Chemotherapy

On Cancer and Dr. Peter Gøtzsche

• Screening for a cancer is useless if it does not make people live longer. When the patients do not live longer, but live longer with the knowledge that they have cancer because the clock started earlier, the “early detection” of cancer is unequivocally harmful. There are many such offers of useless screenings on the private market. - Peter Gøtzsche

• "...it takes much more than logic and clear-cut demonstrations to overcome the inertia and dogma of established thought." - Irving Stone

• A 2004 review of the randomised trials showed that the overall contribution of curative and adjuvant cytotoxic chemotherapy to five-year survival of adult cancer patients in USA and Australia was only 2%. In the vast majority of cancer cases, over 90%, the effect of chemotherapy was marginal, corresponding to a life extension of only three months. And new drugs for solid cancers approved by the European Medicines Agency increased survival by only one month compared to other regimes. - Peter Gøtzsche

Cancer is rotten.

No, I’m not talking about the disease.

I’m referring to the industry. The Institution.

I had my suspicions once I read The Real Anthony Fauci, but it was confirmed when I watched the documentary Cancer: The Forbidden Cures.

Cancer: The Forbidden Cures

Here are my thoughts after watching the (excellent) documentary:

• The history of suppressing effective cancer treatments is very long. Well over 100 years.

• The history of shaming, cancelling, bankrupting, jailing doctors who innovate effective, safe and cheap solutions is very long.

• Do we know how to treat cancer? Yes.

• Would they love to blame it on genetics? Yes.

• Are there many different ways to treat cancer? Yes.

• Are surgery, chemotherapy, and radiation likely the best ways of treating cancer. No.

• Is the whole official industrial cancer complex corrupt? Yes.

• Would I trust a mainstream oncologist as far as I could throw him? No.

• Would I donate to “cancer research”? No.

Cancer is a corruption; a metastasized corruption [pun absolutely intended].

Here is Dr. Robert Yoho from Butchered by “Healthcare”

I was wrong about "healthcare".

Oncology or cancer treatment.

What I thought: we have a lot of cures and the science is advancing rapidly.

The truth: This is a heavily hyped sales pitch created by the industry. Cancer is the second leading cause of death after heart disease, but only a scant few treatments cure or even significantly prolong life. Although pain relief counts, extending life is the critical measure of success, and if the patient dies sooner of something else, it is a failure. Most of our toxic, over-advertised, extortionately priced treatments offer less than two months of prolonged survival.

Two-thirds of cancer doctors’ income comes from retailing drugs, or rather getting “rebates” for selling them. This is legal for corporations, but it would be criminal fee-splitting if done between physicians. Whatever the legalities, manipulating patient care with financial incentives has overwhelming potential for abuse. This must be banned.

Colon cancer.

What I thought: colonoscopy saves us from colon cancer.

The truth: Colonoscopy for random patients looking for colon cancer has no benefit.

This tumor is the second most frequent cancer killer after lung cancer. US gastroenterologists look inside the colon to identify small cancers and pre-cancers before they spread. Since surgeons can often cure these in their early stages by cutting out a section of the colon, this screening program seems reasonable. But examining patients without symptoms or known disease does not increase the average time they live.

Prostate cancer.

What I thought: urologists save men from dying of prostate cancer by checking a blood test on everyone over a certain age.

The truth: This does not work. The standard routine is to check the prostate-specific antigen (PSA) in the blood, and when it is high, to do painful biopsies. If cancer is seen, a removal operation called “radical prostatectomy” is often recommended.

This commonly results in impotence and incontinence and saves no lives overall. Other therapies for the early stages of this cancer are also ineffective and damaging.

Even though about 75 percent of older men get prostate cancer before they die, it is only fatal in two percent. The tumor is usually inactive, and an aggressive approach does more harm than good.

Here is a summary of bullet points from the linked piece by Dr. Ron Hunninghake on High Dose IV Vitamin C and Cancer

Orthomolecular.org-Tribute to Pioneers

• Irwin Stone recognized the potential of high-dose intravenous vitamin C (IVC) therapy for cancer early on, but overcoming medical skepticism requires solid evidence.

• Vitamin C has wide-ranging clinical uses – best antiviral available, neutralizes toxins, enhances immunity, anti-cancer properties.

• Due to vitamin C’s designation as a “vitamin”, its role in high-dose IVC cancer therapy was dismissed, not explored.

