Archive for category Pseudomedicine

Arsenic cures cancer!

Last week The Daily Mail boldly asked “Could arsenic be a miracle cure for cancer? Scientists say it had astonishing results when added to a leukemia drug”. It’s worth pointing out here, that even in the subheading bullet points the Mail Online downplayed their excitement a little, de-escalating from arsenic being a potential “miracle cure” to “makes chemotherapy more effective”.

Headline from the Mail Online reading "Could arsenic be a miracle cure for cancer? Scientists say it had astonishing results when added to a leukemia drug"

The Mail Online wasn’t the only one to cover this story. Medical News Today headlined “Poison or cure? Arsenic can help treat cancer, study finds” while Science Daily said “Arsenic in combination with an existing drug could combat cancer – An ancient medicine shows new promise” and Harvard Magazine asked “Is Arsenic a Key Ingredient in the Battle Against Cancer?”. So, the Mail Online seem to be in good company in reporting this apparently exciting news.

New use for a traditional medicine?

One thing all of these stories had in common was the detailing of arsenic in traditional Chinese medicine. Harvard Magazine quoted study author Kun Ping Lu: “In Chinese traditional medicine, “Arsenic has been used for thousands of years,” said Lu. “Its oxidized form is the active ingredient” for a concoction the Chinese called “magic bullet,” which was used to treat a specific kind of leukemia, APL”.

Arsenic, in fact, has been claimed to treat a whole range of diseases throughout history – in Ancient Greek times it was used to treat ulcers and in Chinese Traditional Medicine it’s been used for over 2000 years. Arsenic was once added to Indian Ayurvedic herbal remedies and when Paracelsus, an Italian Professor of Medicine from the 1500s was skeptical of the old methods of balancing humours to treat disease, he introduced arsenic as an alternative. Paracelsus, in fact, stumbled across a genuine therapeutic action of arsenic in its ability to treat syphilis – an indication for which arsenic was used well into the 20th Century until antibiotics came along.

an open brown medicine bottle laying on its side containing a white powder and labelled "acid arsenic"

But arsenic has not only been a persistent element in traditional medicine, it has also been used to treat cancer – first, to treat chronic myeloid leukaemia in the 1930s and later to treat acute promyelocytic leukaemia (APL). Arsenic trioxide (ATO) has been used to treat APL since its approval in 1995.

The study

The study the Mail Online et al. referenced was summarised in Nature Communications earlier this year in an article titled “Arsenic targets Pin1 and cooperates with retinoic acid to inhibit cancer-driving pathways and tumor-initiating cells”. The study is apparently based on three things:

  • A protein called Pin1 is important in cancer
  • Arsenic trioxide (ATO) is a treatment for cancer
  • All-trans-retinoic acid (ATRA) inhibits Pin1

A good introduction to any peer-reviewed article will use scientific literature to convince you that the question the researchers have asked is a valid one and set their work within the context of what is known in the field. At first glance, this article is particularly industrious in the effort to convince the reader on the three areas above. They strongly stress that “Pin1 is a critical “driver” and a unique drug target in cancer. Pin1 is hyperactivated in most human cancers and correlates with poor clinical outcome”.

ATO and leukaemia

ATO has been approved for use in a certain kind of leukaemia called acute promyelocytic leukaemia (APL) for many years and is successfully used in combination with ATRA in patients with APL. There are very few alternative treatments for this form of leukaemia and ATO combined with ATRA has low toxicity.

The underlying mechanism of this treatment is down to the existence of a protein called PML-RARα which causes APL. PML-RARα doesn’t exist in normal conditions however patients with APL have a genetic mutation which produces this fusion of the genes for two individual proteins PML and RARα – this generates the fusion protein, PML-RARα. It doesn’t really matter what PML-RARα does, only that it drives APL and it doesn’t exist outside of disease. Studies have shown that ATO binds to the PML part of this fusion protein and degrades it.

an image taken from one of the study figures showing the chemical structure of Pin1 and the chemical structure of ATO - the two are shown overlapping to indicate where ATO binds in Pin1

The chemical structure of Pin1 is shown with ATO (I) sitting within in apparent binding pocket on the protein. This image is adapted from the paper.

