it profitable. Here's one idea: link DCA to a  large molecule which is cleaved from DCA in the liver, let's say. The  large molecule is something inert, has little biologic activity, or  perhaps has anti-cancer activity of its own. Et voila. You have a large,  patentable product, and you can doubtless devise a study to make it look  better than DCA alone. Or say fuck it all, I'm not even going to compare  it to DCA alone. I'll do this trial: standard chemo regimen with  "DCA-plus" versus standard chemo regiment alone. Wow! Look how great  "DCA-plus" is!

But this all plays into people's yen for conspiracy theories. Big Pharma  hates us. And yes, I've indulged in this on my blog, I know, I know. Big  Pharma is bad. But they also make money off of healing people.

You know what the worst part of this DCA flap is? It builds false hope. And when it comes to cancer, I think there are fewer things crueller than building false hope. It's sadism, as far as I'm concerned.

•  Tips, flames

  I had meant to elaborate on the evils of building false hope, but the diary was already getting lengthy.

  In my clinical experience, realism trumps false hope every time. Some of the most grateful families are the ones to whom I have leveled. In one instance, I told a patient with anaplastic thyroid cancer (almost uniformly fatal, and quickly so) that he really had very little time, and no, I wasn't being overdramatic. In short order, he got his son home from Germany (he was in the Army) so that they could see each other one last time.

  I'm not trying to discourage research in DCA. Heavens, no. I am trying to discourage plays to peoples' emotions . . . "we have a cancer cure, but THEY won't let us use it!" helps no one. We should focus our efforts on encouraging public sponsorship for the necessary studies.

  by Hobbitfoot on Sun Jan 21, 2007 at 12:01:19 PM PDT

  •  thank you for sharing your expertise

    but I don't believe there is such a thing as false hope.

    if people feel hopeful, for whatever reason, it can help boost their overall systemic health and may give them a few more months or weeks or days.

    even if that reason turns out not to be credible, the belief in it for how ever long they believe it can have a positive effect.

    but it is good to tell people the realistic options too ("most people with your condition die within three months") or whatever the case may be.  People should always plan to say their goodbyes as though they have very little time left.

    In fact, none of us knows how much time we have, so don't postpone joy.  and tell the people you love that you love them, as often as you can.

    by TrueBlueMajority on Sun Jan 21, 2007 at 12:13:09 PM PDT

    •  false hope is real, and it's potentially harmful

      . . . when it causes the patient to sign up for therapy (be it chemo, radiation, or surgery) which offers a tiny percentage chance of cure, and a huge percentage chance that the treatment will either shorten the patient's life or ruin the quality of what's left of it.

      I've seen this many times, unfortunately. Personal example: my father-in-law died of inoperable pancreatic cancer, but not before his oncologist sold him on chemo AND radiation therapy, each time telling him there was a good chance he'd feel well enough to fish (the one thing he loved). Well, he never felt well enough to fish. Did he last a few weeks longer? Who knows. But he suffered the whole time.

      by Hobbitfoot on Sun Jan 21, 2007 at 12:19:36 PM PDT

      •  There's a dreadful anecdote...

        ...about esophoegal (sp?) cancer over in one of the 'Cure' diaries which is not unlike the story you relate.

        Some of these diseases, it is really difficult to understand why horrific treatments are permitted. Gee whiz, median survival time increases by 2 weeks! Let's get busy!

        I mean, nobody wants to die, but to spend your last two months being poisoned and tortured instead of somewhat functional and heavily opiated, I just don't get that choice.

        by Boreal Ecologist on Sun Jan 21, 2007 at 12:34:16 PM PDT

        •  I prefer one of my patient's approaches

          He said, "Doc, if it turns out cancer, I'm taking up skydiving without a 'chute."

          Which made perfect sense to me. I knew what I'd just taken out of him. If it had been cancer (it wasn't), the 'cure' would have been horribly maiming.

          by Hobbitfoot on Sun Jan 21, 2007 at 12:38:26 PM PDT

          •  Well, I don't want to be morbid, but...

            ...I have a few ideas like that, too. As a smoker, one must consider these things.

            It's also worth being able to read a survivorship graph. That was pretty much all I needed to see when my father was diagnosed with mesothelioma.

            Thank you for your diary, btw. I've just subscribed.

            And, I thought I knew most of Borges' ouevre, but I don't know that one. I've got most of his 80's era collections in a box somewhere, should start digging.

            cheers

            by Boreal Ecologist on Sun Jan 21, 2007 at 12:42:32 PM PDT

            •  Borges

              Yeah, what a guy!

