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Medical Forum / Diseases and Disorders / Cancer / March 2008The Hoax Of The "Proven" Cancer Cures
http://whale.to/cancer/griffin7.html > http://whale.to/cancer/griffin7.html Tries to make a case that having surgery or radiotherapy for cancer makes no difference. Who wants to live with this kind of thing growing on/in them? http://www.vci.org/breastcancer1.htm It also says that mortality rates from cancer are increasing. They are not. Even overall, absolute mortality from cancer is decreasing despite increasing incidence as the population grows and ages. Some graphs at http://www.users.on.net/~pmoran/cancer/cancercure.htm show what is happening. PM >> http://whale.to/cancer/griffin7.html >> [quoted text clipped - 9 lines] > > show what is happening. No, they don't because (if nothing else) they make absolutely no allowance for age cohorts. I've ranted at the alties here often enough, so you can take your turn. It is freaking *meaningless* to lump together incidence of e.g. prostate cancer in the 40-50 cohort with incidence in the 70-80 cohort, and it's much LESS meaningful to lump mortality for those two groups together. It's just plain misleading. And yet that's what the public sees. From you. In the present context: assume /arguendo/ that the age distribution of cancer patients is shifting to "older." Not, on its face, implausible. However, this is going to reduce your survival statistics for a host of reasons; if nothing else the older patients are frailer and have less in the way of system reserve capacity. I don't really expect the alties to produce the age cohort data when I challenge them (good thing, too) because facts aren't their thing. You don't have that excuse. Today's post at sciencebasedmedicine.org is on physician communication skills, or lack thereof. Here's an example. | The most important exclamation in science isn't "Eureka!" | | The most important exclamation is "What the BLEEP?" | +---------- D. C. Sessions <dcs@lumbercartel.com> ----------+ >>> http://whale.to/cancer/griffin7.html >>> [quoted text clipped - 22 lines] > lump mortality for those two groups together. It's just > plain misleading. Excellent! But explain to me why. These are age-standardised figures so as to try and get as close as possible to what is happening in absolute terms. The statistics are kept mainly so that trends are known and it would be pointless doing so if they could be so blithely dismissed as "meaningless". In fact, the more detailed figures for individual cancers appear to provide a very coherent picture over time, with some kinds of cancer increasing, others decreasing in a plausible way, and with incidence and mortality figures changing according to influences such as smoking rates between the sexes, or screening, and also with the impact of better treatments, as well as confirming the absence of any improvement in prognosis with cancers where there have been no obvious advances in care. I see no reason to dispute the figures when they also show an apparent overall reduction in mortality. The American statistics involve extrapolation from incomplete popualtion coverage, but every case of cancer and every death from cancer is reported in Australia, in order to produce the figures shown. Adjustments for age would probably be a fraction of a per cent per year. The figures are most unlikely to be "out" by more than a few per cent, with the time lag between diagnosis and death being the main distorting factor when we compare *this year's* incidence with *this years* mortality. The only other possible confounders would be if the biology of cancer is changing so as to make it less lethal, or if diagnostic criteria are changing, but I know of no evidence of either within a relevant time frame.. Thanks for the comments, and I will certainly modify this piece if you can show that it is misleading. This is incidentally not the only evidence pointing to modest but encouraging improvements in cancer care. For most common cancers breast, colon, prostate, etc there are independent statistics showing this. So these overall findings are quite plausuible, although partly also due to decreased lung cancer mortality in men due to fewer male smokers and a reduced incidence of invasive cervical cancer through screening. PM > And yet that's what the public sees. From you. > [quoted text clipped - 4 lines] > if nothing else the older patients are frailer and have > less in the way of system reserve capacity. Which is why they are age-adjusted figures. > I don't really expect the alties to produce the age cohort > data when I challenge them (good thing, too) because facts > aren't their thing. You don't have that excuse. > > Today's post at sciencebasedmedicine.org is on physician > communication skills, or lack thereof. Here's an example. > | The most important exclamation in science isn't "Eureka!" | > | The most important exclamation is "What the BLEEP?" | > +---------- D. C. Sessions <dcs@lumbercartel.com> ----------+ >>> Tries to make a case that having surgery or radiotherapy for cancer makes >>> no [quoted text clipped - 34 lines] > I see no reason to dispute the figures when they also show an apparent > overall reduction in mortality. Peter, you're exhibiting the very thing I brought up WRT David Gorski's post today. Yes, the aggregate data you show is very useful for some