An Example of Inaccurate Information

A Case Study

How Legitimate Studies can be Taken Out of Context

Dr. Elio Spinello

To help illustrate how legitimate studies can be misquoted and taken out of context, I have put together a summary of an actual discussion that took place in August, 2001 on the HealthFraud email discussion list, to which I subscribe.

The discussion started with a post by Mike, a guy whose father-in-law is suffering from cancer but is considering stopping conventional cancer therapy (chemotherapy and radiation) in favor of alternative medicine and herbal supplements. Mike posted a question to the group asking how he could help his father-in-law understand that stopping conventional treatment would probably shorten his life.

After Mike posted his question, Anthony posted a response. Anthony felt that conventional cancer treatments were probably not effective and that Mike's father-in-law might be better off with alternative treatments. Anthony mentioned a study showing that cancer patients that did not undergo chemotherapy and radiation actually lived longer than those that did undergo conventional treatments.

Here is the exchange, starting with Anthony's original response to Mike.

Anthony's Actual Response to Mike's Question

I heard , from a reputable source, that the mainstream peer-review journal, Annals of Oncology, published a study of 13 year survival rates for radiation and/or chemotherapy treated cancer patients (59% of the patients survived), compared to cancer patients who had no radiation/chemotherapy treatment (65% of the patients survived).

Check out the study for yourself. Show it to your father and/or his Oncologist.

I believe modern medicine and other medicine modalities should compare notes and work together. There is health fraud in both systems and much healing in both.  I believe the adage "You are what you eat" pertains to many of the chemotherapy treatments; I do not believe the reason a person gets cancer, (starts cancering), is from a lack of toxic drugs in the diet. Remember to look both ways before choosing a path that will (hopefully) benefit you (your Dad).

Anthony

A number of individuals responded to Anthony (including me). For example:

Response from Jeff to Anthony

I went to the Annals of Oncology site and searched the 2000 abstracts and found only one article relating to your subject:
[snip]

It certainly does not support your conclusion.  Nor did several other articles on similar topics. You have made a statement that should be documented.  You will find their home site at:

http://www.esmo.org/annals/annals.htm 

I have tried to find your article now it's your turn.

Jeff
AIDS Education Global Information Service

Anthony, at that point decided to be more helpful and provide some additional information to help Jeff find the article:

Response from Anthony to Jeff

Dear Jeff,

I wrote down, while making/eating lunch in my car and listening to the radio, "Anals  Onc.    V. 7   p. 245     13 Year Survival   59%   No Therapy  65%".  I tried obtaining Volume 7, Page 245 of the 'Annals of Oncology', after your reply and could not, because I do not belong to an "institution".  I assume you do and did a search with the info of my last letter.  Either the study is located in Volume 7 at Page 245 of the Annals of Oncology, or,  I miswrote the info I heard, or, the radio personality lied.

Anthony

At that point I, your fearless professor, was able to find the exact article Anthony was referring to and wrote the following response:

Professor Spinello's Response to Anthony

Anthony,

I did manage to find the following study abstract that seems to fit the numbers cited in your post.  ...it appears though that rather than comparing a radiation/chemotherapy protocol to a control, Trial I was really the evaluation of the addition of prednisone [a steroid] to [chemotherapy] as a way to [help patients tolerate an] increased dosage [of the chemotherapy].  Someone with better background in oncology may want to comment on this but it certainly doesn't support your post.

Like I tell my students, unless you can read it yourself and verify the study methodology and the context that statistics are used in, assume it doesn't exist.

[Study Citation Snipped]

Elio Spinello

The study that Anthony had referred to did not compare patients who had received chemo/radiation to patients that did not. It compared patients who received regular chemo to patients that received chemo PLUS a steroid (prednisone). This, in no way, supported his conclusion that people who don't get chemo or radiation live longer. The study was really an attempt to see whether the steroid would help patients tolerate a higher dose of chemo so that they could get it over with faster.

Faced with this information, Anthony posted the following message:

Response from Anthony

I am not sure what some of the statistics mean.  It seems that some people with a disease were treated with a medicine and others were treated with the same medicine AND another substance.  The question was, does the additional substance help the first substance?

I was mistaken in my original assertion that the study showed survival rates are lower for those who are treated with chemotherapy - as compared to those who receive no such treatment.

I am sorry to not have researched my assertion before believing in it. Anthony

Epilogue

On April 8, 2004 I received the following message from Mike, letting me know that his father-in-law passed away from cancer, as a result of not having started treatment in the early stages while the cancer was still treatable:

My FIL died a week ago yesterday.

Some of you may remember my case. About four years ago he had early cancer in
his neck and behind his nose. He had a 70% five year cure rate with just
radiation, 90% combined with chemo.

