MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

The objective of this survey was to determine

  1. which patients’ characteristics are associated with the use of so-called alternative medicine (SCAM) during cancer treatment,
  2. their pattern of use,
  3. and if it has any association with its safety profile.

A total of 316 patients undergoing chemotherapy treatment in cancer centers in Poland between 2017 and 2019 were asked about their use of SCAM.

Patients’ opinion regarding the safety of unconventional methods is related to the use of SCAM. Moreover, patients’ thinking that SCAM can replace conventional therapy was correlated with his/her education. Moreover, the researchers performed analyses to determine factors associated with SCAM use including sociodemographic and clinical characteristics.

Crucially, they also conducted a survival analysis of patients undergoing chemotherapy with 42 months of follow-up. Using Kaplan-Meier curves and log-rank analysis, they found no statistical difference in overall survival between the groups that used and did not use any form of SCAM.

The authors concluded that SCAM use is common among patients undergoing chemotherapy treatment and should be considered by medical teams as some agents may interact with chemotherapy drugs and affect their efficacy or cause adverse effects.

As I have stated before, I find most surveys of SCAM use meaningless. This article is no exception – except for the survival analysis. It would have merited a separate, more detailed paper, yet the authors hardly comment on it. The analysis shows that SCAM users do not live longer than non-users. Previously, we have discussed several studies that suggested they live less long than non-users.

While this aspect of the new study is interesting, it proves very little. There are, of course, multiple factors involved in the survival of cancer patients, and even if SCAM use were a determinant, it is surely less important than many other factors. To get a better impression of the role SCAM plays, we need studies that carefully match patients according to the most obvious prognostic variables (RCTs would be problematic, difficult to do and unethical). Such studies do exist and they too fail to show that SCAM use prolongs survival, some even suggest it might shorten survival.

26 Responses to So-called alternative medicine (SCAM) for cancer: does it prolong survival?

  • Don’t worry, Professor, I’m sure Dana will be along shortly to declare that the red line is above the black line and take all the credit for Homeopathy, while totally ignoring that:

    1. This was a low-quality observational study where all of the myriad confounders have far larger error bars than that gap, and

    2. What CAM invariably promises to cancer sufferers is Cures; so anything less than a perfectly horizontal red line means that CAM treatment has catastrophically failed†.

    † Of course, when this is pointed out to them, CAMmers will simply declare it the patients’ fault for also using conventional oncology, for insufficient dilligence in following CAM procedures, for just not believing hard enough. Because CAM never fails patients; it’s always patients who fail CAM.

  • I find most surveys of SCAM use meaningless. This article is no exception – except for the survival analysis.

    I would say that the survival analysis is also meaningless, since the CAM users are a self-selected group. Though I am pleased that they have used a Kaplan-Meier curve to display their survival data, as this is much more informative than simply selecting a few figures.

  • Isn’t the simple fact that CAM-users are more highly educated (=higher income on a population basis) explaining all of the gap in the Kaplan-Meier?

  • Only a minority will have the time and endurance to learn enough about this subject to save themselves before it is too late e.g. absorbing Warburg, Campbell, Gerson, Klenner, Cathcart and Cameron takes a year or two, let alone Seyfried (that requires some organic chemistry) – and no one will do it properly unless they “get it” e.g. healing reactions are shocking (unless you expect them).

    But suppose the healing-reaction is a progression – how is the DIYer to know? They and only they can decide what to do, free from force (depending on one’s oncologist, and one’s family).

    Looking at the above graphics (the vitamin C group vs mushrooms vs whatever…) is floating in space! What about the fundamentals of Air, Water, Food, Exercise etc, for starters (ignoring other preconditions such as the 0.5g of Na in one croissant/whatever is already the daily limit, Gerson-wise).

    From this “ground zero”, *then* you start the DIY therapy, + conventional therapy that you and your friendly oncologist figure out on the fly.

    • Only a minority will have the time and endurance to learn enough about this subject to save themselves before it is too late e.g. absorbing Warburg, Campbell, Gerson, Klenner, Cathcart and Cameron takes a year or two, let alone Seyfried

      Aww, Bob is so adorable when he tries to fake academic respectability. Just cloyingly desperate for approval. But honestly, Quack, Quack, Quack, Quack, Quack, Quack, and Quack works just as well here; and saves a couple years too.

