What Your Doctor May Not Tell You About Breast Cancer

by John R. Lee, M.D., David Zava, Ph.D. and Virginia Hopkins.

CHAPTER 1
THE HISTORY AND POLITICS OF THE BREAST CANCER INDUSTRY

Why We Can't Seem to Prevent or Cure Breast Cancer

Why is modern medicine going nowhere in its attempts to treat breast cancer? Our research has found that the answer to this question lies primarily with the politics of medicine, the cancer industry, and the industries that create the pollutants that contribute to breast cancer. We believe that the only way to truly prevent and treat breast cancer is to go outside the current way of doing things in medicine and stop the wholesale pollution of our planet with petrochemicals, but the forces that would keep things the same are very powerful and entrenched. That's why, just as they did with hormone replacement therapy (HRT), women need to educate themselves about pollutants, about breast cancer, and about alternative treatments. They need to rebel against ineffective and harmful treatments, and do what they can to teach their doctors.

Over the past few decades, conventional medicine has done very little to make any meaningful difference in what will happen to you if you get breast cancer, and virtually nothing it has done has reduced the incidence of the disease. The harsh reality is, if you get breast cancer, you'll get more treatment than you did 50 years ago, you and your insurance company will spend a lot more money, and if it's fatal you may gain a few more months of life (usually of very poor quality), but statistics clearly tell us that conventional medicines for treating breast cancer such as tamoxifen, radiation, and chemotherapy just aren't working in the long run. The way breast cancer is currently treated is a way of doing something in the face of not knowing what else to do. If you have an invasive or nonlocal breast cancer, your chances of dying from it are still about one in three, the same as they have been for decades.

The incidence of breast cancer (how many women are getting it) is steadily rising, and the numbers are appalling: According to the National Cancer Institute, breast cancer incidence rates have increased by more than 40 percent from 1973 to 1998. In the year 2000 approximately 182,800 women were diagnosed with breast cancer. Since 1950 breast cancer incidence has risen by 60 percent. Some will argue that this is due to better and earlier detection. But even for women over 80 years of age, where this early detection issue is doubtful, the incidence of breast cancer has risen the past 30 years from 1 in 30 women to 1 in 8 women. The American Cancer Society estimated that in the year 2000, 552,200 people in the United States would die of cancer, and 40,800, or just over 7 percent, of those would be women dying of breast cancer. This means that about 15 percent of women who die of cancer are dying of breast cancer. These are the annual statistics for the United States, but it's even more sobering to realize that worldwide about 1,670,000 women have breast cancer.

The mortality (death rate) from breast cancer is also staggering. If you combine mortality rates from the United States and Canada (which have the highest rates of breast cancer in the world), in North America a woman dies of breast cancer every twelve minutes.

Do Radiation, Tamoxifen, Mammograms, and Chemotherapy Help or Hurt?

How can we be so bold as to state that conventional medical treatments for breast cancer aren't working? It's very well documented. It seems as if every time we open a medical journal lately, there's an article showing that conventional breast cancer treatments are ineffective, harmful, or both. Just in the past few years, major studies published in prestigious peer-reviewed journals meeting all the conventional medical criteria for so-called evidence-based medicine have shown that:

• Mammograms don't really save lives (G. Sjonell, et al., Lakartidningen 96 (1999): 904-913.
• Radiation doesn't really save lives (Lancet, 22 May 2000).
• Tamoxifen doesn't really save lives (Mitchell, et al., Journal of the National Cancer Institute, November 1999).
• Chemotherapy doesn't save lives (which isn't news; we've known this for a long time).

So what's left for the conventional medical doctor to treat breast cancer patients with? Nothing but the same surgical removal of the cancer that they were doing 50 years ago. More American physicians need to face the hard, cold facts that current therapies just aren't working and open their eyes to alternatives for prevention and treatment of breast cancer. Let's take a broad look at the current treatments.

Radiation

Radiation is the most common treatment for breast cancer following surgery, and yet a recent article in the prestigious British medical journal Lancet showed that this treatment is not working. In fact, while using local radiation to treat breast cancer reduces deaths from this disease by 13.2 percent, it increases death from other causes, mostly heart disease, by 21.2 percent. The obvious conclusion of this study: "The treatment was a success but the patient died."

