Most Chemotherapy Drugs Do Not Improve Overall Survival

One of his best videos.

How Much Does Chemotherapy Improve Survival?, Michael Greger M.D. FACLM, Nutrition Facts, 27 July 2022.

Transcript:

Though we often hear new cancer drugs described as game-changing breakthroughs, most afford much more modest benefits. In my last video, I quoted a recent editorial in the Journal of the National Cancer Institute suggesting that the majority of new cancer drugs don’t deliver clinically meaningful benefits at all. At least when they are later proven to be ineffective, they’re pulled from the market, right? No. Even when postmarket studies show the new drugs to have no clinically meaningful benefit compared to not just older drugs, but compared to nothing—compared to a sugar pill—most chemo drugs retain FDA approval, and remain on the market, even at the same ridiculous prices. In fact, the most expensive drug they looked at, the one costing $169,836 a year, did not improve overall survival at all, and actually worsened quality of life. That’s $169,000 just to make you feel worse with no benefit. Why pay a penny for a treatment that doesn’t actually help?

And even when they do improve survival, what does that actually mean? Currently, the trend is for big Pharma to design large trials that may detect statistically significant, but often trivial, differences in survival endpoints. For example, check out this famous trial. Adding this second drug, erlotinib, to gemcitabine for advanced pancreatic cancer significantly prolonged overall survival. Yeah, they suffered more side effects, but we’re not just talking about tumor shrinkage—they lived significantly longer. The placebo group only lived 5.91 months, whereas the added drug group survived all the way to…6.24 months. Wait a second. They only lived a third of a month longer; that’s just 10 days. All the side effects and expense for an average of just 10 days? That’s why doctors shouldn’t use the statistical jargon—”significant improvement in survival”—while informing patients about benefits of a new treatment. When patients hear the word “survival,” they’re not thinking about a week and a half.

If you put all the new chemo drugs together approved over a dozen years, the average overall survival benefit is 2.1 months. Now look, two months is two months, I don’t want to downplay that. But time and again, surveys have indicated that patients expect much more. Incredibly, about three-quarters of patients with metastatic lung or colorectal cancer did not report understanding that their chemo was not at all likely to cure their cancer. I mean, that’s the primary treatment, but the chemo is not curative; it’s just eking out a few extra weeks or months. Why weren’t the majority of patients told that? It’s not that they were being over-optimistic, explained the researcher. They were under the mistaken belief that the treatment offered a chance of cure when it in fact didn’t. That deprives patients of the opportunity to weigh the risks and benefits and make their own decisions about their own body.

If you ask cancer patients, most want at least half a year to stomach the side effects, which suggests that most cancer patients might not choose chemotherapy if they knew how little they’d actually benefit. But look, everyone’s different. One patient they interviewed said living even one week longer would be worth it; whereas another said they wouldn’t even want to do chemo for two extra years of life since they wouldn’t want anything to interfere with the quality of time they had left. Either way, people deserve to know the truth. I find it telling that oncologists and cancer nurses themselves express less willingness to accept intensive chemotherapy, given the associated toxicities. Most chemo drugs are cytotoxic, meaning they work by killing off cancer cells, but they also kill off some healthy cells as collateral damage, which is why they can damage our nerves, cause irreversible heart failure, slough off the linings of our gut, or damage our immune system.

Drug companies frequently downplay the risks, though––for example, describing this breast cancer drug as having “acceptable” side-effect profiles for most patients, or this pancreatic cancer drug as having a “manageable and mostly reversible safety profile.” These were studies published in top medical journals. Naturally, readers would take these statements to be true. However, if you actually look at the data, the number of serious, even life-threatening side effects was double, or even five times higher, on the new breast cancer drug. And the “manageable and mostly reversible” side effects evidently weren’t referring to those who were killed by the drug. I like how they even included something like a cheat sheet. Acceptable toxicity? Acceptable to whom? Manageable? Serious events and deaths can never be considered manageable. And feasible? Who would sign up for a drug whose toxicity could only be described as feasible? Favorable? Compared to what? Tolerable? That’s for the patient to decide. And any drug that kills people can hardly be considered safe.

Still, patients may very well consider it worth the risk. For some cancers, we’ve made tremendous strides. Testicular cancer, for example. There is greater than a one in three chance that chemotherapy would enable you to survive at least to the five-year mark. It’s the same with Hodgkin’s disease, a relatively rare form of lymphoma. But even when researchers tried to err on the side of overestimating the benefit, for our most common cancers—colon, lung, breast, and prostate—the chances that chemo would enable survival to the five-year mark appear to be more like 1 or 2 percent.

Every single person I know who has had chemotherapy did not survive. The side effects they endured were almost worse than the disease. For me, if I’m ever faced with it, the decision has already made itself.

While Reading About Prunes…

California Prunes has a beautiful site.

I just saw that WebMD says:

Contact your physician before making dried plums a regular part of your diet.

And wondered…

  • Does anyone take responsibility anymore?
  • This assumes that physicians have been schooled in the chemistry of prunes and how that chemistry interacts with human biology. Maybe they have.
  • This lessens a person’s sense of agency, that they can make this decision on their own. It has us relying more on “experts”. In doing so, it funnels people into the medical establishment’s $ merry-go-round. Well, what should I expect with a site that has “MD” as part of its name.

