Questionable for-profit cancer center profits from alternative therapies

It sounds like a crazy conspiracy theory: a secretive businessman founds a for-profit medical center to treat cancer.  His hospitals offer conventional treatments but also sell highly questionable, unscientific treatments to vulnerable patients. These treatments help to increase profits.  The businessman uses the profits from his cancer hospitals to support his favorite right-wing causes.  Patients have no idea that the fees they pay for treatment help support these causes.

It may sound unbelievable, but it's true.  Most of this story was described in a lengthy exposé just published in the Washington Post on Christmas day.  The Post revealed that Richard Stephenson, the founder of a large for-profit cancer center, is also one of the primary funding sources for Freedom Works, a right-wing Tea Party organization that played a major role in the 2012 elections.  As the Post story described him:

[Stephenson is] "a reclusive Illinois millionaire who has exerted increasing control over one of Washington’s most influential conservative grass-roots organizations."

Among other examples, the Post describes how

"more than $12 million in donations was funneled through two Tennessee corporations to the FreedomWorks super PAC after negotiations with Stephenson over a preelection gift of the same size....  The origin of the money has not previously been reported."

What the Post story didn't explain was the source of Stephenson's millions: Cancer Treatment Centers of America (CTCA), a private, for-profit company with five cancer hospitals scattered around the U.S.  Stephenson is the founder and chairman of CTCA.

For-profit hospitals present a big ethical problem, even when they provide proper care.  The problem is that motivation to increase profits may work against the interest of patients.  I don't want to debate that here, because CTCA has another, more serious problem.  Alongside standard, science-based cancer therapies, CTCA also offers an array of questionable, unscientific therapies, which it proudly labels as part of its "integrative cancer treatment."  CTCA advertises many such treatments, including:

• Acupuncture
• Acupressure
• Chiropractic
• Naturopathy 
• Homeopathy
• Mind-Body medicine (including Reiki and Qi Gong)

None of the treatments in this list has any scientific support showing that they provide a benefit to cancer patients.  Some of them carry a real risk of harm, as I've written about previously.  Acupuncture carries a risk of infection and chiropractic treatment has a risk of stroke - very small risks, admittedly, but no risk is acceptable when the benefit is nonexistent.  (See Science-Based Medicine for a summary of the science behind these and other alternative therapies.)

CTCA makes multiple unsupported, unscientific claims for its alternative treatments, such as:

• "Naturopathic medicine can help reduce these [cancer-related] symptoms, strengthen the immune system and support the healing process throughout your brain cancer treatment." 
• "Acupuncture may help to alleviate [cancer] treatment-related side effects, such as nausea and vomiting." 
• "When used during your leukemia treatment, our chiropractic care services can help correct bone, muscle and joint problems and restore nerve function." 

These are just a few examples. These claims, and CTCA's marketing of the therapies involved, present a huge ethical problem.  Cancer patients are facing some of the most difficult decisions in their lives, often while suffering through painful treatments, not to mention the fear that their cancer will kill them.  When a cancer hospital offers an "integrative" treatment with the promise that it may help, the patient is highly likely to try it, regardless of the cost.  These are extremely vulnerable patients, and CTCA is taking advantage of them to sell ineffective therapies.  CTCA and its owners, including Richard Stephenson, are profiting from their unsuspecting patients.

Offering treatments that are little more than snake oil to cancer patients is ethically indefensible.  Believers in acupuncture, naturopathy, Reiki, and homeopathy will argue that they are not unethical, because the treatments work.  This argument, though, flies in the face of overwhelming evidence to the contrary.  Those who argue that these therapies really work only demonstrate that they are unqualified to offer medical care.

Cancer Treatment Centers of America presents a very welcoming, positive picture of itself through its website, and much of what it describes is accurate.  However, its errors of omission are huge: nowhere does its website say that CTCA is a for-profit center, nor does it tell you that its founder is a major donor to right-wing political organizations.  And most critically for patients, CTCA offers a palette of pseudoscientific treatments, making medical claims that are not supported by any evidence and that in some cases violate basic principles of physiology and biology - although the website claims that its integrative treatments are "scientifically-based supportive therapies."

Let's put aside the right-wing propensities of its owners and simply focus on the science and the ethics of CTCA's "integrative" therapies.  Even if the treatments were free, there is no justification for offering treatments based on pseudoscience.  In the context of a for-profit hospital, where every treatment provided adds to the bottom line, the practice of pushing illegitimate treatments onto cancer patients is even more reprehensible.

