HERE AT THE MOSS REPORTS

This week and next I focus on a survey conducted by the American Cancer Society that highlights the very different ways in which the medical profession and the public view the constellation of diseases that we collectively term 'cancer.'

That such widely different perceptions exist is regrettable, but understandable. When the profession itself cannot speak with one voice even on basic issues, who can blame the public for discounting official pronouncements in favor of its own, sometimes darker, interpretation?

Take, for example, the issue of whether or not screening mammography actually reduces mortality from breast cancer. The official doctrine is that yes, it can, and does, by a factor of up to 30 percent. Yet this week in the Journal of the National Cancer Institute a study was published that showed no benefit to such screening. The importance of this study is that it was carried out in the "real world" – that is, in the community setting, as opposed to in the rarefied context of a clinical trial in a major teaching hospital. The patients, the screening methods and overall outcome are therefore more likely to reflect the true worth of screening, "warts and all" (Elmore 2005).

The researchers found no statistically significant reduction in mortality for patients receiving community-based screening mammography.

Yet instead of calling for a re-examination of the worth of mammography, the lead researcher, Joann G. Elmore, MD, emphasized that women should continue getting mammograms on a regular basis from the age of 40 onwards. "I'm encouraging everyone to continue with current recommendations," she said. An accompanying editorial also urges the profession not to allow these negative findings to change current practice.

Contradictions of this sort go a long way towards reinforcing public cynicism concerning the ability of the medical profession to deliver on its promises. I believe that people are more sophisticated than bodies such as the American Cancer Society give them credit for. People are not afraid of ambiguity. It is equivocation, half-truths and broken promises that they find really disturbing.

After thirty years of monitoring cancer research and treatment, I have created an extensive library of reports on more than 200 different cancer diagnoses. Each of these Moss Reports analyzes the current available treatments, both conventional and alternative, and offers the cancer patient a clear-eyed, truthful assessment of what works and what does not.

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

We look forward to helping you.

IS THERE A CANCER CONSPIRACY?

The American Cancer Society (ACS) recently conducted a telephone survey and found some disturbing trends. In particular, its pollsters discovered that 27 percent of Americans believe that a cure for cancer already exists "but it is being withheld from the public in order to increase profits." According to the poll, another 14 percent of Americans aren't sure if this proposition is accurate, but will not dismiss the possibility. Not good news for an organization based on raising money for an impending cure!

The ACS is clearly appalled by the fact that such a large percentage of the American public believes what the ACS characterizes as the "urban myth" of a secret cancer cure, and sees it as a sign of the ignorance of the lay population. But I think there is a deeper explanation, and it is one that the ACS would do well to heed. My interpretation is that the public's wariness on this issue indicates a healthy skepticism and a pervasive distrust of the repeated bland reassurances that everything is going well in the 34-year-old war on cancer.

I have often been accused of fueling cancer conspiracy theories. However, as early as the 1970s I spoke out strongly against such theories. In my first book, The Cancer Industry, I wrote: "Not only is there no hard evidence that such a conspiracy to suppress a known cure for cancer exists, but such a theory defies logic as well" (1980).

I pointed to the obvious fact that leaders of the cancer establishment themselves are not immune to cancer and in fact often die of it. Also, at that time the pharmaceutical industry was already pouring tens of millions of dollars into the search for effective treatments.

But even though I don't subscribe to the notion that there is a conspiracy to withhold a cure, I do emphatically feel that potentially useful methods are being willfully ignored. "The important point," as I said in The Cancer Industry, "is that the suppression of unorthodox methods - and the promotion of the orthodox approach - takes place mainly at an unconscious level. It is an outgrowth of underlying economic and social trends rather than conscious design. This may explain the opposition of members of the establishment itself…to this explanation, since they swim in the sea of this establishment, and are rarely conscious of its pressure all around them.

"[T]he evidence points to the fact that it is the system itself, rather than any particular clique of individuals, which is really to blame for failure to make progress against the cancer problem. In particular, the fact that cancer management is itself a big business means that it must function according to the rules of profit-oriented institutions."

A quarter of a century later, I still believe this is true. Yes, the flat-out conspiracy theory is nonsense and easily refuted. But the fact remains that the system itself strongly favors highly profitable treatments and relegates less profitable ones to the netherworld of banned or so-called "unproven" treatments.

Something Wrong

"Why would anyone hide a cure for cancer?" asks Ted Gansler, MD, MBA, Director of Medical Strategy for the American Cancer Society and lead author of the study. "Medical breakthroughs of all kinds are quickly announced and applied - as the world has seen with antibiotics and vaccines, such as the polio vaccine."

But this statement is not entirely true. Both the Salk vaccine and antibiotics were developed despite obstruction by powerful establishment interests (developments which I detailed in The Cancer Industry). There are in fact many reasons why effective (but intrinsically unprofitable) treatments would be ignored while dangerous or ineffective (but nonetheless profitable) ones promoted. The key question is how much the treatment can make for the pharmaceutical industry and its collaborators.