ATO and Pin1

But the authors of this study were interested in the effect of arsenic on a completely different protein – Pin1.

They don’t really explain why they thought arsenic might remove Pin1 in cancer cells. They used a technique to identify ATRA as a drug of interest, but it seems like they only looked at ATO because it’s already used in combination with ATRA.

In their study the authors find that treating cancer cells with arsenic in the lab reduces the levels of Pin1. They also show that ATO and ATRA combined, reduce cancer cell growth and reduce tumour size in mice. And they go some way towards explaining the mechanism behind these interactions and discounting alternative explanations for their findings.

In many ways, it’s a solid paper.

So why am I skeptical?

There are a few reasons, though, to be wary of the findings in this paper and the way it has been presented. Firstly, it’s the particularly hyped up nature of the story – arsenic has been used to treat leukaemia since the mid-1990s, this isn’t really news. But it does make me wonder if there’s a particular reason this article might be so strongly endorsed.

The authors also don’t really explain why they picked arsenic in the first place other than they’re interested in ATRA and Pin1… In fact they’re very, very interested in Pin1.

They argue “that Pin1 is a critical “driver” and a unique drug target in cancer” – which is particularly interesting because as a cancer researcher with a PhD in cancer cell biology, I’ve never even heard of this protein. They reference three papers to support their claim but two of them are from the group’s own lab – the final paper they reference, an article titled “Pin1 in cancer” is from a separate source. This unrelated (and therefore, unbiased to some degree) article argues that Pin1 is hyperactivated in around 10% of all cancers. That number is pretty high, but it is certainly not enough to say that Pin1 is a “critical driver” in “most human cancers”.

So why are the authors so keen on Pin1? The suggestion that it’s a “unique drug target” might give us a clue.

five stacks of silver coins increasing in height from left to right

At the end of the article is the heading “Competing interests” under which is stated “K.P.L. and X.Z.Z. are inventors of Pin1 technology, which was licensed by BIDMC to Pinteon Therapeutics. Both Dr. Lu and Dr. Zhou own equity in, and consult for, Pinteon. Their interests were reviewed and are managed by BIDMC in accordance with its conflict of interest policy. The remaining authors declare no competing interests.”

Pinteon Therapeutics is a “private venture backed biotechnology company focused on the discovery and development of breakthrough therapeutics targeting Pin1” and we can therefore assume that this company will make money from the generation of Pin1 inhibitors that can be used to treat cancer.

Of course, Pin1 inhibition might well make for an interesting cancer target – there’s no disputing that – but its promise might well be overstated both in this article and in the media coverage of the article.

Me? I’m suspending judgement until we see more compelling evidence.

 

Dr Alice Howarth, PhD

Alice is a cell biologist and cancer researcher who works in the Institute of Translational Medicine at the University of Liverpool. She is the Treasurer of the Merseyside Skeptics Society and co-hosts the popular sceptical podcast Skeptics with a K. In her free time she Instagrams photos of her ridiculous dog, Lupin and watches Buffy the Vampire Slayer ad infinitum. Find her at DrAlice.blog or @AliceEmmaLouise on social media.

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Merseyside Skeptics Society Welcomes New NHS Guidelines on Prescribing Homeopathy

The Independent has today reported that new guidance from NHS England tells doctors to stop prescribing homeopathic ‘medicine’ because “at best, homeopathy is a placebo and a misuse of scarce NHS funds which could better be devoted to treatments that work.”  The draft guidance from NHS England has recommended prescribers in primary care should not “initiate homeopathic items for any new patient” and that Clinical Commissioning Groups should “support prescribers in de-prescribing homeopathic items in all patients” while ensuring  “the availability of relevant services to facilitate this change.”

