Re: Breast Cancer Research

In article <Ii%8g.3447$u4.1926@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx>,
george conklin <george@xxxxxxx> wrote:
The New York Times today has a long article on breast cancer research. It
seems that current recommendations for chemotherapy were made before anyone
bothered to look at estrogen dependent tumors and non-estrogen dependent
tumors. Looking at the data with the one new variable, it turns out that
most of the benefits of the chemotherapy were from those who had
non-estrogen dependent tumors.

But guess what: the hidebound medical business states that since this one
variable was not thought of IN ADVANCE, the results of the actual
chemotherapy sessions do not meet the 'gold standard,' and thus they want to
start all over again. Now that is massive stupidity, but guess what, that
is what is going to happen.

--------the quote------

But most of those studies were done at a time when doctors did not
distinguish between the 70 percent of women with breast cancers fueled by
estrogen and the 30 percent whose cancers were not.

Now Dr. Berry, the M. D. Anderson statistician, and a group of leading
cancer researchers have found that the chemotherapy benefits in those
clinical trials were concentrated almost exclusively in women whose cancers
were impervious to estrogen. For the others, with estrogen-sensitive tumors,
the lifesaving benefit came from hormonal therapy. The results of the
analysis, published recently in The Journal of the American Medical
Association, were the same even if the cancer had spread to the lymph nodes.

The drawback of that study, Dr. Glick notes, is that it was not a large
prospective randomized clinical trial, the gold standard in medicine.

-------



Ok, because one variable was not thought of in advance, real-world
experience is not being used. It is self-inflicted wound in the
medical/industrial complex.


Dr. Berry is one of the few involved who have an
understanding of decision theory. As Dr. Glick points out,
there are problems with not using a prospective trial, but
this is not always necessary for reasonable procedures, and
is not always possible, considering the complexity of the
problem.





--
This address is for information only. I do not claim that these views
are those of the Statistics Department or of Purdue University.
Herman Rubin, Department of Statistics, Purdue University
hrubin@xxxxxxxxxxxxxxx Phone: (765)494-6054 FAX: (765)494-0558
.

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