• Chronically ill patients consistently show vitamin C deficiency – especially true in cancer patients as cancer cells actively deplete vitamin C.

• PET scans show cancer cells voraciously consume glucose, vitamin C is structurally very similar to glucose.

• Cancer cells actively transport vitamin C either mistaking it for glucose, or needing the antioxidant properties – this allows intra-cellular vitamin C accumulation.

• High intra-cellular vitamin C concentrations behave as a pro-oxidant, generating hydrogen peroxide which kills cancer cells due to their low catalase levels.

• IVC enhances multiple mechanisms – immunity, tumor encapsulation, prevents metastasis and induces apoptosis along with selectively killing cancer cells.

• IVC reduces cancer symptoms like pain, fatigue and poor appetite which are often vitamin C deficiency related – allows patients to tolerate and complete conventional therapy.

• Potential IVC complications like iron overload and fluid retention in those with renal impairment need to be screened for – but IVC is very safe overall.

• IVC harnesses the mega-dose vitamin C cancer-killing mechanisms that humans lost due to evolutionary gene mutations – it is a discovery medicine is just waking up to.

Now having said all of that, this article is actually about Chemotherapy and Peter Gøtzsche.

Gøtzsche is a big deal.

Peter C. Gøtzsche, DrMedSci, MD, MSc

Professor Peter C. Gøtzsche graduated as a Master of Science in biology and chemistry in 1974 and as a physician 1984. He is a specialist in internal medicine; worked with clinical trials and regulatory affairs in the drug industry 1975-1983, and at hospitals in Copenhagen 1984-95. Co-founded the Cochrane Collaboration (the founder is Sir Iain Chalmers), and established the Nordic Cochrane Centre in 1993. Became professor of Clinical Research Design and Analysis in 2010 at the University of Copenhagen and has been a member of the Cochrane Governing Board twice. Co-founded Council for Evidence-based Psychiatry in the UK in 2014 and International Institute for Psychiatric Drug Withdrawal in Sweden in 2016. Founded the Institute for Scientific Freedom in 2019 and was visiting professor, University of Newcastle 2019 to 2022. Currently works as researcher, lecturer, author and independent consultant, e.g. in lawsuits.

Peter’s greatest contribution to public health was when he, in 2010, opened the archives of clinical study reports in the European Medicines Agency after a 3-year long battle that involved a complaint to the European Ombudsman. EMA was solely concerned with protecting the drug industry’s interests while ignoring those of the patients. The Ombudsman ruled there was no commercially confident information in the study reports.

Peter has published over 100 papers in “the big five” (BMJ, Lancet, JAMA, Annals of Internal Medicine and New England Journal of Medicine) and his scientific works have been cited over 190,000 times (his H-index is 91 according to Web of Science, June 2023, which means that 91 papers have been cited at least 91 times). Peter is author of several books. The most recent ones are:

• Critical psychiatry textbook (2022).

• The Chinese virus: Killed millions and scientific freedom (2022).

• Mental health survival kit and withdrawal from psychiatric drugs: a user’s guide (2022, in 7 languages).

• The decline and fall of the Cochrane empire (2022)

• Vaccines: truth, lies and controversy (2021, in 7 languages).

• Survival in an overmedicated world: Find the evidence yourself (2019, in 7 languages).

• Death of a whistleblower and Cochrane’s moral collapse (2019).

• Deadly psychiatry and organised denial (2015, in 9 languages).

• Deadly medicines and organised crime: How big pharma has corrupted health care (2013, in 18 languages). Winner, British Medical Association’s Annual Book Award, Basis of Medicine in 2014.

• Mammography screening: truth, lies and controversy (2012). Winner of the Prescrire Prize in 2012.

• Rational diagnosis and treatment: evidence-based clinical decision-making (2007).

Peter has given numerous interviews, one of which – about organised crime in the drug industry – has been seen by half a million on YouTube. Peter was in The Daily Show in New York on 16 Sept 2014 where he played the role of Deep Throat revealing secrets about big pharma. A documentary film about Peter’s reform work, Diagnosing Psychiatry, appeared in 2017, and another one, with the working title, “The honest professor and the fall of the Cochrane empire,” about his life and the moral collapse of the Cochrane Collaboration, is in production. Donations to the film can be given here.

