Wednesday, 21 January 2015

Live Blood Analysis - A Scam

Dr Henry Mannings, who went through hell with the General Medical Council last year after facing groundless accusations from a vindictive consultant oncologist who objected to what the Star Throwers charity was telling his patients, recently sent me a price list from a well-known private clinic that specialises in treating cancer patients. What was shocking to us was not just the prices charged but that this clinic offered patients a service called 'live blood analysis'. Like Dr Mannings I am astounded that any reputable doctor would be offering this to patients, but it is offered and it's not cheap. So, for those who might be interested, just what is 'live blood analysis' (LBA) and is there any evidence that it is useful?

LBA, (which is sometimes called Hemaview, live cell analysis or nutritional blood analysis) is a procedure that involves taking a sample of blood, putting it on a slide and taking a look at it using a microscope. From this it is claimed that a skilled LBA practitioner can detect cancer, immune disorders, yeast and bacterial infections and a spread of other conditions. Patients will be told that the cells are not moving about in the correct way, or that they look abnormal or are showing signs of fermentation or infection and so on. Patients will be told that conventional blood tests cannot capture many of these issues because they do not look at live cells in motion. A lot of scientific sounding terminology will be used along the way, and of course the microscope is a scientific instrument so all of this must be based on fact, right? Wrong.

There is no scientific evidence for LBA. It is junk science - something dressed up to look like science but not based on any evidence or credible scientific theory.

Tuesday, 13 January 2015

Book Review - 'Being Mortal' by Atul Gawande

Keywords: Cancer, aging, medicine
Title:Being Mortal: Illness, Medicine and What Matters in the End
Author: Atul Gawande
Publisher: Profile Books
ISBN: 978-1846685811

In 'Being Mortal' Atul Gawande asks a series of difficult, important but uncomfortable questions about the nature of medicine and mortality. These are tricky waters to navigate, but essential all the same as it gets to the heart of what it is we want medicine to do for us. But navigate them we must, both because we have an aging population that often faces impossible choices regarding social care and also in the context of increasing cancer incidence (one of the consequences of that aging).

The author, a practicing doctor, uses the experiences of family, friends and patients alike to illustrate the choices that face us both in aging and in cancer care. He skilfully weaves in these experiences and in doing so puts complex problems into real situations so that he explore the options available, the things we want and cannot have and also, just importantly, draws out the underlying questions. He explores the history and evolution of patient care, how changes in the pattern of work and family life have impacted our expectations of old age. The contrasts between what we want in terms of autonomy and quality of life on the one hand, and what our medical and social care systems provides on the other are brought sharply into life. For those of us who have had to navigate these problems for elderly relatives it is familiar territory outlined with a thought-provoking honesty.

In terms of cancer the problems are starker still. When treatments fail what do we want to do? We are up against the limits of what medicine can deliver. Up against what our medical systems can cope with. The dilemma here is to risk cripplingly expensive new treatments, often with horrendous side effects or to opt instead for palliative or hospice care. These are hard choices to make, assuming we are given the choices in the first place. Sometimes there are less toxic options to try, but many doctors seem to prefer to go for the toxic chemotherapy route rather than step back and look at what the patient wants.

If there’s a theme that jumps out from this book it is that we need to be moving to a different model of the patient-doctor relationship. Dr Gawande describes this admirably. There is the doctor as expert doling out wisdom from on high. There is the doctor as information source giving facts and figures impartially to patients ill-equipped to come to a decision. And then there is the hardest option of all, which is the doctor as partner to the patient. A doctor who engages with the patient to discover what it is that is most important to them and then to help the patient make the choices that deliver the best compromises that are possible. Unfortunately many doctors are simply not trained or don’t have the tools to take this role, which is hard on the patients but hard too for the doctors.

