I have written before about the uselessness of screening for prostate cancer in the past, which brought on the vitriole of some of my fellow MD bloggers, some of whom had vested financial interests in the perpetuation of this looney practice. But now we have none other than the inventor of the Prostate Surface Antigen (PSA) test, Richard Ablin, coming out to say today in an editorial that it is not only useless, but a public health disaster. He points out that 16% of men will be diagnosed with prostate cancer, but only 3% will die of it. The PSA is used to drive men with mildly elevated values into the medical machine that will leave them with medical bills, possible impotence and urinary problems. In spite of this, PSA testing was not shown to save lives in a US study I wrote about last year here.

In the editorial he writes:

I never dreamed that my discovery four decades ago would lead to such a profit-driven public health disaster. The medical community must confront reality and stop the inappropriate use of P.S.A. screening. Doing so would save billions of dollars and rescue millions of men from unnecessary, debilitating treatments.

In the heat of the moment around healthcare reform maybe we should pay attention to this instead of Billy Tauzin’s whining? Anyone listening?

A recent study from the National Cancer Institute has found that most cancer drugs are not worth the money. For instance, Erbitux, the drug used for the treatment of lung cancer, extends life by only an average of 1.2 months, hardly worth the expense of $80,000 for treatment. The authors calculated that extending life by one year for the 55,000 Americans who die of cancer would cost $440 billion. Other examples of basically useless treatments that will cost you the farm include Avastin and Nexavar, both costing more than $34,000 for a course of treatment.

Of course the usual suspects were trotted out in the form of doctors who stated that for some patients Erbitux is a miracle.

More egregious practices mentioned included doctors using drugs off label or aggressively treating people with Mercedes like drugs who had advanced stages of cancer. Of course Americans don’t like to talk about rationing of healthcare, which Rick Lippin MD has been talking about in the email circuit as well as the fact that more care can be worse care, and that profiting off of the dying should be prosecuted as a crime.

Hear, hear! (or is it Here, here?)

Maybe we as doctors should teach people to grieve their dead and dying, rather than enable them to flee from reality by throwing our expensive technology at their loved ones and colluding in the myth that everyone can live forever (e.g. “Aunt Mabel is fighting her cancer and gonna win” kind of nonsense).

Hat tap to John Mack (@pharmaguy).

There is a front page story in the NY Times today showing how although death rates from heart disease and stroke have plummeted by more than 50% since 1950 the death rate from cancer has dropped by only 5%. This belies the much touted “war on cancer” which has been trumpeted in the media and amongst our leading medical institutions. I have long been annoyed by the cancer medical machine. The thing the bothers me the most about it how much people out and out lie (doctors, journalists, healthcare administrators) about the effectiveness of their treatments and so-called progress in this field. America spends more on cancer research and treatment than any other country. The result? Cancer death rates essentially unchanged, our healthcare outcomes second worse in the industrialized world. Surprised?

I guess we can blame the marketers who want to sell us low fat diet/breakfast cereals/high fiber/vitamins/etc, none of which have been shown to prevent cancer. And I have written here before about the lack of utility of breast and prostate screening although many readers have publicly and privately thrown eggs at me. Back then I wrote about studies showing that breast and prostate cancer screening only decrease your risk from that disease by 1 in 10,000 screened and don’t reduce overall mortality. Unless you are from France. So you can wear your pink ribbon if you want but it won’t necessarily do much good. Sorry to be so negative. 

Fact is that if you have metastatic cancer from whatever you can’t get rid of it, unless it is testicular or thyroid or some types of lymphoma. The treatments only slow down the progression. The “statistically significant improvements in survival” mean that if you take toxic chemotherapies you might live 12 weeks instead of 10. With more nausea and vomiting. Big deal.

[addendum: Fellow MD blogger (”Critical Condition“) Rick Lippin MD sent me this letter to Sen. Specter:

Classification: UNCLASSIFIED

Caveats: NONE

Doug

Thanks

Here is what I wrote in my blog-Open letter to my Senator who was instrumental in obtaining funding to continue this “failed war”

Feel free to circulate

(PS- America seems to have a penchant for declaring war on a number of things and then failing- War is our chief metaphor)

Rick Lippin

Senator Specter,                          Re “CURING CANCER”

Since I heard you make a similar comment I want to express my objection to your and  President Obama’s  use of the phrase “we need to cure cancer in our lifetime”

This phrase is not consistent with what experts know about the biology of cancer- over 200 different types I might add.

Senator -There is no “cure for cancer”.  Just like there is no “cure” for aging. We can cure individual patients with certain types of cancer thank goodness but indisputably the greatest risk factor for most cancers is cellular and bodily aging.

Declaring we “need to cure cancer” is well intentioned but naïve – harkening back to President Richard Nixon’s failed war on cancer from the 1970’s.

