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Evaluating scientific claims: Trash or Treatment

Shortly before moving from my home in Utah to start medical school, my sister made my wife and I a Facebook account so we could “keep in contact with family.” Up to that point, I believed that Facebook was used by people for three things: (1) to stalk people who aren’t really friends, (2) to post cat pictures and/or (3) to argue. Unfortunately, it seems Facebook, among many other social media platforms, is a place for people to spread misinformation about many topics, including cancer. This resulted in me doing one of the aforementioned three things…posting cat pictures! Haha. Just kidding.

I was a 4th year medical student and had just spent a year at the University of Michigan’s Department of Radiation Oncology conducting clinical research. During that year, I was surrounded by some of the best and brightest minds I had ever encountered. The doctors and researchers were passionate and hardworking. Laurie, my wife, had completed chemotherapy for Hodgkin’s Lymphoma, was feeling well and our lives were returning to normal. So here I am, an idealistic medical student working amidst top cancer researchers, nearing medical school graduation, with a wife who faced a terminal illness and was cured after receiving chemotherapy.

Imagine my surprise when I saw a comment from a well-respected friend who posted a link to a “science” paper that concluded that a substance, which coincidentally said person so happened to be selling, may have activity against cancer cells. I found this especially disturbing because what followed was a testimonial about having seen this work in friends, a comment which could have negative impact on the lives of cancer patients.

Because it’s really an interesting example as to how alternative medicine practitioners and marketers can use science to make claims that the evidence does not support, I’m going to summarize the conversation here:

Friend: <Posts Link> So great to see the science back up the benefits I’ve been seeing in people firsthand!

Me: Interesting but until there is evidence that it works and that its safe in humans, it’s probably not okay to be recommending to people with cancer.

Friend: There is plenty of evidence! Look at the link!

Me: Yeah, I saw that. It’s just a single preclinical paper. I just came from a conference where a new cancer drug was discussed. Basically, there were over 800 preclinical studies that appeared much more promising than the single article you’ve posted here. They put this drug into multiple clinical trials and guess what? There was VERY minimal benefit. In fact, there were some trials that showed it may make patients worse!

Friend: This is perfectly safe AND effective! Its NATURAL!

Me: Ummm…I think you missed my point. You must go through all the appropriate steps before you can make that claim. I can’t just say “putting olive oil on someone’s toes cures cancer.”

Friend: That is ridiculous! This is not olive oil on someone’s toes. I know 8 people who have used this for their breast cancer and it has totally cured them.

Me: What you are doing is dangerous. Feel free to keep “treating” people with more money than sense but when it comes to real medical problems, STOP!

Fortunately, the author, either by guilt or wisdom, later deleted the original post. Although, I suspect it was probably in response to an FDA letter directly to the company about making unsupported health claims, including curing cancer. Even now, typing this, I’m reliving the frustration. It was like we were speaking two entirely different languages. (Now that I think about it, this is probably the exact moment when I started going bald.)

Whether it’s done maliciously or ignorantly, using some scientific data, which only tells part of the story, is just one of the ways that alternative practitioners and marketers attempt to mislead cancer patients. This practice has a name: “cherry-picking.” In medicine, scientific information can be overwhelming. Fortunately, there is a straightforward way that physicians evaluate studies. Studies come in a variety of forms and it’s important to know what they are and why they exist. Here is a basic overview of the different evidence types:

  • Case studies: Published peer-reviewed examples of rare occurrences/treatments with a possible scientific basis and objective evidence of benefit (lab values, scans, etc. Not just patients saying they feel better). These are different from stories or anecdotes. This is an example of an anecdote: “My aunt’s neighbor’s uncle went to Mexico and was cured of his cancer” or “I know 8 people who have used this for their breast cancer and it has totally cured them.”

  • Retrospective reviews: studies that look backwards at a group of patients to examine if a factor increases or decreases risk of disease/death or another outcome.

  • Literature Reviews: a summary and evaluation of the medical research in a specific area

  • Preclinical study: Reports on treatments or other exposures to cell lines or animals

  • Randomized Controlled Trials

  • Come in multiple phases (I-IV), which test the following questions/goals in humans:

  • Is it safe?

  • Does it work?

  • Does it work better?

  • Post-market surveillance

  • Meta-Analyses: Usually combines highest-quality randomized evidence to develop a singular conclusion

Until a treatment has been evaluated in many different forms of evidence types and the information has been published in respectable peer-reviewed journals for critical analysis, it should not be used nor recommended in humans because the safety and efficacy have not been established. Just like in the example of my Facebook interaction, those medications have just as much evidence to cure cancer as olive oil on your toes. Think that this example is extreme? Here is an article about how a component in olive oil can kill cancer cells. No, we don’t use olive oil to kill cancer cells. PLEASE don’t try to use olive oil to treat your cancer. And this is just not a way for doctors or big pharma or [insert conspiracy theory group here] to shut out alternative or natural therapies. As I pointed out in the comments of the Facebook interaction, if that new pharmaceutical cancer drug that showed so much promise in the preclinical literature had not gone through the rigorous steps of the scientific process, we’d be treating cancer with it…mostly unsuccessfully and possibly even with harm. This is why going through the appropriate scientific steps is so important. When a cancer doctor is making a recommendation, it’s not based on gut instinct, a few science papers or a story about an aunt’s neighbor’s uncle who was cured after rubbing olive oil on his toes in Mexico, but sound science that will offer the best chance at cure.

Understandably, you may have read this with some reservations, especially if you are skeptical of cancer doctors or medicine. If you read this post and made any of these statements…

“Isn’t natural always safe and always better?”

“Aren’t the treatments worse for you than the cancer?”

“Pharmaceutical companies will never study alternative medicines or natural cures because there is no money and they can’t patent them.”

and (one of my personal favorites) “Doctors don’t want cancer to be cured because there is no money in a cure.”

…please keep reading because I’ll be addressing these questions/statements in future posts.