kinds of trends analysis. On the other hand, I do a fair bit of multivariate analysis myself and would utterly REAM a peer who failed to section a dataset against one of the dominant independent variables. Age, I need not tell you, is arguably the largest independent influence with regards to most forms of cancer. I have no doubt that researchers have sectioned that data, but it's also not being presented to the public. What is the result? You get the kind of response that MHA typifies: lots of noise about how the incidence of cancer is going up and it must be due to subprime mortgages or whatever. Then someone comes along and says it's a function of people living long enough to get cancer, is in turn challenged to prove it, and can't find a useable data set (yes, I can use cdc wonder. Blunt instrument), and away we go again. So why not communicate with the public? Cancer at 45 is not the same as cancer at 75. What data I've been able to scrounge up show that aside from forms dominated by lifestyle (e.g. lung), cancer rates in a given age bracket (40-50 etc.) have been quite stable over time, we just live longer. But I can't prove it because I (rightly) don't have access to raw data and the summaries aren't broken down that way. > The American statistics involve extrapolation from incomplete popualtion > coverage, but every case of cancer and every death from cancer is reported [quoted text clipped - 6 lines] > less lethal, or if diagnostic criteria are changing, but I know of no > evidence of either within a relevant time frame.. Are we talking past each other? I see the implications of a change in the 40-50 age bracket incidence, as distinct from the number of people in the 70-80 age bracket, as being rather significant. My own geekish inclination would be to put together a conditional probability model for all of the above: healthy@age to undetected to detected to any of several treatment options to any of several treatment outcomes etc. That's probably my fascination with playing with numbers, though. To me, it looks like you're approaching this from a process improvement perspective -- which is a good thing in itself. You're removing factors that you can't control (such as patient age). However, not all of us are in the process control section and what we want to know is what's going on. If cancer is a disease of age, you're doing a really great job of hiding that fact from the public. > Thanks for the comments, and I will certainly modify this piece if you can > show that it is misleading. For starts, is the incidence you show applicable to my chances of getting cancer *THIS* *YEAR* ? That has huge public policy implications and the general public impression is that we are, in fact, more likely to get cancer in the year following our 50th birthday than our older siblings were. > This is incidentally not the only evidence pointing to modest but > encouraging improvements in cancer care. For most common cancers breast, > colon, prostate, etc there are independent statistics showing this. So > these overall findings are quite plausuible, although partly also due to > decreased lung cancer mortality in men due to fewer male smokers and a > reduced incidence of invasive cervical cancer through screening. >> And yet that's what the public sees. From you. >> [quoted text clipped - 6 lines] > > Which is why they are age-adjusted figures. That's not what the public sees. The public sees more people dying of cancer and infers that things are getting worse. Not that any male is going to get prostate cancer if he lives long enough, and not that many treatments for prostate cancer in the very old have relatively poor prognoses; what they see is more deaths from prostate cancer as more men live long enough to hit that particular limit. Age-adjusted figures are the exact opposite of what you need to show. Age-adjusted figures remove the effects of age from the picture, rather than emphasize that age is the dominant factor that it is. (They also have some hidden assumptions regarding the stability of the age distribution.) You're looking at it from a point of view of "how well are we doing" rather than "what is going to happen to me?" Gorski. Today. Communicate. | The most important exclamation in science isn't "Eureka!" | | The most important exclamation is "What the BLEEP?" | +---------- D. C. Sessions <dcs@lumbercartel.com> ----------+ >>>> Tries to make a case that having surgery or radiotherapy for cancer >>>> makes [quoted text clipped - 146 lines] > > Gorski. Today. Communicate. There is actually considerable information about age and cancer in the statistics that the ACS publishes each year. Also some of their figures refer to absolute death numbers. These also show improvement despite the effects of advancing age of the popualtion, with the reported cancer deaths in one year actually being fewer than in the year before. Remember the discussion here about that here? http://caonline.amcancersoc.org/cgi/content/full/58/2/71 PM > | The most important exclamation in science isn't "Eureka!" | > | The most important exclamation is "What the BLEEP?" | > +---------- D. C. Sessions <dcs@lumbercartel.com> ----------+ >> http://whale.to/cancer/griffin7.html >> [quoted text clipped - 7 lines] > > http://www.users.on.net/~pmoran/cancer/QUACK > show what is happening. > > PM
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