              If you have Collected Fictions, look on page 322. The story is "Ragnarok" (sorry, I don't know how to put the little dots on that 'o'!)

              by Hobbitfoot on Sun Jan 21, 2007 at 12:50:05 PM PDT

      •  well, i guess you're right

        the example you give certainly is an example of false hope.

        and a few extra weeks, if they are a few extra weeks of suffering, probably aren't worth it...

        by TrueBlueMajority on Sun Jan 21, 2007 at 10:01:07 PM PDT

•  Thank for for presenting a rational view

  I am no cancer biologist either, although I have been peripherally in the field for the last five years. I still get ruffled when "cancer" is talked about as a single entity. The parallels between chemo for cancer and the anti-retrovirals for HIV are quite strong: I wonder whether that could be used as a discussion point.

  And you are right, if DCA worked, pharma would find a way to patent it and make the big $$. It is much like the 100 mpg engine, a myth that is credible to those who do not trust business.

  I think that you should talk more re false hope. There are other MDs out there who could add their insight.

  by riverlover on Sun Jan 21, 2007 at 12:13:56 PM PDT

  •  on false hope --

    see my reply to TrueBlueMajority.

    Another personal story: my wife has MS. For the first ten years or so, we couldn't go a month without someone recommending this new diet or that new drug, always with the tag line, ". . . and it really looks promising!"

    These people don't mean to toy with your emotions. I suspect they're really trying to help. But after a while, such phone calls, letters, and conversations in the grocery store get very, very old. Like salt in an open wound.

    Sad thing is, when it comes to health, there's just as much junk science as there is in the global warming debate. If you do a web search for Health Question Z, you'll find ten bullshit articles for every worthwhile article (which is why I highly recommend you stick to looking at PubMed abstracts, if at all possible). Take the question of whether dairy products cause breast cancer. Google it and you'll soon believe a diet heavy in dairy is THE cause of breast cancer (or at least, an important factor). Take a look at the review articles on PubMed, and you'll see that there's no evidence whatsoever to back that up.

    Grr.

    by Hobbitfoot on Sun Jan 21, 2007 at 12:25:45 PM PDT

    •  I also share this sentiment

      as my wife also has MS. We really appreciate our friends and relatives caring thoughts, but it can begin to be a real drag. At some point, they can begin to make her feel guilty or lazy or close-minded because she is not following their insights that regimen X (yoga, meditation, swimming, aromatherapy, etc.) is critical to her health.

      Anyway, please accept my best wishes for your wife, and I will leave our preferred miracle cure to ourselves for now.

      by ChemGeek on Sun Jan 21, 2007 at 12:53:58 PM PDT

      •  hey, we can swap miracle 'cures'

        'Cures' in quotes because I have no illusions about the possibility of my wife getting sick again at any moment. We live day to day.

        She opted for massive immunosuppression. It wasn't easy, but it worked. She went from about 2 exacerbations per month to fewer than 1/year. But it was a risky treatment and not easy. Cancer chemo without the cancer . . . I don't know how many folks would sign up for that.

        by Hobbitfoot on Sun Jan 21, 2007 at 01:00:29 PM PDT

•  THANK you!

  For finally setting the record straight wrt DCA.  The number of incredibly stupid diaries on this subject just makes me want to scream.  I thought Kossacks were smarter than to fall for this equivalent of cold fusion.  
  Just one little complaint: Big Pharma is not baaad.  Big Pharma suffers from the same ailment as a lot of industries.  They are run by people who want an American aristocracy.  The only difference is that with Big Pharma, lives are on the line.  But singling out Big Pharma for mindless tirades is NOT going to solve the problem.  It is going to take a purging and reformation of the American Businessman Mindset in every industry to get things under control.  Furthermore, it is going to require compromises from our side as well.  Drugs should be affordable, not free.  Also, not every class action lawyer is in it for the consumer.  The GOP has military contractors, we have class action lawyers.  Both are quite capable of raping the little guy.  It's time we start taking a look at the way some of these lawsuits are run and heal ourselves.  

  by goldberry on Sun Jan 21, 2007 at 12:14:03 PM PDT

  •  I don't want to get into a Big Pharma debate

    You're right. Like any industry, they've sinned, but their sins cost lives.

    Unfortunately, they don't have to live by the dictum which rules us docs (MOST of us, anyway): first do no harm.