For prunes! This is getting out of hand.

The chemical in prunes that gives them a laxative effect is likely sorbitol, a sugar alcohol. Prunes aren’t the only food that contain sorbitol. Stone fruits in general contain it, and drying them concentrates it. So dried apricots, peaches, and cherries are also high in sorbitol.

As are, probably, my stewed apricots (check with your doctor before eating them):

Big New Study: Depression Is Not Caused By A “Chemical Imbalance”

Here’s the news summary she referenced:
Little evidence that chemical imbalance causes depression, UCL scientists find, The Guardian, 20 July 2022

Scientists have called into question the widespread use of antidepressants after a major review found “no clear evidence” that low serotonin levels are responsible for depression.

“Many people take antidepressants because they have been led to believe their depression has a biochemical cause, but this new research suggests this belief is not grounded in evidence,” said the study’s lead author, Joanna Moncrieff, a professor of psychiatry at University College London and consultant psychiatrist at North East London NHS foundation trust.

“It is always difficult to prove a negative, but I think we can safely say that after a vast amount of research conducted over several decades, there is no convincing evidence that depression is caused by serotonin abnormalities, particularly by lower levels or reduced activity of serotonin.

“Thousands of people suffer from side-effects of antidepressants, including the severe withdrawal effects that can occur when people try to stop them, yet prescription rates continue to rise. We believe this situation has been driven partly by the false belief that depression is due to a chemical imbalance. It is high time to inform the public that this belief is not grounded in science.”

Most antidepressants are selective serotonin reuptake inhibitors (SSRIs), originally said to work by correcting abnormally low serotonin levels.

The review, published in the journal Molecular Psychiatry, looked at studies examining serotonin and depression involving tens of thousands of people. One of the findings was that research comparing levels of serotonin and its breakdown products in the blood or brain fluids did not discover any difference between people diagnosed with depression and healthy people.

The authors also looked at studies where serotonin levels were artificially lowered in hundreds of people and concluded that lowering serotonin in this way did not produce depression in hundreds of healthy volunteers.

Other studies looked at the effects of stressful life events and found that the more stressful life events a person had experienced, the more likely they were to be depressed, showing the importance of external events.

According to the research, there is also evidence from other studies that antidepressants may actually induce low serotonin in the long term.

“We do not understand what antidepressants are doing to the brain exactly, and giving people this sort of misinformation prevents them from making an informed decision about whether to take antidepressants or not.”

Here’s the actual study:

The serotonin theory of depression: a systematic umbrella review of the evidence, Nature: Molecular Psychiatry, 20 July 2022

From the abstract:

The main areas of serotonin research provide no consistent evidence of there being an association between serotonin and depression, and no support for the hypothesis that depression is caused by lowered serotonin activity or concentrations. Some evidence was consistent with the possibility that long-term antidepressant use reduces serotonin concentration.

This is a watershed moment. No matter how hard the pharmaceutical companies fight this, and boy-oh-boy you can bet they will, there’s no going back. Depression is not caused by a “chemical imbalance”. A lot of it is caused by our reactions to our environment.

I’m sitting here thinking … I don’t understand how people who work for pharmaceutical companies can advance these drugs knowing they don’t work, giving people a false sense of hope, not caring if they suffer or lose their lives. What is the return for them? Money? It has been 35 years of lying (Fluoxetine/Prozac by Eli Lilly was FDA approved in 1987, thought to be the first SSRI marketed) to enrich themselves at other’s expense. This is deeply disturbing.

It is also disturbing, depressing if you will, that people continue to give it over to drug companies, to trust them, instead of believing the science, the evidence … instead of listening to that small still voice in their head, that urge from their heart, to go with their curiosity, to question these people if something feels off.  It’s like … the drug has become a surrogate for love in a loveless society … and people are lining up for it.

When We Feel Sick, Is It The Flu?

There are hundreds of viruses that circulate that cause flu-like symptoms that aren’t the flu, that is, that aren’t caused by an influenza virus. (The flu shot targets influenza viruses.)

From Medscape:

A lot of people who had flu-like symptoms did not have the flu:

About 4.1% of specimens tested at clinical laboratories were positive for flu. Since October 30, 2.7% of specimens have been positive for influenza this season.

When they did have the flu, it was influenza A (for this year anyway):

Nearly all viruses detected (97.7%) have been influenza A.

The flu shot was not very effective against influenza A:

“…these findings suggest there is low to no measurable benefit against influenza A.”

Here’s what Cochrane said about influenza-like illness (ILI):

Over 200 viruses cause ILI, which produces the same symptoms (fever, headache, aches, pains, cough, and runny nose) as influenza. Without laboratory tests, doctors cannot distinguish between ILI and influenza because both last for days and rarely cause serious illness or death.

