Cancer Decisions - Free Newsletter

HERE AT THE MOSS REPORTS

Pharmaceutical companies currently spend upwards of $10 billion per year in the US on inducements such as gifts, speaker's fees, free drug samples, subsidized travel and sponsored educational symposia, in an effort to influence the prescribing habits of the nation's physicians.

Many studies have shown that these efforts pay off handsomely. To cite just one example, a review published in the Journal of the American Medical Association (JAMA) by McGill University researcher Ashley Wazana, MD, found that:

"Meetings with pharmaceutical representatives were associated with requests by physicians for adding the drugs to the hospital formulary and changes in prescribing practice. Drug company-sponsored continuing medical education (CME) preferentially highlighted the sponsor's drug(s) compared with other CME programs. Attending sponsored CME events and accepting funding for travel or lodging for educational symposia were associated with increased prescription rates of the sponsor's medication. Attending presentations given by pharmaceutical representative speakers was also associated with non-rational prescribing" (Wazana 2000).

Industry pressure starts early in a doctor's career. Even while they are still in medical school, physicians-in-training have regular encounters with pharmaceutical company representatives. Such encounters are generally facilitated and sanctioned by the medical schools themselves.

It is encouraging to see that today's medical students are aware of this insidious pressure, and are fighting back. In 2003, the American Medical Student Association launched its Pharm Free campaign, aimed at encouraging academic medical centers to limit the access of pharmaceutical company representatives to medical schools, and preventing faculty and students accepting gifts from industry representatives.

Another admirable group is No Free Lunch, a non-profit organization of doctors, medical students and other healthcare professionals who oppose the influence of the pharmaceutical industry on medical practice. One of the group's guiding principles is that pharmaceutical promotion should not guide medical practice. "Our mission is to encourage health care providers to practice medicine on the basis of scientific evidence rather than on the basis of pharmaceutical promotion," says the organization's site (www.nofreelunch.org).

Unfortunately, this activism has not been uniformly well received within the medical profession. The American Academy of Family Physicians (AAFP), for example, which is one of the largest professional groups within US medicine, refused to rent space to No Free Lunch at the 2005 AAFP annual assembly - but did rent space not only to representatives of many pharmaceutical companies, but also to McDonald's, the fast food company.

Objectivity Begins With Intellectual Independence

Here at the Moss Reports we have always believed passionately that freedom from commercial influence is one of the most precious guarantees of objectivity. This is the reason why we have steadfastly refused to accept advertising or sponsorship of any sort. By doggedly maintaining our independence in this way we have been able to continue bringing our readers the sort of unbiased information that is increasingly hard to find elsewhere.

Over the past 30 years I have written and published extensively on the subject of cancer and its treatment. I have compiled a comprehensive series of more than 200 individual reports on different cancer diagnoses - The Moss Reports - each of which examines both the standard treatment options that are likely to be offered for a particular cancer diagnosis, and the possible alternative and complementary approaches to that disease. These reports also contain extensive dietary and nutritional information for those who are actively dealing with cancer as well as for those who are recovering from treatment and hoping to prevent recurrence.

Typical of the comments we receive from those who have purchased a Moss Report is the following:

"For the past two and a half years I have battled breast cancer by natural and alternative methods, having done an in-depth research of all the options. Dr Moss' support and the knowledge he has compiled have been an endless source of comfort. When I have reached different stages of my illness and I have found myself at a crossroads, I have called upon the advice of Dr. Ralph Moss as one of the only true sources of genuine information and personal care. Without his input, I would have been lost. He has done e more for me than many of the private doctors that I have consulted and I certainly have felt a deep feeling of care on a personal basis. That has been invaluable. I thank him from the bottom of my heart." --- C.H.A.

If you would like to order a Moss Report for yourself or someone you love, you can do so easily and securely from our website, www.cancerdecisions.com, or by calling 1-800-980-1234 (814-238-3367 from outside the US).

To those who have already purchased a Moss Report I also offer phone consultations. A phone consultation can be enormously helpful in drawing up an effective treatment strategy and getting one's options clearly prioritized. A recent phone consultation client wrote:

"Our phone consult with Dr. Moss was invaluable. He was thoroughly knowledgeable, kind, informative and had many answers and suggestions for us for our son who has liver cancer. We appreciate that we can contact him with questions at any time. Thank you again Dr. Moss." --- J.D.

To schedule an appointment for a phone consultation, please call 1-800-980-1234 (814-238-3367 from outside the US), or send an email to Jacquie@cancerdecisions.com.

We look forward to helping you.