We must continue to chip away at the many factors that contribute to cancers but to suggest we will “cure” all is completely unrealistic and is actually irresponsible.

I share your interest in these diseases and applaud your own personal triumphs and political leadership in this arena.

Sincerely,

Richard A Lippin MD

Southampton,Pa

March 2009

This just in from the New England Journal of Medicine, two large studies adding futher evidence that much of our medical screening and interventions are doing more harm than good, this time with the Prostate Specific Antigen (PSA) test, which is used to screen for prostate cancer in men. For the past twenty years, yearly PSA screening with rectal exam has been recommended, based, of course, on little or no evidence that it is useful, just the assumption that it “couldn’t hurt” or “if I had a cancer I’d want to get it out.” So most American men get the tests. The Europeans do it much less commonly, as one of them pointed out “we think differently about these kinds of things than the Americans.”

Oui oui.

So on to the studies. The first study from the Americans, the Prostate, Lung, Colon and Ovarian (PLCO) Cancer Screening Study, involved 76,693 men who were randomly assigned to receive PSA screening and rectal exam every year for six years or have usual care. Although more prostate cancer was diagnosed in the screened group, they didn’t have more prostate cancer related deaths after seven years.

More prostate cancer diagnosed, but no difference in prostate cancer death rates

After ten years there were no differences in deaths between those who got screened (50) and those who did not (44), a 13% higher death rate in the screened group that wasn’t statistically significant.

No difference in mortality with screening for prostate cancer

Dr. B’s comment: Not all cancers are created equal. Most men identified as having abnormal tests will probably never develop a prostate cancer that will kill them (a similar situation holds for mammography). Prostate cancer screening is resulting in men getting a lot of unnecessary treatments that can be associated with impotence and incontinence. The lack of difference in death rates probably means that for every man “saved” from prostate cancer there is one many who has died from radiation treatments when their prostate cancer never would have killed him in the first place.

This article just in from the Women’s Health Initiative Study, published in this month’s edition of the Archives of Internal Medicine, on the utility of taking multivitamins for postmenopausal women. Now since the marketing staff of the Drug Safety and Health News Blog have been conducting focus groups amongst the readers of the blog, we have learned that the average reader is a middle aged woman from Marin County CA with a family member with a history of heart disease and/or mental illness, who is concerned about developing osteoporosis, who has pondered over the utility of hormone replacement therapy, and who shops for organic foods and wants to put more fresh fruits and vegetables in her diet. That said, our readers should be interested in this post.

However, I am aware of the possibility that our readers have become attached to their multivitamins, having given up psychotropic drugs that they put high hopes in, but that turned to have more toxicity than therapy, or having flipped the bird at Sally Field and tossed their Boniva for osteoporosis prevention in the trash and turned to ‘natural’ vitamins and supplements instead. And since the Drug Safety and Health News has lost it’s advertising revenue from the pharmaceutical industry it is a bit going out on a limb risk losing it from the makers of vitamins and supplements as well. But any way (deep breath) here goes…

The study is from data from the Women’s Health Initiative, a large study conducted over many years on a range of health issues. The current article looked at 161,808 women with information collected on use of multivitamins over the course of eight years on average. There were no differences between women who did or did not take multivitamins in the risk of any type of cancer, heart attack or stroke. If anything the risk of death was increased by 2%, which was not statistically significant. Additionally, a report from last month from the Phyisicans Health Study, which reported on 14,641 male physicians over the age of 50, did not find any effect on any type of cancer or total mortality or heart disease with supplementation with vitamins C or E over the course of ten years.

I was watching public TV a couple of years ago when a researcher was being interviewed about the Beta Carotene and Retinol Efficacy Trial (CARET), in which 18,314 smokers took either beta carotene and Vitamin A or a placebo. He embarrassedly stated that the beta carotene (found in carrots and orange vegetables) and Vitamin, even though they are ‘anti-oxidant’ and theoretically should prevent heart disease and cancer, actually increased it in their trial.  In fact people on supplements equal to four carrots a day had 17% more heart disease and were 17% more likely to die than people on a placebo. People taking high doses of Vitamin A also doubled their risk of fracture, leading Denmark to ban vitamin fortified Kellogg’s breakfast cereals.Alpha-Tocopherol, Beta Carotene (ATBC) Cancer Prevention Study smokers treated with beta-carotene and alpha tocopherol (Vitamin E) had an 8% increase in death, while those with a prior history of heart attack had a 75% increase in heart attack with beta carotene therapy. People on Vitamin E had a 2% increase in mortality.all studies put together, there is an increased risk of heart disease with Vitamin A and beta carotene and no heart disease prevention with Vitamin E. Vitamin A and beta carotene when taken together are associated with a 29% increase in mortality.study of Vitamin E combined with Vitamin C showed that vitamins actually accelerated the progression of thickening of the coronary arteries, and doubled the risk of dying of heart disease. Another study of a combination of anti-oxidants, including Vitamins E, C, beta carotene, and selenium, showed that vitamins actually blocked the effects of anti-cholesterol treatment (simvastatin plus niacin) on reducing atherosclerosis and preventing heart attacks and strokes. The vitamins in this study interfered with the ability of the other medications to raise HDL (good) cholesterol. Looking at all studies combined in which Vitamin E was given with beta carotene, there was a 10% overall increase in mortality. So there it is (sigh).