    I tend to look at them as potentially nasty allies.

    by Hobbitfoot on Sun Jan 21, 2007 at 12:28:21 PM PDT

    •  Like DCA, be careful of sources

      Big Pharma certainly looks like it will do anything for money.  But I used to work for a company that really did get the $#*^^y end of the stick in a major case.  The degree of culpability and malice was greatly exaggerated but that didn't stop the company from losing $18 billion dollars.  When I heaar nasty things about how callous a pharma company is, I look to see if the source has any rason to be biased or to spread biased information.  I would really prefer that that $18 billion dollars go to people who need affordable medicine, not to the pockets of a lawyer businessman. If you are truly interested in affordable drugs, you have an obligation to see that extortive class action suits don't happen.  (I'm not saying all class action suits are extortive but the public doesn't seem to be aware that some clearly are)  The degree to which these suits have negatively impacted research can not be understated.  Their effect has been enormous.  the battle to straighten out the drug industry is going to have to be fought on two fronts: 1.)getting rid of the rising aristocracy of the corporate businessman and 2.) curbing the number of exortive class action lawsuits.
      Both entities take advantage of a lack of regualtion and plunder the coffers of big pharma to the detriment of all of us.    

      by goldberry on Sun Jan 21, 2007 at 12:46:18 PM PDT

•  not sure if you're old enough to remember this:

  Laetrile.

  Anyway, there's always someone selling snake oil, and there's always a new "treatment".

  Thanks for the diary, btw.  I agree that Big Pharma is bad, but I also agree they help.  Without them, I'd probably be dead, or close to it.

  by Plutonium Page on Sun Jan 21, 2007 at 12:15:26 PM PDT

  •  Heh. I'm old enough.

    And I don't know if it's true or not, but I remember the stories of what Steve McQueen did to cure his cancer, too.

    A lot of us would be dead without Big Pharma. I didn't go into detail, but I'm mostly annoyed with them with regard to drugs for depression. I've written about that elsewhere (specifically, the Eli Lilly Prozac mess).

    by Hobbitfoot on Sun Jan 21, 2007 at 12:36:17 PM PDT

    •  Yet --

      a lot of us would be dead, or at least institutionalized, without antidepressants.

      The truth of the matter is, drugs have side effects.  Some of them suck.  Sometimes they kill people.  And yet sometimes, even plenty of times, the risk is worth it.

      by lemming22 on Sun Jan 21, 2007 at 03:07:27 PM PDT

      •  the problem is, some of these drugs

        have a significant risk of harm. If we (we, the doctors, I mean -- and patients too, for that matter) are aware of the risks, we can warn our patients to watch out for this or that. If thus-and-so happens, stop taking the drug and call me.

        There have been instances of pharmaceutical manufacturers being aware of problems and hiding that information (because the news would hurt sales, shareholder value, you name it). That's the problem.

        Take a drug I dearly love, Levofloxacin. It's an antibiotic and a damn good one. In a small fraction of patients, it can cause tendonitis. There have been cases of Achilles tendon rupture. And yet, if you were a patient taking this and your ankle started hurting, would it occur to you to suspect the antibiotic? For many people, the answer is 'no'.

        Since the drug company has made us all aware of this risk, we can warn our patients about it. NONE of my patients had ever heard of this complication, by the way.

        Hope that makes my point . . . I'm not trying to get antidepressants yanked off the market. I'd just like to see them given with better informed consent.

        by Hobbitfoot on Sun Jan 21, 2007 at 04:42:01 PM PDT

  •  I have a 1902 Sears Roebuck Catalog.

    I just like looking at the many neat kinds of things you can buy back then.  And you see a whole section on curatives.  Liver pills, blood pills, various innoculates and elixirs.  Looking back now it seems so ridiculous becuase I KNOW there was nothing curative about them.  

    And then I turn on the TV and see commercials for male enhancement pills that are little more than vitamins and for the latest metabolism boosting supplements and weight loss aides that does who knows what, and shake my head and realize we really haven't come very far have we?

    by DawnG on Sun Jan 21, 2007 at 01:51:55 PM PDT

    •  Mmmmm. Snake oil.

      Here's a bit I wrote on modern-day snake oil, AKA Ambrotose.

      Quackery is alive and well.

      by Hobbitfoot on Sun Jan 21, 2007 at 01:59:28 PM PDT

      •  oh that is just SICK!

        A "sugar pill", a.k.a a placebo!  Granted placebos are very useful in experimentation and have a measurable affect on how a patient feels (just a testament to the power of the mind) but it only makes you FEEL better, it doesn't CURE anything.

        That is just sick!

        Long, long ago I wrote a really ranty diary about my frustration with the "no prescription neccessary" pills that get advertised these days.  Claims to cure anything from erectile dysfunction, memory loss, weight loss, etc.  You don't need a prescription becuase they aren't drugs!  I looked up a few of them and they are vitamins and "herbal extracts" (whatever that means).  And it just pissed me off to no end!

        I used to make home-made soap as a hobby (I highly recommend it, great for the skin) and I learned from professional soap makers that they can't make any claims about their soap (like that it's moisturizing, good for acne, or whatnot) beyond "it cleans" without listing active ingredients recognized by the FDA for that purpose.  Now there are several essential oils, tea tree for example, that are really good for the skin, but soapmakers can't make any claims about a product with tea tree oil except that it contains tea tree oil.

