When reading this short article how would you answer these questions ? a. What p

Question

When reading this short article how would you answer these questions ?

a. What phenomena is described/being evaluated?

b. What is the pseudoscience being promoted (as described in the article)?

c. What is the scientific consensus on the phenomena as described in the article?

Abstract

Michael Gearin-Tosh was an English Professor at Oxford University who was diagnosed with multiple myeloma in 1994. He rejected conventional chemotherapeutic approaches and turned to a variety of alternative cancer treatments, particularly those involving nutritional supplements and dietary change. In 2002, Dr Gearin-Tosh published a book, “Living Proof”, recounting his experiences. The book gained significant public and media attention. One chapter was written by Carmen Wheatley, an advocate of alternative cancer treatments. In distinction to Dr Gearin-Tosh’s personal story, Dr Wheatley makes general claims about cancer treatment that are supposedly based on the research literature. This appears to provide scientific validation for a highly unconventional program of cancer care. However, the scientific case made for alternative cancer treatments in “Living Proof” does not bear serious examination. There are numerous inaccuracies, omissions and misrepresentations. Many important claims are either entirely unsubstantiated or not supported by the literature cited. In conclusion, a highly publicized book gives the impression that alternative cancer treatments are supported by scientific research. It also suggests that little progress has been made in the conventional treatment of myeloma. This is highly misleading and may lead to cancer patients rejecting effective treatments.

A critique of “Living Proof”

The recently published and widely publicized book “Living Proof”[1] recounts the personal experience of Michael Gearin-Tosh, an Oxford professor who was diagnosed with multiple myeloma in 1994. Dr Gearin-Tosh used a variety of alternative cancer treatments in place of conventional chemotherapy and remains alive, eight years after diagnosis. One of the chapters in the books was written by Carmen Wheatley, an alternative medicine advocate, who lays out the scientific case for the treatments used by Dr Gearin-Tosh. This chapter contains numerous inaccuracies, omissions and misrepresentations. Dr Wheatley was sent a series of questions about her chapter on several occasions over a six-month period, but stated that personal and professional pressures prevented a timely response.

In the following, the page numbers refer to the hardback edition.

1. On page 276, Dr Wheatley starts a paragraph by mentioning Gerson therapy and orthomolecular medicine, two unorthodox cancer treatments based on nutritional approaches. Reference is then made to scientific work (“thousands of publications in peer-reviewed journals”), reputable institutions (Harvard, National Institutes of Health) and “professional, scientific conferences” that “attest[] to the promise and integrity of this … field”. This is highly misleading. There is of course an enormous quantity of scientific work on the role of nutrition in cancer, but little has any connection to the tenets of Gerson or orthomolecular therapy. Studies of say, the epidemiology of cancer and dietary fat, or the nutritional needs of patients with advanced disease, have no bearing on whether high dose vitamins, or a high potassium, low sodium diet are effective cancer treatments.

2. In discussing the importance of nutrition and cancer, Dr Wheatley misleadingly blurs the important distinction between prevention and treatment of cancer. Reference is repeatedly made to research showing links between cancer and nutrition. Cancer initiation and cancer progression are distinct biologic events. Optimal nutrition probably decreases the chance of cancer-promoting mutation, but it is unclear how diet could destroy or control rapidly multiplying cells once a mutation has taken place.

3. On page 277, Dr Wheatley states that there is “published, peer-reviewed evidence which … showed statistically significant survival rates for Gerson versus chemotherapy in two cancers.” Two papers are cited. The first compares survival in patients undergoing Gerson therapy with historical data from large cohort studies, not with patients specifically undergoing chemotherapy[2]. Dr Wheatley omits to state that:

differences between groups were statistically significant for certain sub-groups only (stage III and IVa)

40% of the Gerson therapy patients were excluded from analysis

in response to detailed criticisms, the author accepted that a non-randomized study such as the one published did not provide strong evidence of a treatment effect[3].

The second paper cited by Dr Wheatley was published in a journal called “J Neuropath Med”. I was unable to locate this paper or find any information about the journal. Dr Wheatley did not accede to a request for a reprint.

4. On page 284–285, Dr Wheatley claims that Gerson therapy induces tumors to break down and that coffee enemas help the liver deal with toxic by-products of this process. She goes on to state that: “Gerson has been proved right”. In support, she cites a paper reporting increases in the activity of a liver enzyme important for detoxification in mice fed green coffee beans. Needless to say, these data do not support the concept of Gerson’s “tumor lysis syndrome”. Moreover, the data are grossly insufficient to “prove” that coffee enemas aid liver function in humans: oral consumption of green coffee beans is quite distinct from rectal administration of coffee; moreover, increases in liver enzyme function in mice do not necessarily translate to clinically relevant effects in humans.

5. On page 285 it is stated that “recent clinical trials have demonstrated that coffee enemas make a significant difference to late-stage pain control in cancer, reducing the need for opiates.” In support of this statement, a citation is given to a non-peer reviewed alternative medicine journal that rarely reports original research. Dr Wheatley was asked to provide a copy of the original paper, but did not do so.

6. On page 286, Dr Wheatley claims that an alternative cancer treatment known as Dr Josef Issels’ whole body therapy has a “16–17% cure rate for terminal cancer patients”. No evidence is cited to support this remarkable contention.

7. On page 286, Dr Wheatley states that most cases of “spontaneous” cancer regressions are related to nutrition. The paper cited in support was published in the “Int J Biosocial Res”. This journal does not appear to have remained in publication. I requested, but did not receive, a copy of this paper from Dr Wheatley.