In other words, the radiation obliterates the breast cancer tumor in a small percentage of women, but in the process it causes many of them to die from other diseases. Proponents of newer and more localized radiation procedures are claiming that it doesn't cause the damage the older radiation techniques do, but at present this is only a claim and not backed up by long-term follow-up. This means that there's no long-term benefit from using radiation to treat breast cancers, because even though the cancer may not recur at the site of the radiation, the overall chances of survival stay the same or are slightly worse. And yet despite the fact that radiation helps so few women–and eventually kills many of those whom it helped in the short term–it remains the standard of care in medicine for women who have breast cancer. How can this be? It's because conventional medicine has little else to offer that reduces death even by 13.2 percent. If you were starving and someone handed you a bowl of moldy old rice, you'd gratefully eat it up because it's better than nothing.

Despite this study, published in one of the most prestigious medical journals in the world, if you have breast cancer your doctor will most likely insist that you undergo radiation treatments rather than exploring possibly safer alternatives not popular among conventional doctors.

Treating women with radiation who later die of heart disease caused by radiation damage also affects breast cancer statistics. It means that the diagnosed cause of death was shifted from breast cancer to cardiovascular disease. As more and more breast cancer patients are subjected to radiotherapy, fewer will be said to die from breast cancer, but more will be said to die of radiation-induced heart disease. These deaths aren't counted in breast cancer statistics, but they should be if we are to have a truthful picture of what's happening to women who get this disease.

Tamoxifen

In the same issue of The Lancet as the above study on radiation was a curious letter from Oxford professor Sir Richard Peto, with a graph showing that breast cancer deaths rose about 20 percent from 1960 to 1985. From 1985 to 1997 breast cancer deaths were said to have decreased about 20 percent. Without speculating on the cause of the 1985 rise in breast cancer mortality, or citing the sources of his information, Sir Peto instead addressed only the matter of the recent decline.

An aside: The probable cause of the rise in breast cancer deaths was the prescription of unopposed estrogen (not balanced with progesterone) to menopausal women, a common practice from the early 1950s to the mid-1970s. While the medical community acknowledged that this practice caused endometrial (uterine) cancer, it never admitted that it also caused breast cancer. From the mid-1970s, doctors were instructed to prescribe synthetic progestins along with the estrogen to prevent the endometrial cancer. This is also when the incidence of hysterectomy skyrocketed: Women felt so terrible on progestins that they refused to take them, so doctors offered them a hysterectomy so they would no longer have to take the progestins, and could take estrogen only. To add insult to injury (literally), it was common practice (and still is in some places) to remove a woman's ovaries along with her uterus as a preventive for ovarian cancer. This misguided practice leads to many other health problems, including osteoporosis, heart disease, fatigue, and a diminished quality of life due to low libido, hot flashes, and other symptoms of "instant menopause."

Back to the supposed decline in breast cancer deaths: Because of the "suddenness" of the decline, Sir Richard felt it was not due to fewer breast cancers but more likely to "changes in the way breast cancer is diagnosed and treated." He speculated that it was "not from a single research breakthrough" but from "the adoption of many interventions," whatever that means. He was later quoted in other news articles as giving credit for the fall in breast cancer deaths to the antiestrogen drug tamoxifen.

We hope that those promoting Tamoxifen remember to mention how many women taking it suffer from blood clots, deterioration of vision, and diminished quality of life (hot flashes, night sweats). Also, how many women have been forced to have a hysterectomy due to a particularly aggressive form of tamoxifen-caused uterine cancer? It's rarely mentioned that women actually die of tamoxifeninduced uterine cancer. When these women die of uterine cancer instead of breast cancer, it improves the breast cancer statistics. This makes tamoxifen look good, but it's a moot issue to the women in question.

If the side effects of tamoxifen are this bad, why is it being used at all, and why is it being trumpeted so loudly as the great cure-all, to the extent that the Food and Drug Administration (FDA) even approved its use as a preventive? It's the moldy rice problem again. It's the lesser of many evils; it's better than nothing. Very few other FDA-approved pharmaceuticals have been made available to oncologists treating breast cancer. Theoretically–on paper, in test tubes, and in laboratory animals used as models for human breast cancer–tamoxifen looks promising, and the rationale for using it is based on a solid scientific foundation: Estrogens increase the rate that breast cancer cells proliferate, and tamoxifen slows the rate of cell proliferation by acting as an antiestrogen.