Since our inception, Merseyside Skeptics has been actively involved in efforts to help patients and consumers recognise that homeopathic products are ineffective,  and therefore both a waste of money, and potentially dangerous if used as an alternative to medicine.  This latest development from NHS England is a step toward removing one of homeopathy’s key claims to legitimacy, that being its availability on prescription from NHS GPs.  We applaud the stance taken by NHS England on this, which follows from the 2010 recommendations by the House of Commons Science and Technology Committee, and a robust assessment of the best available evidence on the use of homeopathy as a medical intervention.

The NHS England consultation document will now be followed up by a public consultation, aimed at reducing NHS prescription costs by weeding out interventions with little or no clinical effectiveness.  Members of the public and other interested parties are invited to put forward their views on this topic in an online survey, which will be available until October 21st.  We urge all of our friends and supporters to participate in this survey, and ensure that a strong skeptical voice is heard, in support of science and evidence-based medicine.

Set up a direct debit with JustGivingMerseyside Skeptics would also like to congratulate our friends at the Good Thinking Society for their hard work and dedication to this cause.  Good Thinking are a small independent charity, but we believe the work they do, both in the promotion of rational inquiry and in compassionate consumer protection, is extremely important.  If you want to see more developments like this one, you can support Good Thinking by making a donation via their website. UK taxpayers are also be given the option to top-up their donation with Gift Aid.

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Cancer researchers respond to Liverpool Echo’s alternative cancer ‘cure’ story

LiverpoolEcho-Letters-20170227

Liverpool Echo letters page, 27th January 2017

On the 26th January, the Merseyside Skeptics Society sent a letter to the editors of the Liverpool ECHO and Mirror, concerning their uncritical promotion of Gerson treatment and other alternative cancer ‘cures’ in their Saturday 21st January editions.

UPDATE: our letter was published in the print edition of the Liverpool ECHO on the 27th January.

Dear Sir/Madam

Promotion of disproven treatments puts vulnerable patients at risk

Saturday’s edition of the Liverpool Echo featured the story of Sean Walsh, a local cancer patient who has elected to ignore the advice of doctors and to refuse treatment for his condition (Man with cancer beats 8 month prognosis – despite shunning hospital treatment, Liverpool Echo, January 21st 2017).

While we sincerely wish Mr Walsh the best of health, we believe the article’s uncritical promotion of his regime of alternative ‘treatments’ is deeply troubling and irresponsible.

Throughout the article Mr Walsh’s choice to dismiss the advice of cancer specialists is praised, with his “different approach” to treatment described as being “gentler on his body”. Also troubling is the positive report that Mr Walsh is “bringing his knowledge back to the UK to help people in Liverpool” – a statement which can only be seen as encouraging other vulnerable cancer patients to follow his example. This is the kind of advice which can lead people to make dangerous and misinformed choices with their healthcare, with potentially lethal consequences.

The Echo may argue that the inclusion of an opinion from Cancer Research UK absolves the newspaper of any culpability for its promotion of these dangerous quack treatments; given that the overwhelming majority of the article is dedicated to the uncritical promotion of disproven therapies, this justification holds little weight.

The treatments promoted in the article have been investigated and studied, by independent researchers and professionals, and for each there is no suggestion that they are worthy of any of the faith some patients and practitioners place in them. There are, however, hundreds of very vulnerable patients who have sadly been convinced by savvy practitioners of regimes like the Gerson regime to waste thousands of pounds – and, worse, critical treatment time – on interventions that have been comprehensively disproven. For many hopeful patients, their last months were spent not in the company of their loved ones, but in a foreign country, undergoing an invasive, deeply uncomfortable and fruitless regime of enemas, vitamin injections, restrictive diets and false hope.

The clinics offering these types of treatment are often based abroad, in jurisdictions where regulations are more lax, allowing them to continue making claims and advertising cures without good evidence of effectiveness. They often promote their successes with case studies and testimonials of ‘cured’ patients – sadly, too often those testimonials are quietly removed from their literature when the patient succumb to their disease. For the clinics, there is little or no repercussion, they merely erase the patient from their literature and carry on; for the patients and their families and friends, there is only heartbreak and tragedy.

The miraculous claims for ‘alternative’ cancer cures make for impressive headlines which are doubtlessly seductive, but as a responsible publication you have a duty to your readers to put truth ahead of sensationalism. By promoting these so-called cures without scrutiny, the Echo lends these dangerous quackeries the legitimacy of the publication’s well-earned reputation, and promotes clear misinformation to some of the most vulnerable of its readers.

We sincerely hope that Mr Walsh’s condition is as positive as he believes it is. However, it is almost certain that any recovery he has made has nothing to do with the ruinously-expensive diet and vitamin regime he has been sold; it is unlikely that the next Echo reader to follow the advice promoted in this article will be so fortunate.

Yours sincerely

Alice Howarth – Research associate, Institute of Translational Medicine, University of Liverpool; and Company Secretary of the Merseyside Skeptics Society

Professor Sarah Coupland – Director of the NWCR-UoL Cancer Research Centre

Professor Andrea Varro – Principle investigator, Institute of Translational Medicine, University of Liverpool

Professor Michael Clague – Principle investigator, Institute of Translational Medicine, University of Liverpool

Doctor Diana Moss – Principle investigator, Institute of Translational Medicine, University of Liverpool

Doctor Ewan MacDonald – Post-doctoral research associate, Institute of Translational Medicine, University of Liverpool

Doctor Fiona Hood – Post-doctoral researcher, Institute of Translational Medicine, University of Liverpool

Doctor Adam Linley – Post-doctoral research associate, Institute of Translational Medicine, University of Liverpool

Vicky Smith – Research technician, Institute of Translational Medicine, University of Liverpool

Aitor Martinez-Zarate – Research associate, Institute of Translational Medicine, University of Liverpool

Zohra Butt – Post-graduate researcher, Institute of Translational Medicine, University of Liverpool

Doug Grimes – Post-graduate researcher, Institute of Translational Medicine, University of Liverpool

Leah Wilson – Post-graduate researcher, Institute of Translational Medicine, University of Liverpool

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NHS Liverpool CCG ends funding for homeopathy

Today, NHS Liverpool CCG officially voted to decommission their homeopathy service, ending the annual spend of NHS funds in the area on the disproven remedies. The decision came about as a result of a review which was prompted by the legal challenge brought by our friends at the Good Thinking Society in February 2015.

The review involved a formal public consultation and an online survey to understand how much support existed for homeopathy in the public, and particularly within Liverpool. We asked for supporters of the Merseyside Skeptics Society to let the CCG know your feelings, and we really are delighted to say that you came through, with 64% of Liverpool residents responding to call for an end to homeopathy funding.

Today’s result is a great victory for evidence-based medicine and for skeptical activism. It also convinces us even further of the importance of skeptical voices being involved in these public consultations. Currently, NHS Wirral CCG is undergoing a similar consultation to that of Liverpool, and they also have an online survey seeking your feedback. We hope we can rely on your support there too, and together we can help ensure that limited NHS funds in the North West are reserved for treatments that actually work.

Finally, it’s important to reiterate that this decision came about as a direct result of the work done by the Good Thinking Society. Their statement on the decision is below, and if you appreciate their work you can show your support by making a small monthly or one-off donation to help keep them going.

 

NHS Liverpool CCG ends funding for homeopathy

3736069_1426544235.2609_funddescription-300x225The Good Thinking Society welcomed today’s decision by NHS Liverpool CCG to decommission homeopathy services. The decision comes after months of public consultation which showed overwhelming support from Liverpool residents for an end to funding.

The report on the consultation, which came about after Good Thinking’s legal challenge to the CCG in February 2015, concluded that 64% of Liverpool residents consulted and 73% of overall respondents wanted to stop homeopathy funding immediately.