While this is a challenging book at times, it is never sentimental or emotive, it’s humane and concerned. Medical systems the world over are in flux, struggling to cope with the increases in demand that our successes in medicine have delivered. In many ways we should not lose sight of how much progress we have made. But neither should we be happy with the status quo that leaves so many patients poorly served. Something has to give. And perhaps part of what has to give is that old-fashioned view of the doctor as expert, with the patient as passive receiver of care with no say in their own treatment.

Monday, 22 December 2014

When less is more

The conventional approach to chemotherapy treatment for cancer is to give the patient a cocktail of different chemo drugs at the maximum tolerated dose (MTD). The idea of MTD treatment is to hit the cancer with the most toxic treatment the patient can stand in the hope that it causes the maximum damage to the disease. Normally a treatment consists of a number of cycles of chemo using a mix of drugs, with the idea that each drug will attack the tumour in a different way – reducing the chance of the tumour surviving the onslaught. And it’s an onslaught for the person receiving the treatment too – most chemotherapy drugs are toxic to a wide range of cells, not just cancer cells. Hence the hair loss, the nausea, the immune suppression, fatigue and the rest of the side effects that makes chemo so hard.

Of necessity a person needs recovery time after each cycle of chemotherapy. Blood counts need to recover, sickness needs to pass, people need to regain some strength. Unfortunately that’s recovery time that tumours can also use to recover. The highest rates of tumour kill tend to be at the least cycles, the later cycles tend to be less effective, particularly if resistance starts to kick in.

However, this isn't the only way of delivering treatment. An alternative approach to chemotherapy has been developing for some time. Low dose metronomic chemotherapy involves many of the same drugs as MTD chemo, but delivered at low doses, often in tablet form, but with no treatment breaks. The continuous dosing is possible because at these low doses the drugs work in very different ways to when they are delivered at MTD levels. The side effects are minimal as the drugs are no longer acting as potent toxins to massively kill cells.

Monday, 15 December 2014

Saatchi Bill and Medical Anecdotes

Opponents of the Medical Innovation Bill (aka as the Saatchi Bill), such as Sarah Wollaston MP, have been very vocal in attacking the Bill by making a number of false claims about what the Bill will do. One such argument is that the Bill will undermine medical progress by doing away with clinical trials, and that instead we will just have to rely on individual anecdotes that arise from doctors using innovative off-label treatments on patients. In fact Sarah Wollaston even referred to the Bill as the ‘Medical Anecdotes Bill’ in her recent speech in the House of Commons.

There are a number of points that to raise in response to this false assertion.

First, there is no intention to replace clinical trials. The Bill is about treating patients with no place left to turn – these are people who have exhausted standard therapies and for whom there are few options left to explore. If a clinical trial is open and the patient is eligible then that is the place to go if it is in the patient’s best interest. There may be cases where it is the right thing to do, just as there are cases when it will not benefit the patient who is offered the additional choice of an non-standard treatment (for example an off-label drug with evidence of clinical activity in the patient’s illness). This will be decided on a case by case basis, what it will not do is force doctors to ignore clinical trials or undermine the trials process.

Friday, 12 December 2014

Not All Journals Are Created Equal

An increasing hazard in science publishing is the increasing number of 'predatory journals'. The term refers to low-quality scientific journals which exist solely to make easy money under the 'author pays' model of publishing. These journals pretend to do peer review and they look and feel like proper academic journals, but in reality they will publish anything to harvest those publication fees. It's a scam, and a successful one given the growth of the number of these journals. The way the scam works is for these journals to solicit papers, to claim they do peer review, then to accept the papers. The authors are billed the article processing and publication fees, and then the paper is published online.

There are multiple dangers in this process. The first and most obvious is that the authors are ripped off - they have effectively just paid for someone to turn there text into a web page. There has been no peer review, no proper scrutiny of the content and the chances are that the paper will be ignored by other academics. If you have a limited budget for publication fees you've just wasted it. If you are starting out in your research career publishing in these journals may seem an easy route to getting some papers to your name, but more knowledgeable colleagues will know what you've done and so the risk is that you damage your career, not enhance it. It is also possible that unscrupulous academics will deliberately use predatory journals to beef up a CV to impress people who don't know about predatory journals - all of which sound eminently respectable to the unsuspecting.