To read economic research about the cancer field is to feel a chill to the bone. All this talk about how "the NSCLC market is poised for dramatic growth" sounds encouraging until you realize that this "market" is built on the combined suffering of tens of thousands of fellow human beings.

Many would argue that we cannot do without the pharmaceutical industry for developing new drugs, and perhaps under current conditions they are right. But it is ludicrous to believe that drug companies are always ethical or would not engage in behavior that was harmful to the public. We have recently seen how top officials of major multinational drug companies knowingly allowed a certain class of drugs, the COX 2 inhibitors, to remain on the market although they knew for years that these drugs were quietly killing people.

In 2004, after the COX 2 scandal broke, the Food and Drug Administration (FDA) belatedly estimated that Vioxx (rofecoxib) alone contributed to 27,785 heart attacks and sudden cardiac deaths between 1999 and 2003. But this figure, alarming as it was, proved to be a gross understatement. On November 18, 2004, an FDA official Dr. David Graham testified under oath before the US Senate Finance Committee that his agency's earlier projection was "an extremely conservative estimate." In fact, Dr. Graham revealed, the number of deaths may have been 55,000. The medical journal Lancet went further, estimating that Vioxx alone could have caused 88,000–140,000 excess cases of serious coronary heart disease in the USA, and many more worldwide.

"We are faced with what may be the single greatest drug-safety catastrophe in the history of this country or the history of the world... a catastrophe that I strongly believe could have (and) should have been avoided," Dr. Graham testified.

Yet if a single patient dies after taking an alternative cancer treatment (as very occasionally happens) the entire medical establishment is up in arms. There are furious articles, stern warnings to patients, and calls for Draconian legislation. To call this a double standard would be an understatement. It is a massively unfair system, which only seems normal to us because the injustices involved happen so often and so persistently that we have grown used to them.

Was there a conspiracy to promote the COX 2 inhibitors in spite of mounting evidence that these drugs were killing tens of thousands of people? Was there some connection between the reluctance of Merck and others to level with the public and the sale of $2.5 billion worth of Vioxx in 2003 alone? At the risk of being branded a conspiracy theorist, it is hard to escape the conclusion that there was indeed a malign purpose to these repeated oversights.

In the case of Vioxx and Bextra, the free market economy functioned with a kind of deadly efficiency. In their headlong rush to improve sales many prominent companies put millions into promoting the use of these drugs – and indirectly, through funding, enlisted the assistance of a large number of academic scientists to the same end.

The Tambocor Scandal

There are certain similarities between the Vioxx fiasco and an earlier drug scandal involving two heart drugs, Tambocor and Enkaid, which together wound up killing tens of thousands of heart patients. This fiasco also sheds some light on the question of conspiracy.

In my 1997 review of Thomas Moore's book on the subject, Deadly Medicine, I wrote the following:

"But was there a 'conspiracy' to approve a deadly medication? I think one needs to read this book to understand the complexity of it all, how the many and various parts fit together. For example, conspiracy theorists will have to account for the fact that [Dr. Robert] Temple [a top FDA official, ed.] himself had grave misgivings about the safety of this whole class of agents. Yet in the end he bowed to pressure and approved them.

"Everyone may not have been in cahoots, yet they all played their respective parts and the result was a tragedy of enormous proportions. It is more complicated by far than eight guys getting together on a boat outside the continental limits and plotting the end of the world. Yet it was not a tragic oversight, either. It was simply the way the drug approval system works in the late twentieth century."

Problem of Drug Development

The basic problem with drug development today, I believe, is a systemic one, and as such it is not one that can easily be fixed. As the regulatory process currently stands, developing a new drug in America costs many millions of dollars. The whole process of animal and human studies is intended to result in the development of a unique and patentable substance that can then be marketed for exorbitant prices around the world. A successful new drug today often grosses over one billion dollars per year. That's the pot of gold at the end of the arduous drug development rainbow.

Currently, pharmaceutical companies are granted a 20-year exclusive patent on new drugs. However, because the licensing and regulatory process can take anywhere from 7 to 10 years the drug may not start to earn any money at all until the patent is already half way to expiration. Up to 80 percent of a drug's profits can vanish in the first year after the patent expires, as cheaper, competing generics flood the market. During the short window of opportunity afforded by the patent, therefore, the company is intent on recouping its development costs along with as much profit as possible. This leads to a sales pressure that is remarkable for its ruthlessness.

But what if you propose a treatment that does not fit this Wall Street paradigm? What if your treatment is unpatentable, inexpensive or, heaven forbid, free of charge (like sunlight-derived vitamin D)? Ideally, the National Cancer Institute should undertake to develop the treatment in the public interest. But even if the NCI could be persuaded to pursue such development, no pharmaceutical company would be willing to do the essential clinical testing and marketing work, since such a treatment would not only be a money loser but might also knock out some other more profitable drug. Since no company is in business to lose money, the inexpensive treatment loses out to the expensive and highly profitable one, every time.

