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?