"" Ralph Moss—Cancer Consultant: 2010-12-05

Saturday, December 11, 2010

The Procrustean Bed

[caption id="attachment_145" align="aligncenter" width="300" caption="Herakles killing Procrustes on his bed"][/caption]

Oncologists sometimes try to recruit patients into Phase I (toxicity) clinical trials. But how effective are the experimental treatments provided in such trials? In a recent 2010 study that pooled data from various phase I chemotherapy trials for sarcoma, the partial response rate was 1.6 percent (2 out of 133 subjects) and the complete response (CR) rate was 0.8 percent (1 out of 133). The median progression-free survival was 2.1 months and the median overall survival was 7.6 months. Meanwhile, 18 percent of patients experienced grade 3 or 4 (i.e., critical or life-threatening) toxicity and 12 percent dropped the trial treatment because of toxicity.

Yet here's the amazing part. The authors of this study, at the Royal Marsden Hospital, London, concluded: “Phase I clinical trials could be considered a therapeutic option in sarcoma...due to the low risk of toxicity” (Jones RL, Olmos D, Thway K, et al. Clinical benefit of early phase clinical trial participation for advanced sarcoma patients. Cancer Chemother Pharmacol. 2010. Available at PubMed, emphasis added).

Pardon me for being blunt, but what universe do these scientists inhabit? I wonder if they themselves would submit to such toxic drugs for a less than one percent chance of a "cure" (a "cure" that in any case may last a month or so). And—it seems almost too obvious to ask—how do these scientists define a "low risk of toxicity"? Grade 4 toxicity classically includes such things as massive hemorrhages, life-threatening infection, more than ten episodes of vomiting in a 24 hour period, etc. Even grade 3 toxicity includes such things as "painful erythema, edema or ulcers and (patients) cannot eat" (http://www.rtog.org/members/toxicity/tox.html)

Sometimes I get the impression that various authors reach their conclusions first and then force their data to fit a preconceived notion. The Greeks had a term for this, a "Procrustean bed." This term came from a myth about a highwayman named Procrustes, who physically either cut or stretched the limbs of his victims  to fit the predetermined length of his torture bed. This term has stuck for any situation in which people stretch (or minimize) the data to conform to some preconceived notion.

Sunday, December 5, 2010


[caption id="attachment_133" align="alignnone" width="300" caption="Doctors at Hadassah Hospital, Ein Kerem"][/caption]

This week I am happy to introduce a new special report on "CAM and Cancer in Israel." This report is the result of a trip I took this summer to Israel, touring clinics and meeting doctors who use complementary and alternative medicine in this small but dynamic country. My visit took me to Tel Aviv, Haifa and Jerusalem and their environs. I visited doctors in private practice, in HMOs and in hospitals and university clinics. I also met with inventors and discoverers in this so-called "start up nation." The trip was fascinating on many levels.  CAM is as popular in this small country as any place I have visited and its degree of integration into conventional medicine is arguably the greatest in the world! Although my focus is on what is offered to Israelis there are opportunities here for international cancer patients who want to explore integrative options from some of the finest doctors I know.

"CAM and Cancer in Israel" totals 63 pages in length. It includes photos of the main practitioners, as well as an appendix of contact information (addresses, phone numbers, emails) of these doctors. There is a ten-page bibliography of peer-reviewed journal articles on CAM in Israel and a listing of the major organizations that support CAM usage in this ancient land.

My visit was supported by a grant from a non-profit European foundation, Reliable Cancer Therapies. It was reviewed for accuracy by leading Israeli and American physicians. Some of their comments are given below:

"Ralph Moss's report on CAM and cancer in Israel is extensive and enlightening. I thank him for his significant contribution and support of our activities in the Holy Land."
—Eran Ben-Arye, MD, Haifa, Israel

"Ralph Moss's report provides in-depth research on a subject never investigated before. In the course of his visit he reached most of the serious CAM-cancer practitioners in this country. He has shown that CAM can be practiced in a serious way and add greatly to the treatment of cancer patients."
—Joseph Brenner, MD, Tel Aviv, Israel

"In this report, the story of CAM in Israel is told in a powerful, comprehensive and interesting way by a keen outside observer. I am impressed by Moss's systematic and informative coverage, including relevant background information, a vast number of facts, and a balanced description of a large variety of CAM activities. Moss has done a great job."
—Jacob Shoham, MD, PhD, Ramat-Gan, Israel

"Ralph Moss provides an in-depth report on CAM and cancer in Israel. His detailed encounter with the various experts is an important and much needed guide for both health providers and patients who are interested in this thriving field."
—Isaac Eliaz, MD, Santa Rosa, Calif.

This new Moss report is now available for sale for $19.95 at our Web site, www.cancerdecisions.com. You can order it directly by clicking on the home page banner or by going directly to: