September 17th, 2009 by David Kroll, Ph.D. in Better Health Network, Quackery Exposed
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The premier US cancer hospital and research center in Houston released a statement today distancing themselves from a Dallas company claiming an endorsement of their water product by The University of Texas M.D. Anderson Cancer Center:
Recently, you may have heard or read about a company that sells Evolv, a “nutraceutical beverage,” which is being promoted in part based upon testing done at The University of Texas M. D. Anderson Cancer Center, but also is being mistakenly viewed as endorsed by M. D. Anderson. M. D. Anderson conducted limited chemical analysis of the product to evaluate its anti-inflammatory activity for a fee at the request of the manufacturer. No efficacy or toxicity data were generated at M. D. Anderson nor was the product tested on humans. Moreover, M. D. Anderson does not have any involvement with the company, the product is not produced by M. D. Anderson, and M. D. Anderson does not endorse the product or recommend its use.
The current text on Evolv’s website an Evolv fan site is that:
Evolv’s nutraceutical beverage with Archaea Active is tested by M.D. Anderson Cancer Center in Houston, Texas.
The statement as listed is not exactly wrong; it’s just not complete. Nothing there about what the product was tested for, but the implication is that it gained some healing power by passing through the hallowed halls of M.D. Anderson. I also have no clue as to whether it was tested for archaea (formerly archaebacteria) or if it has the capacity to amplify DNA.
Of course, my blogging about this is going to give the company publicity (a very, very small amount). Evolv is not just water but it is sold by a multi-level marketing company. I already knew to put one hand on my wallet when I dialed up their website. The header has the quote from Mary Kay Ash, “Nothing happens until somebody sells something,” which rotates with others from her and Zig Ziglar who, no doubt, did not authorize their association with the company.
But water? The next multi-level marketing craze?
I don’t think this holds water.
Now if we could only get M.D. Anderson to address this other misuse of their name.
Note added 10 September 2009: This comment from EvolvHealth’s Chief Marketing Officer, Mr Jonathan Gilliam, brought to my attention that I had the incorrect website for the company (as corrected above). The actual website should be http://evolvhealth.com. Currently, their product page lists the M.D. Anderson claim as follows:
Our active ingredient has been tested by the MD Anderson Cancer Center of the University of Texas. Evolv will be released in Fall 2009
*This blog post was originally published at Terra Sigillata*
September 16th, 2009 by DrRob in Better Health Network, Health Policy
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I got something in my e-mail this morning. It’s a press release aimed at helping with prostate cancer awareness month, and is supported by Lance Armstrong’s foundation.
SURVEY SHOWS AT-RISK MEN LACKING IN PROSTATE CANCER KNOWLEDGE
SUNNYVALE, CALIF.,– September 9, 2009 – Prostate cancer remains one of the most commonly diagnosed cancers in the United States. In fact, one in six men will develop prostate cancer. It is also the second-leading cause of cancer death in the United States. But a recent survey suggests that many men at risk for the cancer still aren’t aware of all available treatment options. The survey, conducted late last year, reveals that nearly 50% of men aged 40 and older are not aware of the most common approach to surgery for prostate cancer — robotic-assisted surgery to remove the prostate. “I had to do my own research and then self-admit myself to the [hospital],” says surgery patient Tim Propheter. “…. Most people are just told … ‘Sorry, you have to have surgery, and we’ll set you up for such and such day,’ and they don’t know any better until they run into someone like me,” he says. This lack of information persists despite the fact that prostate cancer treatment has changed dramatically in the last decade. For example, surgery — which remains the gold standard treatment for localized prostate cancer — has become much less invasive. According to the American Urologic Association, the major benefit of prostatectomy, or prostate removal, is a potential “cancer cure” in patients with localized or early stage cancer.
Guess who the press release was from? Guess who sponsored the survey? The following was at the bottom of the email:
About the survey
Data was collected from 1000 self-selected adult healthcare information seekers through an online panel available through Ztelligence.com, using an survey questionnaire. Fifty-four percent of those were male and 46 percent were female. The results reflect only the opinions of the healthcare seekers who chose to participate.
About Intuitive Surgical, Inc.
