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From: smb@ulysses.UUCP (Steven Bellovin)
Newsgroups: net.med
Subject: Re: Misquotes
Message-ID: <654@ulysses.UUCP>
Date: Sat, 15-Oct-83 13:20:16 EDT
Article-I.D.: ulysses.654
Posted: Sat Oct 15 13:20:16 1983
Date-Received: Sun, 16-Oct-83 11:28:14 EDT
References: <106@houxk.UUCP>
Organization: AT&T Bell Laboratories, Murray Hill
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> From: jmg@houxk.UUCP (J.MCGHEE)
> Subject: Misquotes
> Message-ID: <106@houxk.UUCP>
> Date: Fri, 14-Oct-83 17:25:26 EDT
> 
> .... And I never suggested that anyone should suspend their
> medical therapy.

Let me include your exact words:

	What could be dangerous to someone under a death sentence from
	cancer? And I've never heard of macrobiotic people wanting to cut
	organs out of people. Isn't that much more dangerous and debilitating
	than a beneficial (according to U.S. Government publications and
	studies) change in diet?

I find it reasonable to infer from this that at least some proponents of
a macrobiotic diet feel that (a) removal of organs is dangerous and
debilitating; (b) feel that it is purposeless (since these people are "under
a death sentence"); and hence (c) is wanton -- do you have a better word?
I agree that quote marks should be reserved for exact quotations, of course,
but I don't think Steve Dyer's reading of your article was incorrect.

As for "suspend[ing] their medical therapy" -- some proponents of macrobiotic
treatment of cancer do indeed advocate that; they claim that removal of
organs is "dangerous and debilitating", and that radiation burns healthy
tissues, and that chemotherapy poisons people.  All of these claims are
obviously correct -- if you don't consider the tradeoff between an unpleasant
course of treatment and a painful death.  Modern medical practice on treatment
of cancer is very conservative; doctors will remove as much tissue as they
think necessary to guarantee that they've removed all of the cancerous cells.
As new, and less drastic, treatments are shown to be effective, they're
adopted.  Treatment of breast cancer has moved (in some cases) from radical
mastectomies to simple mastectomies to lumpectomies -- depending on the
the patient's exact condition, and the confidence the doctor has in the
less agressive forms of therapy.  The latest figures I've seen put the
aggregate 5-year cure rate for all forms of cancer at close to 50% -- an
impressive change from 20 years ago.  So much for death sentences.

> 	The harmlessness and flexibility of the macrobiotic diet is that
> it can be used without interrupting standard medical therapy, but we all
> know of instances where all treatment is withheld from large groups of
> people in control groups when our medical system experiments with a new
> form of therapy is tried.

You raise on interesting point of ethics:  how do you suggest we assess
the validity of any proposed treatment.  Current practice calls for
convincing data from animal experimentation before any human trials are
instituted; when there is sufficient data to warrant it, a trial is conducted
on human volunteers.  If appropriate, this trial is on terminally ill
patients, who, as you have noted, have little to risk.  Granted, some
patients are not given this new form of treatment.  On the other hand, there
is no assurance that it actually does anything, or that the side effects
won't be more lethal.  But how do you know, and how do you form any sort
of rational judgement without such tests?  I confess, I'm quite uncom-
fortable with the process, but I don't know of any alternative.  Uncontolled
studies are too vulnerable to coincidence and wishful thinking -- as has
been demonstrated many times before.

I'm not claiming that this model is always followed; everyone knows that
it isn't.  The most notorious violation of it was the famous Tuskegee
syphillis experiment, where a group of black men was denied even the
medications available at the time.  Far worse, when penicillin became
available and was known to be useful, the study was continued!  I regard such
behavior as criminal.  (Those interested in this sordid story can read "Bad
Blood", which came out about two years ago.)  On the other hand, a recent
study on treating heart attack victims was interrupted early because the
researchers found that results were so dramatic that it was unethical to
withhold the drug (an anticoagulant, I believe) from anyone.

Let me ask you this.  You claim that macrobiotic diets are useful in
treating cancer.  (Incidentally, I agree that many elements of the macro-
biotic diet are useful in preventing cancer, though I have my doubts about
fried foods -- the frying process seems likely to produce nitrosamines.
But we're talking here about treatment, not prevention.)  I claim that
more conventional medical techniques -- surgery, chemotherapy, and radio-
therapy -- are more useful.  How do you suggest that our disagreement
be resolved?


		--Steve Bellovin