Clinical trials Complementary and alternative medicine Medicine Quackery

A particularly egregious misrepresentation of a study

i-e7a12c3d2598161273c9ed31d61fe694-ClassicInsolence.jpgWhile I am on vacation, I’m reprinting a number of “Classic Insolence” posts to keep the blog active while I’m gone. (It also has the salutory effect of allowing me to move some of my favorite posts from the old blog over to the new blog, and I’m guessing that quite a few of my readers have probably never seen many of these old posts, most of which are more than a year old.) These posts will be interspersed with occasional fresh material. This post originally appeared on January 24, 2006

I was made aware of a most interesting study today appearing in the journal Cancer, which is the official journal of the American Cancer Society. However, I wasn’t made aware of it through the journal itself, but rather through a very deceptive misrepresentation of the article. The title alone got my attention: ‘Miracle’ cures shown to work. It begins:

Doctors have found statistical evidence that alternative treatments such as special diets, herbal potions and faith healing can cure apparently terminal illness, but they remain unsure about the reasons.

How do I know that the study is being misrepresented? It’s mind-numbingly obvious from reading the the rest of the article that it is, that’s why:

A study of patients with incurable lung cancer who were given weeks to live and received only low-dose radiotherapy to make their final weeks more comfortable found a small number recovered completely.

Researchers who followed 2,337 patients whose disease was too advanced for curative treatment found that 25 had survived five years and 18 had achieved “an apparent cure”. They appeared to have been cured by treatment that “would not normally be considered to have any curative potential whatsoever”.

The researchers, led by Michael MacManus, a consultant radiation oncologist in Melbourne, say: “Our data indicate that a chance for prolonged survival and possibly even cure exists for approximately 1 per cent of patients with non small cell lung cancer who receive palliative radiotherapy.

“It is important that the frequency of this phenomenon should be appreciated so that claims of apparent cure by novel treatment strategies or even by unconventional medicine or ‘faith healing’ can be seen in an appropriate context.”

Unorthodox cancer cures have included vitamin C, laetrile extracted from apricot stones, and the Gershon diet of raw vegetables.

The discovery of a small group of patients who unexpectedly recovered could yield new insights into the disease, the researchers say.

Note that there was no mention in the actual study of the Gershon diet, laetrile, or any other alternative therapy “curing” anything. Instead, the study simply presented findings that a small number of “terminal” lung cancer patients (approximately 1%) were still alive five years after low dose radiation therapy given strictly for palliative purposes, even though the median survival for such patients is usually between 4 and 5 months. In fact, the study’s lead author even went out of his way to state that the results of this study should allow investigators to take the claims of alternative medicine practitioners of “miracle cancer cures” in proper context, given that a small number of patients survive considerably longer than expected. If you don’t believe me, look at the abstract itself, downloaded through my university (it’s an e-publication ahead of print):

Unexpected long-term survival after low-dose palliative radiotherapy for nonsmall cell lung cancer

Michael P. MacManus, M.D., Jane P. Matthews, Ph.D, Morikatsu Wada, Andrew Wirth, Valentina Worotniuk, David L. Ball, M.D.

Many experienced oncologists have encountered patients with proven nonsmall cell lung cancer (NSCLC) who received modest doses of palliative radiotherapy (RT) and who unexpectedly survived for > 5 years; some were apparently cured. We used a very large prospective database to estimate the frequency of this phenomenon and to look for correlative prognostic factors.

Patients with histologically or cytologically proven NSCLC, treated with palliative RT to a dose of 36 Gy, were identified from a prospective database containing details of 3035 new patients registered from 1984-1990.

An estimated 1.1% (95% confidence interval, 0.7-1.6%) of 2337 palliative RT patients survived for 5 or more years after commencement of RT, including 18 patients who survived progression-free for 5 years. Estimated median survival was 4.6 months. Five-year survivors had significantly better Eastern Cooperative Oncology Group performance status at presentation than non-5-year survivors (P = 0.024) and were less likely to have distant metastases (P = 0.020). RT dose did not appear to be a significant prognostic factor. Patients who survived 5 years without progression had an estimated 78% probability of remaining free from progression in the next 5 years.

Approximately 1% of patients with proven NSCLC survived for > 5 years after palliative RT, and many of these patients appeared to have been cured by a treatment usually considered to be without curative potential. Because of the potential for long-term survival, doses to late-reacting normal tissues should be kept within tolerance when prescribing palliative RT in NSCLC.

