The lousy and non-collegial editorial review process that allowed JAMA Oncology to publish the erroneous data-mining article from two Yale researchers that stimulated my recent Retraction Needed? JAMA Oncology’s Bum Science Suggests People Die Faster Using Complementary Medicine continues to make waves. Many of you were interested in the topic. Here are some brief updates.
Integrative Oncologist Letters to JAMA Oncology: What Is Being Requested?
Multiple sources have shared that JAMA Oncology editors have seen a good deal of negative response to their publication. Holger Cramer, PhD, a colleague from the University of Duisburg-Essen in Germany and a member of the board of ISCMR, shared a high-quality response letter from his institution that he said was rejected for publication. Cramer shared that the reason given by the editors was that the journal had received others that they would be publishing. The letter concluded, gently: “It might have been more precise to conclude that ‘patients who use unproven cancer treatments administered by non-medical personnel were more likely to refuse conventional cancer treatment, and had a higher risk of death.’” The letter from the globally-renown trio was co-authored with Gustav Dobos and Petra Vioss.
My own less forgiving disposition toward urging retraction – in part due to the gross misinformation to the public that flowed from their failure to fundamentally distinguish between “alternative” and “complementary” – does not appear to be the favored strategy of the integrative oncology community. These seem to be more likely to call for the publication of an “erratum” or for a clarifying dialogue in the journal’s pages. The value in a retraction is that it is bigger news and thus more likely to stimulate a clarifying news cycle for those who don’t read JAMA Oncology and who have been shaped by this. Then the journal can follow the mea culpa with a dialogue. We shall see. I will send links to letters if and when they become available.
Oncology Association of Naturopathic Physicians’ (OncANP) Position Statement
The OncANP is among the integrative oncology professional associations that have been in touch with the JAMA Oncology editors and the article authors. The organization’s president, Heather Wright, ND, FABNO, sent a note that her organization has made public a formal position statement on the article: Response to Johnson et al JAMA Oncology Article. They use the opportunity to not only make clear what a problem the author’s mis-classification of “alternative” as “complementary” caused, but also to educate about basic precepts of naturopathic integrative oncology.
“The central message of the article is clear: patients with cancer who refuse or delay proven, standard-of-care cancer treatments have a worse overall prognosis and survival. This statement actually reinforces the philosophy and benefits of integrative oncology and ultimately the naturopathic approach to cancer care espoused by the Oncology Association of Naturopathic Physicians (OncANP).”
The organization chooses to quote at length from the statistical analysis of Scott Mist, PhD, MACOM, MS, MA, LAc from my prior article. The Yale researchers could have grounded themselves with a quick call to these or other prospective colleagues.
The Media Corrects the Alt-News Propounded by JAMA Oncology
One observation of close followers of the media response was that good journalists and headline writers simply corrected the authors. Article titles were shifted sometimes to focus on “alternative medicine” instead of “complementary medicine.” The model example was a widely picked up Reuters piece entitled “Cancer patients using alternative medicine may skip some standard care”. Credit writer Lisa Rapaport for reaching out to interview Jun Mao, MD, the director of the Memorial Sloan Kettering integrative oncology program and Moshe Frenkel, MD, the past director of the MD Anderson program for setting the record straight. Either was a phone call away from Yale authors Johnson and Lu – and Mao a short drive – had they chosen to connect with experts in the field.
In Which CSPI’s Confusing Reference Gets it Right
Colleague and Integrator adviser Taylor Walsh sent a notice on August 24 that the influential – and not typically integrative friendly – Center for Science in the Public Interest (CSPI) had recently tweeted out information that would, given the present debate, appear to be on the present study.
August 24, 2018: What happens to cancer patients who choose only “alternative” treatments? Nutrition Action explains a recent study: http://ow.ly/Wc2f30lwUb5
Each of these links one to a brief article in CSPI’s own Nutrition Action that has this headline: “What happens to cancer patients who choose “alternative” treatment?” The headline would, like the Reuters example above, appear to be corrective of the Johnson/Yu message. The Nutrition Action blurb references a tiny group of “roughly 280 users.” There are 258 in the Johnson/Lu complementary medicine article. There is no direct link, however, to the Johnson/Lu 2018 article. Then, at the bottom of the short blurb, they tag on this: “(Note: This study didn’t look at people who use complementary and integrative medicine in addition to conventional treatment.)” If you follow the link it goes to the Johnson/Lu 2017 article that specifically looked only at alternative medicine users! (See the Sabin, below.) What?
A positive take on this might be that CSPI reached back to the Johnson/Yu 2017 “alternative medicine” article to correct the misrepresentation in the 2018 “complementary medicine” article. They could thus honorably report, while also sticking to their editorial line that tends to be against all practices that may be in addition to what conventional practice recommends. On second thought, it may just be more evidence of the utter confusion sown by the JAMA Oncology publication.
Glenn Sabin’s Post Clarifies the Errors and Damage in Plain Language
Just after writing this, a post from my friend and Integrator adviser Glenn Sabin, Does “Complementary Medicine” in Cancer Care Cause Early Death? arrived in the in-box. In Sabin’s usual plain speaking, he lays out the flaws in the language used by the authors. Sabin had written a powerful post, When Alternative Cancer Care Kills, on the authors’ 2017 article – to which the recent CSPI re-directed readers (see above). In that piece, the authors correctly identified their research target as individuals who were choosing “alternatives” to conventional treatment. Sabin, a cancer survivor, also drilled down to capture nuances of actual patient choices that might have influenced their decisions beyond a belief that an “alternative” would cure them. For instance, consider those with a glioblastoma who decide that they’d maybe rather live a little shorter life without the invasiveness and destruction of the treatment piling on to that of the cancer itself. Sabin writes: “Sometimes standard of care cancer treatment can hasten death.” Good piece.
An Invitation from Larry Dossey and Explore, Plus
One interesting development for me was an invitation from Larry Dossey, MD, Ben Kligler, MD, MPH and the rest of the Explore editorial team to submit a lengthy commentary on this topic as a feature to their journal. I responded affirmatively after sharing that I also plan a column in JACM. The mid-October due date for Explore will offer a chance to observe whether in the ensuing two months any of this activity appears to be moving us toward the more constructive, less error-prone, and respectfully collegial era that Society for Integrative Oncology president Lynda Balneaves, RN, PhD urged in my interview with her on the article.
Additional Thought: “The Beginning of Wisdom …”
Clearly this has been a message to all of us that many in oncology, in the media, and in the public, are still stumbling over fundamental definitions. I did a Google search for a column a couple years back on the importance of training our discourse to distinguish “health care” from “disease management” from “symptom suppression” from “medical industry.” The search taught me that Confucius had something to say on this: “The beginning of wisdom is to call things by their proper name.”