Interestingly, the report also found that many respondents did not understand the true nature of homeopathy, suggesting that the number of people calling to an end to the treatment may have been higher if it had been clearer that homeopathic remedies are not the same as ‘herbal’ or ‘natural’ remedies, and in particular that homeopathic remedies typically contain no active ingredient at all.

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Have your say on NHS Homeopathy funding in the Wirral

3736069_1426544235.2609_funddescription-300x225Last year, skeptical charity the Good Thinking Society successfully challenged NHS Liverpool CCG over their decision to spend over £30,000 per year on homeopathic remedies. Given that homeopathy has proven to be nothing other than placebo, they argued that spending any money at all on this treatment was unjustifiable and possibly unlawful, and we at the Merseyside Skeptics Society supported them full. We’re expecting the results of the consultation soon, but meanwhile some of the few remaining CCGs to still fund homeopathy are beginning to conduct their own consultations, with NHS Wirral CCG next to seek the opinions of the public on the funding of homeopathy.

Please take a moment to share your thoughts with the CCG via their online survey, which is open to everyone, even if you are not a resident of the Wirral: https://www.surveymonkey.co.uk/r/WHDHW3X

This is a rare chance for us to make our opinions known. Liverpool CCG’s online consultation doubtlessly received responses from a great deal of homeopathy supporters, which we were hopefully able to balance out with the views of members of the general public, including scientists and rationalists. It is almost certain that this consultation by Wirral CCG will receive just as much attention from supporters of homeopathy. If supporters of evidence based medicine don’t speak up, the consultation will be swamped with homeopathy fans and funding may continue.

It takes less than 5 minutes for you to do your part to ensure the reputation of the NHS is not used to lend credibility to a system of alternative medicine that can offer no benefits to patients. Take the survey now >>

If you’d like to understand more about the consultation, the accompanying pages offer some insights into the issues surrounding homeopathy in the Wirral.

Once you’ve taken the survey, be sure to share it with friends and colleagues – the more support NHS Wirral CCG gets for ending homeopathy funding, the better chance we have of helping them make this decision happen.

You can also support the work the Good Thinking Society is doing to challenge NHS homeopathy by making a small monthly or one-off donation. It was their legal challenge which pressured Liverpool CCG to consult on homeopathy and which contributed to the pressure to consult in the Wirral, and it was their legal challenge which resulted in the current nationwide consultation on banning homeopathy prescriptions on the NHS. If you think that’s worth a fiver or a tenner, you can donate now.

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Have your say on NHS Homeopathy funding in Liverpool

Back in June the Good Thinking Society challenged NHS Liverpool CCG over their decision to spend over £30,000 per year on homeopathic remedies. Given that homeopathy has proven to be nothing other than placebo, Good Thinking (where I work full time as Project Director) argued that spending any money at all on this treatment was unjustifiable and possibly unlawful.

In June, NHS Liverpool CCG withdrew their funding decision and promised to re-consult on the issue. It’s now the time for supporters of evidence-based medicine to have their say, and to explain to NHS Liverpool CCG why spending money on treatments that don’t work is unacceptable.

The process is simple, and can be done via an online form: http://www.liverpooltalkshealth.info/homeopathy

After registering, the survey takes just 5 minutes to complete. If you are not a resident of Liverpool, you can still offer your views – simply skip the questions that require a Liverpool perspective.

This is a rare and genuine opportunity for the skeptical community to have our say, and to make our opinions known. If we do not speak up now, then only homeopaths will contribute to the consultation and funding will likely continue.

Please take 5 minutes to ensure the reputation of the NHS is not used to lend credibility to a system of alternative medicine that can offer no benefits to patients. Take the survey now >>

If you’d like to understand more about the consultation, the accompanying FAQs offer some insights into the issues surrounding homeopathy in Liverpool.

Once you’ve taken the survey, be sure to share it with friends and colleagues – the more support NHS Liverpool CCG gets for ending homeopathy funding, the better chance we have of helping them make this decision happen.

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