The survey was conducted by Intuitive Surgical, Inc. (NASDAQ: ISRG), the manufacturer of the da Vinci Surgical System, the world’s only commercially available system designed to allow physicians to provide a minimally invasive option for complex surgeries. Intuitive Surgical, headquartered in Sunnyvale, California, is the global technology leader in robotic-assisted, minimally invasive surgery (MIS). Intuitive Surgical develops, manufactures and markets robotic technologies designed to improve clinical outcomes and help patients return more quickly to active and productive lives. The company’s mission is to extend the benefits of minimally invasive surgery to the broadest possible base of patients. Intuitive Surgical — Taking surgery beyond the limits of the human hand.™
Imagine that. A survey done by company that sells the da Vinci robotic surgical equipment shows that men have tragically no knowledge of the da Vinci robotic prostate surgery!
So let’s see what the evidence shows:
- Prostate cancer occurs in 186,000 men each year and kills nearly 29,000.
- In a well-known autopsy survey, over 1/3 of men over 80 were found to have cancer present in their prostate without evidence of significant disease. It is not clear how many of these men will progress to overt cancer, but it is very clear that this is the vast minority.
- PSA Testing (the blood test for prostate cancer screening) is by far the largest source of surgical candidates. It is a controversial test, having a high rate of false positives and an unproven record of significant benefit.
From the reference uptodate.com:
The European Randomized Study of Screening for Prostate Cancer (ERSPC) reported a small absolute survival benefit with PSA screening after nine years of follow-up; however, 48 additional patients would need aggressive treatment to prevent one prostate cancer death. Although the report did not address quality of life outcomes, considerable data show the potential harms from aggressive treatments. Further sustaining the uncertainty surrounding screening, a report from the large United States trial, the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, published concurrently with the European trial, found no benefit for annual PSA and digital rectal examination (DRE) screening after seven to ten years of follow-up. The crux of this screening dilemma was aptly stated by the urologist Willet Whitmore, who asked “is cure possible in those for whom it is necessary, and is cure necessary in those for whom it is possible?”
The most important line in this is at the end of the first sentence, stating that 48 patients would need aggressive treatment (including prostatectomy) to prevent one prostate cancer death. So how much does “aggressive treatment to prevent cancer death” cost?
From the Journal of Clinical Oncology:
For patients in the treatment-received analysis, the average costs were significantly different; $14,048 (95% confidence interval [CI], $13,765 to $14,330) for radiation therapy and $17,226 (95% CI, $16,891 to $17,560) for radical prostatectomy (P < .001). The average costs for patients in the intent-to-treat analysis were also significantly less for radiation therapy patients ($14,048; 95% CI, $13,765 to $14,330) than for those who underwent radical prostatectomy ($17,516; 95% CI, $17,195 to $17,837; P < .001).
note: it was very hard to find numbers here. This is actually from Medicare claims from 1992 and 1993, so it is a huge underestimate from today’s numbers.
Which means that based on the 1992 numbers, you would spend $672,000 to save one life using radiation therapy and $1,084,000 if you used surgery. This does not take into account the consequences of surgery for the men who underwent the surgery.
What about robotic surgery? In a comparison of the cost of open prostatectomy to robot-assisted surgery, the cost is even higher.
Cost was the one area in which the older open surgery was the clear winner: Open radical prostatectomy costs $487 less a case than non-robotic laparoscopy and $1,726 less than robot-assisted prostatectomy.
According to the review, “Shorter operative time and decreased hospital stays associated with the robotic procedure did not make up for the cost of the additional equipment expenditure.” Estimated costs of the robotic system to a provider run about $1.2 million a year, with maintenance costs of $120,000 a year and one-time costs of $1,500 a case.
To summarize:
- Prostate cancer screening is controversial, as it fails to differentiate between the minority of men who would die from the disease from the majority who would simply die with it.
- PSA Testing as greatly increased the number of men diagnosed with early stage cancers.
- Prostate cancer surgery or radiation therapy is recommended for men who have early stage cancers.
- Aggressive prostate cancer treatment has to be done 48 times to save one life.
- The most expensive treatment for prostate cancer is prostatectomy, or removal of the prostate.
- The robotic form of the surgery is a higher-cost procedure by a significant amount.