World Health Organization Director’s Statement On Monkeypox, 23 July 2022

World Health Organization (WHO) Director-General’s statement at the press conference following International Health Regulations (IHR) Emergency Committee regarding the multi-country outbreak of monkeypox, WHO, 23 July 2022

WHO director Tedros Adhanom Ghebreyesus:

Although I am declaring a public health emergency of international concern, for the moment this is an outbreak that is concentrated among men who have sex with men, especially those with multiple sexual partners.

That means that this is an outbreak that can be stopped with the right strategies in the right groups.

Marwan Azar, MD, a Yale Medicine infectious diseases specialist

Monkeypox is typically a mild disease and this current outbreak has an extremely low fatality rate.

Repost: Stewed Apricots

This post is from 2016. I still do it this way. Sometimes I need to add a few more tablespoons of water, depends on the fruit. It really is simple!

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8 hard, bitter, not-very-tasty, but very pretty apricots:

ApricotsStewed3

Apricots have pits. Inside the pit is a seed. The seed kernel looks and tastes like an almond. Whole Foods sells bags of apricot kernels (thank you, Shaun). Like a superfood. Which is crazy. Because apricot kernels contain a poisonous compound called amygdalin that converts to cyanide after eating. Don’t eat apricot kernels.

ApricotsStewed4

These 8 apricots just about filled a 2 quart saucepan (seen in the background in the above photo).

ApricotsStewed5

After about 10 minutes on a very low heat, they reduce considerably. (I added a tablespoon of water to keep them from scorching, 1 or 2 tablespoons of sugar, and a dash of cinnamon.)

ApricotsStewed6

Keeping the pot covered makes them cook faster, but they tend to foam up so you have to keep an eye on them. Stir often. After about 20 minutes they turn into this crazy good nectar that no one can get enough of.

This photo makes them appear more brown than they actually are. See next photo for better color:

ApricotsStewed7

ApricotsStewed9

They go really, really good with Grapenuts cereal. So I’m told. The crunchy texture of the cereal complements the gooiness of the fruit. And the roasted flavor of Grapenuts is a perfect match for the bitter-sweet apricot taste.

ApricotsStewed10

Please buy lots of apricots. If you do, demand will grow, more farmers will plant more apricots, and I’ll be able to find them more often. At a lower price. Thank you.

CDC Says Effectiveness Of The Flu Vaccine Last Year (2021–22) Was 14%

The CDC says the effectiveness of the flu vaccine last year (2021–22) was 14%.

Interim Estimates of 2021–22 Seasonal Influenza Vaccine Effectiveness — United States, February 2022, MMWR, CDC, 11 March 2022

VE [vaccine effectiveness] against outpatient medically attended ARI [acute respiratory infection] associated with influenza A virus types was 14%.

Based on data from 3,636 children, adolescents, and adults with acute respiratory infection during October 4, 2021–February 12, 2022, seasonal influenza vaccination did not reduce the risk for outpatient respiratory illness caused by influenza A(H3N2) viruses that have predominated so far this season.

The FDA requires that any vaccine, including flu vaccine, be at least 50% more effective than a placebo in preventing disease.

What about the upcoming season?

So far, data from the US Flu Vaccine Effectiveness (VE) network, which consists of seven study sites, have not shown that the vaccine [for 2022-2023 season] is protective against influenza A. “We can say that it is not highly effective,” said Brendan Flannery, PhD, who leads the US Flu VE network for the Centers for Disease Control and Prevention (CDC).

The vaccine is estimated to be 8% effective against preventing influenza A infection (95% CI, -31% to 36%) and 14% effective against preventing A/H3N2 infection (95% CI, -28% to 43%) for people aged 6 months and older.

This is a lot of vaccine being sold for not a lot of effectiveness. Do you think? It’s almost as if the CDC had some other incentive for promoting the drug other than public health.

Fauci On Masks: “It Might Make People Feel A Little Better, But It’s Not Providing Protection People Think”

When you’re in the middle of an outbreak, wearing a mask might make people feel a little bit better and it might even block a droplet but it’s not providing the perfect protection that people think that it is and often there are unintended consequences. People keep fiddling with the mask and they keep touching their face.

He also said, “Masks are important for someone who’s infected to prevent them from infecting someone else.” I learned that in school. That masks help contain infection, but they do not prevent infection.

After reading several papers on the matter, I have come to see that, as he says, masks might make a person feel better, but they do not stop a person from getting infected (especially since SARS-CoV-2 spreads via aerosol, tiny particles that can slip inside masks when we inhale).

The New York Times, May this year:

When you look at the data on mask-wearing – both before vaccines were available and after, as well as both in the U.S. and abroad – you struggle to see any patterns.

No patterns? It’s true. Sometimes cases rose after people started wearing masks, sometimes they fell. That may be because, as the paper below describes, there are a lot of contributors to case rise and fall, mask wearing isn’t a big one.

Association of State-Issued Mask Mandates with COVID-19 Case and Death Counts, May 2021

The increase in incidence of a respiratory borne illness over time, in a given population, is dependent upon various factors, including population density, climate, population age and general health. An initial period of exponential spread of a novel pathogen is expected, and exponential increases in the number of new cases has been observed historically at early stages of other epidemics. With or without medical interventions*, exponential growth is invariably tempered, beginning when a minority of the population has been affected.

* A mask is a medical intervention.