      (Disappointed Bob didn’t throw in some Clark, Simoncini, and Young too, because Cancer SCAM is an absolute smorgasbord of mutually contradictory “One True Cause and Cure” assertions; and the more you do know about them the quicker you realize that it’s logically impossible for all of their claims to be true, and that the whole freaking lot of them are really just predatory scumbags who need to be pushed under a truck as an act of public service.)

      • has on Thursday 28 January 2021 at 17:50 said:

        “(Disappointed Bob didn’t throw in… “One True Cause and Cure” assertions…)”

        Sure, but I disagree with “Cure” because you cannot “cure” a continuing process from birth to death… if we live long enough, we will either die of it or with it.

        Intermutational and intramutational heterogeneity are the reason for the failure of the SMT to find a “cure” for cancer (page 114-118 of Tripping Over The Truth by Christofferson) but you ain’t seen nut’in yet! – Page 146 winds up experiments done by two different groups, the second, Jerry Shay’s at the university of Texas, finally, after repeating the results of a previous group (failure of cancer to follow the nucleus) reversed the experiment and “…When they transplanted the recons containing a malignant cytoplasm and a normal nucleus into newborn mice, 97 percent of the mice developed tumors”

        In other words, the cancer went with the cytoplasm, not with the nucleus.

        Shay tripped over the truth but picked himself off and hurried off without noticing (this same Churchillian quote is used by Gerson at the end of one of his chapters).

        • Aww, Bob is still trying to talk like he thinks a real scientist talks, effecting an affable air of expert informality peppered with Sonorously Significant Surnames.

          Protip, Bob: Real scientists cite their primary sources, typically in form of PubMed links to the original peer-reviewed research, not self-published Amazon book titles† flogged to pretentious mugs like you.

          Get out, you risible fraud. Once again fooling no-one but yourself.

          † Not even one step up from YouTube links on the Hierarchy of Scientific Evidence.

          • has on Friday 29 January 2021 at 10:33 said:
            “…Get out, you risible fraud. Once again fooling no-one but yourself.”

            https://en.wikipedia.org/wiki/Psychological_projection
            https://en.wikipedia.org/wiki/Ad_hominem
            https://en.wikipedia.org/wiki/Shooting_the_messenger

          • Looks like we can ad logical fallacies to the list of things Bob doesn’t understand.

            Much like with science, the quacks see their arguments being dissected by people and imagine that they can use the same techniques.

            They can’t.

            They are just words, Bob. You need to understand them.

          • @Bob: Mildly amusing, but I’m not the one here who’s pretending (poorly) to know more than I do. Hell, I couldn’t even make it past 1st-year pre-med. My understanding of science and medicine is only very slightly better than “absolute layman”; inasmuch as I understand that it’s A Bit More Complicated Than That.

            (And by “a bit” I mean massively, massively more complicated; and that’s even before you get to pathologies, which is 3rd-year onwards for good reason.)

            Now, most of the surnames you “cited” (without, you know, actually citing anything) I don’t recognize, but I spot Max Gerson right away, and know that particular (and thankfully now dead) loon clamied to cure cancer with vitamin megadoses and coffee up the poop chute. Never actually did the work that would [dis]prove this, mind; just lots of grandiose claims and personal testimonials, and no doubt made good money doing it too.

            However, I do vaguely remember there was a study done on a “protocol” very similar to Gerson. And that study found patients on the Gerson-ish arm actually died sooner and had poorer quality of life than those on palliative care only. Which I can’t say I find surprising. After all, if I really wanted to make desperate frightened people utterly, wretchedly miserable in their last few months of life, then forcing them to choke down vast numbers of pills and forcing coffee up their arse a good five times a day, every day, would be a pretty damned effective way to wreck their bowels, their homeostasis, and their general will to live. Especially when, after they fail to get better, I blame not the “treatment” but the patients themselves for just not trying hard enough.

            Now, if I can eventually track down that study I’ll be happy to post both its title and URLs to primary source and/or further reading, so that anyone here can follow it up without having to trawl through Amazon’s sewers for themselves.

            However, seeing as you’re already a self-appointed expert in anal-coffee-chugging and pill-popping, perhaps you are already aware of this paper and can link it here first? After all, someone who respects the power and limitations of medical science and the patients who trust their lives to it should be unafraid of announcing negative results as negative results, and moving on. After all, it is only by being wrong again and again, admitting and acknowledging each time that we are wrong, and working to understand how and why we arrived at that wrongness, can we ever hope to become less wrong in time.