[Note: the publisher of Forbes magazine, Steve Forbes, is a board member for Freedom Works.  In case it's not obvious, I don't speak for Forbes and they don't endorse the content of my blog, which appears both here and on the Forbes site.]

[Note 2: for a more detailed, critical look at some of CTCA's offerings and its claims, see this post by Orac at Respectful Insolence from mid-2010.]

Have another cup o' joe, it's good for you

My favorite science studies are the ones that tell us that what we're already doing is good for us. This story fits the bill. In the American Journal of Epidemiology this month, Janet Hildebrand and colleagues reported on a large study looking at the effects of coffee on throat cancers.

Let's get right to the good news: drinking coffee seems to reduce your risk of death from oral or pharyngeal cancer by about 50%. Drinking more coffee is better than drinking less, and drinking caffeinated (normal) coffee is better than decaf.

I knew there was something wrong with decaf.

Now for some details. This study is part of an enormous project, the Cancer Prevention Study II, with over 1 million participants who've been followed for 30 years. The participants regularly fill out questionnaires answering a variety of questions, including how much coffee and tea they drink. After excluding people with missing information about coffee drinking and those who already had cancer in 1982, the researchers still had over 950,000 people. Coffee drinking was categorized based on daily consumption: less than a cup (or none), 1-2 cups, 3-4 cups, and more than 4 cups. They asked about decaf coffee and tea drinking as well.

A study like this is hard to do well, because there are so many confounding variables, especially smoking. Smokers have a dramatically higher risk of throat cancer, and smokers also drink a lot of coffee. Hildebrand and colleagues did a good job at separating out this effect, looking at the risk of cancer in nonsmokers separately and adjusting the statistics accordingly.

Perhaps the most encouraging finding is this: in people who have been nonsmokers for at least 20 years, 1-2 cups of coffee per day corresponds to a 32% decrease in the risk of death from throat cancer.  More than 2 cups per day corresponds to a 64% decrease. And among all participants (including former smokers), more than 4 cups a day seemed to provide the greatest benefit.

Decaf coffee also seems to reduce the risk of fatal throat cancer, though not quite as much. Tea drinkers, in contrast, don't seem to get any benefit, not for this type of cancer.

All this comes with some very big caveats.  First, despite the very large size of the study, the number of deaths oral or pharyngeal cancer was very small, only a few hundred. (Oral/pharyngeal cancer is very common worldwide, but less common in the U.S., where this study was conducted, with about 7850 deaths per year. This includes cancers of the tongue, mouth, and pharynx.)  So the absolute risk is very small.  Another big caveat is that this study only looked at cancer deaths - it did not measure the risk of getting cancer in the first place.

But skepticism aside, drinking coffee seems to reduce the risk of oral cancer.  This confirms my long-held view that the three major food groups - coffee, chocolate, and red wine - are all good for you.  So the next time you feel like a second cup, or a third: drink up!

Congress holds an anti-vaccine hearing

I was in my car yesterday listening to C-SPAN (yes, I do that sometimes), when to my stunned surprise I heard Congressman Dan Burton launch into a diatribe on how mercury in vaccines causes autism.  No, this was not a replay of a recording from a decade ago.  The hearing was held just a few days ago by the Committee on Oversight and Government Reform.

Congressman Burton used this hearing to rehash a series of some of the most thoroughly discredited anti-vaccine positions of the past decade.  Burton is a firm believer in the myth that vaccines cause autism, and he arrogantly holds the position that he knows the truth better than the thousands of scientists who have spent much of the past decade doing real science that proves him wrong.  

In a classic political move, the committee called on scientists Alan Guttmacher from the NIH and Colleen Boyle from the CDC to testify, but in fact the committee just wanted to bully the scientists.  Committee members lectured the scientists, throwing out bad science claims, often disguised as questions, thick and fast.  Alas, Guttmacher and Boyle weren't prepared for this kind of rapid-fire assault by pseudoscience.

Burton himself was the worst offender, offering anecdotes and bad science with an air of authority.  He stated bluntly: 

“I’m convinced that the mercury in vaccinations is a contributing factor to neurological diseases such as autism."

No, it isn't.  Dozens of studies, involving hundreds of thousands of children, have found the same thing: there is no link whatsoever between thimerosal and autism, or between vaccines and autism.  And Burton went off the deep end with this: 

"It wasn’t so bad when a child gets one or two or three vaccines… Mercury accumulates in the brain until it has to be chelated.” 