        Yet I am bombarded with commercials that are intentially formated to look like prescription drug commercials that implicitly and explicitly make claims about their purpose or function without ever needing to list any active ingredients that do squat!

        What the heck is that all about?

        by DawnG on Sun Jan 21, 2007 at 02:28:57 PM PDT

        •  worse still . . .

          are dietary supplements which don't fall under FDA jurisdiction, and yet are outright harmful.

          My friend with breast cancer asked me about colostrum, which her sister had sent her. Now, excuse me, but colostrum is breast milk, and the only way to get it is from a recently-pregnant animal. Wouldn't it be laden with hormones? And aren't we trying to limit intake of estrogen / endogenous production of estrogen in breast cancer patients?

          I'm not sure if it's safe or not, colostrum, but I told my friend to play it safe and avoid the stuff.

          by Hobbitfoot on Sun Jan 21, 2007 at 04:35:52 PM PDT

•  while i don't believe

  there is really such a thing as false hope (hope being an act of faith), false expectations are a dangerous thing and lead to all sorts of turning to hucksterism, from laetrile (hat tip to plutonium page) to psychic surgery.

  thank you so much for sharing your expertise.

  by jmonch on Sun Jan 21, 2007 at 12:34:57 PM PDT

  •  Okay, I'll allow that ;)

    Yes, false expectations is the name of the game. But I think that for many of my patients, expectations and hopes are awfully close to one and the same thing.

    You're welcome.

    by Hobbitfoot on Sun Jan 21, 2007 at 12:40:54 PM PDT

•  I also have a PhD and you are wrong

  about one thing.
  It's not "yatta yatta", it's "yadda yadda" or "yada yada".
  I agree with you about everything else, and many thanks for sharing your expertise.
  (my PhD is in Pharmaceutical Chemistry, but I am a fierce critic of the Pharmaceutical Industry)

  by ChemGeek on Sun Jan 21, 2007 at 12:45:59 PM PDT

  •  I stand corrected :)

    I'm Jewish, btw, and I remember my grandfather saying it differently: yatata yatata yatata.

    Wikipedia was no help whatsoever in settling this question.

    by Hobbitfoot on Sun Jan 21, 2007 at 12:52:46 PM PDT

    •  I'm Jewish but

      my family is mostly Jewish-Italian, which doesn't help much with the yiddishkeit (helps a lot with the cooking, though).
      If you google "yada yada", you might come across a Wikipedia entry on the Seinfeld "Yada Yada episode".

      Not that the gravity of this topic is on a par with Cancer or MS...

      by ChemGeek on Sun Jan 21, 2007 at 12:57:56 PM PDT

•  What we're up against

  On the one hand, we have Big Pharma, which at least wants to make us better.

  On the other hand, there are no shortage of sites like this one on the web, suggesting that cures abound and are being suppressed. Click on the link, read the list. It's a who's who of lunacy, from urine therapy to "blood electrification."

  Our system works surprisingly well, except when it comes to rare illnesses and orphan drugs. We could always use better peer review, but that's a doable fix. And we could certainly do with more public funding of human trials.

  by Hobbitfoot on Sun Jan 21, 2007 at 12:46:38 PM PDT

  •  Thanks and a comment

    I am aware of a trend in cancers among farmers and ranchers in the upper Midwest.  I'm speaking of ND, SD, MN, IA, NE.  All of these are traceable to the use of pesticides or herbicides.

    I've oft wondered why we don't hear about things like this - it seems to be a well-guarded secret.  We talk about bad Pharma, but bad chem companies seem to be worse.

    by kfred on Sun Jan 21, 2007 at 12:55:36 PM PDT

    •  I haven't looked into it, but

      if you start looking at breast cancer support sites, you'll learn that a lot of those folks think there's a breast cancer epidemic, too, possibly related to chemical companies.

      Well, that's what epidemiologists are for. I hope someone's working on these questions.

      by Hobbitfoot on Sun Jan 21, 2007 at 01:02:27 PM PDT

    •  As a former agrichem research chemist

      let me say that I am NOT surprised. We were not the famer's friend.

      by Kurlan Naiskos on Sun Jan 21, 2007 at 01:15:28 PM PDT

      •  I hope you'll tell us more some day

        . . . sounds very interesting!

        by Hobbitfoot on Sun Jan 21, 2007 at 01:27:30 PM PDT

  •  I thought that I had heard/read that federal

    funding for cancer research has decreased this year. Is that the case. I really learned a lot from your post, and it is clear that more human trials are needed to determine whether this drug, and others, are really effective in humans. Now if we weren't buring money in Iraq, manbe we could be improving lives here.

    by blue jersey mom on Sun Jan 21, 2007 at 12:57:02 PM PDT

    •  yes, yes, YES

      and if I remember correctly, Bush had the nerve to take credit for the drop in cancer deaths, even though he and the Repugs CUT funding for cancer research. The  nerve!