If you read the paper itself, you see that all the investigators did was to study patients with advanced “incurable” lung cancer treated for palliative purposes only, following them to see how long they survived. They followed 2,337 such patients, of which 2,297 completed enough of the course of radiation therapy to be counted in the final analysis, for five or more years and observed that there were 24 five year survivors, approximately 1.1%. Of these, 18 had no evidence of disease progression at five years. Of the known five year survivors, 32% survived another five years, or approximately 0.35% of the total (which means that the 24 five year survivors weren’t all apparent “cures”–as the news article called them–because more than half of them still went on to die of their disease). Survival was not correlated with radiation dose. The only characteristic that survival seemed to correlate with was performance status (a measure of general health and ability to handle activities of daily living) and having no distant metastases at the time of the commencement of treatment. The authors speculate that these patients may represent a very small subset of non-small cell lung cancer patients whose tumors are either highly responsive to radiation or not biologically aggressive. The money paragraph is this:

Our data indicate that a chance for prolonged survival and possibly even cure exists for approximately 1% of patients with NSCLC who receive palliative RT. This is a very small proportion, but lung cancer is a very common malignancy. It is important that the frequency of this phenomenon should be appreciated, so that claims of apparent cure by novel treatment strategies or even by unconventional medicine or faith healing can be seen in an appropriate context. All patients in this study had histologic or cytologic diagnoses of NSCLC in an appropriate clinical context. It is possible that errors could have been made in diagnosis in a proportion of cases, but it is very unlikely that all of the cases were misdiagnoses. In many of these patients, biopsy specimens were generous, including some surgical cases. It is well known that conventional cytologic or histopathologic tumor morphology is, by itself, a poor predictor of treatment response in NSCLC. The phenomenon reported here is potentially an important one, in that a subset of patients with NSCLC appears to have disease that is curable with minimal therapy and that prospective identification of such patients could potentially profoundly influence treatment.

There are two possibilities. One possibility is that the reporter just straight out lied about the findings of the study. However, an equally plausible explanation is that the reporter accurately reported the results of this very interesting study, and then his editor inserted text to represent the study as supporting “miracle cures,” either because of bias or just to “spice up” the story. Consider: The first sentence is jarringly inconsistent with the rest of the story. After all, the article even included the money quote about how this study demonstrates that there is a small, but real, subset of lung cancer patients who are “cured” by palliative low dose radiation therapy and how this observation should be taken into account when evaluating claims for lung cancer “cures,” either due to new conventional treatment or due to alternative therapy or faith healers. Given how common lung cancer is, there are probably a fair number of these patients out there, some of whom undoubtedly attribute their good fortune to some alternative medicine or other. (Also, given how rare these long term lung survivors are, there almost certainly aren’t as many such patients as there are breast cancer patients, whose testimonials I discussed long ago, but certainly enough for alties to point to.) Another obviously out of place sentence is this one: “Unorthodox cancer cures have included vitamin C, laetrile extracted from apricot stones, and the Gershon diet of raw vegetables.” Nowhere in the study or even the description of the study is any mention of alternative medicine other than the one I cited, and certainly nowhere in the article is an indication that any “miracle cures” from alternative medicine were observed or even possible. In fact, it should be emphasized that every single patient analyzed received conventional therapy; i.e., radiation therapy. Consequently, even if the use of alternative medicine had been identified as a factor associated with long term survival of these patients, that observation would not have shown that alternative medicine had any value on its own for “curing” lung cancer.

My guess is that the reporter probably interviewed Dr. MacManus and did a straightforward story about this study, and then the editor inserted the two sentences in question and gave the article its dubious title. The title is a lie, pure and simple, and the “spin” put on the article is such an obvious hack job that I stand in awe that the editor and/or the reporter could think its readers are so incredibly stupid that they won’t see the disconnect between what the study actually says and how it has been represented. Nonetheless, right here I make this not-so-bold prediction: It won’t be long before this news story describing this study makes appearances on altie websites, Usenet newsgroups (like, and perhaps even in other media sources, offered by alties as “proof” that alternative medicine can “cure” lung cancer.

Just watch.

And if you ever happen to see this study being misused that way, feel free to respond with a link to this blog posting.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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