I found that pretty surprising, given all the hype you hear about the benefits of anti-oxidant vitamins.

I later visited my sister-in-law Rossana (pronounced ROE – SSSS – ana, as my kids always point out) in the US Virgin Islands. Rumaging in her refrigerator while she was at work (hey I didn’t have anything else to do) I found several large bottles of vitamins and supplements. I looked at the ingredients and found that she was taking Vitamin A at several times the recommended daily levels. When she got home from work I confronted her about it.

Doug: “Rossana, why are you taking so many vitamins and supplements?”

Rossana: “I don’t have time to cook meals and eat enough vegetables, so this gives me what I need.”

Doug: “But did you realize that the amount of Vitamin A you are taking may cause osteoporosis?”

[It's true-- women taking the highest amounts of Vitamin A supplements

I don't want to be dodgy and name the company that made the vitamins and supplements she was taking, but I looked them up on the internet, and if you followed their recommendations, you would be spending $7,128 dollars per year on their products!

Even though in the laboratory there has been shown some connection between oxidative stress and heart disease, and in spite of the known role of vitamins C and E as anti-oxidants, you can't get around the fact that there is now a large body of research including studies with tens of thousands of patients that have shown that vitamins do not prevent heart disease or lengthen your life.

In fact, they may actually have the opposite effect.

I think the vitamins may be giving a boost to little tumors that wouldn't have been a problem otherwise.

I know the readers of this blog are going to protest and say they didn't use the right dose or right type of vitamins. But why don't you just get your vitamins from natural sources instead of a pill? And what about the conflicts of interest of those trying to sell you something? Here at Drug News and Health Safety we have been growing our own herbs and vegetables from seed. There is an added mental health benefit in helping the little parsley plants raise up their tired heads from the earth.

We can do it. Yes we can!

My daughter always wanted to take a pill when she wasn’t feeling well when she was a little girl, so my wife, after she had given her various cold remedies or whatever, would give her a pine nut. It was small, and tasty, and you could almost feel its beneficial effects.

For all you do, this (pine nut) pill is for you!

Kind of like obecalp, the fake medication sold to kids to make them feel better. See my post “Mommy Can I Have a Yummy Blue Pill?” Oh btw obecalp is placebo spelled backwards (I said that to make your head spin around like they did on the Exorcist).

Hat tip to Mrs. Bremner.

A certain SOMEONE that I know who is a healthy middle aged woman had to undergo a colonoscopy cuz her gynecologist came up with a positive guaiac test (screening for internal bleeding). Only AFTER the scope did I start to wonder about if there could be false positives, and me ‘n goolgle learned that if you eat a lot of tomatoes you can come up false positive, and since she is Yugoslavian (har, har) she eats a lot of tomatoes. Her physician SHOULD HAVE warned her of that. Doh! Now her mammogram got flagged for additional testing and I am starting to wonder (yup) could it be false positive?

That is why an article in this weeks’s bmj about breast cancer screening caught my eye. Current recommendations state that women over 50 should get yearly mammograms, and pamphlets say that screening will save lives and decrease mastectomies, which, alas, is apparently not true. The article shows that one in 10,000 women will be saved from a death related to breast cancer if they get yearly mammograms. However, 5% of mammograms come up as false positives, meaning that women will have to wait for months with anxiety, coming back in for more painful and expensive tests, all for nothing. And what is more, over a ten year period there is a 50% chance of a false positive. That means that women getting mammograms as recommended can flip a coin; heads you get a false positive reading, tails you don’t.

And what is worse, if you are found to have a cancer in situ, which constitutes 20% of cases, that will likely lead to radiation, even though less than half of these cases will progress to a spreading cancer. Obtaining this information was described as lilke “trying to uncover a closely guarded state secret.”

Which brings us to the fact that breast cancer screening has not been shown to have any effect on mortality. The implication is that for each life saved from breast cancer, there is one life lost due to the effects of radiation treatment for something like cancer in situ that would never have progressed anyway.

In other words, breast cancer screening is of little substantive value.

Arghhh!

Let’s start making our list of useless screening procedures.

Hat tip to the Gary Schwitzer Health News Blog.