      Second time today: grrr.

      by Hobbitfoot on Sun Jan 21, 2007 at 01:03:35 PM PDT

      •  A disgrace

        Last year, the budget for the National Cancer Institute declined for the first time in 35 years. Lance Armstrong has been speaking out quite forcefully about this, as a cancer survivor who attributes his recovery from testicular cancer in part to cancer research funded by the federal government.

        The larger shame is that this comes as part of a hostility for funding of science in general, as the budget for the National Science Foundation has also been held in check, despite Congress authorizing a doubling of its budget over the course of 10 years. Chalk this up to another pathetic chapter in the saga of the "unitary executive".

        Research programs in Asian countries are starting to look much more attractive in comparison. It may not be much longer before we could be talking about a brain drain away from the US.

        by ChemGeek on Sun Jan 21, 2007 at 01:38:50 PM PDT

        •  Because intelligence is suspect, dontcha know

          There's a viral vid making the rounds on the 'net of a UK comedian interviewing Americans. He asks, "Name a country that starts with the letter U."

          People answer: "Utah? Yugoslavia? Utopia?"

          When he finally says, "How about the United States," they say, "oooooh!"

          And it gets worse. Much worse.

          In my geeky family, "Uruguay" was the first thing we thought of.

          by Hobbitfoot on Sun Jan 21, 2007 at 01:49:42 PM PDT

    •  Generally, ALL science funding is down

      due to Republican malfeasance. There are some real ethical questions about human trials. We can all agree that they need to be done, but in many trials the patient may die from the treatment, or was assigned the placebo and dies. MDs do not want to hasten death.

      If you watch television (what a strange word, BTW) you have probably seen ads for clinical trials looking for participants. My guess is that that draws into the false hope domain, I think that many people who buy into a clinical trial have a very deep-seated hope that their trial will be of the miracle drug. And they will be in the test group, not the control group. My MIL was in a large trial for an anti-rejection drug (rapamycin) for kidney transplant patients. She was in the treated group, and did well with her transplant. She is dead now: did rapamycin hasten muscle wasting, non-healing wounds and dementia? That retrospective trial is probably ongoing.

      by riverlover on Sun Jan 21, 2007 at 01:08:01 PM PDT

      •  In most clinical trials,

        the patient is randomized either to (A) the conventional treatment -- the standard one she would have gotten anyway, outside of the trial, or (B) the experimental treatment. 'No treatment' is usually not a wing of the study, unless of course we're talking about a disease for which there are no helpful treatments.

        But, yes, there have been some spectacular failures in clinical trials -- I'm specifically thinking about some of the gene therapy trials.

        by Hobbitfoot on Sun Jan 21, 2007 at 01:15:03 PM PDT

•  sadism

  is mainstream these days...

  1. Bringing freedom to Iraq

  2. Nancy 'sadism masquerading as empathy for crime victims' Grace

  3. Free trade and privatization

  4. The heathcare and insurance 'industries' in the US..(no insurance, die mfer or spend the rest of your natural life on skid row and plan on being laid to rest in bakers field after cremation)

  5. Depleted uranium

  6. 6 years of constant fear mongering by politicians and MSM is systemic sadism

  7. Watching the current breed of television programming or commercials.  'News' filled with junk, commercials getting even worse than they always have been.

  8. The WH wanting to nuke Iran but its okay to send vast amounts of US manufacturing capability to China (the petri dish of free trade thriving like cancer on a pancreas in a communist country?) and India who do have nukes.  Anyone else see something wrong with that besides me?

  False hope?  I hope my trust in the democrats isn't false hope also.  So far...they're okay but a megalomaniac is still running the country.

  by FreeTradeIsYourEpitaph on Sun Jan 21, 2007 at 12:53:58 PM PDT

•  Question about Chemo

  In any given tumor, you have a population of cells with genetic  variability within the population. Think of it as evolution on a small  scale. When you radiate or give chemo to the patient, you're applying  selective pressure to that population. Many die, but the ones who resist  are left behind to continue their cell division. Only now you have a new  population, don't you? Newer, tougher.

  What is the benefit of Chemo or Radiation? Does it always have this small  scale "evolution" outcome?  Thank you for your diary.

  by CalifSherry on Sun Jan 21, 2007 at 12:54:59 PM PDT

  •  I'm most familiar with breast cancer

    as I have a dear friend with it, and I've been doing a lot of online research, talking to medical oncologists and radiation oncologists, etc.

    Here's the answer to your question, specifically with breast cancer in mind.