Unfortunately, breast cancer cells in a test tube and laboratory animals can't really explain to us how they feel, and don't live long enough to give us a genuine appreciation for long-term health risks. Research investigating the effects of tamoxifen on hormone-dependent cancers looks good in the short term. However, in reality, tamoxifen is unnatural to the human body, and these side effects are the body's warning signals that something is terribly wrong.

Tamoxifen has been available for 25 years and its effect on breast cancer prevention is still being debated: This in and of itself should tell us something. Two studies, a five-year placebo-controlled one from England in 1992, and a nine-year placebo-controlled one from Italy in 1998, showed no difference in cancer incidence between tamoxifen- treated women and controls. The only large study in the United States was cut short, supposedly because the incidence of breast cancer dropped so much in the tamoxifen group that they couldn't justify withholding this treatment from the placebo group. It's worth noting, however, that the trial was stopped at around the same time that breast cancer began to reappear, despite the tamoxifen, in the two European studies.

The lessons we learned from those studies are that in some women tamoxifen may put a breast cancer to sleep for a few years, and in women who have breast cancer it may slow the rate of recurrence for a few years. But in the long term it tends to do more harm than good. Again, the only reason this is such a popular treatment right now is that it seems to oncologists to be better than doing nothing, which many of them believe is the only other viable option open to them. But as you'll discover, it's definitely not the only option available.

For the most part, it's only in the United States that doctors still believe tamoxifen significantly prevents or reverses breast cancer. In fact, now even the National Cancer Institute (NCI) has come out with a statement that in all but a very narrow group of women under the age of sixty, tamoxifen may do more harm than good in terms of preventing cancer. Despite this, the FDA just approved the use of tamoxifen to treat a form of breast cancer known as ductal carcinoma in situ (DCIS). You'll understand later in the book why we believe this is an outrageous move.

Mammography

Like tamoxifen, radiation, and chemotherapy, mammography is big business these days. Mammography is also conventional medicine's only real answer to breast cancer "prevention," although it isn't preventing cancer at all, it's simply detecting it.

Countless advertisements and physicians are telling women to have mammograms. But the value of this procedure is far from clear. We all know women diagnosed with breast cancer that wasn't detected by mammography, and we all know that mammograms present a real risk of false positive and false negative findings. The test procedure is unpleasant and the radiation is potentially harmful. Both tissue damage and radiation are known risk factors for breast cancer, so it may even be logical to assume that mammography can contribute to breast cancer.

A summer 2000 study published in the journal Spine, and looking at data collected over 40 years, showed that women with scoliosis who received many diagnostic X rays during childhood and adolescence have a 70 percent higher risk of breast cancer than women in the general population. The more X rays a woman was exposed to, and the higher the dose of radiation, the greater her risk of breast cancer. Although the dose of radiation in a typical X ray is now much lower than it was when these women were being X rayed, the point is still valid: Radiation is a potent risk factor for breast cancer, its effect is cumulative, and mammography involves forcefully squashing the breast and then shooting radiation through it.

It has been claimed that mammography lowers the risk of dying from breast cancer. Proponents argue that mammography can detect breast tumors a year or so earlier than simple palpation such as breast self-exams. This early detection, so the argument goes, leads to earlier treatment and a lower risk of breast cancer mortality. Statistics, it is claimed, have validated this argument.

Many statisticians, however, disagree. Statistics are not immune from biases, which include mechanical factors (use of different measuring instruments in different subjects), study methodology, conscious or unconscious assumptions, age of subjects, socioeconomic factors, faulty randomization of subjects and controls, duration of observation, and other confounding factors.

More than 15 years ago Dr. John C. Bailar III observed that counting survival time after treatment creates a bias in most mammography studies because mammography detects breast tumors a year before they would have been found by palpation. He pointed out that subjects with breast tumors found by palpation have lived at least a year prior to the time when they would have been found by mammography. When this year is added to the survival time of the control women (those who did not use mammography), their survival results match those of subject women whose tumors were found by mammography.

