Drugs and Your Doctor - Taking Charge

Doctors talk amongst themselves about patients'2.1% in the USA. As the five year survival rate
unrealistic expectations about the effectiveness offor cancer is now 60% you can see how little
drugs. Quite often this conversation is done withimpact chemo has on the overall outcomes. For
shaking of heads and often sarcasm in theirbreast cancer the rates are 1.4% and for
voices. However it is time that we ask theprostate cancer the rate is 0%, that is zero
question: Just who is being unrealistic? Why shouldeffect.
the patient (or the country where socializedHow can this be? Surely that can't be right? I
medicine pays or subsidizes the cost) pay for acouldn't believe it and so I started asking the
drug that has a very low level of effectiveness?doctors I work with. They all agreed the
When you go to the doctor and the doctoreffectiveness was much lower than almost
prescribes a drug, what level of effectiveness doeveryone expected but they didn't realize that
you expect this drug to have? Do you expect itthe rates were as low as mentioned in the article.
to be 100% effective? Or 98% or 90%, orOne oncologist just wouldn't answer me, but also
80%? Or would you take the drug if the doctordidn't say the paper was wrong. She just kept
told you that it might reduce your chances of asaying, "We must ask the patients' what they
bad outcome by 4%? Or what about 1% orwant."
even less?But how can patients make an informed decision
This is a question I have been asking for the lastif the doctors aren't honest about the
couple of months. I ask anyone I come across -effectiveness of the drugs? Now there will be the
people in the bus queue, shop assistants,occasional person who wants to use every drug
colleagues in the staff room at work, and evenavailable in the hope of gaining a few extra days
medical students. The consistent response hasor weeks to be with their family. But I believe
been that most people expect drugs to be 90%there would be many, many more who would
effective, with a few dropping as low as 80%.forgo the months of agony from side effects if
Even one of the medical students said, verythey realized just how poor the results were. If
honestly, "Well I'm a trained pharmacist, so Iinstead of being told you were at grave risk of
know how effective they are but when mydying you were told that the average survival
doctor gives it to me I expect it to be 90%time was 20 years (as in women with breast
effective."cancer), and that the chemotherapy would add an
I am a health researcher and one of the things Iaverage of 5 months to survival time, then would
do is to go and search the medical literature toyou take it?
find out what works to improve health. I buryI would suggest that a great many people would
myself deep in the literature. When I wentbe interested in the research which shows that in
searching deep into the literature about the use ofmany cancers people who exercise at least three
cholesterol lowering drugs, statins, I washours a week have much better cancer
staggered to find out just how low the effectoutcomes than those who don't. It seems that
was.those with breast cancer have an improved
When I looked at the actual results of the drugsurvival of 7-10% which is six times better than
trials I found that the results often didn't matchchemo but I have never heard of a doctor who
what was conveyed by the title of the journalprescribes exercise for cancer. Other possible
article and certainly not in the drug companyimprovements could be had through eating lots of
advertising. For example, women had nobright green, yellow, orange, red and purple
improvement in overall survival when takingvegetables several times a day and cutting back
statins. For men who had no history of hearton sugar consumption.
problems only one life was saved out of 250 menThe big problem is that doctors have been
when taking the drugs for five years. That is abrainwashed to only accept treatments proven
0.4% effectiveness. For those who had had aby randomized controlled trials. We can never
previous heart attack the figures were 1 in 25.prove that exercise or vegetables can improve
That is 25 men had to take the drug for 5 yearslife expectancy to the same level of proof
to save one life - that is a 4% effectiveness - abecause we can never use the same research
long, long way away from the 90'100%methods. We cannot stop people from exercising
effectiveness that most people look for.or eating fresh vegetables to do the research as
Some time later I came across a paper looking atthat would be unethical when we already know
the effectiveness of chemotherapy on cancer.how good they are. So as we can never prove
Now I don't know about you, but I have alwaysexercise and vegetables are better than the
had the assumption that with the horrendous sidechemo using exactly the same research methods;
effects of the treatment one could at expect athe drug companies win, and the patients suffer
90% increase in survival times, or at least 50%.from side effects. It is time we became a bit
That is, I would expect that it would cut my riskmore discriminating and started to learn to ask
of dying at least by half, and that I could then gobetter questions about the research assumptions
and live a full length of life.that underpin the methods they use. Or
A paper published in 2004 in the cancer journalalternatively, just go natural - do what your body
Clinical Oncology paints an altogether differentintended: eat as close to nature as possible, move
picture. Morgan and colleagues found theregularly throughout the day and have an
contribution of chemotherapy to the five yearenjoyable family and social life.
survival in adults was only 2.3% in Australia and