Tuesday 29 January 2013

More On Stress and Cancer

A new open access research paper, 'Behavioural Stress Accelerates Prostate Cancer Development in Mice' (http://www.jci.org/articles/view/63324), adds more detail to the emerging picture of the relationship between stress and cancer. In this case the research team used mouse models to investigate the effect of stress on the development and progression of prostate cancer. And, as expected, those mice subjected to a stressful environment had greater incidence of cancer and higher rates of disease progression. And, just as importantly, some of the ill-effects of a stressful environment could be prevented through the use of drugs that interfere with the stress response to raised adrenalin and noradrenaline (i.e. like beta blockers).

From a science point of view this paper uncovers some of the molecular mechanisms at play here, which further advances our understanding of the relationship between psycho-social stresses, the resulting hormone stress response and the process of cancer initiation and progression.

However, it's the human angle that is of direct interest to me, (and to most readers of this article I would guess). What this new paper does is point out the horrible vicious circle that is at play here. As we know a cancer diagnosis is an incredibly frightening and stressful experience. It shakes your world up completely. The body responds to this stress by releasing adrenaline and other stress hormones. These can drive the cancer forward, causing even more stress as the disease progresses. It's not just the bad news. Cancer treatments are stressful too. Physically they are hard to take - there are side effects of drugs, radiotherapy and surgery. But there's also the stress induced by the whole process - the endless waiting, the delays, the uncertainty, the feeling of being disempowered.

Tuesday 15 January 2013

Statement from Star Throwers

Dr Henry Mannings Restrictions Lifted After Review Hearing

Star Throwers are delighted to declare that all restrictions placed on Dr Henry Mannings imposed after an initial Interim Orders Panel (IOP) hearing on the 27th November 2012 have been revoked.

Back in November, an Interim Orders Panel imposed an order on Dr Mannings to restrict him from prescribing any medication.

At the IOP review hearing on Monday 14th January 2013, Dr Mannings, who represented himself, produced additional scientific evidence to the panel to prove the efficacy and safety of his approach in the cases of the two patients in question. He also reiterated the testimonials from eminent specialists which disagreed with and challenged the allegations made. Furthermore, the petition which has garnered approximately 3000 signatories so far was brought to the panel's attention, along with the hundreds of letters of support written from patients and families of patients.

In their conclusion, the Interim Orders Review Panel wrote: "The scientific papers to which the Panel has been referred indicate that the treatment which you gave was minimally toxic in the dosage you prescribed.

“In light of this additional information it does not consider that you present a risk to the public which makes it necessary to impose an interim order. It considers that an interim order could have a serious impact on you and the patients in your care and the risk posed does not justify these consequences.

“In all the circumstances, the Panel has determined that it is no longer necessary for the protection of members of the public, in the public interest or in your own interests for your registration to be subject to an order. The previous interim order is therefore revoked."

The hearing was held in public at the request of Dr Mannings in order to have full transparency, and was attended by members of the press and supporters of Dr Mannings.

Dr Mannings said after the hearing: "I am obviously very pleased with the common sense shown by the interim panel and their realisation of all the good work that is done at Star Throwers, based on all the evidence that was shown, including the petition and letters of support.

He continued: “We are exceptionally pleased that we will now be treating patients again, but can only hope that the time lost whereby they had not received any treatments will not have any long term consequences. "

The GMC will continue their investigations into the veracity of the allegations and a full hearing may still ensue. In the meantime, however, it is a very positive result for Dr Mannings and his patients.

Star Throwers manager Steven Ho said: “We are delighted at this common sense outcome as we can now go back to work giving the best service we possibly can to our patients and continue our important work looking after people affected by cancer.

“Once again, we would like to thank every single person who signed our petition, wrote a letter of support or helped to spread the word through their friends, families, and the media. We did it!”

Monday 14 January 2013

Henry Mannings - Successful Appeal

It's with great pleasure that I can report that Dr Henry Manning's appeal to the GMC's Interim Orders Panel has been successful and that all restrictions have been lifted. This is great news as it means that Henry can pick up where he left off treating patients at Star Throwers.

While we all should all be pleased, I can't help but feel angry at the whole affair. Effectively treatment was interrupted for cancer patients with no other options. And, just as importantly it cast a cloud over Dr Mannings professional reputation - one that effected his ability to earn a living in the short term and which may have damaged his reputation permanently in the long term. And why? Because one other doctor took it upon himself to make a complaint that had no foundation. As anyone who reads the transcripts can see, this lone doctor pretended to speak on behalf of his colleagues when in fact he was speaking for no one but himself. Will there be any come back? I'm not holding my breath, but if this doctor had any integrity he'd make a public apology.

Thursday 10 January 2013

More On Beta Blockers

Back in October 2011 I wrote about the increasing evidence that beta blockers – normally prescribed for high blood pressure – might have some significant anti-cancer effects. A recently published paper, this time looking at people treated with radiotherapy for non-small cell lung cancer (NSCLC), examined what effect taking beta blockers had. And, it has to be said that the results were very positive.

Specifically, those taking beta blockers had better distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS), even after taking account of age, disease staging and previous treatments. This suggests that taking beta blockers is independently associated with better overall survival. Mostly the effect seems to be related to stopping metastatic spread of the disease, as there was little evidence that it had much effect on the primary tumour. However, it’s worth keeping in mind that very often it’s the metastases that ultimately kill rather than the primary tumour.

This was a retrospective study, which means the data for it came from previously treated patients, but it was reasonably large (722 patients, of whom 155 were taking beta blockers). So, while this is solid evidence it’s not the same as a randomised clinical trial. There are lots of questions still to be explored, for example does the effect of beta blockers depend on prior exposure (i.e. do you have to have been taken them for a long time before diagnosis), is the effect still there if beta blockers are started after diagnosis, and at what dosage?

The hope is that this additional study adds to the weight of evidence and that it helps make a really strong case for some controlled clinical trials.

The paper reporting the trial can be downloaded here.

Monday 7 January 2013

Dr Mannings - Case Review

We start the year with some good news regarding Dr Henry Mannings. The General Medical Council's Interim Orders Panel has granted an early review of his case. A new panel will sit on Monday Jan 14th, and will decide whether to uphold, amend or revoke the restriction on Dr Mannings ability to prescribe medication. We hope, of course, that the restriction is completely lifted. And, in time, we hope that a full investigation will reveal the dishonest and political nature of the allegations against him. In the meantime the petition and other activities in support of Dr Mannings can only help his case.