CURRENT TOPICS

Recently we launched a new report in our popular Current Topics series - "On Guard - Gardasil" - focusing on the controversial new anti-cervical cancer vaccine, Gardasil. This report, and the others in the series (listed below), can be purchased for $9.95 each and downloaded directly from our Web site, www.cancerdecisions.com:

On Guard – Gardasil
Mammography, Biopsy and the Diagnosis of Breast Cancer
Herceptin or Deceptin? (An evaluation of the use of Herceptin in breast cancer)
Avastin: Your Money Or Your Life. (A clear-eyed look at the 'targeted' drug Avastin)
Do Antioxidants and Chemotherapy Conflict?
The Politics of Hope: Andrew von Eschenbach and the Decline of the National Cancer Institute
The Mexican Cancer Clinics in the Era of Evidence-Based Medicine

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STUDIES QUESTION ACCURACY OF MANY COLONOSCOPIES

Colonoscopy is a reasonably effective way of finding and removing colon polyps, the benign lesions from which most colon cancers eventually develop. The U.S. Preventive Services Task Force has found what it judges to be "fair to good evidence" that several screening methods, including colonoscopy, are effective in reducing mortality from colon and rectal cancer. It has concluded that the benefits from screening substantially outweigh potential harms, but the quality of evidence, magnitude of benefit, and potential harms vary with each method.

The Task Force recommends initiating colonoscopy screening at 50 years of age for men and women at average risk for colorectal cancer. But in persons at higher risk (for example, those with a first-degree relative who receives a diagnosis of colorectal cancer before 60 years of age), initiating screening at an earlier age is reasonable. As a general rule, people over age 50 should undergo colonoscopy once every five years. If a doctor has previously found and removed a polyp, that schedule is moved up to a three year interval.

But now new concerns have emerged over the accuracy of many colonoscopy examinations. The ability of colonoscopy to detect abnormalities ultimately relies on the vigilance and experience of the operator. Like many screening tests, colonoscopy can result in a false negative (i.e., an abnormality may be overlooked by the operator), or a false positive (i.e., the operator may detect what he or she thinks is a malignancy or a suspicious lesion, but it may subsequently turn out to be totally harmless). The rate of false negatives (i.e., missed polyps or colorectal cancers) after colonoscopy is influenced by a number of factors.

For example, who performs the colonoscopy, and where it is carried out, can have a major influence on the reliability of the test. University of Western Ontario researchers have found that colonoscopy is far more likely to result in a false negative (i.e., cancer is more likely to be missed) when the test is performed by an internist or family physician, and when it is done in an office setting. Colonoscopy is far more accurate when done by a gastroenterologist in a hospital (Bressler 2007).

The senior author of this paper, Dr. Linda Rabeneck, has said: "There is something different about the practice of colonoscopy in these settings that gives rise to higher cancer miss rates, a worrisome finding" (Douglas 2007). Of 12,487 patients included in the study, 430 (or 3.4 percent) had new or missed cancer within 6 months to 3 years of having a colonoscopy. Reducing this interval to just 2 years yielded a 2.4 percent failure rate. An increase to 5 years gave a figure of 4.6 percent. Thus, to be really safe, patients may need to consider more frequent colonoscopies.

Compared to colonoscopy performed in the hospital, having the procedure done in a doctor's office yielded an odds ratio of new or missed colorectal cancer of 3.07 in men and 1.95 in women. In plain language, this means that you have a two to three times greater risk of a potentially fatal growth being missed just by having your colonoscopy done in an office, rather than a hospital! If you have it done by a family doctor it nearly doubles the missed cancer risk compared to gastroenterologist-performed colonoscopy.

Afternoon Delight?

The time of day you schedule your colonoscopy may also make a significant difference in the accuracy of the test. A recent study found that the colonoscopy failure rate was higher in the afternoon than when the procedure was performed in the morning (Sanaka 2006). The reason for this curious finding was partly that bowel preparation was not as thorough for afternoon colonoscopies, and partly because of the all-too-human factor of fatigue among endoscopists as the afternoon rolled around. Some doctors apparently weary of doing one after another of these somewhat tedious procedures. They tend to miss things when they get tired - as we all do. But in this case, lives are at stake.

This particular study involved 2,087 colonoscopies, roughly half of which were performed in the morning and half in the afternoon. The colonoscopy failure rate was 6.5 percent in the afternoon compared to just 4.1 percent in the morning, a significant difference of 2.1 percent. That could translate into quite a few lives saved - or lost - solely because of fatigue.

TO BE CONCLUDED, WITH REFERENCES, NEXT WEEK.

--Ralph W. Moss, Ph.D.

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IMPORTANT DISCLAIMER

The news and other items in this newsletter are intended for informational purposes only. Nothing in this newsletter is intended to be a substitute for professional medical advice.