What does “risk” mean when they say that some behavior is a “risk” for some health disorder? How do the latest breast cancer surveys stack up in our quest for answers?
This is an extended comment on “Drug Shows Promise In Reducing Breast Cancer Risk” posted on NPR for 6 June 2011. No experiment shows that the drug prevents breast cancer, only a survey suggests a link between exemestane and lower breast cancer rates. Much of what was said in this report suggest causes of breast cancer have never been studied in a controlled experiment. By not doing so, the doctors can only suggest that exercise, eating healthy meals, losing weight or taking this drug might be good for the patient. We just do not know what exactly these factors have to do with the occurrence of breast cancer.
A study in post-menopausal women found that a hormone-blocking drug, exemestane, which helps prevent re-occurrence of breast cancer may help prevent it. It cuts “risk of invasive breast cancer” by 65%. NPR reporter Michele Norris interviewed Dr. Otis Brawley. Exemestane will not work in pre-menopausal women. Tamoxifen and raloxifene do seem to work in pre-menopausal. This study lasted only three years. Most of these drugs only work to reduce risk while women are taking it, so none are a cure. Tamoxifen increases risk of uterine cancer, blood clots and pulmonary emboli, but all of these drugs have serious side effects. So it is critical to understand the risks of taking any of these drugs. Most women may not want to take it for the prescribed five years, and most must also take drugs for osteoporosis.
My Comment Posted at NPR:
Here is another doctor who confuses the term “risk” with “cause”, when in fact, no properly controlled experimental study was done, either for this study or for the effects of “high caloric intake” or “lack of exercise” as a “cause” of cancer. By relying heavily on these “observational” studies, doctors avoid finding a “cause” and thus a “cure” for cancer, leaving the work to finding a cure to the drug companies. It tends to reduce a doctor’s observational skills when he/she doesn’t practice them. The frontline for pharmaceutical companies has always been the doctor’s observational skills, since they raise questions about possible causes that can be tested in the laboratory animals as part of any drug research and development. No wonder we have seen little by way of a “cure” for anything in the past 30 years.
Even though Dr. Brawley says that high caloric intake of foods and lack of exercise “cause cancer”, we know no such thing. They are just characteristics associated with presence of cancer–they are NOT causes. No study has taken people with no likelihood of getting cancer, who are not obese, but doing a recommended moderate amount of regular exercise, and then experimentally remove them from that regimen, and/or give them high caloric foods. Both of these groups should develop cancer, according to what Dr. Brawley stated.
Dr. Brawley says that lowering the risk doesn’t mean you can’t get cancer, because 15% of those who quit smoking still get lung cancer. The fact that doctors cannot prescribe anything that will prevent cancer means that they still are not addressing the cause of the cancer. Using the term “risk”, unfortunately, gives their patients false information, simply because so many studies lacking the types of controls I have mentioned in the above example have been done.
By far the majority of studies are “observational”, meaning “non-experimental”, but more specifically, “associational”. Finding a correlation (association) does not show cause and effect. Such studies have been misinterpreted by both doctors and the news media to suggest that one factor can “lower the risk” if patients do it. When a study finds a link between two variables, then it should instead conclude that experimental studies need to be done. Or the presenter should state all the variables so correlated with the factor from other studies in discussion, again, stating that no cause for these correlations has been found. Lack of exercise is no more a risk for cancer than having cancer is a risk for not exercising. A correlation always goes both ways until proven otherwise.
It is possible that doctors want patients to change their lifestyles and by stating that making these changes “lowers their risks” for particular bad outcomes, it simply makes their argument more forceful–never mind the lack of accuracy. No wonder they want relief from malpractice lawsuits! Stop making outlandish claims and people might learn how inaccurate the practice of medicine is. They might also realize the limitations of scientific investigation and any kind of medical practice, thus appreciating what they do get in methods of treatment that seem to relieve symptoms. We have all been through the pronouncements of the wonders of a particular “cure”, only to be disappointed some time later. A real cure becomes truly sensational, if all health discovery announcements are held to the usual standard of experimental science.
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© Copyright 2014 by Martha L. Hyde and https://marthalhyde.wordpress.com.