    1. Radiation therapy greatly reduces the risk of local recurrence. It does nothing to drop the chance of distant spread (metastasis).

    2. Chemotherapy reduces the risk of distant spread. Depending on the stage of the breast cancer, the effect can appear quite small if you compare 10-year survival numbers. BUT, if you compare 10-year disease-free survival numbers, the effect is magnified.

    Now, circa 2007, we have no cure for metastatic breast cancer. We can help those patients live longer, but my understanding is none of them survive in the long run. (Yeah, I know, none of us survive in the long run.) But the point is, you really, really want to improve your 10-year disease-free survival numbers. What I told my friend: "Not only do you want to be alive in ten years, you want to be alive without cancer." Because, gee whiz, we'd kind of prefer it if she were alive 15 years from now, too.

    3. Not that you asked, but for the sake of completeness: hormonal treatment (e.g. tamoxifen) also reduces the risk of recurrence. IIRC, it reduces the risk of metastasis -- I'm not sure if it reduces the risk of local recurrence. But the effect is quite large: it cuts recurrence numbers in half.

    As to your second question, the answer would have to be no. We know from the statistics that for any given cancer, some folks really are 'saved' by the chemo. Leukemia and lymphoma would be the best examples, I suspect. So in some instances, there are no surviving cells left behind.

    by Hobbitfoot on Sun Jan 21, 2007 at 01:11:04 PM PDT

    •  Very helpful, thank you

      A dear friend's (too) young son is being treated for a cancer. She's a breast cancer survivor - well past the 10 yr mark - and I'm very grateful she's in my life. At any rate, she knows way more about this than I do. I'm trying to be a supportive and at least marginally informed friend. I've subscribed and will look for your diaries.

      by CalifSherry on Sun Jan 21, 2007 at 01:20:04 PM PDT

      •  thanks, Sherry

        I don't write diaries often. I do have a nice collection of medicine-related posts at my blog, collected under the category The Barbarous Craft. But it's a mixture of humor (some of it raunchy) and serious stuff. You've been warned :0)

        by Hobbitfoot on Sun Jan 21, 2007 at 01:26:56 PM PDT

        •  Bookmarked

          Thank you! for the humor, too. Laughter is a good thing.

          by CalifSherry on Sun Jan 21, 2007 at 01:44:38 PM PDT

          •  oh, I don't know . . .

            some of my humor is pretty crude. Hope you're not easily offended. On occasion, I'll go back and think, "Did I write that? No, really?"

            See ya.

            by Hobbitfoot on Sun Jan 21, 2007 at 01:50:52 PM PDT

            •  Not so easily

              and I know how to avert my eyes.

              by CalifSherry on Sun Jan 21, 2007 at 04:36:04 PM PDT

•  Life's Tough Realities

  Information from an educated perspective is what everyone needs, whether one is just an interested reader, or a cancer sufferer.

  Many of us are proud to call ourselves members of the reality-based community -- myself included.  Sometimes it's a hard row to hoe.

  Your diary, like neoperiapt's Habeas:  Gonzales NOT Wrong, may offer painful-to-swallow assessments, but nevertheless, they speak truth.  Thank you for it.

  by Limelite on Sun Jan 21, 2007 at 01:09:58 PM PDT

  •  So you weren't persuaded by Big Tent Democrat? nt

    by Wee Mama on Sun Jan 21, 2007 at 02:09:05 PM PDT

    •  I wasn't persuaded, either.

      Neoperiapt's argument had the ring of truth to it. I'm no lawyer, though!

      by Hobbitfoot on Sun Jan 21, 2007 at 04:32:33 PM PDT

•  Fatal flaw with the blogs and media

  The man-bites-dog stories will end up on the rec list while the truth is too dull to get more than 36 comments, 90% of whom were probably already outraged by the stupidity of the DCA post this week.

  Thanks for posting this though.  If only expertise meant something on the net.

  by lordkelvin on Sun Jan 21, 2007 at 01:35:52 PM PDT

•  yeah, I'm a bit disappointed

  I would have liked a bigger audience, of course, but this ain't half bad.

  I'm still sizzling over Randula's annoying force poll.

  by Hobbitfoot on Sun Jan 21, 2007 at 01:40:22 PM PDT

  •  quality over quantity. :) (n/t)

    by DawnG on Sun Jan 21, 2007 at 01:56:56 PM PDT

  •  You might have a lot of lurkers.