So, an expensive form of surgery that may not be appropriate is done on a group of men identified on a very unreliable test yielding a very small number of lives saved and a lot of men who then have to deal with the physical consequences of the surgery. Why in the world is this being promoted at all?
Money. Here’s the homepage of one of our local hospitals. They have aggressively marketed da Vinci surgery on television, billboards, and the radio.
Why do you think they would pay as much money as they do for this device? It’s good business? Not so fast. Dr. Paul Levy stated back in 2007 about this very procedure:
Here you have it folks — the problem facing every hospital, and especially every academic medical center. Do I spend over $1 million on a machine that has no proven incremental value for patients, so that our doctors can become adept at using it and stay up-to-date with the “state of the art”, so that I can then spend more money marketing it, and so that I can protect profitable market share against similar moves by my competitors?
No, hospitals are employing this just to keep pace. The real winner in this is Intuitive Surgical, Inc., who has been a darling of Wall Street, beating estimates in earnings with a Q2 net profit of $62.4 Million.
Why is the cost of healthcare going up while physician reimbursement goes down and hospitals go out of business?
It’s Intuitive.
God Bless America!
*This blog post was originally published at Musings of a Distractible Mind*
September 15th, 2009 by Medgadget in Better Health Network, News
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Researchers from the University of Sheffield, with collaboration of a team from the University of Edinburgh, are experimenting with a voice replacement technique for people who are about to lose their vocal cords. The group partnered with a woman that was going to have her vocal cords removed in a scheduled cancer surgery. Prior to the procedure, her voice was recorded on a computer and then used as a template to create a digitized voice that sounds very much like her. We are 100% for this new technology, as we can’t stand that terrible, scary, artificial voice converter that’s being used nowadays.
The voice was built using around seven minutes of speech from the client, which amounted to 100 sentences. This method is therefore much more practical than established `Voice Banking´ technologies which require two or three hours of recording to build a voice.
The client´s regenerated voice was developed by University of Sheffield Master´s student Zahoor Khan as part of his dissertation, with guidance from research student Sarah Creer, whose doctoral work uses the same technique to improve the voices of people with speech disorders. Their work forms part of the research done within the CAST (Clinical Application of Speech Technology) group, which is a multidisciplinary research group interested in applying speech technology in clinical areas such as assistive technology, speech and language therapy and electronic control systems.
Researchers have since assessed the quality of the recordings by getting listeners to judge the similarity of the simulated voice with the original and by asking Mrs Chapman and her family what they think of the voice. All listeners have thought the regenerated voice sounded very similar to the original.
Researchers in CAST hope to use these personalised synthetic voices in communication aids for people whose speech has become intelligible, speaking for them like a human interpreter.
Bernadette Chapman [the study subject] said: “For many years the Servox machine, or artificial larynx, has been the main means of communication for patients following laryngectomy or for those who have had severe speech impairment. The machine tends to sound very like a dalek and can be very embarrassing to use, especially in public places.”
Press release: Researchers rebuild a voice
Image: soundman1024
(hat tip: The Engineer Online)
*This blog post was originally published at Medgadget*
September 14th, 2009 by Dr. Val Jones in Announcements, Better Health Network, Expert Interviews, Health Policy, News, True Stories, Uncategorized
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Patrick Swayze, the popular actor perhaps known best for his role in the 1987 hit movie “Dirty Dancing,” died today of pancreatic cancer. My thoughts are with his family in this time of grief.
Pancreatic cancer is among the more deadly forms of cancer. I asked GI oncologist, Heinz-Josef Lenz, M.D., professor of medicine and professor of preventive medicine in the Division of Medical Oncology at the Keck School of Medicine at the University of Southern California, to explain why that’s so.
Dr. Val: Why is pancreatic cancer so much more deadly (i.e. less treatable) than many other forms of cancer?
Dr. Lenz: Unfortunately we don’t have very effective drugs for pancreatic cancer, which makes it one of the deadliest cancers of all. The median survival is about 8 months with metastatic disease. Even when the tumor is successfully removed there is a very high risk for tumor recurrence. We need more funding to better understand the risk for pancreatic cancer and identify and develop more effective therapies.
Dr. Val: Can you describe the typical course of metastatic pancreatic cancer?