            That’s how science works; and though I may not know much about science, I really don’t need to know much to spot when someone is faking its form really, really terribly. Because if science research sounds a little like Sherlock Holmes, you sound absolutely nothing like that at all.

            And while you may think you are stand-out special, trust me: quack scammers are a dozen a-penny; and you can’t possibly all be correct, so the only question I actually need ask is:

            What have any of you ever done to prove yourselves wrong?

            And yeah: <crickets&rt;.

          • has on Friday 29 January 2021 at 10:33 said:
            “Aww, Bob is still trying to talk like he thinks a real scientist talks, effecting an affable air of expert informality peppered with Sonorously Significant Surnames.

            Protip, Bob: Real scientists cite their primary sources, typically in form of PubMed links to the original peer-reviewed research, not self-published Amazon book titles† flogged to pretentious mugs like you.”

            Quote, page 44, Surely You’re Joking Mr Feynman, by Richard Feynman:
            “…TANto SAca TULna TI, na PUta Tuchi PUti TI la.
            RUNto CAta CHANto CHANta MANto CHI la Ti da…”
            end-of-Quote

          • My best guess at the Shay paper is:
            Jerry W Shay & Y N Liu; Cytoplasmic suppression of tumor progression in reconstituted cells; August 1988; Somatic Cell and Molecular Genetics 14(4):345-50; DOI: 10.1007/BF01534642
            https://www.researchgate.net/publication/19756296_Cytoplasmic_suppression_of_tumor_progression_in_reconstituted_cells (not paywalled)

            But OldBob says: “When they transplanted the recons containing a malignant cytoplasm and a normal nucleus into newborn mice, 97 percent of the mice developed tumors”. I couldn’t see that any actual mice were used in the work described in that paper.

            The language of the quote isn’t what I’d expect to find in a published paper, so I’d guess the source is secondary at best.

          • And Bob continues to prove he’s got nothing but bluster and evasion.

            Here’s a secret, Bob: We already know beyond doubt that AltMed is a fraud, because if AltMed was a science then all of its practitioners would be locked in knife-fights-to-the-death with all its other practitioners, until only one (or none) is left alive. That’s how science works, because when science encounters two claims that are mutually contradictory, it knows that it is logically impossible for both to be right. Therefore one of them (at least) must be wrong and, science being science, it will not stop until it has resolved that contradiction and dispensed the loser(s) to the annals (or rectum, in this case) of ancient history. They did it to Galen, they did it Ptolemy, they even did it to Hoyle; and nobody regrets their passing because now we have antibiotics, machines exploring every planet, and a workable (if incomplete) explanation of how our universe itself came to be.

            You Alties may indulge the occasional internal tribal skirmish, but the open truth is that you are all thick as thieves; and none of you would ever dare destroy each others’ houses as you know damn well your own would fall down too. All of your “causes” and “cures” flat out contradict each other, and none of you care about this one whit. No matter that lives are literally on the line here, and errors cause suffering, penury, and death. All you care about is how wonderful you are, puffing yourselves up with indulgent fluffs, singing your own praises to hopeful new convents, and all in perfectly agreement with each other on the one single point that perfectly represents what you’re all about: that it’s real medicine which is evil and wrong and worthless and should be destroyed. That is beyond offensive; it is the calculated and deliberate abuse of other people, all for your own personal profit and glory.

            When the Khmer Rouge seized power, one of their earliest acts was to drag all the real doctors and nurses out into the paddy fields and shoot them in the head, just so they could dress up and play at being doctors and nurses themselves.

            And that’s you, Bob. What you really are at heart. A malicious, abusive, narcissistic child. The only reason you don’t murder people in person as the Maoists did is that you don’t feel the need, nor have the stones to look them in the eye when you do it. But you’re perfectly happy to kill them at a distance—by deception, manipulation, exploitation, neglect, and denial. Which is why I absolutely despise you, and all like you, you festering sack of pompous pretentious shit. Not because you are a flawed, dishonest, cowardly person—because all of us are that—but because you absolutely revel in it: taking gleeful delight in smearing your precious shit over everyone else, then giggling and running away when called out on it.