This means that the apparent difference in survival after treatment was due not to earlier treatment, as a result of mammography, but merely to starting the counting of survival time one year earlier among mammography subjects. When this factor is included in the statistical analysis, the so-called benefit of mammography and earlier treatment disappears. Dr. Bailar, now professor of epidemiology and biostatistics at McGill University and senior scientist in the Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services, called this the lead-time bias.

This should not be surprising. For a breast cancer cell to become large enough to detect by palpation, the cancer has usually been growing for about ten years. If found one year earlier by mammography, the cancer has been growing for about nine years, which is plenty of time to spawn metastases if the cancer is prone to do that. The one-year difference between palpation and mammography detection is ultimately of little importance.

Does mammography truly save lives? If you read the numerous ads for it, you might think the case is closed–of course it does. If you read the studies themselves, the answer isn't so clear. For example, a 1999 epidemiological study found no decrease in breast cancer mortality in Sweden, where mammography screening has been recommended since 1985.

As a result, two Swedish scientists reviewed all published mammography trials to evaluate their methodological quality. Their purpose was to ascertain whether or not mammography truly saved lives. Their findings are worth a close look.

In their analysis of eight different clinical studies on mammography, the authors found six of them seriously flawed by baseline imbalances and/or inconsistencies of randomization. The flaws were sufficient to nullify the studies' claims of a benefit from mammography. The two adequately randomized trials found no effect of mammography screening on breast cancer mortality.

The meta-analysis conclusion is clear. Since there is no reliable evidence that mammography screening decreases breast cancer mortality, mammography screening for breast cancer is unjustified. This means that physicians should not order routine mammography screening.

However, mammograms have become a substitute for breast selfexams. If you stop having mammograms, it becomes essential that you examine your own breasts thoroughly at least once a month. If you're premenopausal, you should examine them shortly after your period, when hormone levels are low, so that premenopausal lumps aren't confused with a cancerous lump. You should also examine your breasts in the mirror and look for any unusual skin abnormalities or dimpling. After a few months you'll become very familiar with how your breasts feel, and you'll be able to detect very small abnormalities.

Chemotherapy

It's difficult to make generalizations about chemotherapy these days, because there are so many different kinds, most of them extremely poorly studied: The women who agree to try new chemotherapies are guinea pigs for a type of treatment with a notoriously poor track record. Like most other aspects of the breast cancer industry, there's little agreement about what constitutes chemotherapy. We'll make the generalization that chemotherapy is an attempt to poison the body just short of death in the hope of killing the cancer before the entire body is killed. Most of the time it doesn't work. There are new chemotherapies that target specific parts of the cancer process, but none have proven themselves truly effective in stopping the entire process.

Some chemotherapy does prolong life for a few months, but generally at the high price of devastating side effects, and if a woman does happen to get lucky and survive that bout of cancer, her body is permanently damaged; recurrence rates are high. The use of chemotherapy is purely a gamble, and we don't think it's worth taking. Sometimes it works, and sometimes it doesn't, and sometimes it makes things worse. Precious little is known about why it works or doesn't, and it seems much smarter to find an alternative therapy with a good track record that will both support your body in fighting off the cancer and promote health.

There are some chemotherapylike approaches to fighting metastatic cancer, including inducing a high fever for a number of days and insulin potentiation therapy (see the Resources section at the end of the book), that hold much promise with less potential damage done to the body. They are much more widely used in Europe than the United States. They may never be widely available in the United States, because there's no patent medicine to sell. Europe is decades ahead of the us in its approach to treating cancer.

The Breast Cancer Numbers

It's important that women understand how much breast cancer numbers are misused and abused, juggled, twiddled, and tweaked, depending upon who wants you to believe what. So let's keep it simple:

Breast cancer is the most common cause of death from cancer among women between the ages of 18 and 54, and it's the most common cause of death period among women aged 45 to 50.

Women less than 45 years old have a 26 percent higher risk of a recurrence of breast cancer compared to older women. The types of cancer that these middle-aged women are dying from are not the mostly benign, "99 percent curable" DCIS "cancers" that have been detected since the early 1980s with mammograms (thus increasing the rate of detection); they're deadly metastatic cancers that kill quickly once they start to spread.

According to the Centers for Disease Control, cancer ranks higher than heart disease in terms of age-adjusted death rates among people under age 65 in the United States. While heart disease has declined, cancer has not.

Breast cancer is the second most common form of cancer in women after lung cancer, which is almost always due to smoking cigarettes.

Statistical Shell Games

The breast cancer industry has been playing a statistical shell game with the disease by including ductal carcinoma in situ as a breast cancer diagnosis when in fact it's rarely fatal, with or without treatment. Many oncologists like to say that DCIS is "99 percent curable." (Since DCIS wasn't detectable-and thus not diagnosed or treated-until the advent of mammograms, we don't even really know the true nature or course of untreated DCIS, because it has always been treated if diagnosed.) We'll go into this in more detail later in the book, but for now, we want to focus on the fact that some 30 percent of breast cancers are DCIS.

Given that DCIS is rarely fatal, let's make some gross generalizations to illustrate a point. If we simply eliminate DCIS from breast cancer statistics, and thus subtract 30 percent of those who have survived breast cancer from the statistics, we would then not have a recent drop of 20 percent (as claimed by some) but rather a rise of 10 percent in breast cancer mortality rates. This is a crude way of making the point, but it's important to consider when a doctor is using these types of statistics to justify a treatment. For example, let's say a doctor justifies putting you on tamoxifen to prevent breast cancer based on the now much-quoted "fact" that breast cancer deaths have dropped by 20 percent thanks to tamoxifen (see chapter 12 for details). If you know going into the doctor's office that this is a highly questionable statistic, you'll be more empowered to make the right decisions for yourself. In fact, we suspect that if women with lowgrade DCIS weren't subjected to tamoxifen, chemo, and radiation, their survival rate would stay the same-but the women wouldn't be damaged for life by the treatments.

A Word about Prevention

Of course the key to reducing the incidence of breast cancer is prevention, but prevention is a dirty word in the breast cancer industry unless you're referring to tamoxifen or mammograms, neither of which is really remotely like prevention. TV personality and author Bob Arnot, M.D., wrote a book called The Breast Cancer Prevention Diet, which contained mostly good, solid, practical dietary advice associated with reducing the known risk factors for breast cancer. Sadly, he was terribly trashed by the American media for using the word prevention, as if he were suggesting that diet was a cure-all (he wasn't), and as if he were somehow hurting women by suggesting that a healthy diet could fend off breast cancer (it can only help). Arnot was an unfortunate victim of the intense breast cancer political establishment, which savagely attacks those who stray outside conventional medical boundaries and dare to suggest that something besides surgery, chemotherapy, radiation, and tamoxifen might be helpful.

It may shock you to know that despite breast cancer being the leading cause of death among middle-aged women in the United States, only 5 percent of the National Cancer Institute's budget is allocated to research on cancer prevention. And just in case you thought some other branch of the U.S. government was going to pitch in with some unbiased, nondrug, prevention-oriented research, the enormously expensive, taxpayer-financed Women's Breast Cancer Initiative will be researching only pharmaceutical drugs (Premarin plus various synthetic estrogens and progestins) in relationship to breast cancer. We believe this is like subsidizing the drug companies–which already make billions of dollars in profits after spending billions on advertising, public relations, and lobbying money to influence congressional decisions. Drug testing should be the responsibility of the drug companies, not taxpayers. To add insult to injury, this is research that should have been done by the drug companies decades ago, before the drugs were approved.

The prevention picture is equally dreary in other big cancer organizations. When you log onto the Web site for the American Cancer Society (ACS) and access the area about cancer prevention, it says, "At this time, there is no way to prevent breast cancer." This is true only in that we can't point to one cause and make it the culprit. The reality is that we know so much about what causes breast cancer that of course we know what we can do to help prevent it, in the same sense that we know how to help prevent heart disease or diabetes.

