JAMA October 2108 - Does Complementar... - Advanced Prostate...

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JAMA October 2108 - Does Complementary Medicine Increase Risk of Death for Cancer Patients?

cujoe profile image
36 Replies

On a subject that consumes a lot of written space on any post that suggest alternative treatments for Pca, interested parties should take the time to look at how one of the premier medical journals is willing to publish a true "hit piece" on complementary/alternative medicine use by cancer patients.

Of special note to those who tout the superior techniques of the "legitimate" science-based medical industry, I offer the following comment from the critique of the JAMA article from Natural Medicine Journal.

"Yet in Johnson et al’s data, only 258 cases out of nearly 2 million patients met the study’s criteria as using either complementary or alternative medicine. This calculates to less than 0.01% of the initial cohort. Even if we take the NIH’s conservative estimate that only 30% of adults with cancer engage in CAM practices, there should be half a million or more patients in the CM group; the incredibly low number of people meeting the study criteria is highly suspect for a flawed study design." (emphasis added)

I can only imagine what the resident pharmaceutical-only treatment option proponents would have to say about a published article for a supplement that used such a minuscule population percentage to draw such a broad study conclusion/headline.

The JAMA article (abstract only) is here:

jamanetwork.com/journals/ja...

And the Natural Medicine Journal review is here:

naturalmedicinejournal.com/...

The lesson for everyone is to always look beyond the headline (and abstracts), for as the saying goes, "the devil is (truly) in the details".

Be Well - cujoe

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36 Replies
Tall_Allen profile image
Tall_Allen

That comment from "Natural Medicine" is bogus. As someone who has spent most of his career designing large research studies, the technique they used in the study, "propensity score matching", is an excellent method when a randomized clinical trial can't be done. ALL research studies are based on random samples of a larger population. When using large numbers of sample size (over a hundred), the sample distribution matches the population distribution quite well. Furthermore, there is a statistic (called "p") that can tell you if the sample distribution could have deviated from the population distribution by chance. The larger the sample, and the bigger the difference, the lower the "p." by convention, most of us are willing to accept a p below 0.05. That means we can have 95% confidence that the difference did not occur by chance. If you are following any of the polling leading up to Election Day, they often quote the p statistic for the sample they contact.

"Natural Medicine" is either completely ignorant of research methods (which is scary), or is trying to dupe its customers by saying things that sound right, but are in fact quite wrong. Tellingly, JAMA (or any legitimate journal) did not publish it.

BTW - the same authors looked at both complementary medicine (non-standard plus standard) and alternative medicine (non-standard only) use. Use of complementary medicine increased the 5-year chance of dying by 110% . Use of alternative medicine increased the 5-year chance of dying by 150%.

cujoe profile image
cujoe in reply toTall_Allen

You can't really be serious?? You did read their critique, didn't you?!

Tall_Allen profile image
Tall_Allen in reply tocujoe

Yes, I read it. As I said, there were two studies by the same researchers from Yale- did you read them?

jamanetwork.com/journals/ja...

academic.oup.com/jnci/artic...

The definitions they used were:

Complementary medicine was defined as use of “other-unproven: cancer treatments administered by nonmedical personnel” in addition to at least one conventional cancer treatment modality, defined as surgery, radiotherapy, chemotherapy, and/or hormone therapy. 258 patients who chose a complementary therapy were matched to 1032 patients who did not use any complementary medicine on age, clinical group stage, Charlson-Deyo comorbidity score (CDCS), insurance type, race/ethnicity, year of diagnosis, and cancer type using the propensity score matching technique.

Alternative medicine was defined as “other-unproven: cancer treatments administered by nonmedical personnel” and who also did not receive conventional cancer therapy, defined as chemotherapy, radiotherapy, surgery, and/or hormone therapy. 281 patients who used alternative medicine were matched to 560 patients with similar characteristics (cancer type, age, clinical group stage, CDCS, insurance type, race, and year of diagnosis) who did not use alternative therapies using propensity score matching.

Of course, many patients using complementary medicine don't tell their doctors about it, and many of those who use alternative medicines never go to doctors (tragically) or only show up when it's too late.

