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Townsend's New York observer: Third Column on knockout, a book on Cancer, by Suzanne Somers.

Knockout, by Suzanne Somers, features interviews with doctors who control cancer primarily through alternative treatments. Knockout also includes interviews with oncologists who are open-minded about integrating conventional and alternative therapeutic approaches. Knockout even includes a chapter for people who only trust mainstream cancer therapy. It's an interview with Bill Faloon, director and cofounder of the Life Extension Foundation, in which Faloon gives advice on improving whatever benefits chemotherapy produces while moderating its toxic side effects.

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Ms. Somers is probably best known as a TV actress. Since her heyday on TV, she has written best-sellers on ridding our diets of sugar, and on bioidentical hormone replacement therapy (BHRT). In 2001, Somers was diagnosed with breast cancer, which was treated by lumpectomy and follow-up radiation. The physician she has since trusted to keep her cancer-free is among the oncologists who, as Ms. Somers words it, "have gone outside of the standard of care box and integrated their protocols, to appeal to a specific segment of society which doesn't feel comfortable with all their eggs in the alternative basket." (See my first column about Knockout, Townsend Letter, November 2009).

My impression after reading Ms. Somers's interview with Dr. Julie Taguchi, her "personal oncologist" (Somers's term), is that Somers opted for Dr. Taguchi largely because this mainstream physician has been conducting a study of breast cancer patients on bioidentical hormones to prevent a recurrence. Ms. Somers is part of Dr. Taguchi's study. Given everyone else interviewed or consulted in Knockout, I wouldn't place Suzanne Somers in that "specific segment of society which doesn't feel comfortable with all their eggs in the alternative basket."

My First and Second Columns on Knockout

In my initial column on Knockout, I mentioned Ms. Somers's provision of treatment options for the full range of cancer patients almost in passing. Her motivation for writing a book about cancer that would take readers beyond the "orthodox trinity of cancer therapy" (as I put it) concerned me most.

"A Cancer Story--Mine," the first chapter in Knockout, dramatically recalls the main reasons. This chapter is the only example of Ms. Somers's story-telling ability in the book, and an attempt to summarize it within the confines of a column would diffuse its intensity and power. She refers to the motivations in the opening of my interview with her (see again Townsend Letter, November 2009), and quoting a few passages from that interview should adequately indicate the impact of the experience that compelled her to write Knockout.

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"The horrible, unbelievable body blow of being misdiagnosed with full body cancer this last November [2008]," she says, "was powerful. Had I been another kind of patient, I probably would have accepted the 'full body chemo; chemical poisoning' they recommended, and would have destroyed my perfectly healthy body--had I been able to survive it at all.

"It made me realize that as patients we must do the work to be informed, to understand that even when told to 'get your things in order,' that you can't give up hope, and that it is crucial to look for other answers."

I associated Suzanne Somers in my first column about her book with independent-thinking patients whom I knew when I became immersed in the politics of health care a quarter of a century ago. Many of these cancer patients had chosen alternative therapy after conventional treatment failed to benefit them or to avoid the loss in quality of life that usually happens with chemotherapy (Ms. Somers had refused chemotherapy when treated for breast cancer, mainly because she feared its often devastating side effects.) Like Somers, the most dedicated of these patients were passionate about spreading word that alternative approaches to managing cancer successfully were available.

My second column on Knockout (January 2010) analyzed currents in mainstream medicine that I felt would swell the audience for the book. I had expected reviewers parroting the negative view of alternative cancer treatment by the medical establishment to portray Suzanne Somers as an obvious novice on the subject of cancer, an individual lacking any scientific understanding of cancer treatment, who is taking advantage of her celebrity to gain media exposure for her views.

I countered with evidence from the scientific literature and the major print media that a sizable portion of both the medical profession and the American public have grown concerned about the inadequacy of treatment for numerous cancers. Consequently, information about practically any treatment that can boost the odds of beating cancer is of general interest.