For example, there's no question that you can significantly reduce your risk of these diseases by eating a wholesome diet, getting regular moderate exercise, maintaining a healthy weight, and managing stress effectively. This same approach will also help you lower your risk of breast cancer by creating better overall health. The factors that dictate which women get breast cancer and which don't include all of the practical commonsense solutions listed above. Yes, we all know a health food nut who has gotten breast cancer, but all the tofu and vegetables in the world may not make up for a devastating insult to breast tissue such as years of estrogen dominance or heavy exposure to pesticides or solvents. And then again they might make a difference, depending on your genetics and a dozen other factors. There is no one right formula for preventing breast cancer in every woman. The key to prevention of breast cancer is being aware of the various factors that cause the disease and avoiding them as much as possible, while at the same time being aware of what discourages cancerous growth in breast tissue and promoting that kind of lifestyle.

Preventive medicine is a multidimensional approach that takes the entire human–the physical, emotional, mental, and spiritual aspects–into account, and optimizes health for that particular individual. Conventional medicine, which is narrowly focused on diagnosing disease and then prescribing a drug to kill it, is a failure when it comes to treating cancer and chronic diseases such as diabetes and arthritis because it ignores most of the human it's purporting to heal. And this is also why, in the year 2000, patient visits to alternative health care professionals exceeded visits to conventional physicians–despite the fact that insurance doesn't cover most alternative health care. Take a middle-aged woman with breast cancer who is terribly depressed and emotionally devastated because of a major trauma or loss in her life: All the drugs in the world aren't going to help her unless her emotional and spiritual needs are also addressed.

Prevention is also a dirty word during the richly endowed, muchhyped and -touted Breast Cancer Awareness Month that occurs every October, because it's largely sponsored and funded by the drug company that makes tamoxifen. Ironically, this firm also manufactures some of the toxic chemicals that help cause breast cancer. Breast Cancer Awareness Month is about being aware of cancer establishment treatments; there is little focus on preventing breast cancer or raising funds for independent research. It really should be called Breast Cancer Unawareness Month.

The Politics of the Breast Cancer Industry

To get to the bottom of why progress isn't being made in preventing or treating breast cancer, it's important to consider the breast cancer industry and what makes it tick. The detection and treatment of breast cancer is hugely profitable in the United States, generating billions of dollars a year. All those mammograms, biopsies, lumpectomies, and mastectomies, and all that chemotherapy, radiation, and tamoxifen, create a substantial income stream for hospitals, physicians, their support staff, those who make all the equipment, and especially those who make the drugs. And that doesn't even take into consideration all the research being done that's funded by the hundreds of millions of dollars donated to nonprofit breast cancer organizations. Where's the financial incentive to go outside this framework?

If just a fraction of the research money now going into perpetuating the above industries were honestly put into prevention and effective treatment, the mortality rate from breast cancer would very likely drop precipitously within a few years. But doctors keep squishing and radiating women's breasts with mammograms, and possibly increasing their chances of getting breast cancer in the process, perhaps because it's lucrative and it's the standard of care. (Thanks to new technology using the–hopefully–safer techniques of thermography and ultrasound, mammograms are becoming obsolete anyway, but it will probably take decades to phase out all those expensive machines.) Doctors keep doing unneeded biopsies because they could get sued if they don't. They keep removing women's breasts and giving them toxic drugs because they don't know what else to do, and they feel they have to do something.

In its zeal to find a magic drug to stop breast cancer, the industry has forgotten about healing. It doesn't have time. It has to run the patients through the HMO mill, get them out of the hospital faster, cut costs, avoid lawsuits, keep positions and funding, and make the drug companies happy by promoting and prescribing their products so that they'll keep funding the universities and hospitals.

Where does this leave the woman with breast cancer? She's terribly afraid and confused, but she's also pretty much crushed by the cog wheels of the medical machinery. Granted, she's what keeps the machinery going, but she certainly isn't the center of attention; she's a supporting player in a much larger drama. She'll be shuffled off to this operating table or that radiation clinic not because it's necessarily best for her as an individual, and not because that's what's going to truly help and heal her, but because she fits into that slot, that's how the breast cancer industry machine works, and there's no other choice. What conventional medicine presents her with is that she's going to die if she doesn't do it. But if she sorts out the statistics accurately, she's going to realize that if she has a nonlocal (non-DCIS) cancer, even if she does everything the doctors tell her to do there's still a one in three chance that she's going to die, from the cancer or as a result of its treatment. These aren't great odds, and the path to possible recovery is paved with treatments that can do permanent damage.