A "friend" of his talked him out of it the day before he was to start
radiation. He did the Lorraine Day program, Cantron, the Zapper, and a projector to
shine colored lights on his head.

During this course of period I kept researching all the stuff he was doing
and showing that it had no chance of working and that it was a progressing
disease and that he would soon reach the point of no return. I encountered a lot of
hostility from my MIL, SIL, and others.

He suffered tremendously and his death was a blessing.

Summary

This exchange is a great example of how a legitimate article in a reputable journal can be taken totally out of context. In this particular case, the only thing Anthony got right were the numbers that he quoted -- but not what the numbers related to. In fact, the way I was able to find the article was by screening for articles in Medline that had that particular combination of numbers in them.

The key here is that the radio host that originally quoted the statistics and stated the conclusion (that cancer patients who don't undergo chemotherapy live longer) relied on the fact that very few people, if any, would ever bother to or know how to look up the article and read/understand it. In fact, from the radio host's perspective, giving out the citation information was a great ploy because it added credibility to his argument. I would bet dollars to donuts that the real intent of the radio host was to sell a nutritional supplement that would supposedly prevent cancer.

This points out the specific need to always look up and read articles when possible. If someone cites a finding in the Annals of Oncology, the New England Journal of Medicine, or any other reputable journal, there is no way to really know whether that finding really exists unless you look up the article and read it for yourself.

Here is the abstract of the article that Anthony referred to:

Pertinent sections of the article are underlined

Author(s): Marini G ; Murray S ; Goldhirsch A ; Gelber RD ;
Castiglione-Gertsch M ; Price KN ; Tattersall MH ; Rudenstam CM ; Collins J
; Lindtner J ; Cavalli F ; Cortés-Funes H ; Gudgeon A ; Forbes JF ;
Galligioni E ; Coates AS ; Senn HJ
Affiliation: International Breast Cancer Study Group, Ospedale Civico,
Switzerland.

Title: The effect of adjuvant prednisone combined with CMF on patterns of
relapse and occurrence of second malignancies in patients with breast
cancer. International (Ludwig) Breast Cancer Study Group.
Source: Ann Oncol (Annals of oncology : official journal of the European
Society for Medical Oncology / ESMO.) 1996 Mar; 7(3): 245-50 Journal Code:
AYF
Additional Info: NETHERLANDS
Standard No: ISSN: 0923-7534; NLM Unique Identifier: 9007735
Language: English

Abstract: BACKGROUND: The addition of low-dose prednisone (p) to the
adjuvant regimen of cyclophosphamide, methotrexate, 5-fluorouracil (CMF)
allowed patients to receive a larger dose of cytotoxics when compared with
those on CMF alone. However, disease-free survival and overall survival were
similar for the two groups. To test the hypothesis that low-dose prednisone
might influence the efficacy of the cytotoxic regimen used, the toxicity
profiles of the two treatment regimens and the patterns of treatment failure
(relapse, second malignancy, or death) were examined. PATIENTS AND METHODS:
491 premenopausal and perimenopausal patients with one to three positive
axillary lymph nodes included in International (Ludwig) Breast Cancer Study
Group (IBCSG) trial I from 1978 to 1981 and randomized to receive CMF or
CMFp were analyzed for differences in long-term outcome and toxic events.
The 250 patients assigned to CMF and prednisone received on the average 12%
more cytotoxic drugs than those who received CMF alone. RESULTS: The 13-year
DFS for the CMFp group was 49% as compared to 52% for CMF alone, and the
respective OS percents were 59% and 65%. Several toxic effects such as
leukopenia, alopecia, mucositis and induced amenorrhea were reported at a
similar incidence in the two treatment groups. Using cumulative incidence
methodology for competing risks, we detected a statistically significant
increase in first relapse in the skeleton for the CMFp group at 13 years
follow-up with a relative risk (RR) of 2.06 [95% confidence interval (CI),
1.23 to 3.46; P = 0.004]. Patients with larger tumors in the CMFp regimen
were especially subject to this increase with a RR for failure in the
skeleton of 3.32 (95% CI, 1.57 to 7.02; P = 0.0005). CMFp-treated patients
also had a larger proportion of second malignancies (not breast cancer),
with RR of 3.34 (95% CI, 0.91 to 12.31; P = 0.09). CONCLUSIONS: Low-dose
continuous prednisone added to adjuvant CMF chemotherapy enabled the use of
higher doses of cytotoxics. This increased dose had no beneficial effect on
treatment outcome, but was associated with an increased risk for bone
relapses and a small, not statistically significant increased incidence of
second malignancies. The effects of steroids, which are widely used as
antiemetics (oral or pulse injection) together with cytotoxics, should be
investigated to identify their influence upon treatment outcome.