Peter has an interest in statistics and research methodology. He has co-authored guidelines for good reporting: CONSORT for randomised trials, STROBE for observational studies, PRISMA for systematic reviews and meta-analyses, and SPIRIT for trial protocols. Peter was an editor in the Cochrane Methodology Review Group 1997-2014.

Peter is Protector for the Hearing Voices Network in Denmark.

Websites: scientificfreedom.dk and deadlymedicines.dk.
Twitter: @Pgtzsche1
Email: pcg@scientificfreedom.dk 

This short video of Peter, sent to me by a friend, is worth listening to about the corruption of medicine.

Which finally brings us to the point of this article. Chemotherapy. But specifically what Peter Gøtzsche has to say about it.

With thanks to Peter C Gøtzsche, Institute for Scientific Freedom

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Should I get chemotherapy for cancer? Probably not – Institute for Scientific Freedom

If you get cancer, one of the most important questions is to decide if you should accept or decline chemotherapy. By far most patients accept chemotherapy, likely because they think that if it wasn’t worthwhile, it wouldn’t be offered.

This is a mistake.

Chemotherapy is rarely worthwhile

We hear a lot about progress against cancer. This narrative increases donations to cancer charities and benefits doctors who do research on cancer therapies, and it affects not only the public but the doctors themselves. Their belief in the effectiveness of chemotherapy is so strong that virtually every cancer patient is offered chemotherapy, even in the last few weeks before they die.

The truth is that, with a few exceptions, little progress has been made the last 70 years when it comes to chemotherapy.

A 2004 review of the randomised trials showed that the overall contribution of curative and adjuvant cytotoxic chemotherapy to five-year survival of adult cancer patients in USA and Australia was only 2%. In the vast majority of cancer cases, over 90%, the effect of chemotherapy was marginal, corresponding to a life extension of only three months. And new drugs for solid cancers approved by the European Medicines Agency increased survival by only one month compared to other regimes.

But when you analyse specific types of cancers, there are a few where chemotherapy has significant benefits. The contribution to five-year survival was 39% for testicular cancer, 39% for Hodgkin’s disease, 12% for cervical cancer, 11% for lymphoma, and 9% for ovarian cancer.

This is an interesting passage.

I accept that different cancers will respond different to chemotherapy.

But what I think when I see these positive results is; compared to what?

Has anyone done a well-funded, honest, study to compare chemotherapy and high dose vitamin C for testicular cancer. I’ll go out on a limb and say no.

But with that said, I’m glad that Peter is honest in highlighting where chemotherapy has shown some benefit.

Would doctors accept chemotherapy for themselves?

In Denmark, two journalists asked two prominent doctors what they would do if they got cancer and were offered chemotherapy that gave them a poor chance of surviving. Both would refuse the chemotherapy and one explained he would prefer to enjoy the life he had left.

Such reasonable ideas have powerful enemies in interest groups. The chair of the Danish Cancer Society, Frede Olesen, reprimanded the doctors, saying they harmed the trust between patients and doctors.

They didn’t, in my opinion. They gave sound and honest advice to the public, which is what the public needs. The patients should enjoy the same privileges as health professionals, and few oncologists and nurses are willing to accept the chemotherapy their patients endure for minimal benefit. In elderly patients, aggressive treatment is even more misplaced. What is most important to them is to maintain their independence and dignity, not to gain a few extra weeks of doubtful quality. Ending our lives spending time with our loved ones is far more attractive than being pestered by the toxic effects of chemotherapy, with frequent hospital admissions, which increase the risk that we will die in a hospital bed rather than at home.

I have often witnessed the horrible consequences for the patients, their friends and relatives of fighting till the bitter end. I have also met with people who have been ruthlessly exploited by charlatans, and here is an example.

Regional chemotherapy in Germany

In 2010, the Danish Cancer Society asked me to review the evidence for regional chemotherapy, which was offered by Professor Thomas J. Vogl at the Göthe University in Frankfurt, because hundreds of Danish cancer patients had sought treatment there, at their own expense. For example, patients with bowel cancer with liver metastases could have chemotherapy injected directly into the metastases.

My deputy director reviewed 43 original studies and 8 review articles, and we concluded that there was no evidence that the treatment had any effect on survival. Vogel’s scientific articles were of appallingly poor quality. He described some treated patients, with no control group, and with no explanation of who was included and who was not. The methods used to analyse the data were flawed and Vogl consistently confused a decrease in the size of the cancerous nodule with an improvement for the patient even though it is well known that some forms of chemotherapy that shrink tumours increase mortality. In the extreme, if the dose of the chemotherapy is very high, while it might kill the tumour, it might also kill the patient.