    Anyway, it's a good diary and interesting in that you stuck around to chat. Informative and well written too. Good luck to your wife.

    by northsylvania on Sun Jan 21, 2007 at 02:15:55 PM PDT

    •  thank you! n/t

      by Hobbitfoot on Sun Jan 21, 2007 at 04:31:34 PM PDT

•  Absolutely :)

  I didn't mean to disparage the great discussion we've had here! Thanks, everyone.

  by Hobbitfoot on Sun Jan 21, 2007 at 02:00:37 PM PDT

  •  one of these days I'll get the hang of replying

    to the post, rather than writing a whole new comment. Doh!

    by Hobbitfoot on Sun Jan 21, 2007 at 02:01:38 PM PDT

•  Please recommend this diary, folks -

  I was wondering in DCA would be a general acetylating agent. Any thoughts on that and whether that would be a bad thing?

  by Wee Mama on Sun Jan 21, 2007 at 02:10:24 PM PDT

  •  I'll defer to chem geek, if he's still around,

    but I'll give a big "maybe" to that. If I remember my organic chem, dichloracetate should be much more 'active' at acetylation than, say, acetic acid. Interesting point.

    by Hobbitfoot on Sun Jan 21, 2007 at 04:28:25 PM PDT

•  this is a good diary

  and really needed to be written.

  I'm sure glad I didn't have to do it though... thanks for swatting this one down.

  on a number of topics, I see the left's well-earned suspicion of corporations spilling over into total blind animosity -- which is a huge weakness.

  If you have the patience for it, the next thing to do is to seek out blogs repeating the DCA mis-reporting and use the comments to link back to this correction piece.  This kind of diary (while it doesn't usually get a ton of comments or recommends) is a good example of a "reference piece" that serves as the first step in debunking these kinds of legends.  (You might also consider a second post that's more link-heavy and explains what the real results are that were recently reported, what they are likely to mean, and how DCA works in more detail.) It gives those of us who feel the need to defend science something to link back to rather than explaining the whole story again, every time.

  thanks for this.

  by emptypockets on Sun Jan 21, 2007 at 02:30:00 PM PDT

  •  thanks for the recommendations

    I'm curious about DCA now, so I think I'll try to dig up more information.

    I've left a link at the original Rangula post, but I'll take your advice on the other posts, too.

    by Hobbitfoot on Sun Jan 21, 2007 at 04:30:08 PM PDT

    •  basic strategy

      Hobbitfoot, I don't know if you've been following this other story at all but I've been doing quite a bit of work on another debunking that (for whatever reason) really gnawed at me.  This is the "gay sheep" story, some lies from PETA that attack an Oregon researcher studying the biological basis of sexual behavior.  If you haven't seen them already you may be interested in the most recent post and the end of this one and the end of this one.

      The second two lay out 1-2-3 schemes for debunking, the first one is a summary of how well it has & hasn't worked.

      Short version, as applied to you, would be:

      1. write a thorough, heavily referenced debunking post (this one is good, more links and details specific to DCA would improve it)

      2. use blogsearch.google.com to search for DCA

      3. visit those blogs and post comments linking back to your debunking post.  comments should stick to the facts, and give some sense of why it's important (something like "you're right that there was a recent exciting study on DCA but the story has been overhyped -- I've got the real story here.  Spreading the hype like this also spreads false hope to cancer patients, which can be frustrating and devastating, and do much more harm than good.")  I try to customize the message slightly for each site, but stick to one or two basic talking points.  In this case, be ready to be accused of being a Big Pharma shill and perhaps offer some credentials at the outset to show you don't have a dog in this fight other than the truth.

      4. one key here is to venture even into areas of the blogosphere where you might not normally go, including LiveJournal and even MySpace.  There's an explanation why at the third of the links I give above, but basically these sites make up a highly interlinked, semi-independent web where information spreads very quickly (it also generates a lot of links, and elevates the google ranking of your piece).

      I'm glad to help if I can, and can always help shine light on this story through The Next Hurrah.  One of our readers just offered to set up a database of some kind for debunking science mis-reporting (I'm not sure what he has in mind).

      This story is a little different because it's not overtly political -- just sensationalized.  But there is a political component (unfortunately, it's another case of the left abusing science) as it erodes the public trust in pharmaceutical companies (which is already stretched thin, with good reason) and makes people more susceptible to the "nutraceutical" supplement industry, which of course is often snake oil.

      by emptypockets on Sun Jan 21, 2007 at 06:36:28 PM PDT

      •  thanks again for all your advice

        I'm at work now, but I'll get busy on this tonight.

        Interestingly, even some of the earlier DCA diaries here on Kos had good info -- buried way down in the comments. I'm not the first one to voice skepticism.

        Speaking of which, the Skeptic's Dictionary (skepdic.com, IIRC) is a fine resource, as is Snopes, but I think Skeptic's tends to be more scholarly.

        by Hobbitfoot on Mon Jan 22, 2007 at 12:51:00 PM PDT

•  But haven't you heard? Within the hour, ...

  ... there's news that a widely used, small(ish) molecule cures muscular dystrophy in mice!

