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How Much Do New Chemotherapy Drugs Extend Life?

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If you put together all the new chemotherapy drugs approved over a dozen years, the average overall survival benefit is only 2.1 months. Though we often hear new cancer drugs described as “game changers” or “breakthroughs,” most afford much more modest benefits. In my last blog, I quoted an editorial in the Journal of the National Cancer Institute suggesting that the majority of new cancer drugs don’t deliver clinically meaningful benefits—at all. When they’re later proven to be ineffective, they’re pulled from the market, right? No. “[E]ven when postmarket studies show the new drugs to have no clinically meaningful benefit compared with [a sugar pill] placebo or observation, most drugs retain FDA [U.S. Food and Drug Administration] approval and remain on the market at prices comparable to those of the most expensive cancer drugs,” the same ridiculous prices. In fact, the most expensive drug the authors looked at, the one costing $169,836 a year, did not improve overall survival a...
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Chemotherapy Is Expensive—Is It Effective?

Most chemotherapy drugs are approved by the U.S. Food and Drug Administration (FDA) without evidence that they benefit survival or quality of life. By 2030, the number of new cancer cases in the United States is expected to skyrocket by 45%, from 1.6 million to 2.3 million every year. Are we really winning the war on cancer? Sadly, in general, no, despite the hundreds of new anticancer drugs that have been introduced. As I discuss in my video How Effective Is Chemotherapy? , the war on cancer has been likened to the war on terror. No matter how many drone strikes you do, it’s nearly impossible to kill all the bad guys, and no matter how precise the bombing, one must always consider the collateral damage. Toxicity from cancer therapy can be debilitating—and not just health-wise. There is also “financial toxicity.” Some patented anticancer drugs can cost nearly a thousand dollars a day. Even with health insurance, the average cost to patients with stage IV breast cancer, for exa...
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How Many Minutes of Life Does a Burger Cost?

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If you care about your health so much that it would be unthinkable to light up a cigarette before and after lunch, maybe you should order a bean burrito instead of a meaty one. According to the Global Burden of Disease Study, diets high in processed meat, like bacon, ham, hot dogs, lunch meat, and sausage, may kill more than 100,000 people every year, due largely to heart disease, but also cancer and diabetes. This results in millions of healthy years of life lost every year around the world, as you can see below and at 0:29 in my video How Much Does Meat Affect Longevity? . It doesn’t take much either. The Union of Concerned Scientists estimated that if Americans could cut down to just an ounce of processed meat a week, thousands of cancer deaths could be averted every year. But that’s on a population scale. How can we better understand our individual risk? In the last few blogs, I’ve talked a lot about the NutriRECS meat papers published in the Annals of Internal Medicine . T...
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The Meat Papers Contradicted Their Own Data

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The meat industry’s own study concluded that meat consumption increased the risk of cancer, heart disease, diabetes, and premature death. A series of papers published in the Annals of Internal Medicine that “largely discounted all but the highest quality randomised studies…reached a conclusion directly contrary to the public health advice we’ve heard for years.” They suggested that we should continue our current consumption of red and processed meats. The authors based their exclusion of evidence on the so-called GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria, which were mainly created for evaluating evidence from drug trials. We need randomized, double-blind, placebo-controlled trials for drugs, but the “strictness of these criteria will probably cause evidence for just about every dietary, lifestyle, and environmental factor related to chronic disease to be graded as ‘low’ or ‘very low.’ If the GRADE criteria were used to evaluate the evidenc...
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The Many Conflicts of Interest Behind the Meat Studies

The same person paid by Big Sugar to downplay the risks of sugar was paid by Big Meat to downplay the risks of meat. A series of articles published in the Annals of Internal Medicine recommending people just keep eating their meat was decried by nutrition researchers as “irresponsible and unethical,” a “travesty of science,” an “assault on public health,” and the “most egregious abuse of evidence” that they had ever seen. There were calls for retraction even before it was published from eminent public health leaders, including a former U.S. Surgeon General, a former president of the American College of Cardiology, and the directors of preventive medicine and nutrition institutes from Harvard, Yale, Tufts, and Stanford. In my last blog, I explained the how , the method by which they manipulated the science, but never really got to the why . As I discuss in my video Conflicts of Interest in the Annals of Internal Medicine Meat Studies , the lead author’s similar attempt to discredit...
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Meat Studies Fail to Apply GRADE Properly

The meat industry comes up with a perversion of evidence-based medicine. A series of articles published in the Annals of Internal Medicine culminated in a recommendation suggesting people keep eating red and processed meat. Nutrition researchers blasted these articles. The chair of the nutrition department at Harvard called it “a very irresponsible public health recommendation,” and the past Harvard nutrition chair was even less restrained. “It’s the most egregious abuse of data I’ve ever seen,” said Walter Willett. “There are just layers and layers of problems.” Let us start to pick through these layers. The first of “several serious weaknesses” was that the analyses and recommendations were largely based on the so-called GRADE criteria (Grading of Recommendations, Assessment, Development, and Evaluation), which I talked about in my last blog. The authors erred by applying the GRADE tool, since that was designed for drug trials. As I discuss in my video Failing GRADE for Ann...
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When Should We Rely on Observational Studies?

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How legitimate is the common corporate criticism of the scientific nutrition literature that the credibility of observational studies is questionable? While randomized controlled trials are highly reliable in assessing interventions like drugs, they’re harder to do with diet. Dietary diseases can take decades to develop. People can’t eat placebo food, and it’s difficult to get them to stick to assigned diets, especially for the years it would take to observe effects on hard endpoints like cancer or heart disease. That’s why we have to use observational studies of large numbers of people and their diets over time to see which foods appear to be linked to which diseases. And interestingly, if you compare data obtained from observational population studies versus randomized trials, on average, there is little evidence for significant differences between the findings. The effects were not only in the same direction, but also of the same general magnitude in about 90% of the treatments...
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