            I sincerely hope Prof Ernst will permit this post despite its language, because it is difficult for me to express what a petty malicious monster you truly are—that AltMed cultists are—without it. And you lot weaponize language every day—if we display emotion we are “rude”; if we don’t we are “cold”—so whichever I use I will not win that way. The only way I can win is by being absolutely, rigorously honest in my words and behavior; which is something you cannot and will not ever match. So this is me, and I am sick past disgust of you cultists’ endless abuse, and for my own wellbeing if no-one else’s I shall not entertain it any further.

            /out

          • The Gerson-like AltMed “treatment” that I mentioned previously, that wrecked its patients instead of curing (or even pallating) them, I have finally remembered was the “Gonzalez Protocol”.

            https://sciencebasedmedicine.org/the-gonzalez-trial-for-pancreatic-cancer-outcome-revealed/

            https://sciencebasedmedicine.org/gonzalez-regimen-for-cancer-of-the-pancreas-even-worse-than-we-thought-part-i-results/

            Unfortunately, I get a 404 when clicking on the cancer.gov link to the original study, so I shan’t repost that link here. Still, there is more than enough detail there for someone else to track down the original—damning—work if they wish to compare.

            KBO, Prof Ernst.

          • has on Friday 29 January 2021 at 20:30 said:

            “My understanding of science… it’s A Bit More Complicated Than That… but… Max Gerson… clamied to cure cancer…Never actually did the work that would [dis]prove this, mind; just lots of grandiose claims and personal testimonials… And while you may think you are stand-out special… What have any of you ever done to prove yourselves wrong?”

            Being a an anonymous nobody, I have nothing to gain or lose, reputation-wise (that fit with previous posted link to Stoicism by James B. Stockwell).

            You have read Feynman? – if so that is the way to be: anti-establishment – reputation is irrelevant to him, only reality – the psychological-test for the army found him nuts, (to the delight of Hans Bethe)
            From memory:
            Guys standing in line; one says to Feynman,
            “Hey, to avoid the army, just do this.”
            “Well why don’t you do dat!”
            “Oh, I wanna join the army!”
            “You wanna join, do that, and they’ll take you!” (ya gotta be mad to be invited – Feynam said it better, whatever it was, I can’t remember)

            Evidently if I make any claim, it has no meaning (being anonymous), hence I just reference other stuff.

            Projection:
            Evidently I project myself onto other people by default, it is biologically impossible to avoid, being subconscious, so I expect everything I say to be trivial, hence I try to condense to the minimum – a touch here and there, like a sketch – maybe this gives the appearance of trivia (to the content too?) by association? But for my own self-protection (why if one is anonymous?) I try to walk quietly and carry a big stick – at least that is a constant aspiration of mine: a good margin of safety – so that if someone says “That’s a load of bollocks”, there is nothing to reply, whereas “Why is that?” or “Prove it” – then that is the invitation for my indulgence (but only if invited).

            And you have done just that 🙂 With your “mildly amusing” – thank you, we have some common ground 🙂 (Feynman – the anti-authority figure from Rockaway, who wanted to jump backwards like a frog after accepting his Nobel).

            Suppose I said “Gerson is wonderful” – that has no meaning, from an anonymous nobody from nowhere, also I don’t speak German – but he wrote a book in English that still sells today on Amazon – the first sentence says, something like “People ask me what is my secret? There is no secret!…” ).

            The minimum standard required to access Gerson would be a doctor, a German doctor, and most folks want “a reputation” as a prerequisite, otherwise that referee carries no “weight” (see short story by Thurber called “What the leftists are trying to say”, on the “unmasking” – if you like James Thurber?) – ideally contemporary with Gerson and nobel laureate too, maybe also an expert of Bach performances?

            That guy would be Albert Schweitzer who said that Gerson was probably one of the most eminent physicians of the 20th century – so why would he say that?

            Now who would be best to access Gerson? How about a newspaperman who was determined to expose him? That would be S. J. Haught:
            https://www.amazon.com/Censured-Curing-Cancer-American-Experience/dp/B08KHR758Z/ref=sr_1_1?dchild=1&keywords=haught+Gerson&qid=1612004303&sr=8-1

            Why did Haught change his mind? He prints the correspondence he had with the AMA – you can read it for yourself and decide who is telling the truth, the AMA or Gerson. Haught also prints the transcript of the 1946 sub senate committee of Neely/Pepper – the reader can decide for themselves the veracity of that too. Likewise the reaction to Raymond Gram Swings broadcast of said committee’s evidence and later, the reaction to the broadcast of Long John Nebel – the reader can decide.

