Just as the etiology of cancer itself is uncertain and complicated, the etiological effect of any treatment on the outcome of a cancer patient is also uncertain and complicated. It is all uncertain and complicated because the causal chain of events in relation to cancer, or any disease for that matter, are complicated and uncertain. Causation as a thing in itself is never an empirically verifiable phenomena. As a result, all claims about causation in any physical phenomena, whether in medicine or elsewhere, are inherently theoretical. Therefore, your claim that holistic therapy did not save her is your personal theory that can never be an empirically verified fact.
“It was not holistic therapy that saved her. She was among the 16 or so women out of 20 cured with surgery.”
Is it possible that the holistic therapy and the surgery were complimentary and BOTH contributed to her good outcome????
I would also like to learn more about this patient involved decision making process because I have the impression that treatment choices are not being presented to most people and that insurance companies have a lot of influence on the selection of treatment plans.
Well, i think for sure an informed-consent based partnerships and collaboration between patient and doctor is correct. But if/when the media or Elle describes more of a patronizing relationship, are you sure they are exaggerating or misportraying it? It sounds like you idealisticly want things to be a way they may often not be. Ive heard hundreds or thousands of stories of patients being pressured and shamed and gaslit by doctors for various reasons---often for admitting to using or expressing interest in natural approaches, refusing vaccination, refusing procedures that were formerly unpleasant for the patient, asking too many questions or making too many suggestions indicating theyve done their own research.
Docs tend not to like having their authority challenged or being humble that some wacky ideas might just work or at least be no more dangerous and unscientific than their own wacky ideas. The patronizing approach is extremely baked in, even into the financial system where the patient is at the mercy of not knowing how much anything costs.
In reality a collaboration should be optimal because the doctor has a degree and experience with many different people to rely on, as well as being the gatekeeper to certain diagnostics and solutions, but the patient has their own personal knowledge of their body, the time to research and become highly educated in their exact disease,
the power to crowd source the most likely diagnosis and promising solutions, and the ability to have an open mind to all the types of medicine and be critical about the status quo due to a lack of a medical education.
Sensible questions are along the lines of whats the benefit of chemo for how long and what are the additional benefits and risks? what is the benefit of holistic adjuncts for how long and what are the additional benefits and risks? How much does each cost me financially ? How much does each potentially save me financially? Everything must be examined in terms of all costs and all benefits over all time. Not just on cancer.
Im not sure the chemo has any positive effects other than preventing cancer, but holistic adjuncts could have subtle positive effects on every organ and system in the body and prevent other diagnoses down the road. Depending on what they are they could also be free. Diet and exercise, mediation, visualization, prayer and sleep and giving up drugs and alcohol are all free. Self massage and self reiki are free or can be exchanged.
Yes, given the miniscule benefit of having chemotherapy, has anyone proven that lifestyle changes and adjunct therapies do not have MORE benefit than chemotherapy? Even a small benefit would be enough.
What would be helpful is for you doctors to go through the empirical evidence on chemotherapy. I’d also like to hear more about whether stage zero breast cancer should even be treated at all.
The three media headlines you highlighted sound fairly similar. Wonder if pharma had anything to do with influencing those media outlets and their coverage of Ms. Macpherson’s story.
If the chemo were only prophylactic and she rolled the dice, hoping that it would turn out that she didn’t need it, then that’s not necessarily an unwise move. I was offered one round of prophylactic chemo after my surgery. I thought that seemed nuts and declined. Then I had a recurrence and had to have four rounds of chemo. Who knows what would’ve happened had I had that one round!
Good points, y'all. And I have to add, EVERY person I've ever known who went on chemotherapy lost their appetite (which is putting it mildly), and was therefore encouraged to eat and drink ANYTHING that appealed to them, as long as it would stay down. One was strictly instructed by her oncologist to NOT change her typical American diet in any way. I'm still scratching my head over that one.
My heart breaks every time I see this scenario play out. And my apologies to Drs Prasad and Cifu, but after seeing a dozen or so friends and colleagues go through this, with the vast majority NOT surviving much past 5 years in spite of (or because of?) the grueling treatments, and some not even making it past a couple of years, I have lost faith in the cancer industry. And yes, I did use to believe that they were curing cancer.
One of my friends explained to me after she completed her treatments that she would be on Tamoxifen for some years, to prevent recurrence. I looked up Tamoxifen, and saw studies suggesting a link with fatty liver disease and liver cancer. A few years later, my friend had liver cancer, which she was told had spread from her [removed] breast -- no mention of any possible relationship with the Tamoxifen. She underwent more chemotherapy, with even worse side effects than her previous regimen, and her last year of life was one of pain and misery.
I'm not claiming any knowledge or belief in alternative treatments here. I don't know what the best answer is, but the whole paradigm of early screening to catch cancers that may or may not have ever grown life-threatening, in order to undergo a treatment that seems guaranteed to instantly destroy quality and likely quantity of life ... it just doesn't make sense to me.
