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Niche Science And Targeted Medicines Vs. “Magic Bullets”

Maybe you read the other day in The New York Times that the pharmaceutical industry has a problem. Big blockbuster drugs like Lipitor are going off patent and the industry leaders don’t have new blockbusters showing promise to replace them. So the big companies search for little companies with new discoveries and they consider buying them. Industry observers think the days of $5 billion-a-year drugs to lower cholesterol or control diabetes may be past for awhile, and the companies will have smaller hits with new compounds for autoimmune conditions and cancer.

When I saw my oncologist for a checkup yesterday — the news was good — we chatted about the article and the trend toward “niche science.” We welcomed it. We didn’t think — from our perspective — the world needed yet another drug to lower cholesterol. We need unique products to fight illnesses that remain daunting, some where there are no effective drugs at all. For example, my daughter has suffered for years from what seems to be an autoimmune condition called eosinophilic gastroenteritis (EGID). Her stomach gets inflamed with her own eosinophil cells. They would normally be marshaled to fight a parasite in her GI tract but in this case, there’s nothing to attack. So the cells make trouble on the lining of the stomach and cause pain and scarring. Right now, there’s no “magic bullet” to turn off these cells. My hope is some pharma scientists will come up with something to fill this unmet need.

In the waiting room before I saw my doctor at the cancer center in Seattle I overheard a woman on the phone speaking about her husband’s new diagnosis of pancreatic cancer. I was sitting at a patient education computer station nearby. When she was finished I introduced myself and showed her some webpages to give her education and hope: pancan.org and our Patient Power programs about the disease. She was grateful. I did tell her — and she already knew — that there was no miracle drug for pancreatic cancer and that it was a usually-fatal condition. But that there were exceptions and, hopefully, her husband would be one. Of course, wouldn’t an effective medicine be best? Read more »

*This blog post was originally published at Andrew's Blog*

Cancer And Science-Based Medicine: Skepticism Vs. Nihilism

Last Friday, Mark Crislip posted an excellent deconstruction of a very disappointing article that appeared in the most recent issue of Skeptical Inquirer (SI), the flagship publication of the Committee for Skeptical Inquiry (CSI). I say “disappointing,” because I was disappointed to see SI publish such a biased, poorly thought out article, apparently for the sake of controversy. I’m a subscriber myself, and in general enjoy reading the magazine, although of late I must admit that I don’t always read each issue cover to cover the way I used to do. Between work, grant writing, blogging, and other activities, my outside reading, even of publications I like, has declined. Perhaps SI will soon find itself off my reading list.

Be that as it may, I couldn’t miss the article that so irritated Mark, because it irritated me as well. There it was, emblazoned prominently on the cover of the March/April 2011 issue: “Seven Deadly Medical Hypotheses.” I flipped through the issue to the article to find out that this little gem was written by someone named Michael Spector, M.D. A tinge of familiarity going through my brain, I tried to think where I had heard that name before.

And then I remembered.

Dr. Spector, it turns out, first got on my nerves about a year ago, when he wrote an article for the January/February 2010 issue of SI entitled “The War on Cancer: A Progress Report for Skeptics.” I remember at that time being irritated by the article and wanting to pen a discussion of the points in that article but don’t recall why I never did. It was probably a combination of the fact that SI doesn’t publish its articles online until some months have passed and perhaps my laziness about having to manually transcribe with my own little typing fingers any passages of text that I wanted to cite. By the time the article was available online, I forgot about it and never came back to it — until now. I should therefore, right here, right now, publicly thank Mark (and, of course, Dr. Spector) for providing me the opportunity to revisit that article in the context of piling on, so to speak, Dr. Spector’s most recent article. After all, Deadly Hypothesis Seven (as Dr. Spector so cheesily put it) is:

From a cancer patient population and public health perspective, cancer chemotherapy (chemo) has been a major medical advance.

Dr. Spector then takes this opportunity to cite copiously from his 2010 article, sprinkling “(Spector, 2010)” throughout the text like powdered sugar on a cupcake. There’s the opening I needed to justify revisiting an article that’s more than a year old! And what fantastic timing, too, hot on the heals of my post from a couple of weeks ago entitled “Why Haven’t We Cured Cancer Yet?Read more »

*This blog post was originally published at Science-Based Medicine*

Why Science Should Override Celebrity

Dr. Barron Lerner has written a book about breast cancer: “The Breast Cancer Wars: Hope, Fear, and the Pursuit of a Cure in Twentieth-Century America.” And he’s written a book about celebrity patients: “When Illness Goes Public: Celebrity Patients and How We Look at Medicine.” He wed the two topics in a blog post on the New York Times health blog entitled “Suzanne Somers, Cancer Expert.” Excerpts:

“Earlier this week, NBC’s “Dateline” devoted an entire hour on Sunday evening to allow the actress Suzanne Somers to express her rather unconventional beliefs about cancer.