          • prl on Saturday 30 January 2021 at 07:55 said:
            My best guess at the Shay paper is:
            Jerry W Shay & Y N Liu; Cytoplasmic suppression of tumor progression in reconstituted cells; August 1988; Somatic Cell and Molecular Genetics 14(4):345-50; DOI: 10.1007/BF01534642
            https://www.researchgate.net/publication/19756296_Cytoplasmic_suppression_of_tumor_progression_in_reconstituted_cells (not paywalled)

            Hi prl, here is (mostly-I-hope) more pages from the book:

            Quote, page 145-146, of Tripping Over The Truth by Chrisstofferson:
            “Two groups working independently, one in Vermont and the other in Texas, performed a meticulous series of nuclear transfer experiments, both with shocking results. The experiments consisted of a simple transfer. Warren Shaeffer’s group at the University of Vermont wondered how much control the cytoplasm… had over the process of tumorigenesis. To find out they conceived of a beautiful experiment. Simply put, they took the nucleus of a cancer cell and transferred it into a healthy cell with its nucleus removed. The reconstituted cell (or recon) now contained the DNA of the cancer cell, with all its supposed driver mutations, but retained the cytoplasm and mitochondria of a noncancerous cell.

            The recon now had tremendous power. It alone could answer the question of who was right: Warburg or Varmus and Bishop. If mutation to DNA caused and drove cancer, the recons should be cancerous, regardless of their healthy mitochondria. But if, as Warburg, Pedersen, and Seyfried contended, the mitochondria are responsible for starting and driving cancer and mutations were largely irrelevant, the recons should be normal, healthy cells.

            The Vermont group found that when they transplanted the recon cells into sixty-eight mice, only a single mouse grew a tumor over the course of an entire year. The cells containing the mutations thought to be responsible for the disease were silenced by the healthy cytoplasm (mitochondria). But without a metabolic theory of cancer in place, or any theory that explained these results, Schaeffer’s groups was not sure what to think. They knew that what they found contradicted the prevailing dogma, but they struggled to find an explanation that made sense.

            While the Vermont group mulled over the strange outcome, Jerry Shay’s group at the University of Texas Southwestern Medical Center in Dallas confirmed Schaeffer’s results. They ran the same transfer experiment and injected the recons into ten mice. Not a single one developed a tumor, substantiating the amazing result seen in Vermont. Like Schaeffer’s group, the Texas group struggled to make sense of the results. To ensure that an experimental artifact wasn’t screwing up their finding, S?hay’s group performed a set of painstaking controls. They took the nucleus of a cancer cell and transferred it into the cytoplasm of another cancer cell. They wanted to make sure that the experimental procedure itself wasn’t responsible for turning the recons into normal cells. Seven out of the eight control recons remained cancerous when transferred to the mice. They then reversed the control and transferred normal nuclei into normal cytoplasm. None of these recons turned cancerous in the mice, confirming that the shocking results were not due to an experimental artifact.

            Schaeffer’s groups next ran the same eperiment in reverse. Instead of adding the nucleus of a cancer cell to the cytoplasm of a normal cell, they added the nucleus of a normal cell to the cytoplasm of a tumor cell (a whole tumor cell with its nucleus removed). If mutations to DNA caused cancer, the recons should remain healthy, normal cells. However, if damage to the mitochondria, followed by a retrograde response to the nucleus, was the cause of cancer, the recons should become cancerous. Again the results flew in the face of everything known about cancer, directly contradicting the SMT of cancer. When they transplanted the recons containing a malignant cytoplasm and normal nucleus into newborn mice, 97 percent of the mice developed tumors…”
            End-of-quote

            Quote from page 147:
            “Schaeffer recalls:
            Inner-quote:
            “My only thoughts then, as now, is that the results we obtained were due to epigenetic effects. Obviously, since the nuclei were obtained free of cytoplasm and were then fused into cells from which the nucleus was removed, one also has to take into consideration the effect of mitochondria. Something akin to nuclear/cytoplasmic incompatibility. That was also the thinking of Junichi Hyashi, then a postdoc with Jerry Shay in Texas. We talked about this a great deal. Unfortunately, the wisdom (or lack of it) from NIH study committees would not entertain such an idea at the time.”
            End-of-inner-quote”
            End-of quote.