An aside: In contrast, Dr. Zava recently had contact with a woman who was given three to six months to live in 1993 because she had a very large, node-positive breast cancer tumor. She opted against conventional chemoradiation therapy and began juicing and progesterone therapy as an alternative. She called Dr. Zava (in 2001) to update him on her progress and get a saliva test! Granted, this is just one story, but we hear them on a regular basis.

To make matters even more confusing for the average woman with breast cancer who wants to do some research on whatever course of treatment her doctor is suggesting, a great deal of medical research needs to be interpreted in light of the context in which it was conceived and/or carried out. Unfortunately, much of it is sponsored by drug companies, so it's no surprise that thousands of small studies come out every year advocating some point that the companies want to pay a scientist to support. You can come up with all kinds of medical theories and support them, with perfectly reputable references from peer-reviewed journals found on Medline, the National Library of Medicine's huge research database.

The Politics of Medical Research and Media Information on Breast Cancer

The politics of physician attitudes that don't support healing, medical research, and media information on breast cancer are disheartening, because they're largely controlled by large drug companies with one agenda: Sell more drugs.

At the root of physician beliefs and attitudes about breast cancer treatment is the fact that the pharmaceutical industry now powerfully influences both medical education and research. A recent Journal of the American Medical Association (JAMA) reported that 31 percent of medical school funding comes from governmental and pharmaceutical grants; we think this is a gross underestimate. In addition, drug company money is the driving force behind medical research, with a profound influence on the research that's chosen. For example, if a drug that has the potential to be patented is competing for funding with a drug that can't be patented because it's found in nature, there's no contest. The patent drug wins, even if the drug found in nature might be the biggest breakthrough since penicillin.

You don't hear much that's positive about non-drug alternative health treatments in the national media, yet millions of people visit the Internet daily looking for information on alternative health. Would they be flocking to the Web in such large numbers if they were getting what they need from their doctors, or from print media and TV? We think not. Drug company money is a primary source of advertising revenue for the media, especially for TV and magazines, so unless you're Bill Moyers you're unlikely to expose drug company and medical politics or talk about alternative health in positive terms and keep your job.

How about the FDA–aren't they looking out for the consumer? On the contrary, endorsement of a drug or treatment by the FDA should not necessarily give you confidence that it's a safe and effective treatment. According to the prestigious Journal of the American Medical Association and New England Journal of Medicine, deaths from the side effects of properly prescribed prescription drugs are the fourth-or fifth-leading cause of death in the United States. This doesn't even include deaths from improperly prescribed drugs, deaths from in-hospital errors, and unreported drug deaths; if these were thrown into the statistics, drug treatments in general would easily be in the top three causes of death in the nation. All the drugs that are killing so many people are approved by the FDA and considered part of the standard of medical care.

A recent scathing editorial in the Lancet took the FDA to task for its inappropriately close association with pharmaceutical companies. The title of the article was "Lotronex and the FDA: a Fatal Erosion of Integrity," and it described the process by which the drug Lotronex, developed for irritable bowel syndrome (IBS), was approved by the FDA after inadequate testing, killed five people, was withdrawn, and then as put back on the FDA table for reinstatement. The Lancet editorial concluded that, "...private communications appear to have subverted official procedures, while suppressed scientific debate has superseded a full and open review process.... The Lotronex episode may show in microcosm a serious erosion of integrity within the FDA, and in particular CDER [Center for Drug Evaluation and Research], whose operating budget now depends on industry money." Buyer beware.

The original intent of the FDA was to protect consumers from dangerous products, but the agency appears to have lost its way, and to be heavily influenced in its decisions by the drug industry. A recent survey conducted by the newspaper USA Today found that 54 percent of the time, experts hired to advise the FDA on which medicines should be approved for sale have a direct financial interest in the drug or topic they're asked to evaluate. In turn, it's very common for FDA employees to retire to well-paid positions on the advisory boards of large drug companies.