Misleading statistics about progress against cancer

The type of data we see most often in scientific papers and in the media is the survival after the diagnosis is made, e.g. the 5-year survival rate, but such results are misleading.

Today, if someone receives a cancer diagnosis, as opposed to getting a diagnosis a decade ago, there could be an increase in 5-year survival, even though people with that diagnosis die at the same age, on average, as ten years ago.

This is a very important point.

Because of the increased obsession with testing, they are diagnosing it earlier, which shows up in the statistics as an “increase in 5-year survival”, but people are dying at the same age as they were 10 years earlier.

It’s a statistical magic trick of earlier diagnosis.

This can happen, for example, if people become more cancer aware and see doctors at earlier stages of the disease. Or if they attend cancer screening, as the next examples illustrate.

In 2016, a journalist wrote that, after Denmark had had the poorest cancer survival, cancer treatment in Denmark was now equally good as in our neighbouring countries. The title of his article was sensationalist: “Cancer – has the code been broken?”

His argument was that 5-year survival for breast cancer had risen from 82% to 88% in 20 years. But in the meantime, we had introduced screening for breast cancer in Denmark, which leads to 33% overdiagnosis. Many healthy women who would never have received this diagnosis in their lifetime if they had not gone to screening will get a diagnosis of breast cancer. As none of them would have died from breast cancer, this improves 5-year breast cancer survival. I calculated that, because of the overdiagnosis, the true increase in survival is nowhere near 6% but closer to 2%.

Sometimes, the annual number of cancer deaths is related to the number of cancers, but such information can be similarly misleading.

As an example, the mortality rate (number of cancer deaths per 100,000 inhabitants) for malignant melanoma was fairly constant for many years, whereas the incidence was steeply increasing. If the detected cancers were always deadly without treatment, it would mean outstanding progress in the treatment of malignant melanoma. But this was not the case. Many more diagnoses are made in recent years because people are more likely to get their brown spots examined. The surprising fact is that almost all these additional cancers are harmless.¹ Chemotherapy doesn’t work for malignant melanoma, but biological substances have been introduced that improve survival.

Screening for a cancer is useless if it does not make people live longer. When the patients do not live longer, but live longer with the knowledge that they have cancer because the clock started earlier, the “early detection” of cancer is unequivocally harmful. There are many such offers of useless screenings on the private market.

Randomised trials

In randomised trials, there is no problem with using 5-year survival rates because everyone has cancer to begin with and, on average, they will have had the cancer for a similar length of time in the two groups.

But even these studies can be seriously biased. A popular outcome is disease-free survival, but, as already noted, some cancer treatments that do not improve survival lead to tumour shrinkage. It therefore takes longer before “the disease comes back” on a scan, which, moreover, is a misleading concept because it never went away.

A related problem in cancer trials is that the outcome is almost always cancer-specific mortality. As chemotherapy is toxic, it increases mortality, e.g. because of infections. Therefore, the only unbiased mortality measure is mortality from any cause, which is also what matters for patients. They want to stay alive and are not concerned about which cause of death that will eventually be written on their death certificate.

A worked-through example: polychemotherapy for breast cancer

In the review mentioned above, the contribution of chemotherapy to 5-year survival of breast cancer was only 1.4%.

This is not what people are being told, and even I thought that chemotherapy was quite effective until I looked up the evidence when I wrote a book about how people can find reliable information on the Internet.

I found a large meta-analysis of trials in early breast cancer (early means that the cancer and any affected lymph nodes can be surgically removed). For women aged 50 to 69 years who received polychemotherapy, the breast cancer mortality was 47.4% after 15 years, compared to 50.4% in women who did not get polychemotherapy. The difference was only 3.0%, but it was reassuring that half of the women had not died from breast cancer after 15 years, which is because this cancer usually has a good prognosis.

Although the meta-analysis takes up 31 pages in The Lancet, total mortality is nowhere to be found. The readers are referred to graphs in a web appendix, but the paper does not say where one can find the appendix, which hurled me into the most bizarre type of academic playing hide-and-seek I have ever encountered. I used a lot of time on this and had given up when I decided to try one last time. I found the relevant graph in a document with 249 pages of graphs, often more than one on each page, and with no meaningful legends or index to help readers find what they were looking for. The difference in total mortality was only 2.1% (53.6% versus 55.7%), which means that quite a few women had been killed by the polychemotherapy who would not have been killed with single agent chemotherapy.