If you have a better clinical study, I'm certainly willing to look at it. Rather than rejecting what does not conform to preconceived notions, I invite you to ask yourself - what if it's true?

cujoe profile image
cujoe in reply toTall_Allen

From the NMJ critique:

"Past researchers have made a significant distinction between complementary medicine, which is used in addition to standard of care therapies, and alternative medicine, which is used instead of conventional therapies. The National Institutes of Health (NIH) also officially defines “complementary” and “alternative” medicines as separate entities.1 Johnson et al chose to consider use of “complementary therapies” as falling on a continuous spectrum, grouping together all practices whether they are used along with or instead of conventional cancer care."

Almost seems that the study criteria was established to guarantee the results they "wanted".

PS I would have been astonished if you had not responded to the original post.

Be Well - cujoe

Tall_Allen profile image
Tall_Allen in reply tocujoe

They are misleading you. As I said, there were TWO different studies, one on complementary medicine, the other on alternative medicine. For the last time, the Yale researchers defined complementary medicine as "Other-Unproven: Cancer treatments administered by nonmedical personnel” IN ADDITION TO at least 1 [conventional cancer treatment] modality, defined as surgery, radiotherapy, chemotherapy, and/or hormone therapy."

Because neither you nor the authors of that so called "critique" seem to acknowledge what is plainly a fact, what they and you (parroting them) write is worthless.

cujoe profile image
cujoe in reply toTall_Allen

Tall

You have such a nice way with words. I have no intentions in engaging in your usual tit-for-tat dailogue. Hurling written insults back and forth is not the reason for my original posting. I'm actually off to the gym for my daily workout which along with a radical change in my diet and a rigorously researched regiem of supplements has kept me off treatment for my first cancer for 12 years and has me currenlty off treatment and "undetectable' for my Pca.

Be Well ( and do think about getting a hobby, dude)

cujoe

Tall_Allen profile image
Tall_Allen in reply tocujoe

I think there is some power in belief. THIS is my hobby.

dbrooks_h profile image
dbrooks_h in reply toTall_Allen

Thank you Tall_Allen for keeping us updated here!

whatsinaname profile image
whatsinaname in reply todbrooks_h

Yes, I would definitely agree with Tall_Allen on this issue.

Schwah profile image
Schwah in reply toTall_Allen

“This is my hobby”. That brought a smile to my face. While others seem to view your responses as argumentative, many of us see them as logical explanations based upon your own research and knowledge. We are all here to learn and without competing ideas and and thoughts no real learning can occur. We all gather information and make our own choices. Thank you for your thoughts. And thank you Cujoe for your contributions. By the way, Tall, Do you consider metamorfin “complimentary medicine” or mainstream ? How about melatonin? Thanks again.

Schwah

Tall_Allen profile image
Tall_Allen in reply toSchwah

Metformin has never been proved to increase survival in a large randomized clinical trial, and a smaller randomized study showed no effect on PSA:

ascopubs.org/doi/abs/10.120...

Some observational studies suggested there was no effect on incidence, risk of high grade, or on recurrent cancer.

On the other hand, it has a long safety record, it is inexpensive and there is no evidence it makes the cancer worse - so why not? (the same could be said for statins and low-dose aspirin).

Melatonin has been studied less, but I have never seen any suggestion of harm. So, worst case, you sleep more soundly.

cesanon profile image
cesanon

LOL, What an interesting conjecture. I can see why it might be.

TommyTV profile image
TommyTV

I have to confess to not reading the article, however my view of alternative therapies remains the same.

Alternative Medicine for Cancer and its Impact on Survival

PSA-RISING.COM·FRIDAY, 19 JANUARY 2018

Source: Yale Cancer Center

According to Altmetric, which tracks the distribution and discussion of research papers online, a July article by several Yale physicians is the most-discussed paper ever published in the Journal of the National Cancer Institute (JNCI). The title of this blockbuster: “Use of Alternative Medicine for Cancer and Its Impact on Survival.”

“It struck a chord,” said senior author James Yu, MD, MHS, Associate Professor of Therapeutic Radiology.

The Yale researchers used the U.S. National Cancer Database to collect information on patients with non-metastatic breast, lung, colon, and prostate cancer from 2004 to 2013. They looked for people who reported using only unproven alternative treatments instead of conventional medical therapies such as surgery, radiation, and chemotherapy. The researchers found 280 such people and then compared their outcomes after 5½ years to 560 people with the same cancer, diagnosis, age, and race who had received conventional treatment.