Dr. Lenz: Unfortunately, the 5 year survival rate for pancreatic cancer is only 15 to 20%. The average survival after diagnosis is 12 to 19 months. The best predictor of long term survival is if the tumor is found and removed before it reaches 3 cm in size. Patients with metastatic pancreatic cancer are usually treated with a combination chemotherapy consisting of gemcitabine, tarceva, xeloda or oxaliplatin. However the response rates are (despite using aggressive combination therapies) low. Large clinical trials recently did not show any benefit from erbitux or avastin, again demonstrating that pancreatic cancer therapy is a difficult clinical challenge.
Dr. Val: Are certain populations at higher risk than others for pancreatic cancer?
Dr. Lenz: Age is the most important risk factor for this cancer. It is most common in individuals over age 50 and increases in frequency with age. Black men and women are slightly more likely to get pancreatic cancer (though the reasons for this are unclear), and men are slightly more likely than women to get the cancer. Other risk factors are smoking, diabetes, and obesity.
Dr. Val: If you suspect that someone is “high risk” for pancreatic cancer, what tests should he/she have?
Dr. Lenz: Patients with a genetic predisposition for breast cancer known as BRCA are also at higher risk for pancreatic cancer. There is also a familial form of pancreatic cancer. These high risk families are being followed up with specific screening plans. However there is not a reliable test for pancreatic cancer. Imaging with CT or MRI can miss pancreatic cancer and there is no reliable blood marker. The most common used is CA 19-9, which can be used for monitoring and diagnosis but is not elevated in all patients.
Dr. Val: What if the cancer is caught very early? Does that increase likelihood of survival?
Dr. Lenz: Absolutely. The best chance of survival is when the cancer is limited to the pancreas, and is surgically removed before it reaches a size of 3 centimeters. There are certainly people who have been cured this way, but unfortunately it’s very rare to catch the cancer at such an early stage since it usually has no symptoms until it’s quite advanced.
***
There is a wonderful advocacy group for those whose lives are touched by pancreatic cancer: PanCAN. One of PanCAN’s founders, Paula Kim, is a friend of mine and was inspired to create the organization after her dad was diagnosed with pancreatic cancer in 1999. At that time there was very little advocacy for this deadly disease. PanCAN helps people with pancreatic cancer find help and support.
September 8th, 2009 by Dr. Val Jones in Health Tips, True Stories
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Ed Walker is 102 years old. I met him by chance on a steep hill in Lunenburg, Nova Scotia – not long after my husband blurted, “I hope you’ve got good brakes on that scooter!” Ed pulled up next to us (to demonstrate his brakes) and jubilantly announced his age, along with his suspected reason for it: “I have prostate cancer but chose to leave it alone.”
I chuckled to myself, thinking that he was probably right about his longevity-hospital avoidance connection.
Of course, the diagnosis and treatment of prostate cancer is being hotly debated these days. While no one likes the idea of leaving cancer untreated, slow-growing prostate cancer may be less of a threat to men at a certain age than the treatment required to cure it. And that’s a difficult truth to accept – especially for Americans.
My fellow blog contributors have noted the disconnect between scientific evidence and clinical practice in regards to prostate cancer. According to a recent study in the New England Journal of Medicine, PSA (a screening test for prostate cancer) testing has not made a difference in overall longevity. Urologists still favor testing (the American Urological Association guidelines recommend initiating PSA testing for all men starting at age 40) while family medicine physicians don’t usually recommend it. Is there a conflict of interest driving this difference in recommendation? Perhaps – though I suspect it has more to do with a surgical mentality (to cut is to cure!) than a conscious decision to protect one’s income. If you think there’s a shortage of urologic procedures to go around, then I’d recommend you simply consider the increasing age of the US population. It’s not as if the prostate gland is the only thing that needs work “down there.”
Perhaps Americans can take some cues from their elderly neighbors to the north – and try to accept that doing something is not always better than “doing nothing.” In the case of some prostate cancers, it’s cheaper, safer, and a lot less painful.
Just ask Ed Walker.
The premier US cancer hospital and research center in Houston released a statement today distancing themselves from a Dallas company claiming an endorsement of their water product by The University of Texas M.D. Anderson Cancer Center:
