Questioning Chemotherapy (Paperback)

I started as a believer in chemotherapy. As a science writer at Memorial Sloan-Kettering Cancer Center in New York, I wrote articles praising the latest advances in chemotherapy. I was impressed by the then-emerging cures for Hodgkin's disease, acute lymphocytic leukemia and some other relatively rare cancers. At the same time, I began to learn how skeptical many good scientists were about chemotherapy's future.

The major objection to "chemo" was that these drugs did not discriminate between normal and cancerous cells, but attacked all rapidly dividing cells . One scientist described this method as "trying to melt a patient's left ear , while leaving the right one alone." It seemed particularly inappropriate in the treatment of solid tumors of adults, which are often slow-growing.

Because chemotherapy drugs were general cellular poisons, they could be terribly toxic. They were also very expensive for patients and for society as a whole. When I learned about the links between the pharmaceutical industry and the cancer establishment (later detailed in my book, The Cance r Industry) I understood the commercial reason that such an inadequate modality was so heavily promoted.

In 1989, a German biostatistician named Ulrich Abel, Ph.D. published a groundbreaking monograph called "Chemotherapy of Advanced Epithelial Cancer. It made few waves in the U.S. and soon went out of print. In this excellent work, however, Dr. Abel rigorously demonstrated that chemotherapy had never been scientifically proven to extend life through randomized clinical trials (RCTs) in the vast majority of "epithelial cancers." These are the common types of carcinoma that affect most cancer patients in the Western world.

Some years later, in response to many requests, I decided to write a critical book about chemotherapy (a sort of companion piece to Cancer Therapy). I took Abel's out-of-print work as my starting point, but also consulted the work of many other students of chemotherapy. In this book, I update statistics and speak about all cancers and not just carcinomas. I go into depth on the politics and economics of the chemotherapy industry, on the biases, fallacies and frauds that occur, and on ways of warding off the sometimes catastrophic side effects that accompany this treatment.

The essential point of the book is that one must question the measure of success in chemotherapy. Oncologists have tended to equate an increasing percentage of "responses" with progress. However, responses are generally measurements of tumor shrinkage, for as little as one month's duration. One cannot automatically assume that a response--even a complete response--will lead to increased survival. One must look for increased survival. Yet the number of cancers for which life prolongation through chemotherapy has been proven through randomized clinical trials is very small. (I do bend over backwards to point these out, when they occur.)

So when a doctor says her regimen yields a 40 percent response rate, "what exactly is she promising? A short-term shrinkage of tumors--or actual life-prolongation? What effect is this treatment likely to have on the patient's quality of life? And what is the cost?" It is only by obtaining information such as this that patients are able to make rational treatment choices. Questioning Chemotherapy is intended to help patients by providing them with a critical perspective on this now dominant modality.