The results were clear. Patients who initially relied on unproven alternatives were, on average, 2.5 times more likely to die within the 5½ year window. Within particular cancers, the risk associated with alternative medicine was often much worse—almost six times higher for patients with breast cancer, four times for colon cancer, two times for lung cancer.

Skyler Johnson, MD, Resident in Therapeutic Radiology and the paper’s lead author, thinks the discrepancy in survival rates would be even more alarming if the patients had been followed for longer than five years to take into account slow-growing cancers such as prostate cancer. He also calls the 280 people identified as using only alternative medicine “a huge underestimate” because the researchers excluded a large group of patients who had been coded as having refused treatment, with no reason given. Dr. Johnson suspects that many of them chose an alternative therapy first but did not report it to their physicians.

Another interesting finding from the paper was that people who preferred alternative treatments tended to have had more formal education, and higher incomes.

The researchers have some theories about this seeming conundrum. Dr. Johnson mentions the Dunning-Kruger effect, in which people overestimate their knowledge, in part by relying on the Internet. Dr. Yu speculates that people with higher incomes can afford more types of healthcare and know how to seek them out, such as clinical trials. “But in this case it’s wishful thinking,” he said. “These alternatives don’t necessarily cause harm, but they’re placebos, and placebos don’t cure cancer, but they can delay real cancer care.”

Co-author Cary P. Gross, MD, Professor of Medicine and of Epidemiology, wasn’t that surprised by the demographic finding, citing increased skepticism about science and conventional medicine that has driven things such as the anti-vaccination movement. “And just as the Internet and social media have fueled discord in the political process,” he added, “they also have enabled conspiracy theories about medicine and health to spread rapidly and wildly.”

The researchers also believe, based on their own patients, that the number of people choosing alternative treatments over conventional ones is increasing. “I understand the human impulse to think there’s got to be something else,” said Dr. Yu. “And when the answer is ‘no, there isn’t’, then there’s the opportunity for someone to say, ‘Just rub these crystals or sit in a salt bath or eat special food.’”

All of the researchers noted that the problem should not be pinned only on patients and providers of alternative medicine. “Physicians need to shoulder some of the blame as well,” said Dr. Johnson. “We need to take the time to really listen to patients’ concerns and explain things more clearly. That builds a relation of trust, and makes them more willing to believe the data.”

Dr. Yu agrees. “We need to bring these conversations about alternative therapies to the forefront,” he said, “and because of this study we now have the data to help us.” The researchers also noted that their work focused on alternative medicine, when patients choose not to receive conventional medical therapies, rather than “complementary medicine,” in which patients undergo conventional cancer treatment as well as additional therapies from disciplines that are not part of traditional Western medicine.

The researchers know that facts and data won’t be enough to persuade everyone, a common symptom of our time, but their paper is a start. They hope it convinces a few people to reconsider relying on alternative treatments, or prompts someone to insist that a loved one see an oncologist. “That’s why we do research,” said Dr. Johnson. “We try to help people one at a time, and hopefully our research can help patients and families to make more informed decisions.”

billy1950 profile image
billy1950 in reply toTommyTV

Is anyone familiar with the alternative treatments that are being done by Dr. Antonio Jimenez in Mexico? He is the founder I believe of Hope4 cancer. Sounds as if they are into boosting the immune system, dexotification, and different immuno therapies, etc.

Thanks, Billy

TommyTV profile image
TommyTV in reply tobilly1950

And, not surprisingly, at a massive cost. Anyone would think they’re profiting from desperate people in an unregulated country.

in reply tobilly1950

Sounds like the already debunked Gerson therapy.

curt504a profile image
curt504a in reply to

The daugher of Gerson ruined the protocol, taking it vegan... Geeze! Original Dr Gerson had successes, and only in my view as an adjunct to conventional. Calorie restriction lots of phyto's help chemo per the reports I've read. Which to me is what complementary + conventional is about. But never mind, no double blind gold standard results. No profit in that. Might reduce the duration or dosing of chemo. OMG that would be terrible. No good data..... Just anecdotal.

in reply tocurt504a

That's the ticket -- this kind of complementary/alternative diet/supplements/whatever ... in addition to conventional cancer treatments.

Litlerny profile image
Litlerny

I don’t understand some of these issues like some of you guys, but I have to question two points of the article. When you click on the first link, the header specifically notes that the study relates to patients with CURABLE cancers. Many of us in here are already Stage 4 with distant metastasis. Therefore, that article would not apply to us.