So what's a woman to believe? You need to find medical authorities whose opinions you trust: people who have been successful in their practice and proven right in their viewpoints over and over again for decades. People whose opinions are not based on how large a grant they're getting from the drug industry, or the soy industry, or the dairy industry, or a vitamin company, but people who are objectively and intelligently looking at the facts, interpreting experience, and evaluating studies. Put your trust in a physician who's willing to take the time to talk with you; after all, this is a life-and death matter.

How about doctors who would like to try treatments for cancer that are outside the mainstream? They can't: They're forced to use medications (even if they know they aren't working well), because there are no large-scale studies to prove the effectiveness of alternatives and thus the FDA will not approve them. (The evidence proving the effectiveness of conventional medical treatments is scant, but that's politics.) If an alternative treatment doesn't have FDA approval, a doctor can be fined, be reprimanded, or even lose his or her medical license for using it. If you find the rare and courageous physician willing to guide and support you through an alternative treatment, be grateful!

The Implications of Being Honest

The political and financial implications of admitting that conventional hormone replacement therapy, plastics, pesticides, and other environmental toxins disrupt the body's ability to manufacture normal levels of hormones and consequently contribute to causing breast cancer are enormous. (We'll explain how and why these things can cause breast cancer later in the book.) Just think what would happen to the drug company giants if they were forced to admit that their products had contributed to the deaths of tens of thousands of women? The tobacco companies would have to move over in the litigation courts. However, the largest drug companies alone (never mind the pesticide and plastics companies) spent $74.4 million in 1997-1998 to influence congressional thinking via their lobbying efforts. That's one powerful influence. The only potentially stronger influence is your vote.

Thanks to an undeniably steep rise in the incidence of prostate and testicular cancer, Congress has taken some action to find out more about how chemicals that mimic hormones affect humans. A 1996 mandate from Congress charged the Environmental Protection Agency (EPA) with examining the hormonal effects of the top 100 selling chemicals in the United States. As the first studies trickle out, the evidence is clear: We are awash in a sea of chemicals, many of them estrogenic in nature, that profoundly affect every aspect of our health. Because estrogens oppose or negate the actions of testosterone, our little boys–and eventually men–are as profoundly affected as women are.

As it becomes clear to our political representatives that these chemicals are affecting their own families, perhaps they'll be inspired to take action to protect their constituents. It's also incumbent upon each individual to maintain a lifestyle that's protective–this alone would dramatically change the economics, because millions of people would stop spraying their homes, lawns, and gardens with pesticides; start buying organic produce; and stop eating hormone-laden meat. (Did you know that U.S. beef is banned in Europe because of the hormones it contains?)

The Bottom Line

The bottom line is that a woman with breast cancer is left with few viable options from the medical community. She can't completely trust breast cancer research or recommendations about medical treatments, and she lives in a culture that's averting its gaze from the real causes of her disease. Thus, it takes enormous courage and fortitude to stand up and take charge of your health, to question your physician and ask for clear answers, and to carefully examine alternatives. We hope that through this book we can inspire you to do just that.

Perhaps this excerpt from a letter to Dr. Lee will be inspiring:

My deepest appreciation to you for being gutsy enough to tell me your opinion concerning tamoxifen. You advised me against it, giving me the courage to buck my very pushy oncologist who wanted me to take it. I have been thriving without tamoxifen. I've had several follow-up mammograms and was told the opposite breast looked "textbook perfect," and the breast that had the lumpectomy looked normal and benign.

I am 56, postmenopausal, and am using progesterone cream. You reassured me it was safe even for a woman like me with high estrogen and progesterone receptors, explaining this means progesterone can get in and do its job of stopping the cancer when the receptors are present.

When I heard the flap about the "hazards of progesterone" I knew before even checking further that it was probably a botched reporting job that really referred to the synthetic progestins.

Thanks to you my life has been quite serene despite my diagnosis of cancer. I think progesterone is a mood elevator, also. I have blessed you silently many times since you replied to my letter asking about tamoxifen.

Blessings on you and your work,
MH

Copyright 2002 John R. Lee, M.D., Virginia Hopkins, M.A. and David T. Zava, Ph.D.

All rights reserved. Posted with permission from Time Warner Bookmark

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