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CHEMO'S "BERLIN WALL" CRUMBLESFrom The Cancer Chronicles #7 © Dec. 1990 by Ralph W. Moss, Ph.D.
This past year will certainly go down in history as the year of German surprises. The Berlin Wall came down. The two Germanys united. And now in Germany another wall is beginning to crumble: the myth of chemotherapy's invincibility. A Heidelberg cancer biostatistician, Dr. Ulrich Abel, has issued a groundbreaking monograph, "Chemotherapy of Advanced Epithelial Cancer" in which he puts the biggest hole yet in orthodoxy's solid front (SADLY, THE BOOK IS NOW OUT OF PRINT.) "Ten years of activity as a statistician in clinical oncology," he explains, led to his increasing uneasiness. "A sober and unprejudiced analysis of the literature," he discovered, "has rarely revealed any therapeutic success by the regimens in question" in treating advanced epithelial cancer. This is an astounding charge coming from a member of the cancer establishment. In Germany they earned Abel a big, largely favorable, article in Der Spiegel, the German equivalent of Time. Here, the powerful chemotherapy establishment has maintained discreet silence. By "epithelial" Abel means the most common forms of adenocarcinoma-- lung, breast, prostate, colon, etc. These account for at least 80 percent of cancer deaths in advanced industrial countries. More and more, toxic chemotherapy is being used against advanced cases of such diseases. More than a million people die worldwide of these forms of cancer every year and the majority of them now "receive some form of systemic cytotoxic therapy before death." In 92 tightly-reasoned pages, however, Abel shows that "there is no evidence for the vast majority of cancers that treatment with these drugs exerts any positive influence on survival or quality of life in patients with advanced disease." The "almost dogmatic belief in the efficacy of chemotherapy" is "usually based on false conclusions from inappropriate data." Abel also polled hundreds of cancer doctors while writing his paper. "The personal views of many oncologists," he reports, "seem to be in striking contrast to communications intended for the public." Indeed, studies cited by Abel have shown that many oncologists would not take chemotherapy themselves if they had cancer. The establishment ascribes the alleged historical increase in 5 - year survival rates over the last few decades to the beneficial effects of chemotherapy. But as Abel demonstrates this is erroneous thinking. "Equating cure with 5-year-survival is misleading," because it combines data for both local and disseminated cancers. And comparisons with historical controls are highly biased. "Modern methodologists agree that reliable information on the relative value of two therapies can only be obtained by means of randomized comparisons." It is astounding that such comparisons almost never take place for orthodox therapies. Some of the reasons five - year survival rates might be better today than years ago include:
In one astounding chart Abel summarizes all the available direct evidence from randomized studies as to whether chemotherapy extends survival. Small-cell lung cancer "is the only carcinoma for which good direct evidence of a survival improvement by chemotherapy exists." But this improvement amounted to a matter of three months! For non-small cell lung cancer there is also some "weak indications" of small benefit. For other kinds of chemotherapy, the news is far less promising:
Given these almost uniformly bad results, where did the idea originate that chemotherapy is of such benefit in these cancers? One reason is because toxic drugs often do effect a response. i.e., a partial or complete shrinkage of the tumor. But contrary to popular opinion, this "reduction of tumor mass does not prolong expected survival." Sometimes, in fact, the cancer returns more aggressively than before because killing off 99 percent of a mass fosters the growth of resistant cell lines. But doesn't chemotherapy at least improve the patient's quality of life (QL)? In the sense that it offers a dying patient some choice, it probably brings a modicum of psychological relief. (This is often based on the misconception that it will be curative, however.) If it palliates symptoms, as in head/neck cancer, that is a plus. But as Abel points out, "to date there have been no randomized studies yielding clear evidence for an improvement of QL by means of chemotherapy." In fact, most of these drugs are so toxic [see next article] that they can lead to a horrendous loss of QL in many patients pushed to what one oncologist calls "the vital frontier" (i.e., the brink of death). But what about that rare and lucky individual whose advanced carcinoma seems to be cured by drug treatment? A few people may indeed respond in this "miraculous" way. But one must measure this one person's gain against the total cost to all those recipients who do not benefit. It is the totality of risk vs. benefit that must be weighed, otherwise the argument takes on "the same structure as a recommendation for gambling" based on "the profit of the winners." In short, "oncology has been unable to provide a solid scientific foundation for cytotoxic therapy in its present form." Yet the "thesis of the efficacy of chemotherapy" has now assumed "the character of a dogma." In fact, in Germany as in the US, it has become "unethical" not to give these toxic treatments to a widening circle of patients. Thus, clinical oncology has become "a prisoner of its own tenets." There is more to this brilliant book than we can possible fit in a short review. Let us just say that in this annus mirabilis, Abel's book is one of the most remarkable wonders. Doctors sometimes brush off chemotherapy's side effects as a small price to pay for increased survival. But chemotherapy came out of World War II mustard gas experiments and it remains poison.
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