Last October was National Breast Cancer Awareness Month (NBCAM) for most of us. It was a different month for the newest members of the junk science mob cut-throat pharmaceutical companies who used specious science to undercut their competitors' products.
Historically, junk science was the weapon of choice for an unsavory crowd lawsuit-happy personal injury lawyers, overzealous regulators, the lifestyle police, and Chicken Little environmentalists. Now, some pharmaceutical manufacturers have opted to use junk science to scare the public about rival products.
This rogue behavior is even more reprehensible in the context of breast cancer. Although breast cancer is responsible for only 4 percent of women's deaths annually (compared with 30 percent from heart disease), more than 180,000 women will be stricken this year according to the National Cancer Institute. Almost 44,000 will die from it. Breast cancer is the second leading cause of cancer death for all women.
Though not preventable, more than 90 percent of breast cancers can be treated successfully if detected early. So a number of organizations jointly sponsor NBCAM every year to promote early detection and, ultimately, survival a worthy endeavor, indeed.
But while NBCAM sponsors promote women's health, the new junk science mobsters used NBCAM to target their competition.
Take the ongoing debate concerning a reported link between hormone replacement therapy (HRT) and breast cancer. Used successfully for 55 years to ease menopausal symptoms such as hot flashes, HRT has beneficial side effects, including reducing risk of osteoporosis and heart disease.
But some circumstantial evidence has raised controversy about HRT and breast cancer risk. Reduced breast cancer has been reported where women's exposure to their own estrogen has been reduced, such as through hysterectomy, early pregnancy or exercise. Increased breast cancer has been reported where women's exposure to their own estrogen has been increased, such as through early menstruation, having children late, not having children, or reaching menopause late. While some have been anxious to extrapolate this information to include the use of HRT, the available science does not support this theory.
Some studies of HRT have reported an increased risk, but others show no increase and even a decrease in breast cancer. The lack of consistent results suggests that HRT has no discernible effect on breast cancer. But junk scientists are nothing if not resourceful.
The latest incident occurred in the United Kingdom when a study scheduled for publication during NBCAM in the British journal Lancet was leaked to the London Sunday Times. The study claimed post-menopausal estrogen increased breast cancer risk by more than 2 percent per year of use, and by 35 percent for 5 or more years of use.
Although the study was billed as the most comprehensive study of its kind, it turned out to be a re-analysis of existing, inconclusive data. Researchers used a statistical technique called "meta-analysis" to combine 51 small epidemiologic studies into one big study. While a meta-analysis is useful in well-controlled clinical trials, it is not appropriate for relatively uncontrolled epidemiologic studies with dissimilar study populations and inconsistent analytical methods. Combining the 51 studies was like adding apples to oranges.
But that didn't stop the Times from announcing in a particularly sensational headline -- "HRT Link to Breast Cancer Proved." The report described the questionable meta-analysis as having "indisputably linked" HRT to breast cancer, even though in the final paragraph, the article quotes David Sturdee, former chairman of the British Menopause Society, "We are not seeing an epidemic of breast cancer among HRT users in the clinic and it will be very unfortunate if this investigation causes women to stop taking it."
Why go after HRT and its 55-year track record of benefit and safety? Simple -- economic opportunity. As pharmaceutical companies race to take advantage of the scare, the first drug being rushed to market is Eli Lily's raloxifene. Part of the class of drugs termed "selective-estrogens," it's being touted by the media as having all the benefits of HRT with none of the risks. This, despite the fact that one member of the FDA advisory committee reviewing raloxifene termed it "estrogen-lite" because it didn't perform as well as existing estrogen therapies.
Lily's latest ads play directly to emotions instead of health concerns saying, "Many women have serious worries about a possible link between estrogen replacements and cancer." Yes, they do. Thanks to junk science.
Another breast cancer-scare story came during NBCAM at the expense of a widely prescribed class of drugs used to treat high blood pressure, called "calcium channel blockers" or CCBs. Published in the journal Cancer, this study reported post-menopausal women using CCBs had a 150 percent increased risk of breast cancer.
But the study was small and, as stated in a National Institutes of Health press release, "the findings do not establish a causal link between calcium channel blocker use and breast cancer." Moreover, the study conflicts with results of SYST-EUR, a recent long-term clinical trial of CCBs that did not reveal any increased cancer incidence.
The Cancer study is just the latest in a series of CCB-scares manufactured by Dr. Curt Furberg of Bowman Gray Medical School and oft-time cohort Dr. Bruce Psaty of the University of Washington. Their first scare linked CCBs with increased heart attack risk. But the evidence was so shoddy that Dr. Psaty was forced to apologize to colleagues at the American Society of Hypertension for launching a scare based on a single study with serious limitations.
Since then, Drs. Furberg and Psaty have tried to link CCBs with everything from AIDS to cancer to Parkinson's disease to suicide. Their modus operandi is the same small, unreliable epidemiologic studies.
But as with HRT and breast cancer, junk science is being used to propel cut-throat blood pressure medicine competition. Rival product manufacturer Merck sponsors Dr. Furberg at forums around the world where he speaks against CCBs and in favor of Merck products.
Of course, the grand irony is the HRT and CCB studies appeared in the midst of an effort to encourage early detection, not prevention, of breast cancer. But the public's understandable hope of prevention provides fertile ground for junk scientists who practice "risk factor epidemiology" the torturing of statistics in quixotic efforts to identify the cause of disease. Risk factor epidemiology has given us such gems as orange juice-caused lung cancer, margarine- caused heart disease, and the recently debunked power lines-cancer scare.
Will the public nemesis of risk factor epidemiology be around for the next NBCAM? Unfortunately, probably yes. Recently, the American College of Epidemiology sponsored an Oxford-style debate about risk factor epidemiology. Attendees voted 2-to-1 to keep doing it. Why? They acknowledged not doing risk factor epidemiology would put them out of business.
Now would that be so terrible? Only for the new junk science mobsters and their Luca Brasi-ish junk scientists.
Copyright © 1998 Steven J. Milloy. All rights reserved. Site developed and hosted by WestLake Solutions, Inc.