I am glad you started off with she "made a reasonable choice," however I disagree that she sends the "wrong" message. The message she sends is it is a personal choice and the holistic approach worked for HER. My friend had a brain tumor and chose not to have chemo, radiation or surgery. They told her she had 6 months to live. She lived for 10 years. My sister-in-law chose to have 6 rounds of chemo and was told if she had any more, she would have a heart attack. She is alive 10 years later. The chemo compromised her body but she is alive. To each his own. sabrinalabow.substack.com
One nuance missed in the article is how recurrence risk could be measured by the key driver mutations, copy number changes, and methylation state of the primary tumor. Even if she just had the genetic mutation profile of the primary tumor that was removed, this might further give some level of risk assessment for recurrence or OS rate without chemo. Part of the “luck” could reside there…
It is also known that chemo with certain mutations may drive a subset of resistance as precision medicine is still pretty terrible in capturing tumor heterogeneity. Honestly it is the rich and famous who could seriously drive more nuanced science behind cancer treatment and no chemo + naturopath could also be considered (Ie could MRD be monitored). Whatever the case I would argue that her decision (or non-decision) as well as the viewpoints of the docs are based on whatever best knowledge they held…our understanding of cancer recurrence needs much more nuanced scientific inquiry than anything (besides even just tumorigenesis itself). One last thing is we don’t know family history Ie did her mother, grandmother also suffer from BC…yet another nuance in the treatment game (risk for cancer in the first place…that could effect the whole family).
Do the not so sensible comments make Sensible Medicine less of a great resource for practicing physicians?? Literally, the site is called Sensible Medicine not sensible chiropathy or homeopathy. Deep breath. Deep breath. OK just don’t read the comments.
I am sorry I’m so insensitive, but who cares? This woman made her own decision with her doctors. What I or anyone else might think about it is immaterial and none of our da— business. Why is the press discussing this. Butt our folks and leave the lady in peace.
As a top commenter said, that's not critical thinking, that's just dismissal.
In other words, this comment you've made basically amounts to a bunch of dishonest generalities, mostly because what you're saying is so broad that it basically says nothing.
No one said this: "we should believe every insane holistic quack who has snake oil potions to sell."
Just as the etiology of cancer itself is uncertain and complicated, the etiological effect of any treatment on the outcome of a cancer patient is also uncertain and complicated. It is all uncertain and complicated because the causal chain of events in relation to cancer, or any disease for that matter, are complicated and uncertain. Causation as a thing in itself is never an empirically verifiable phenomena. As a result, all claims about causation in any physical phenomena, whether in medicine or elsewhere, are inherently theoretical. Therefore, your claim that holistic therapy did not save her is your personal theory that can never be an empirically verified fact.
“It was not holistic therapy that saved her. She was among the 16 or so women out of 20 cured with surgery.”
Is it possible that the holistic therapy and the surgery were complimentary and BOTH contributed to her good outcome????
I would also like to learn more about this patient involved decision making process because I have the impression that treatment choices are not being presented to most people and that insurance companies have a lot of influence on the selection of treatment plans.
How many people die from chemotherapy every year in the US? Is this info available? How many people who “die” from cancer actually die from chemo?
Well, i think for sure an informed-consent based partnerships and collaboration between patient and doctor is correct. But if/when the media or Elle describes more of a patronizing relationship, are you sure they are exaggerating or misportraying it? It sounds like you idealisticly want things to be a way they may often not be. Ive heard hundreds or thousands of stories of patients being pressured and shamed and gaslit by doctors for various reasons---often for admitting to using or expressing interest in natural approaches, refusing vaccination, refusing procedures that were formerly unpleasant for the patient, asking too many questions or making too many suggestions indicating theyve done their own research.
Docs tend not to like having their authority challenged or being humble that some wacky ideas might just work or at least be no more dangerous and unscientific than their own wacky ideas. The patronizing approach is extremely baked in, even into the financial system where the patient is at the mercy of not knowing how much anything costs.
In reality a collaboration should be optimal because the doctor has a degree and experience with many different people to rely on, as well as being the gatekeeper to certain diagnostics and solutions, but the patient has their own personal knowledge of their body, the time to research and become highly educated in their exact disease,
the power to crowd source the most likely diagnosis and promising solutions, and the ability to have an open mind to all the types of medicine and be critical about the status quo due to a lack of a medical education.
Sensible questions are along the lines of whats the benefit of chemo for how long and what are the additional benefits and risks? what is the benefit of holistic adjuncts for how long and what are the additional benefits and risks? How much does each cost me financially ? How much does each potentially save me financially? Everything must be examined in terms of all costs and all benefits over all time. Not just on cancer.
Im not sure the chemo has any positive effects other than preventing cancer, but holistic adjuncts could have subtle positive effects on every organ and system in the body and prevent other diagnoses down the road. Depending on what they are they could also be free. Diet and exercise, mediation, visualization, prayer and sleep and giving up drugs and alcohol are all free. Self massage and self reiki are free or can be exchanged.