Then, I quoted a paragraph from a "Sounding Board" article by John E. Wennberg, MD, MPH, published in the New England journal of Medicine in 1990. The title is "Outcomes Research, Cost Containment, and the Fear of Health Care Rationing." Dr. Wennberg, at the Dartmouth Medical School, is a highly respected pioneer in modern outcomes research. The paragraph I quoted speaks of two ideas about choices in treatment gaining currency in mainstream medicine through Dr. Wennberg and outcomes researchers influenced by him.

"For most conditions," Dr. Wennberg says, "rational choices among treatments require that individual patients understand the predicaments they face. The predicaments arise because there is seldom a single correct answer to a medical problem. Most conditions or illnesses entail a number of morbidities, symptoms, and disabilities. Outcomes research will clarify the probabilities of the various outcomes for the various treatments, showing many to be effective in some respects that are important to patients."

Simply interpreted, this statement broaches the idea that therapeutic options exist for most diseases.

Dr. Wennberg's very next sentence advances an idea which, if increasingly put into practice, tips the balance in the traditional doctor/patient relationship toward the patient. "Learning what the demand for any given treatment truly is," he says, "depends on asking patients what they want in a fashion that disentangles the preferences of the patient from those of the physician."

Such a disentanglement, as I see it, elevates the role of patients in decisions on treatment. Dr. Wennberg and his colleagues at the Dartmouth Medical School have incorporated this concept as a guiding principle of the Foundation for Informed Medical Decision Making, which they established in Hanover, New Hampshire. (The foundation now has its headquarters in Boston, Massachusetts.)

On its website, the foundation declares: "We believe it is an ethical right of every patient to be informed and involved in decisions that could affect their health or well-being. We believe that patients should have the opportunity to learn about all relevant treatment options and to engage in an active shared decision-making process in which they communicate their values and preferences to their health care provider."

How this foundation's shared decision-making process operates is complicated. As I understand it, the process begins with rigorous evaluation of the evidence for plausible therapeutic options and ends with doctor/patient discussion of the treatments that pass scrutiny in a clinical or hospital setting. Clearly, at present, a very limited number of patients can take advantage of the sort of "ideal" therapeutic options provided by the Foundation for Informed Medical Decision Making.

Some day, I would like to visit the foundation started by Dr. Wennberg, interview the people who run it, observe examples of how it operates, and report on my visit in a Townsend Letter column. My point in speaking here about Dr. Wennberg and his foundation and Ms. Somers and her book is that the two ideas Dr. Wennberg and the foundation espouse--that there is seldom only one way to treat a medical condition, and that patients have the right to know the options available for their condition--may be helping to enlarge the audience for her book. (Knockout was published last October. In early November, it was among the top five hardcover advice books in the best seller lists that appear in the "Sunday Book Review" section of The New York Times.)

As I said earlier, there appears to be widespread concern about the effectiveness of treatment for many major cancers, leading more and more people to seek approaches outside of conventional treatment, and to want more of a say over cancer treatment. Knockout essentially presents information about alternative ways of managing cancer and addresses the desire for greater control by patients over choices of treatment.

Why I'm Devoting a Third Column to Knockout

Suzanne Somers's Knockout heats in me a stew of emotions about presenting information on cancer treatment. I have never published a column in Townsend Letter which reviews a book that promotes any therapeutic approach, unconventional or conventional. Ms. Somers doesn't actually advocate alternative cancer treatment through her book. She conscientiously avoids suggestions that patients on standard therapy get off it and try alternative or complimentary approaches instead.

Yet the "picture" of conventional cancer care that emerges from her interviews in Knockout is generally bleak, with chemotherapy in particular characterized as a dismal failure in most cases. The views expressed in Ms. Somers's book, I should emphasize, tend to agree with a series of reports in the New York Times about the meager progress in cancer treatment. The series has been running since April 2009, under the heading "The Forty Years' War."