        • Old Bob,

          When they transplanted the recons containing a malignant cytoplasm and a normal nucleus into newborn mice, 97 percent of the mice developed tumors

          If this is true then it would be an interesting and important paper. However, I doubt very much that these were the findings, not least because it is not usual to report this kind of experiment in percentages. Biomedical scientists (hopefully) have enough training in statistics to know that it is misleading to report percentages rather than absolute numbers unless the number of subjects is large enough, by which I mean at least 100 or so, and if not the authors, then at least the editor of the journal they published in. I would be very surprised if anybody doing this sort of work would have used more than a minimum number of mice, not only because of the cost and effort involved but also that their application for a licence to use live animals would not otherwise have been approved.

          I would be very interested if you could provide the reference to the original published paper – you should have it to hand in Christofferson’s book.

          • Dr Julian Money-Kyrle on Saturday 30 January 2021 at 10:54
            Old Bob,

            “I would be very interested if you could provide the reference to the original published paper – you should have it to hand in Christofferson’s book.”

            Quote from references to Chapter 6: Mitochondria: An Old Theory Is New Again, page 234:
            “…
            Schaeffer, Warren I. In discussion with the author. 2014

            Shay, Jerry. In discussion with the author. 2014
            …”
            end-of-quote

          • Old Bob,

            “I would be very interested if you could provide the reference to the original published paper – you should have it to hand in Christofferson’s book.”

            Quote from references to Chapter 6: Mitochondria: An Old Theory Is New Again, page 234:
            “…
            Schaeffer, Warren I. In discussion with the author. 2014

            Shay, Jerry. In discussion with the author. 2014
            …”
            end-of-quote

            Well then, it seems that I can’t look up the original papers to see what their methods were or their findings. The quotes you provide describe the experiments in layman’s terms and with very little detail, which doesn’t really mean very much to me.

            Quote from page 147:
            “Schaeffer recalls:
            Inner-quote:
            “My only thoughts then, as now, is that the results we obtained were due to epigenetic effects. Obviously, since the nuclei were obtained free of cytoplasm and were then fused into cells from which the nucleus was removed, one also has to take into consideration the effect of mitochondria. Something akin to nuclear/cytoplasmic incompatibility. That was also the thinking of Junichi Hyashi, then a postdoc with Jerry Shay in Texas.

            I would expect epigenetic effects to follow the nucleus, not the cytoplasm. Also I should point out that cytoplasm contains a great many other things besides mitochnodria. One thing I would expect to find is mRNA transcribed from the nucleus that had been removed, which would contain copies of mutations from the cancerous nucleus, as well as abnormal levels of transcription factors which would bind to the new nucleus and alter gene expression in the fused cell.

            If prl is right about the paper he has managed to find, note that the date of publication is 1988, which is just after I first qualified as a doctor. I have been retired for four years now after thirty years of practice, and in that time the explosion of the discipline of molecular biology has given us the tools to examine in great detail what is going on in tumours at a genetic level and has turned our understanding of cancer upside-down. It is now routine to profile the mutations found in a newly-diagnosed cancer and to prescribe drugs targeted against the pathways involved. Whole-genome sequencing can be done in an ordinary pathology lab in an afternoon and at a cost of a few hundred pounds. There are still a lot of details being worked out, of course, as the pathways are very complex, but biomedical scientists all over the world are doing just that.

            You have read Feynman? – if so that is the way to be: anti-establishment – reputation is irrelevant to him, only reality

            Richard Feynman is somebody that I have a huge amount of respect for, and I have enjoyed reading his writing, though I haven’t tackled the more advanced physics as I have better things to do than to learn the maths required. He was a superb teacher as he could explain things very clearly (the first chapter of “Six Easy Pieces” summarises high school physics in a way that is completely different from how I was taught yet very easy to understand). More than that, he was interested in everything, and always based his hypotheses on his own observations, rather than taking somebody else’s word for it, before testing them experimentally.

            If you haven’t already, I can strongly recommend his report on the Challenger space shuttle disaster. He was put on the investigation committee to add legitimacy to its findings, but he refused to be party to any politically-driven whitewash. By talking to the engineers working on the shuttle programme he came to realise that their estimate of the reliability of the shuttle was two orders of magnitude less than that of their managers and that the real cause of the problem was the environment within NASA that stifled free communication. The proximate cause of the explosion was a fuel leak due to a seal losing its flexibility as a result of the cold weather; the weather should have prevented the launch but they went ahead anyway. He was banned from talking about this in the subsequent press conference, so he gave a demonstration instead – after the seal had been passed around the journalists he bent it and put it into his glass of iced water, then held it up to show that it didn’t straighten again when it was cold.