However, the biggest danger is not with academics, but with the general public. Most people are impressed by a paper that is published in a scientific journal. Scammers and snake-oil salesmen can use this to peddle fake medical treatments to desperate patients. Shoddy papers that sound scientifically plausible can be published in predatory journals and then used to convince people that there's some real science behind the scam. If you're not a scientist or someone versed in the medical literature a paper that claims to treat late stage cancer patients and to have miraculous results can be very convincing. The best examples of this are the scammers selling GcMAF as a miracle cure for cancer, autism, AIDS and just about everything else.

How can you, as a reader, verify that the journal paper you are reading is not a piece of junk published in exchange for a few hundred dollars?

Thursday, 27 November 2014

Alveolar Soft Part Sarcoma - The Reverse Warburg Effect In Action?

Alveolar soft part sarcoma (ASPS) is a rare cancer - rare even among soft tissue sarcomas - that is slow growing but hard to treat. When the disease metastasises the prognosis is generally grim and there are few options for treatment if surgical resection is not possible. A new paper, published in the journal Cancer Cell, describes work in a mouse model of the disease which may ultimately have important therapeutic consequences.

A team at the University of Utah have created a mouse model of ASPS, by fusing two strands of DNA to create a fusion gene which forms tumours in the mice in which it is implanted. What's more the resulting disease behaves very much like ASPS in humans, including producing very similar genetic profiles. Intriguingly the mouse tumours formed preferentially in areas of the body which had high concentrations of lactate. In humans this tends to be in the skeletal muscles as lactate is a by-product when our muscles are straining for energy in low oxygen conditions. In the mice the areas with the highest lactate concentrations were in the skull.

Generally tumours are believed to generate excess lactate as a by-product of their metabolism - this is known as the Warburg effect. And yet here the tumours seem to be feeding off the lactate produced by non-cancer cells. As one of the researchers, Kevin Jones explains: "It's unusual to find a cancer using lactate this way. The ASPS cells grow preferentially where they are bathed in high concentrations of lactate."

The most likely explanation is that this is yet another example of the reverse Warburg effect, first described by Michael Lisanti and his team. This is a topic of huge importance as it revises what has been seen as a core component of our understanding of cancer. In this model of cancer, the tumour cells act on non-cancer cells to change their metabolism so that they emit lactate and glutamine, which the tumour cells use as a more powerful fuel source.

This does open up opportunities for intervention, however. If we can interrupt that 'metabolic shuttle' between lactate consuming tumour cells and stromal cells they are 'farming' then we can starve the cancer cells and so slow - or possibly even halt - tumour growth.

Cimetidine as an anticancer drug - New ReDO paper

The latest paper from the ReDO project has just been published. Our focus for this paper is the well-known antacid cimetidine (trade name Tagamet, but now available as a generic). The paper summarises the extensive pre-clinical and clinical evidence that shows cimetidine has huge potential in cancer treatment. It has multiple mechanisms of action and there is clinical trial evidence that it is associated with a survival in colorectal cancers.

The paper is published as open access at the journal ecancer.

The press release provides a few more details:

How a common antacid could lead to cheaper anti-cancer drugs

The cancer solution in your medicine cabinet

A popular indigestion medication can increase survival in colorectal cancer, according to research published in ecancermedicalscience. But in fact, scientists have studied this for years - and a group of cancer advocates want to know why this research isn't more widely used.

"Cimetidine is an interesting drug as it's very safe, very well-known, and has clinical results in cancer that have been confirmed in a number of trials," says Pan Pantziarka, lead author of the paper and member of the Repurposing Drugs in Oncology (ReDO) project.