Some alternative health websites promote conspiracy theories of 'hidden cures' for cancer. These conspiracy theories are false, and they are harmful to patients.

Let's look at two of these claims to see why they don't make sense. Then I'll explain why these conspiracy theories hurt patients.

Conspiracy Theory #1: There's a cure for cancer, but doctors are hiding it.
The premise with this statement is that since doctors make a living from treating cancer, if there was a cure, we’d all be hitting the unemployment lines. So we just clam up and keep the cure to ourselves.

There’s one obvious problem with this logic: doctors and their family members die of cancer too. I have known cancer doctors who died of cancer, and some of my colleagues have lost their spouses or children to cancer. If there were a cure that we were not sharing with the public, certainly we would use it for ourselves and our loved ones. Does it seem logical that an oncologist would let her child die, or die herself, just to keep a secret cure hidden? No sane person would do that.

The other problem with this theory is that doctors and researchers spend huge amounts of unpaid time working on cancer research, often in the evenings and on weekends, away from family and friends. Many of us also donate to cancer research. For my upcoming book, Taking Charge of Cancer, which focuses on helping patients get top-quality care, I've donated all the author royalties to cancer research. Why would we waste so much time and money if there was already a cure?

This idea just doesn't make sense.
 
Conspiracy Theory #2: Pharmaceutical Companies Are Hiding the Cure
In this version, the doctors are blameless, but the magic bullet is hidden by a greedy pharmaceutical company that wants to keep the real cure hidden so that instead, it can continue to sell drugs that don’t work as well.

Let’s consider the economics of this. We’ll imagine that a pharmaceutical company has a magic bullet, a single pill that will cure all cancers. Is it better to sell the single pill, or to sell less-effective treatments that patients have to keep taking for years?

Governments and insurers pay a lot of money for medical treatments. In many countries, the decision about how much to pay for a drug (or whether to pay for it at all) depends on its benefit compared to the cost. A drug that increases someone’s life span by 10 years is worth much more than a drug that gets only an extra month.

To calculate if a drug is worth paying for, health economists use a value called the quality-adjusted life year, or QALY. If a drug adds one year of high-quality time to your life (in other words, during that extra year, you are not sick with side effects or disabled), it adds one QALY. This allows payers to decide which medical treatments are worth funding. If one treatment costs $100,000 per QALY and another costs $500,000 per QALY, it makes sense to prioritize the cheaper one over the more expensive one.

Some countries draw a line in the sand dictating the maximum they will pay per extra QALY. A cost of $100,000 per QALY is a reasonable line. If a new drug comes along that costs $500,000 per QALY, it would not be funded with that cutoff. Some countries have higher or lower cutoffs or no cutoff at all.

If we were willing to pay $100,000 per QALY, we can calculate the value of that magic bullet hidden by a drug company. If you give the magic bullet to a 30-year-old patient who is about to pass away from a terminal cancer, she would be cured and might be expected to live to age 80. As long as she has good quality of life, you’ve given her 50 extra QALYs, and the drug company could reasonably charge $5 million ($100,000 per QALY x 50 QALYs). If, instead, the drug company offered a series of drugs that kept the patient alive for five years, the most it could get under this system would be $500,000.

With those numbers, the economic value of a magic bullet would be staggering. Keeping a magic bullet locked away in a safe would be the worst business model of all time.

How Conspiracy Theories Harm Patients
These conspiracy theories often include a statement that there is a hidden alternative cure for cancer, perhaps related to diet or vitamins. This is also untrue. Click to read an article from a former naturopath debunking many alternative cancer remedies.

The problem is that for many patients who have a curable cancer, the window of time to cure that cancer is not very long. If too much time passes without treatment, the cancer can spread and no longer be curable. If a patient decides to forgo conventional treatment and instead pursues alternative treatments, the cancer can become incurable in that time. There is no going back.

In my experience as a cancer doctor, only a small minority of patients choose to forgo a potentially curative treatment because of beliefs in a conspiracy theory or an alternative cure. But for those who have made that decision, the consequences I have seen have been tragic. In some cases, patients have changed their mind after it became clear that the cancer had grown, wanting to pursue treatment then, but the chance of cure was gone.

These conspiracy theories are not harmless.

What can we do to fight these conspiracy theories? It can be difficult to stamp out fake health information, as we've seen in the battle against false vaccine claims. But one way to start is by standing up for the truth. When we are faced with a claim like one of the ones above, we need to say - or post - that the claim is false and harmful to patients.

We protect our families against all sorts of household dangers. But many of us don't check our houses for radon gas, even though radon causes thousands of cases of lung cancer every year.

Radon is a radioactive gas formed by the breakdown of uranium, which is naturally found in rocks and soil. Radon has no color, smell, or taste, making it undetectable to our senses.

Radon gas can enter a house through any small gaps where the house touches dirt. These gaps can include construction joints, cracks in the foundation or floor, and the spaces around pipes. Radon can also come from some sources of water, and from certain building materials that contain small amounts of uranium. In the outdoors, radon isn't a problem, since it is diluted by fresh air. But in a house, radon can accumulate to high levels.