            Feynman’s one goal was always to find out the truth and to communicate it as clearly as possible, regardless of whether those in authority might disapprove. He wasn’t anti-establishment, but he didn’t like being told nonsense.

            That guy would be Albert Schweitzer who said that Gerson was probably one of the most eminent physicians of the 20th century – so why would he say that?

            Albert Schweitzer was born in 1875 and died 55 years ago, when medical practice was utterly different from what it is today, though his endorsement of Gerson was longer ago still, though I have no idea why he did that. Scweitzer was distinguished for his work as a missionary, a theologian and a philosopher, as well as for championing the organ works of J S Bach. He won the Nobel Peace Prize, not the prize in medicine.

            It is not just medicine which has moved forward in the last century or so. Our understanding of J S Bach has also changed, and Schweitzer’s recordings are painful to listen to when judged by modern standards, though I generally enjoy historical performances of music, which are often thought-provoking.

          • Dr Julian Money-Kyrle on Saturday 30 January 2021 at 22:43 said:

            A: “I would expect epigenetic effects to follow the nucleus, not the cytoplasm…”

            And

            B: “…Also I should point out that cytoplasm contains a great many other things besides mitochondria. One thing I would expect to find is mRNA transcribed from the nucleus that had been removed, which would contain copies of mutations from the cancerous nucleus, as well as abnormal levels of transcription factors which would bind to the new nucleus and alter gene expression in the fused cell.”

            So if B is true, then “…epigenetic effects…” will follow the “cytoplasm”, making A “false”.

            In A, the “…follow the nucleus…” is Central Dogma whereas “…epigenetic effects…” are the reverse (feedback from the “outside” controls the “inside”) hence A should read: “I would expect epigenetic effects to follow the cytoplasm (“outside”), not the nucleus (“inside”).”

            “…Whole-genome sequencing can be done in an ordinary pathology lab in an afternoon and at a cost of a few hundred pounds. There are still a lot of details being worked out, of course, as the pathways are very complex, but biomedical scientists all over the world are doing just that…”

            But heterogeneity makes bespoke treatment impossible, per mutation, per cell, per tumour.

            And even if the cancer is homogeneous and “targetable”, there are problems e.g. quoting again:

            Quote Christofferson describes the story of Imatinib (Gleevec) (p148-153):
            “…The holy grail of chemotherapy: a nontoxic cure. But it carried a hidden danger… The problem lay with the fact that as far as cancers go, CML is unique. Unlike the vast majority of solid tumors, CML is remarkably homogeneous. While most tumors display a hurricane of genetic chaos, CML is pure, its genetic landscape dominated by a single alteration: the Philadelphia chromosome. Author Clifton Leaf put it this way: “the danger of the targeted drug revolution – of The Gleevec Story – is that it oversimplified cancer, treating the disease as an orderly march to disorder, the result of a lone, driving genetic aberration. That is not the case with the vast majority of cancers.” …The vast majority of cancers are too complex to apply the “Gleevec model” to them. Watson admitted that it might be an impossible task, as did Loeb, as did Voglstein.

            Imatinib posed another danger: In addition to serving as proof of principle for targeted drug design, it seemed on the surface to validate the SMT of cancer. It appears that CML originates and progresses due to a single, pervasive genetic alteration. Digging deeper, however, researchers found that the Philadelphia chromosome exists in perfectly healthy people who will never develop CML – this was a small but crucial detail. That simply cannot be. If the Philadelphia chromosome alone caused CML, these blissfully ignorant individuals should harbor the malignancy, but this is not the case. The out-of-control kinase produced by the BCR-ABL gene is not enough by itself to cause CML. Further, more advanced cases of CML do not always respond to imatinib. Twenty percent of advanced cases succumb to CML, even with imatiainib therapy and even with a single supposed “founding” mutation that permeates the entire genetic landscape for the cancer – a single mutation that a targeted therapy could grab hold of in every cancer cell, not just a fraction. These two facts provide clear proof that something else beyond BCR-ABL is driving the disease…”
            end-of-quote

          • Old Bob,

            Dr Julian Money-Kyrle on Saturday 30 January 2021 at 22:43 said:

            A: “I would expect epigenetic effects to follow the nucleus, not the cytoplasm…”

            And

            B: “…Also I should point out that cytoplasm contains a great many other things besides mitochondria. One thing I would expect to find is mRNA transcribed from the nucleus that had been removed, which would contain copies of mutations from the cancerous nucleus, as well as abnormal levels of transcription factors which would bind to the new nucleus and alter gene expression in the fused cell.”