It is not the first time a major media outlet has given air time to Ms. Somers, whose journey into the medical realm has been featured on a variety of news programs, talk shows and entertainment channels. A few years ago, Oprah Winfrey invited Ms. Somers on her show to share the secrets behind her youthful appearance — a complex regimen of unregulated hormone creams and some 60 vitamins and supplements.

But is it entirely outrageous that respected media organizations continue to give the “Three’s Company” sitcom star a platform to dispense medical advice? Not really, in a world in which celebrities have become among the most recognizable spokespeople — and sometimes experts — about various diseases.

…patients — especially those who want to explore every possible avenue — have the right to know that there are unorthodox cancer therapies that some people believe are helpful.

But not without several caveats, and that is where Ms. Somers, and many of those in the media who discuss her books and views, have failed. Ms. Somers says she is promoting hope, but false hope benefits no one.

Many people with end-stage cancer are, understandably, desperate, and thus potentially vulnerable to a sales pitch — even an expensive one. But here is a case when an informed patient may truly be a wiser patient. Perhaps if doctors were more willing to address the fact that these nontraditional treatments exist, and share what we do and don’t know about their effectiveness, an actress like Ms. Somers would have less influence, and science would override celebrity.”

There’s been quite an online response to Dr. Lerner’s blog post. One reader wrote, succinctly:

“From Thigh Master to Snake Oil.”

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*

Book Review: “Tabloid Medicine: How The Internet Is Being Used To Hijack Medical Science For Fear And Profit”

This was the Guest Blog at Scientific American on February 23rd, 2011. 

In his new book, “Tabloid Medicine: How The Internet Is Being Used to Hijack Medical Science for Fear and Profit,” Robert Goldberg, PhD, explains why the Internet is a double-edged sword when it comes to health information. On the one hand, the Web can empower people with quality medical information that can help them make informed decisions. On the other hand, the Web is an unfiltered breeding ground for urban legends, fear-mongering and snake oil salesmen.

Goldberg uses case studies to expose the sinister side of health misinformation. Perhaps the most compelling example of a medical “manufactroversy” (defined as a manufactured controversy that is motivated by profit or extreme ideology to intentionally create public confusion about an issue that is not in dispute) is the anti-vaccine movement. Thanks to the efforts of corrupt scientists, personal injury lawyers, self-proclaimed medical experts, and Hollywood starlets, a false link between vaccines and autism has been promoted on a global scale via the Internet. The resulting panic, legal feeding frenzy, money-making alternative medicine sales, and reduction in childhood vaccination rates (causing countless preventable deaths), are sickening and tragic.

As Goldberg continues to explore the hyperbole behind specific “health threats,” a fascinating pattern emerges. Behind the most powerful manufactroversies, lies a predictable formula: First, a new problem is generated by redefining terminology. For example, an autism “epidemic” suddenly exists when a wide range of childhood mental health diagnoses are all reclassified as part of an autism spectrum. The reclassification creates the appearance of a surge in autism cases, and that sets the stage for cause-seeking.

Second, “instant experts” immediately proclaim that they have special insight into the cause. They enjoy the authority and attention that their unique “expertise” brings them and begin to position themselves as a “little guy” crusader against injustice. They also are likely to spin conspiracy theories about government cover-ups or pharmaceutical malfeasance to make their case more appealing to the media. In many cases the experts have a financial incentive in promoting their point of view (they sell treatments or promote their books, for example).

Third, because mainstream media craves David and Goliath stories and always wants to be the first to break news, they often report the information without thorough fact-checking. This results in the phenomenon of “Tabloid Medicine.” Read more »

A Pseudo-Homeopathic Remedy

Never in a million years would I have dreamed I would be able to say this, but I actually recommended a homeopathic remedy today. To briefly review, for anyone who may be under the mistaken impression that homeopathic remedies actually do anything — they don’t. Here’s why in a nutshell:

Homeopathy is an unscientific and absurd pseudoscience, which persists today as an accepted form of complementary medicine, despite there never having been any reliable scientific evidence that it works.

So what on earth possessed me to seriously recommend it? I’ll tell you.

I saw a beautiful little four-month-old today whose mother thinks he might be teething. Everyone thinks their four-month-olds are teething because they start getting more drooly as their hand-mouth coordination improves, allowing them to get more things into their mouths. Most of the time they don’t actually get their teeth until about six months, though four month olds pop out teeth often enough to keep us on their toes. I told her this. She’s cool. Here’s her problem:

“The daycare is getting fussy. They want me to bring in the Oragel. I don’t really think he needs it, and I don’t like the idea of giving medicine when it’s not really necessary.”

Daycares can be fussier than babies sometimes. That’s when I realized that a homeopathic teething remedy is the perfect solution:

  • The baby is happy because someone’s rubbing his gums.
  • Mom is happy because the baby’s not getting any medicine.
  • Daycare is happy because they’re “doing something.”

Win-win-win.

*This blog post was originally published at Musings of a Dinosaur*

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