Also, the article states the presumption that most patients who use complementary medicine are more likely to refuse conventional cancer treatments. I thought the whole idea of complementary treatment is that it is used in conjunction with conventional treatment. I would think the converse would be true of those of us who use complementary treatment and supplements...that we are more likely to continue conventional treatment with the complementary treatment as an adjunct. For example, my MO won’t prescribe Metformin, which has shown to have synergistic effects with ADT, because it has not been FDA approved for that purpose, but he was totally agreeable with my having it prescribed by my family physician.

Tall_Allen profile image
Tall_Allen in reply toLitlerny

If use of alternative and complementary medicines decreased survival in people who are not yet metastatic, it seems the effect would be worse among those who are.

In spite of what you imagine, they found that patients who get complementary medicine are more likely to refuse conventional treatments (even though they received at least one conventional treatment) and are about twice as likely to die because of that decision.

The single, small randomized clinical trial of metformin + ADT found there was no statistically significant difference in PSA response compared to men with advanced PC beginning to take ADT alone.

ascopubs.org/doi/abs/10.120...

Litlerny profile image
Litlerny in reply toTall_Allen

Thanks for the reply and the info. You always have solid and well researched info and advice. Much appreciated.

curt504a profile image
curt504a

Nice discussion, but circling the AMA drain!!! $90B spent on cancer research and very little to show for it so the high and mighty associations certainly DO have bragging rights.

This report wasn't targeting MDs/practitioners, its targeting the media to amplify the message that file into your local Oncologist and ask for the latest drug protocols (most expensive) and don't ask questions about efficacy, just pay up.

I only see TV at hotels, its amazing the pseudo science info-mercials touting "latest scientific solution" to some age old problem. Its all physiological to condition us to reach for the latest, it'll be the best solution. "Don't worry we are the experts"... They are conditioning the public to never question, just file into MD offices and do as they say... In my view, this is corrupt manipulation. They justify it on the backs of their fudged tests wrapped in the cloak of unrefutability "gold standard". ;(

Not much science in this study, its waste basket material (for us anyway).

And thank you for offering up a reason why I can't stop lurking on this topic,, I must have a hobby as well on this topic and a few other health topics. Thanks for that justification!

cujoe profile image
cujoe in reply tocurt504a

Thanks Curt. We are on the same page here.

Be Well - cujoe

Tall_Allen profile image
Tall_Allen in reply tocurt504a

I can see you don't let facts get in the way of a firmly held opinion.

Throw out the word complementary. Aren't they just talking about men who pursue alternative medicine after rejecting conventional treatment?

j-o-h-n profile image
j-o-h-n

my hobby is humor....

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 11/05/2018 4:15 PM EST

in reply toj-o-h-n

My hobby is busting out of poker tournaments. Maybe I need a new hobby.

cujoe profile image
cujoe in reply toj-o-h-n

Good Hobby to have - and you are very capable at it.

Be Well - cujoe-the-canine-terror-of-tall-tales

j-o-h-n profile image
j-o-h-n in reply tocujoe

and my fall back hobby is collecting belly button lint.

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 11/05/2018 8:53 PM EST

cujoe profile image
cujoe in reply toj-o-h-n

Keep at it. I made a throw pillow with mine.

Be Well - cujoe

j-o-h-n profile image
j-o-h-n in reply tocujoe

Shoot why didn't I think of that, stupid me was saving up to build a mattress... always a day late and a dollar short....

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 11/05/2018 9:52 PM EST

cujoe profile image
cujoe in reply toj-o-h-n

Always think BIG, but start small.

cujoe-the lint-free-canine-terror

j-o-h-n profile image
j-o-h-n in reply tocujoe

j-o-h-n <===<<< giggling

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 11/06/2018 4:45 PM EST

j-o-h-n profile image
j-o-h-n

did ya ever think of entering a "Go Fish" tournament?

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 11/05/2018 6:29 PM EST

Magnus1964 profile image
Magnus1964

Any one who takes supplements and ignores Traditional medicine is surely at risk for serious consequences. In that light I would agree with the study. I would never encourage anyone to choose alternatives therapies in place of traditional medicine. This is the flaw in the study. Nothing is said of those who take complimentary supplements WITH traditional therapies. The word "complimentary" is the give-away.

cfrees1 profile image
cfrees1 in reply toMagnus1964

That's the definition of complementary, as opposed to "alternative".

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