Taken together with the reports in the Times on the generally limited gains in the War Against Cancer, Knockout is an inducement to people with cancer to look closely at the examples of alternative therapy or approaches that integrate conventional with alternative or complementary treatment which Ms. Somers's book spotlights.

With patients advised by oncologists that there's little more that they can do for them, I have no problem if they pursue the leads in Knockout. They just might luck into an alternative or integrated approach that puts them in lengthy remission.

Patients with cancers that respond poorly to standard care are already at great risk, so if they first try one of the treatments discussed in Knockout, I don't see this as a problem either. They, too, may find a more effective (and safer) therapy.

Philosophically, I side with books and other sources that supply reliable information about unconventional cancer treatment. I protest against books, organizations, websites of research institutions, etc., that omit such information or represent all alternatives as unproven with the intent to scare away patients and physicians. These omissions and misrepresentations leave patients unaware of potentially life-saving therapy, and leave the patients in the worst cases dependent on standard treatments actually proven to be of no help.

Practitioners of alternative cancer therapy, I must point out, have sought impartial trials to prove efficacy and safety for more than half a century. The response by mainstream medicine has largely been to stall on starting, or to design trials that set up protocols to replicate how an alternative therapy is given and then to change or violate the protocols during evaluation, which usually (predictably) ends with negative results.

Where I edge into uneasiness, and this is very personal, is when there are conventional treatments for particular cancers that have a relatively high success rate, and patients who are candidates for such treatment shy from it in fear of adverse effects. I'm not talking only about chemotherapy, where the side effects are truly frightful. I have in mind surgery and radiation, which can depress the immune system, but their deleterious effects are more controllable and recovery from them is more likely.

Conclusion

For sure, some readers of Knockout will head off to doctors the book names as curing cancer through alternative treatments. And others will go to doctors integrating conventional and unconventional treatments, because Knockout says these doctors are obtaining results through integrated care that are better than results obtained through strictly standard care. What percentage of both groups of readers will be patients fighting cancer is impossible to estimate.

If patients, how many have cancers altogether unresponsive to standard treatment? How many have been disillusioned with conventional therapy because the adverse effects were more pronounced or lasting than the benefits? Again, the percentages are impossible to estimate.

In my second column on Knockout, I quoted from the foreword to Unconventional Cancer Treatments, a report by the congressional Office of Technology Assessment (OTA) published in September 1990. The first paragraph read:

"While mainstream medicine can improve the prospects for long-term survival for about half of the approximately one million Americans diagnosed each year, the rest will die of their disease within a few years. There remains a degree of uncertainty and desperation associated with 'facing the odds' in cancer treatment."

According to Times "The Forty Years' War," series, the death rate for cancer, "adjusted for the size and age of the population, dropped only 5 percent from 1950 to 2005." (1)

Roughly two decades after publication of the OTA report on unconventional cancer treatments, for almost half the Americans diagnosed with cancer annually, mainstream medicine has only insignificantly improved the odds for surviving cancer for more than a few years.

Let's suppose that Suzanne Somers, by drawing attention in Knockout to alternatives to mainstream therapy and to approaches that integrate unconventional with conventional treatments, helps just a handful of patients-patients who would likely die continuing under standard care--to become long-term cancer survivors. That, in the end, is a commendable achievement.

Future Column: The Economics of Cancer Chemotherapy

I've promised in my previous columns about Knockout to investigate how profitable cancer chemotherapy is, whether its profitability accounts for its increasing use despite studies that show that its medical benefits are small and that it is not cost-effective. I still have much research to do before I can write confidently about it. But the subject rates a column by itself, and I plan on devoting one to it in the not-too-distant future.

by Marcus A. Cohen marcusacohen@aol.com

Notes

(1.) Kolata G. Advances elusive in the drive to cure cancer. New York Times. April 24, 2009.
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Author:Cohen, Marcus A.
Publication:Townsend Letter
Article Type:Column
Geographic Code:1USA
Date:Feb 1, 2010
Words:2295
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