Use of Alternative Medicine for Cancer and Its Impact on Survival

nnguyen

Use of Alternative Medicine for Cancer and Its Impact on Survival

https://academic.oup.com/jnci/article/110/1/121/4064136

kaynotrealname

The only thing that surprises me about this article is that the death rate of people doing AM is not 100%.

recoveringbelle

Wow. Just saw this "article" and wanted to respond, since while all scientific writing is rhetorical/constructed, this one's uniquely sloppy AND offensive. I have to conclude the very ideologically motivated point behind this was to "publish" something that would cough up (however poorly derived) a highly dramatic figure that doctors, cancer centers, pharma companies, reporters, etc. could cite and re-cite uncritically. They knew the shoddy work behind it would be lost leaving only the bullet point available to invalidate patients exploring serious alternatives, due to comorbidities or other limitations.

Yes, the article has a limitations section, which in itself ought to have precluded its being published, but that wasn't the point. The point was to be able to bully, invalidate, and ridicule any women patients—breast cancer patients in particular— who question their doctors' recommendations.

Here are some weaknesses—though if I've gotten some of this wrong please let me know.

First, they're removing Stage 4 from the study and then use the term "curable cancer" for Stages 1-3. I didn't think any invasive cancer was considered "curable" but in remission, unless you're talking about DCIS and a double mastectomy, and even then someone might get lobular de novo years later. Since this term wouldn't be used in a more rigorous scientific study, I believe the rationale for using it here is only to blame patients—like, it's CURABLE, so why are you being so stupid as to refuse our conventional treatment?

Second, I can't figure out the source from which they drew their patient charts, or its time period. And their tables/charts are poorly designed, enabling them to make all sorts of dubious claims.

Third, they throw around the term multivariate and claim or imply that the patients w/ the worst survival are highly educated younger women with breast cancer and low to zero comorbidities. However, it seems to me they're adding up the variables w/ the lowest p-values and then creating a non scientifically validated (but very eye-rolling sexist) profile. Like, they conclude AT for breast cancer has a five-fold overall death rate, but they don't control for whether that's Stage 1 node negative or Stage 3 w/ comorbidities (despite saying they've controlled for it).

Fourth—and this realllly irritates me because it's deeply subtle sexism—they literally use prostate cancer, which is proxy for men and all of the unconscious privilege we give them, as the "reference" cancer, because they indicate that prostate cancer patients using alternative tx show no significant difference in survival. They qualify this by saying it's a slower growing cancer or whatever . .. but I wonder how much prostate cancer is already classified up front to reflect male patients' needs. Interestingly, in this study, you don't see slower growing pre-cursor low grade breast cancers—which are widely dx in the age of scanning—given as its own category, for which women might want to choose AT. Had the authors (or the cancer world at large) constructed pre-cursor low-grade lesions in women as a separate category like they have the slow growing version of prostate cancer, then women would have an equally indolent cancer category as well, and maybe WE would be the reference class.

Nope—the conclusion meant to be drawn from this is that women w/ DCIS or even Stage 1 at age 70 must suffer the last years of their lives with endocrine therapies, because via this study they're conflated w/ 30-year-olds dx w/ Stage III who presumably read too much and are too emotional to follow the doctors' orders. Disease classifications don't invent themselves—per the philosophy, rhetoric, and sociology of science & medicine, they're developed based on prior cultural biases as well as data, patterns, and tx expectations. As a result, this article reinforces the notion that men are the reasonable ones and women are more likely to be crazy and disobedient.

And fifth, more sloppy conflations meant to reinforce the talking point the Editors probably requested from them. From their limitations section: " because patients receiving alternative medicine were more likely to be younger, more affluent, more well-educated, and less burdened with comorbidities, this would not likely account for the observed survival differences." Since they've already said that breast cancer survival is most affected, they're implying the AT group is female. And worse, they're conflating the 5x worse survival rate the descriptive characteristics of their target population, when in fact they're not statistically linked.

Sixth, they finally conclude their limitations section with the statement that "we lack information regarding the type of alternative therapies delivered, though there is limited to no available evidence that specific AM therapies have been shown to improve cancer survival."

WHAT specific AM therapies? Actually metabolic therapies even in gliablastoma are showing significant abilities to shrink tumor size, and intermittent fasting alone is showing promise across a range of cancers, including breast cancer. That's not zero or even limited evidence. Yes this is from 2017 but Seyfried's work was being published in the late aughts.


This is a sloppily designed and irresponsibly presented, sexist article published (probably even commissioned) to help doctors et. alia push conventional treatments onto women, while the healthcare professionals in the conference audience chuckle and roll their eyes at "those" women.

Maybe we should start a new thread focused on implicit sexism in breast cancer-related articles. (We'd need 20 more for racism, ageism, homophobia, etc. ) Gotta start somewhere . . .