People – including doctors – often say that a small average benefit can be worthwhile because some patients benefit more than others: “Perhaps I will be one of the lucky ones who adds 6-12 months to my life, and not the 1-3-month average.” And sometimes, patients refer to other patients who lived many years after chemotherapy.

These are false hopes. Cancer has highly variable growth rates, and some patients are therefore destined to live longer than others. We can only make rational decisions if we base them on the average life extension obtained in randomised trials and also know if the chemotherapy has any effect on total mortality.

Our spineless drug regulators

Our drug regulators are part of the problem with the current level of overtreatment with chemotherapy. Over the last couple of decades, they have lowered the standards considerably for approval of new cancer drugs, particularly in the USA.

Drug regulators approve new cancer drugs without having a clue whether they are better or worse than those we already have, or even just better than doing nothing. This broken system has resulted in huge expenditures on cancer drugs with certain toxicity but uncertain benefit.

The authors of a 2019 review reported that approximately one-third of cancer drugs are approved by the US Food and Drug Administration based on response rate, which is the percentage of patients whose tumours shrink beyond an arbitrary threshold, typically assessed in a single-arm study. Thus, some new cancer drugs are approved without any evidence from a randomised trial that they work.

Even when randomised trials have been performed and marginal effects have been found, these trivial differences may disappear when the drugs are used in real life on patients suffering from co-morbidities.

Conclusions

I agree with my Danish colleagues. Apart from testicular cancer and lymphomas, I cannot imagine any cancer that would make me accept chemotherapy should I get cancer.

Obituaries often say: “He lost the battle against cancer.” But why the war rhetoric? Why not say something positive, like “He had a good life,” as most of the life was not about fighting cancer?

And should we fight at all? We should not fight a battle we have already lost, and it will surprise most people, doctors included, that, unfortunately, this is the case for most cancer patients.

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References

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2 Bailar JC 3rd, Smith EM. Progress against cancer? N Engl J Med 1986;314:1226-32.

3 Morgan G, Ward R, Barton M. The contribution of cytotoxic chemotherapy to 5-year survival in adult malignancies. Clin Oncol 2004;16:549-60.

4 Wise PH. Cancer drugs, survival, and ethics. BMJ 2016;355:i5792.

5 Jensen JH, Korsgaard P. Vi ville droppe kemoen og nyde livet. Ekstra Bladet 2012;16. marts.

6 Dreier J. Kemoterapi eller ej? Kræftens Bekæmpelse 2012;19. marts.

7 Slevin ML, Stubbs L, Plant HJ, et al. Attitudes to chemotherapy: comparing views of patients with cancer with those of doctors, nurses, and general public. BMJ 1990;300:1458–60.

8 Watts G. Why the exclusion of older people from clinical research must stop. BMJ 2012;344:e3445.

9 Regional kemoterapi – ingen mirakelkur. Pressemeddelelse, Danish Cancer Society 2010;16. april.

10 Larsen K. Kræft – er koden knækket? Ugeskr Læger 2016;178:1566-9.

11 Jørgensen KJ, Zahl P-H, Gøtzsche PC. Overdiagnosis in organised mammography screening in Denmark: a comparative study. BMC Women’s Health 2009;9:36.

12 Gøtzsche PC. Survival in an overmedicated world: look up the evidence yourself. Copenhagen: People’s Press; 2019.

13 Welch HG, Schwartz L, Woloshin S. Overdiagnosed: making people sick in the pursuit of health. Boston: Beacon Press; 2011.

14 Pasquali S, Hadjinicolaou AV, Chiarion Sileni V, et al. Systemic treatments for metastatic cutaneous melanoma. Cochrane Database Syst Rev 2018;2:CD011123.

15 Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005;365:1687-717.

16 Gøtzsche PC. Deadly medicines and organised crime: How big pharma has corrupted health care. London: Radcliffe Publishing; 2013.

17 Prasad V. Do cancer drugs improve survival or quality of life? BMJ 2017;359:j4528.

18 Chen EY, Raghunathan V, Prasad V. An overview of cancer drugs approved by the US Food and Drug Administration based on the surrogate end point of response rate. JAMA Intern Med 2019;179:915-21.