  My theory is that an emerging race of supermice has been pursuing their own genetic engineering programme behind our backs, in our own labs, and will eventually manipulate us into ingesting the small molecule that turns the tables by enlarging mice and shrinking humans.

  by RonK Seattle on Sun Jan 21, 2007 at 04:14:57 PM PDT

  •  shades of Hitchhiker's Guide :) n/t

    by Hobbitfoot on Sun Jan 21, 2007 at 04:31:04 PM PDT

•  Thanks for the diary.

  On medical quackery, I tend to follow the guidelines of Dr. Andrew Weil, who points out that Western medical treatments really are the best option in many instances. If you get critically injured in a car accident, after all, are you going to screw around with accupuncture, or are you going to head to the ER? The same may well be true with some emotionally difficult diagnoses, like cancer. The Western medical treatments are PROVEN to meet a certain standard of effectiveness; use the homeopathy for palliation, if it helps, but please don't shun chemotherapy, falling for claims that homeopathy will "cure" you.

  But Weil points out, wisely, that Western medicine doesn't do very well, at all, with certain conditions. Autoimmunity is one example. I myself was diagnosed with multiple sclerosis in 2000. (The reason I can't get health insurance.) At that time, the only FDA-approved treatments for the disease were generally quite unpopular with patients, because of cost, inconvenience, low rates of effectiveness, and side effects. I don't think this picture has changed much (although I understand the Lipitor treatment is now into human trials, and holds promise).

  Anyway, if you have a condition that lacks a Western treatment that is clearly worthwhile, what do you do? I don't believe in abandoning hope. Many people in just exactly my boat are experimenting with lifestyle variables like diet, stress management, and emotional release, to combat autoimmune conditions, although these remedies aren't "proven," and may never really be.

  by karmsy on Sun Jan 21, 2007 at 08:26:51 PM PDT

  •  lipitor for MS?

    Hey, that's news to me. I'm going to go to PubMed to see what I can find. My wife needs to be on a statin anyway!

    Thanks for the comments, karmsy.

    by Hobbitfoot on Mon Jan 22, 2007 at 12:52:53 PM PDT

    •  Can't remember where I heard this,

      but I do think it was in a popular publication somewhere.

      Being a physician, you could probably make a better determination than I, about just "how exciting" this information about Lipitor is, given the kinds of studies that have been performed, how they've been funded, etc.:-)

      by karmsy on Mon Jan 22, 2007 at 04:37:23 PM PDT

      •  yup, i'm in the process of checking this out

        I asked a neurologist friend about this and he pointed me towards Scott Zamvil at UCSF.

        Doesn't look like the human data is in yet, but (like soooo many MS treatments) the drug looks promising in mice with EAE, the animal model for MS.

        by Hobbitfoot on Mon Jan 22, 2007 at 08:31:58 PM PDT

        •  I'm quite sure

          I read somewhere that human trials had been performed on MS patients given Lipitor, with very good success, taken in combination with Copaxone, or one of the other "official" treatments for MS. Lipitor, apparently, enhances the effectiveness of Copaxone.

          They were going to progress to giving Lipitor, alone, to MS patients.

          by karmsy on Tue Jan 23, 2007 at 07:33:06 AM PDT

•  You can get human trial updates from U Alberta

  Here's the link.

  Here's the meat from that site:

  At this point, the University of Alberta, the Alberta Cancer Board and Capital Health do not condone or advise the use of dichloroacetate (DCA) in human beings for the treatment of cancer since no human beings have gone through clinical trials using DCA to treat cancer. However, the University of Alberta and the Alberta Cancer Board are committed to performing clinical trials in the immediate future in consultation with regulatory agencies such as Health Canada. We believe that because DCA has been used on human beings in Phase 1 and Phase 2 trials of metabolic diseases, the cancer clinical trials timeline for our research will be much shorter than usual.

  Dr. Michelakis is soliciting donations.

  by Hobbitfoot on Mon Jan 22, 2007 at 08:35:05 PM PDT

  •  Yes, it needs research.

    But you seem to be dismissing it right out of the gate.  WHY???

    by alkatt on Mon Jan 29, 2007 at 09:28:04 PM PDT

•  I think your arguments are wonky

  "Don't give false hope!  It's really complicated!  They've only tested it in mice!  There's no point in researching DCA's any further because CANCER IS REEEEALLY COMPLICATED!"

  Yes, embrace the approach of death.  What was I thinking?

  Yes, Big Pharma could make it profitable.  Big Oil could make alternative fuels profitable too.  It takes a little research, that's all.  The debate should be about whether there's a possibility, not whether we're incorrectly maligning Big Pharma.  And it seems this story has no traction anyway, so your goal is achieved.

  by alkatt on Mon Jan 29, 2007 at 09:26:24 PM PDT