Bang bang, two false claims in 10 seconds.  First he claims that mercury from vaccines "accumulates in the brain", a statement with no scientific support at all. Then he claims that chelation therapy is the solution - a radical, potentially very harmful treatment that no sensible parent would ever force on their child.  Unfortunately, some quack doctors have experimented with chelation therapy on autistic children, despite that fact that it can cause deadly liver and kidney damage, and one of them caused the death of a 5-year-old boy in 2005.

Burton also claimed that single-shot vials would "eliminate the possibilty of neurological damage from vaccines" - a claim that was invented out of thin air by the discredited anti-vax doctor Andrew Wakefield, whose fraudulent 1998 study was the spark that started the current wave of anti-vax hysteria.

Congressman Bill Posey from Florida was just as bad as Burton, demanding a study of vaccinated versus unvaccinated children, a standard talking point of the anti-vax movement.  (Congressman Posey: do you even realize that your question is almost identical to what Jenny McCarthy asked five years ago, on the Larry King Live show?)  Here's his question to the CDC's Boyle:

"I wonder if the CDC has conducted or facilitated a study comparing vaccinated children with unvaccinated children yet - have you done that?"

Dr. Boyle wasn't prepared for this.  She tried to point out that many studies have been done looking at the relation between vaccines and autism, but she didn't get very far before interrupted, thus: 

Rep. Posey: “So clearly, definitely, unequivocally, you have studied vaccinated versus unvaccinated?” 

Dr. Boyle: “We have not studied vaccinated versus unvaccinated." 

Posey: “Never mind. Stop there. That was the meaning of my question. You wasted two minutes of my time."

Dr. Boyle simply wasn't prepared for a Congressman who was parroting anti-vax activists.  It's too late now, but her response should have been this:

Congressman Posey, only an extremely unethical scientist would consider conducting such a study.  To compare vaccinated versus unvaccinated children in the manner you suggest, one would have to withhold vaccines from young children.  We know from decades of evidence, involving tens of millions of children, that vaccines save lives.  Few if any medical interventions are more effective than vaccines. 

But Congressman, the scientific community has done observational studies of vaccinated versus unvaccinated children, comparing autism rates in children whose parents chose not to vaccinate.  Those studies show that autism rates were slightly higher in unvaccinated children.  That's right, vaccinated children had autism at a lower rate. 

So no, Congressman Posey, the CDC hasn't done a study of vaccinated versus unvaccinated children.  Only a corrupt dictatorship could impose a study like that on its people.  Is that what you want?

To make matters worse, the House committee invited Mark Blaxill to testify.  Blaxill is a well-known anti-vaccine activist whose organization, SafeMinds, seems to revolve around the bogus claim that mercury in vaccines causes autism.  His organization urges parents not to vaccinate their children, and giving him such a prominent platform only serves to spread misinformation among parents of young children.  

Blaxill's central claim is that that we're in the midst of an autism epidemic: 

"For a long time, reported U.S. autism rates were low, estimated at about 1 in 10,000. Then around 1990 something new and terrible happened to a generation of children. Autism rates didn’t just rise, they multiplied," claimed Blaxill in his written testimony.

His entire argument builds on this.  Yet multiple studies, looking carefully and objectively at the data, indicate that all or nearly all of the rise in autism cases is due to increasing diagnoses, which in turn is due to multiple factors: a dramatically broading of the definition of autism in the early 1990s, a greater awareness of the condition, and a greater willingness of doctors and parents to accept the diagnosis.  For an objective summary of the evidence, see the articles by neurologist Steven Novella here and here, which summarize a dozen epidemiological studies.  The weight of the evidence shows that the actual incidence of autism is either stable or possibly rising very slowly.  There is no "autism epidemic."

It's also worth pointing out that Blaxill is a conspiracy theorist who claims that the "CDC has actively covered up the evidence surrounding autism’s environmental causes."  

Congress has every right to conduct oversight into medical research at the NIH and the CDC.  But when Dan Burton, Bob Posey, and others decide in advance what the science says, and abuse their power to demand "answers" that validate their badly mistaken beliefs, people can be harmed. Over the past decade, the anti-vaccine movement has successfully convinced millions of parents to leave their kids unvaccinated, and the result has been serious outbreaks of whooping cough, haemophilus, measles, chicken pox, and mumps around the U.S. and Europe.  

Some anti-vax parents claim that these childhood illnesses aren't so bad.  I wish they would talk to the parents of young children who have died in recent whooping cough outbreaks.  These illnesses can be deadly.

Message to Congress: science isn't easy, and autism is complicated.  Don't criticize science when it doesn't give you the answer you thought you knew.  That's not how science works.  Thousands of scientists are now trying to identify the causes of autism, and they've made progress, especially on the genetic front.  The answer might not be simple, but we will find it.