Radon gas naturally breaks down into radioactive particles that we breathe in. Those particles settle in our lungs and deliver radiation to our healthy lung tissues. That radiation can cause lung cancer.

Lung cancer is responsible for more deaths than any other cancer, and radon itself causes one out of every six lung cancer deaths.

According to Health Canada, if you are a non-smoker who is exposed to high levels of radon, your lifetime risk of lung cancer is about one-in-twenty. For smokers, the risk is substantially higher. A smoker who is exposed to those high levels of radon has a lifetime risk of lung cancer of one-in-three.

It is estimated that about 400 Americans and 40 Canadians die of radon-related lung cancers each week.

Some geographic regions are more likely to have higher levels of radon, based on the underlying amount of uranium in the earth in that area. But even in low-radon areas, some houses can have high levels of radon, and the only way to know is to check.

Home radon testing is recommended by both the U.S. Environmental Protection Agency and Health Canada. Testing can be done by purchasing a do-it-yourself test kit, or by hiring a radon testing service. The do-it-yourself tests provide a kit that you send back to a laboratory once the testing is complete. Setting up the test kit takes only a few minutes.

For more information on Radon, and how to test your home, go to the US. Environmental Protection Agency Radon Website and the Health Canada Radon Website.

Sources:

• US. EPA Radon Website
• Health Canada Radon Website

These two websites give slightly different estimates of the risk of cancer from radon, but they are in the same ballpark

In the early years of my career, I've mainly focused on two things: treating patients and doing research. But over the past year I've also developed an interest in helping to promote high-quality cancer care, a quest that led to the development of this website.

For cancer patients, getting top-notch cancer care is very important and can directly impact the chances of treatment success. But most patients are unaware of the importance of getting good-quality treatment, and don't know how to make sure that the treatment they are receiving is indeed the best available.

A website alone can't provide enough of the detailed information needed to help patients get top-notch care. Websites tend to be consumed in small, blog-sized bites. Longer, more-detailed posts are often skimmed or ignored. So last year, my wife Cheryl and I came up with the idea that patients really need a 'how-to' manual, a book to help them get good-quality cancer care.

So I put together a proposal for the book, which was picked up by a superstar literary agent in California. She found a home for the idea at New Harbinger publications.

The book is called Taking Charge of Cancer, and it will be published on July 1. It is already listed on Amazon. The book includes a foreword by Dr. Anthony Zietman. Dr. Zietman is a Harvard Professor and editor of one of the major journals in our field. Last month, he was the recipient of an ASTRO Gold Medal for his outstanding lifetime contributions to our field.

There are thousands of books about cancer treatment, but as far as I know, this is the only book specifically geared toward helping patients get high-quality treatment. Here are some of the topics covered in the book:

• How to obtain and decipher your medical records.
• How to make sure all the correct tests are done, and that you are assigned the correct stage.
• How doctors decide which treatments are best, and why doctors can be biased.
• How to double-check your doctors' treatment recommendations against published guidelines.
• How to ensure you are receiving top-notch surgery, radiation, or chemotherapy.
• How to make sure all the correct procedures are in place for follow-up after treatment is finished.
• How to distinguish myths from truths about cancer treatment.

The book includes an online Patient Toolkit, with helpful videos that guide patients through many of the steps described above.

My other goal in writing this book is to improve the lives of future patients through cancer research. So I've signed off all the author royalties to the London Health Sciences Foundation, to be used for cancer research in London. The LHSF's fundraising efforts have made a major impact on cancer care and research, and this book will help them advance their goals a little bit further. The hundreds of hours spent writing this book has been a volunteer effort for me.

I've already shared early drafts of the book with some friends and colleagues, who have provided valuable input. I look forward to sharing the book with the rest of the world in July!

Surgery, radiation, or observation - which is best? Two big studies published this summer will change the way doctors and patients choose between treatment options.

Prostate cancer is one of the most common cancers in men, affecting more than one in seven males. Over the past two decades, there have been big debates over the optimal treatment approach. Treatment options include surgery, external radiation, internal radiation, and close observation (often called active surveillance or monitoring). Until now, doctors have not had good data to compare these options.

Making things more complicated, a new type of surgery, called robotic surgery, has taken off in popularity, About 80% of the prostate cancer surgeries done in the U.S. now use the robot, adding about $5,000 to the cost of each surgery. Although the robotic approach has been touted as a way of reducing side effects and perhaps improving cure rates, the science to support its use has lagged behind its popularity.

Two new studies published this summer have gone a long way toward tackling these questions. They are both randomized studies, which are viewed as the strongest study design in medicine. Randomized studies assign patients to different treatments groups at random (like flipping a coin), allowing for fair comparisons between treatment options. You can read more about the importance of randomized studies here.

The first randomized trial compared two approaches in men having surgery for prostate cancer: robotic surgery vs. open surgery. Open surgery is the traditional approach, where the surgeon makes a standard incision, almost always in the lower abdomen. Researchers in Australia enrolled 326 men aged 35-70 with prostate cancers that had not spread outside the prostate, and all men had a PSA test measured at no higher than 20. Half of the men were assigned to receive robotic surgery and half were assigned to receive open surgery. The main outcomes that the researchers wanted to examine included urinary and sexual function after treatment.