As a result, there has come into existence over the past century a whole alternate universe of promising treatments that are understudied, underutilized, and undervalued by almost the entire medical profession. From time to time, one of these treatments comes to public prominence, usually in the context of some controversial and highly publicized case. More often than not this leads to a backlash from the medical profession, complete with a barrage of "Where are your clinical trials?" Because of the expense involved, few clinical trials have typically been done to validate such unconventional approaches. They therefore become a prime target for ridicule, dismissal and finally suppression by the FDA on grounds that they are unproven.

Granted, some of these treatments are indeed probably worthless or even harmful. But in a surprising number of cases there are plausible grounds to suggest that there may be some therapeutic value in the treatment of cancer or other conditions. Until they are rigorously tested, it will be impossible to say whether or not they truly have scientific merit. Yet because they are relatively inexpensive and already in the public domain (and therefore unpatentable) they are ignored by the pharmaceutical industry, and excluded by default from the marketplace.

This is a much more difficult and intractable problem than some simplistic "cancer conspiracy" staffed by stereotypical villains sent over by Central Casting. How can we as citizens restructure the drug discovery and regulatory process so as to allow inexpensive treatments to be given as much attention as more expensive drugs?

This is a problem that the ACS does not even recognize, much less address. That is hardly surprising, since the ACS itself is an integral part of this high-powered game of drug development. One must first be able to see a problem before one can solve it. The ACS can do neither.

Dr. Gansler writes that "to suggest that there currently exists an all-encompassing cure for cancer that doctors are aware of is quite inaccurate." True. But that's a straw man argument (i.e., an argument set up to be easily refuted).

Furthermore, Dr. Gansler sidesteps the indisputable fact that many potentially useful treatments - from Coley's toxins in the 1890s to the latest developments in CAM today - have been systematically denied a full hearing and proper development. Public awareness of this entrenched inequity is precisely what fuels conspiracy thinking. Is it any wonder that four out of ten people no longer believe the ACS line that everything possible is being done to uncover useful treatments for cancer?

The ACS survey also asked people whether or not they agree with the following statement: "There is currently a cure for cancer but the medical industry won't tell the public about it because they make too much money treating cancer patients." Notice how the phrasing of the question itself directs people's attention away from Big Pharma and towards the doctors who "treat cancer patients." The question also presupposes that people believe in a single "cure for cancer," and then derides them for this belief! What is driving the ACS authors, as they admit, is a fear that people who believe in this conspiracy "might be less likely to adhere to treatment regimens and more likely to resort to less efficacious alternative therapies" (Gansler 2005). It is dismaying that after a brief hiatus of open mindedness, the ACS seems to have reverted to its traditional alternative medicine bashing.

When it comes to complementary and alternative approaches to illness, there is an entrenched, almost reflexive attitude of disapproval within the ACS and throughout the medical profession. Anticipating that their physicians will frown on unconventional approaches, patients are driven to conceal their intention to seek such treatments, thereby widening the gulf between doctor and patient. Large segments of the public have a sense of cynicism and disillusionment concerning the apparent stacking of the regulatory deck in favor of the pharmaceutical industry. This has helped to polarize the debate to the point where people are actually prepared to believe that the medical industry is stifling, rather than nurturing, effective cancer treatments.

In this atmosphere, for a poll respondent to say that there was no conspiracy might seem to give tacit approval to the cancer establishment's long-term indifference to potentially useful but undeveloped treatments. In this way, an affirmation of the possibility of conspiracy could be seen as a kind of protest vote.

Imagine if the ACS had framed the question as follows: "Do you believe that valuable treatments for cancer have been less than vigorously pursued because they are unlikely to earn vast profits for the pharmaceutical industry?" This phrasing would have removed the inbuilt stigma of "conspiracy theory" from the question. I suspect that if asked in this more precise way, the great majority of Americans—including many physicians-- would show their awareness that something is terribly wrong with the search for new cancer treatments.

"People with lower education levels were most likely to believe this conspiracy theory," says the ACS website. "In addition," states the paper, published in the journal Cancer, "African Americans were less likely than whites and Hispanics to reject this misconception." But let me remind the ACS authors that being from the poorer sections of the working class does not make you stupid. In fact, people near the bottom of the social order sometimes see things with greater clarity than those who move in more privileged strata. Besides, this argument is reminiscent of those ACS articles of yore claiming that people who used alternative medicine did so because they were poor and uneducated - until it turned out that in fact the opposite was the case.

Perhaps the ACS might better serve the American public by addressing the urgent need for regulatory reform within the FDA and pharmaceutical industry, rather than putting its megalithic weight and formidable financial resources to work in setting up straw men and knocking them down.

To be concluded, with references, next week.

NOTE: In last week's newsletter I mentioned use of the herbal sweetener stevia as an alternative to sugar when making jams and preserves. Since the article appeared, an anecdotal report has come to my attention of the possibility that stevia may, on rare occasions, be associated with the development of hives (urticaria).

The association is far from certain. However, I now feel it would be prudent for individuals who have existing food allergies, or are otherwise allergy-prone, to avoid stevia for this reason.

I would also be very interested in hearing from anyone who feels that his or her hives or allergies were caused by ingestion of stevia.

--Ralph W. Moss, Ph.D.

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.

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