8. On page 288, Dr Wheatley cites “the impressive work of Cameron and Pauling” in researching vitamin C and cancer. The scientific studies quoted compared survival at one hospital, where vitamin C was used, to survival at another where it was not. Obviously, there may be many differences between the hospitals and patients other than the use of vitamin C. A superior method is to randomly assign patients to receive vitamin C or placebo and compare their survival. This has been done in two large trials, and in neither case was any benefit seen for vitamin C.[4,5] Dr Wheatley does not even mention these important studies, resulting in a highly misleading impression of the data on vitamin C and cancer survival.

9. On page 290, Dr Wheatley claims that the anticancer mushroom Maitake has been “researched and demonstrated to the point where it is used a sole chemotherapy for stomach cancer in Japan”. This claim is not only unsubstantiated, it is highly dubious: Memorial Sloan-Kettering Cancer Center is currently undertaking clinical and laboratory research on Maitake and nowhere in our detailed reading of the literature nor in our contact with manufacturers have we found any indication that would support Dr Wheatley’s claim. Dr Wheatley did not respond to requests for appropriate documentation.

10. On page 299, Dr Wheatley states that “the contribution and connections between the mind, stress and cancer initiation and survival are now well-validated”. This is untrue. The links between stress and cancer are highly controversial and continue to be actively debated. There is excellent research, for example, showing that stress probably does not play an important direct role in cancer initiation[6,7] and that coping style does not affect survival[8].

11. On page 302, the claim that “diets that are low in calories have been demonstrated to slow cancer progression” is supported by an incomplete and inaccurate reference. The paper cited is concerned with carcinogenesis and reviews data that “caloric restriction without malnutrition lowers the incidence of most spontaneous and induced tumors” in animal models (emphasis added). This has little to do with the treatment of established cancer in humans.

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Conclusion

“Living Proof” was reviewed by many leading publications. It was serialized in the British Sunday Times. The British newspaper “The Observer” (September 15, 2002) gave Dr Wheatley several thousand words to promote her beliefs about the rigorous scientific basis of alternative cancer treatments, the ignorance of the medical profession and the persecution by medical authorities of doctors who use nutritional approaches to health. The article mentions that many patients are “turning down radiation and chemotherapy in favour of a vitamin-rich diet”. Dr Wheatley also restates a key claim of “Living Proof” which is that Dr Gearin-Tosh’s “chance of surviving eight years, without the chemotherapy he rejected, was 0.05 per cent.” It should be pointed out that the figure in the book (page 309) was 0.5%, and was based on statistical extrapolations from a median survival of 6 – 9 months in the pre-chemotherapy era. The validity of this estimate is dubious because the development of better diagnostic methods has led to myeloma patients being diagnosed earlier, and hence more recently diagnosed patients having apparently longer survival. Moreover, long-term extrapolation to small survival probabilities is statistically questionable. Yet even if Dr Wheatley's estimate were correct, it would not provide "Living Proof" of anything. Each year, about 16,000 people in the United States are diagnosed with multiple myeloma. The survival of 80 of these patients will be in the top 0.5%. Given that so many cancer patients use unconventional diets and other treatments, perhaps the only surprising thing about Dr Gearin-Tosh is that there are not more patients like him, writing books claiming that they are "Living Proof" of whatever approach they happen to have taken.

The main problem with Dr Wheatley’s claims of unusual survival time, however, is that they are essentially irrelevant: surely the key question concerns Dr Gearin-Tosh’s chance of survival had he used conventional approaches. Dr Wheatley consistently disparages conventional oncology, stating, for example, that “newer treatment approaches … have done little so far to change the outlook for long-term survival [in myeloma]” (page 269). One of the references given in support of this statement is a randomized comparison between conventional or high-dose chemotherapy with stem cell support.[9] Five year survival on the high-dose regime was 52%, compared to 12% in controls. This casts some doubt on Dr Wheatley’s assertion of scant progress. Moreover, a median survival of around five years would give an eight year survival probability close to 33%. A subsequent cohort study of 127 patients with multiple myeloma treated with high-dose therapy reports that 25% survived for 12 years[10] giving an approximate 40% eight-year survival probability. For another estimate, I consulted the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) Program, which collates cancer data on approximately 14% of the US population. SEER gives five-year survival for myeloma of around 30%, equivalent to 15% eight-year survival. This general population estimate is probably conservative as applied to Dr Gearin-Tosh because he was relatively young at diagnosis and had access to the very best care. Whichever of these figures are taken, Dr Gearin-Tosh’s survival cannot be seen as exceptional in comparison to conventionally treated patients. This is especially given that Dr Gearin-Tosh remained unwell throughout his course of alternative treatment, whereas many patients receiving chemotherapy experience periods of remission and good health. Dr Gearin-Tosh died in 2005, battling medical convention to the end: the cause of death was sepsis after he refused antibiotics for a tooth infection.

In conclusion, Dr Carmen Wheatley’s contribution to “Living Proof” gives a seriously misleading impression of both the scientific basis of alternative cancer medicine and the effectiveness of conventional approaches to myeloma. It is highly plausible that the book may influence some patients to reject conventional therapies of known effectiveness in favor of unproven or disproven alternatives.

Explanation / Answer

a. The article examines Dr. Carmen Wheatley’s book on alternative cancer treatments, ‘Living Proof’ in terms of how it gives misleading and incorrect information to its readers.

b. The Dr. Wheatley rejected conventional chemotherapeutic approaches and in turn, promoted a variety of alternative cancer treatments, particularly those involving nutritional supplements and dietary change.

c. The scientific consensus on alternative cancer therapy apprers to disregard its claims as false. All the supporting evidence provided by Dr. Wheatley in her book have been challenged and their methods are found to be unscientific.

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