When comparing these two groups of men after treatment, those who received the robotic surgery vs. those who received the open surgery, there was no difference in urinary or sexual function at 6-weeks or 12-weeks post-surgery. The authors also looked at the rates of "positive margins", meaning that the tumor came to the edge of the surgical specimen, a finding that raises concerns that some tumor is left behind. The positive margin rates were similar in the two groups - 15% in the robotic group and 10% in the open group. The robotic approach did have some minor advantages, including less blood loss (although no one in the open group needed a transfusion), but these are considered much less important than the main outcomes.

We are awaiting the long-term data from this trial, including the outcomes at two years post-surgery. But this early data suggests that there's not a big difference between the two approaches. In the words of the authors: "In the interim, we encourage patients to choose an experienced surgeon they trust and with whom they have rapport, rather than a specific surgical approach."

Read more about picking a good surgeon.

The second trial, done in the UK, took a broader approach and compared three options for prostate cancer: surgery, external radiation, or active monitoring. Active monitoring means holding off on treatment until it becomes clear that the cancer is progressing. The trial enrolled 1643 men aged 50-69 who had prostate cancer detected by PSA testing and had not spread beyond the prostate.

The men were each assigned to one of the three groups (surgery, radiation, or active monitoring). The main purpose of the trial was to look at the rates of death from prostate cancer at 10 years, and there were no differences found. In each group, only about 1% of patients had died of prostate cancer by 10 years. And the chances of dying from anything within 10 years was also very similar in all three groups, around 10%.

The advantage of the active monitoring group is apparent: almost half of the patients in that group (45%) still didn't need any treatment 10 years later. Because they were able to delay or avoid treatment, the active monitoring group did better in many of the quality of life outcomes (such as sexual function and urinary continence). The disadvantage of the active monitoring group is that they had a higher chance of the cancer spreading elsewhere in the body, but that risk was very low, about 0.6% per year.

These two studies provide valuable information that will help patients diagnosed with prostate cancer. To me, the bottom line is this:

• Active monitoring is an excellent approach that spares many men from the side effects of treatment, and the long-term risk of death (10 years later) is no different than in men who choose to have surgery or radiation.
• For men who choose to have treatment, outcomes after surgery or radiation are very similar, so the decision between the two should come down to the patient's preference. To make sure that the patient hears all sides of the story, it is important they meet with both a surgeon and a radiation doctor before choosing treatment.
  
• For men who choose surgery, paying extra to have robotic surgery doesn't seem warranted. It's best to find a good, trustworthy surgeon who performs large numbers of prostate cancer surgeries every year, rather than finding a surgeon who takes a specific surgical approach.

The crowd of almost 10,000 people at last night's Tragically Hip concert knew that it would be a special night. The concert was scheduled to start at 8:30 PM, but almost everyone was in their seat early. When the band stepped on stage in a blaze of lights and sound, the crowd roared its approval, the cheers louder than at any concert I'd been to before.

The Tragically Hip did not disappoint, performing for more than two hours in a high-energy concert capped with an emotional goodbye to their London fans, Singer Gord Downie was perfect. Although everyone in the room was aware of Downie's recent diagnosis of a brain cancer called glioblastoma, his performance was unaffected - he was his normal, musical-genius self.

For a generation of Canadians, the Tragically Hip is the band that wrote the soundtrack to our lives. With a career spanning more than 30 years, including 13 albums, they have been part of our culture since we were little kids. Their songs bring back golden memories of the major events in our lives: high-school dances, summer campfires, times with friends, and even weddings.

The news that a Canadian legend has been diagnosed with an incurable brain tumor has led to an outpouring of support online, including a petition for Downie to be awarded the Order of Canada. The petition currently has almost 70,000 signatures and hopefully will spur our government to act. Downie has also launched the Gord Downie Fund for Brain Cancer Research at Sunnybrook, a world-leading centre in the research and treatment of brain tumors.

The research is badly needed. Glioblastoma is a rare tumor - only occurring in 2-3 adults per 100,000 every year - but it is one of the most difficult cancers to treat. Even the most aggressive treatment, which is a combination of surgery, radiation and chemotherapy, doesn't achieve the results that we need. We've lost several important people to brain cancers, including U.S. politician Ted Kennedy, and O.J. Simpson lawyer Johnnie Cochrane.

Watching the concert yesterday, I was blown away by Downie's courage. Despite facing an extremely difficult diagnosis, he is giving Canadians the chance to say goodbye. He is using his stature as a way to raise money to help other patients diagnosed with cancer.

The band's last song was Fiddler's Green, a song written as a tribute to Downie's nephew who died as a child. In Irish legend, Fiddler's Green was a place where old sailors would go in the afterlife, a place of never-ending happiness and a fiddle that never stops playing. When the music ended, Downie waved one last goodbye to the adoring crowd and walked off down the tunnel.

Let's walk with him. Please sign the petition and donate to Gord's cause.