            So if B is true, then “…epigenetic effects…” will follow the “cytoplasm”, making A “false”.

            In A, the “…follow the nucleus…” is Central Dogma whereas “…epigenetic effects…” are the reverse (feedback from the “outside” controls the “inside”) hence A should read: “I would expect epigenetic effects to follow the cytoplasm (“outside”), not the nucleus (“inside”).”

            I think you have misunderstood what epigenetics is. It is true that it is a phenomenon whereby external conditions can affect the expression of the genome, but the mechanism is methylation of the DNA, which is part of the nucleus. That is how epigenetic effects can be propagated through several generations (of descendents, not of cells).

            Since you have been raising fairly technical points about genetics I was under the impression that you had some understanding of the subject, but from your comments I am beginning to wonder whether you even know the basics. If not, then I apologise for going over your head. However, it isn’t going to be possible for us to have a meaningful conversation if we don’t share the language, and I am not really in a position to coach you through a first-year undergraduate genetics module. There are plenty of textbooks, however, and once you have had a look at one of those maybe we can continue this discussion.

            With regard to your comment suggesting that targeted therapy is an oversimplification that is doomed to failure, I should remind you that these drugs are now being used routinely in oncology clinics on the basis of evidence from clinical trials that they work. Indeed, I owe the past three years of my life to them.

          • Dr Julian Money-Kyrle on Tuesday 02 February 2021 at 02:16 said:

            “I think you have misunderstood what epigenetics is. It is true that it is a phenomenon whereby external conditions can affect the expression of the genome, but the mechanism is methylation of the DNA, which is part of the nucleus. That is how epigenetic effects can be propagated through several generations (of descendents, not of cells)…

            And how are these “switches” thrown in the first place? Not by the DNA itself, on itself!

            This is the shock of epigenetics: that the “outside” can affect the “inside”, not only Today, but also in one’s offspring Tomorrow, and theirs the Day After: “C’est le Terrain…” – one does not have to wait eons for “genetic” evolution, it is happening in real time, according to the prevailing conditions.

            …and I am not really in a position to coach you through a first-year undergraduate genetics module. There are plenty of textbooks, however, and once you have had a look at one of those maybe we can continue this discussion.”

            Larmarck was right over two hundred years ago, without knowing the mechanism.

          • Giraffes gained their long necks in a couple of generations via methylation?

            Who knew?

          • Dr Julian Money-Kyrle on Saturday 30 January 2021 at 22:43 said:

            “I would be very interested if you could provide the reference to the original published paper – you should have it to hand in Christofferson’s book.”

            Quote from references to Chapter 6: Mitochondria: An Old Theory Is New Again, page 234:
            “…
            Schaeffer, Warren I. In discussion with the author. 2014

            Shay, Jerry. In discussion with the author. 2014
            …”
            end-of-quote

            “Well then, it seems that I can’t look up the original papers to see what their methods were or their findings. The quotes you provide describe the experiments in layman’s terms and with very little detail, which doesn’t really mean very much to me.”

            Perhaps these are the original sources:
            Quote, page 204 from Cancer as a Metabolic Disease by Seyfried:

            3. Israel BA, Schaeffer WI. Cytoplasmic mediation of malignancy. In Vitro Cell Dev Biol. 1987;23:627-32.
            4. Israel BA, Schaeffer WI. Cytoplasmic mediation of malignancy. In Vitro Cell Dev Biol. 1988;24:487-90
            5. Shay JW, Werbin H. Cytoplasmic suppression of tumorigenicity in reconstructed mouse cells. Cancer Res. 1988;4848;830-3
            6 Shay JW, Liu YN, Werbin H. Cytoplasmic suppression of tumor progression in reconstituted cells. Somat CEll Mol Genet. 1988;14:345-50.

            End-of-quote

        • I wasn’t asking about the book – I’d already worked out that your quote about the mice was at least second-hand. I was asking about the research.

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