When women are autocratic, isn't it "maternalistic?:
Without a randomized, controlled trial how can you conclude that the adjuvant holistic therapy she chose did or did not alter her outcome?
Yes, given the miniscule benefit of having chemotherapy, has anyone proven that lifestyle changes and adjunct therapies do not have MORE benefit than chemotherapy? Even a small benefit would be enough.
What would be helpful is for you doctors to go through the empirical evidence on chemotherapy. I’d also like to hear more about whether stage zero breast cancer should even be treated at all.
The three media headlines you highlighted sound fairly similar. Wonder if pharma had anything to do with influencing those media outlets and their coverage of Ms. Macpherson’s story.
If the chemo were only prophylactic and she rolled the dice, hoping that it would turn out that she didn’t need it, then that’s not necessarily an unwise move. I was offered one round of prophylactic chemo after my surgery. I thought that seemed nuts and declined. Then I had a recurrence and had to have four rounds of chemo. Who knows what would’ve happened had I had that one round!
Good points, y'all. And I have to add, EVERY person I've ever known who went on chemotherapy lost their appetite (which is putting it mildly), and was therefore encouraged to eat and drink ANYTHING that appealed to them, as long as it would stay down. One was strictly instructed by her oncologist to NOT change her typical American diet in any way. I'm still scratching my head over that one.
My heart breaks every time I see this scenario play out. And my apologies to Drs Prasad and Cifu, but after seeing a dozen or so friends and colleagues go through this, with the vast majority NOT surviving much past 5 years in spite of (or because of?) the grueling treatments, and some not even making it past a couple of years, I have lost faith in the cancer industry. And yes, I did use to believe that they were curing cancer.
One of my friends explained to me after she completed her treatments that she would be on Tamoxifen for some years, to prevent recurrence. I looked up Tamoxifen, and saw studies suggesting a link with fatty liver disease and liver cancer. A few years later, my friend had liver cancer, which she was told had spread from her [removed] breast -- no mention of any possible relationship with the Tamoxifen. She underwent more chemotherapy, with even worse side effects than her previous regimen, and her last year of life was one of pain and misery.
I'm not claiming any knowledge or belief in alternative treatments here. I don't know what the best answer is, but the whole paradigm of early screening to catch cancers that may or may not have ever grown life-threatening, in order to undergo a treatment that seems guaranteed to instantly destroy quality and likely quantity of life ... it just doesn't make sense to me.
I am glad you started off with she "made a reasonable choice," however I disagree that she sends the "wrong" message. The message she sends is it is a personal choice and the holistic approach worked for HER. My friend had a brain tumor and chose not to have chemo, radiation or surgery. They told her she had 6 months to live. She lived for 10 years. My sister-in-law chose to have 6 rounds of chemo and was told if she had any more, she would have a heart attack. She is alive 10 years later. The chemo compromised her body but she is alive. To each his own. sabrinalabow.substack.com
One nuance missed in the article is how recurrence risk could be measured by the key driver mutations, copy number changes, and methylation state of the primary tumor. Even if she just had the genetic mutation profile of the primary tumor that was removed, this might further give some level of risk assessment for recurrence or OS rate without chemo. Part of the “luck” could reside there…
It is also known that chemo with certain mutations may drive a subset of resistance as precision medicine is still pretty terrible in capturing tumor heterogeneity. Honestly it is the rich and famous who could seriously drive more nuanced science behind cancer treatment and no chemo + naturopath could also be considered (Ie could MRD be monitored). Whatever the case I would argue that her decision (or non-decision) as well as the viewpoints of the docs are based on whatever best knowledge they held…our understanding of cancer recurrence needs much more nuanced scientific inquiry than anything (besides even just tumorigenesis itself). One last thing is we don’t know family history Ie did her mother, grandmother also suffer from BC…yet another nuance in the treatment game (risk for cancer in the first place…that could effect the whole family).
If EM wanted peace or privacy she wouldn't have written the book.
Can't have it both ways
Do the not so sensible comments make Sensible Medicine less of a great resource for practicing physicians?? Literally, the site is called Sensible Medicine not sensible chiropathy or homeopathy. Deep breath. Deep breath. OK just don’t read the comments.
As always, thank you for your time.
I am sorry I’m so insensitive, but who cares? This woman made her own decision with her doctors. What I or anyone else might think about it is immaterial and none of our da— business. Why is the press discussing this. Butt our folks and leave the lady in peace.
Thank you for your OUTSTANDING POST.
The amount of holistic BS, quack cancer cures, and just outright nonsense I am hearing is nauseating.
Just because Covid vaccine was a disaster, does not mean than we should believe every insane holistic quack who has snake oil potions to sell
As a top commenter said, that's not critical thinking, that's just dismissal.
In other words, this comment you've made basically amounts to a bunch of dishonest generalities, mostly because what you're saying is so broad that it basically says nothing.
No one said this: "we should believe every insane holistic quack who has snake oil potions to sell."
How dishonest.