Reporting Cancer

By Don Benjamin

There is a distinct bias in the media's reporting of the treatment of cancer in Australia. It is most profound in the newspapers. It applies to all treatments, surgery, radiotherapy and chemotherapy. This has been the subject of scholarly research.

One recent example of this is a paper by Pam McGrath and Geoff Turner entitled "The ethics of hope: newspaper reporting of chemotherapy" (Australian Studies in Journalism 1995; 4: 50-71). They analysed all articles mentioning the word chemotherapy in The Courier-Mail and The Sunday Mail (Queensland) from January 1990 to March 1992. What they found was a consistent portrayal of "the myth of a breakthrough to hide the frustration of the present reality". This was done by the use of headlines creating the impression of success whereas the content was about hope and promise which was rarely justified by the evidence. They stated that "such reporting is powerful in terms of the mindset it produces, and the subconscious individual and community attitudes it creates". German biostatistician Ulrich Abel analysed the results of clinical trials using chemotherapy in advanced epithelial cancer and found that "with few exceptions there is no good scientific basis for the application of chemotherapy in symptom-free patients" (Biomed & Pharmacother 1992. 46. 439-452).

In the area of surgery and radiotherapy a recent example occurred in The Sydney Morning Herald on Saturday 9 August under the page 1 headline "Breast Cancer Hope for Younger Women". This was the story about the possible use of mammogram screening. (This has not been found to help younger women.) A group of medical scientists with a vested interest in screening had looked at the literature again. The report said "everybody is agreed there is now some evidence of benefit".

Behind the scenes the reality is rather different. Over the past 20 years there has been an increasing number of leading cancer specialists throughout the world who have been questioning the current paradigm of what cancer is, and therefore how it should be treated. In the field of breast cancer this concern has been expressed by The Lancet in organising a special international conference "The Challenge of Breast Cancer" in 1994 using the theme of their editorial of 6 February 1993 "Breast cancer. Have we lost our way?" The keynote speaker James Devitt concluded that none of the current treatments for breast cancer had any effect on survival or mortality and questioned the current paradigm of breast cancer being a localised disease.

Political pressures from women demanding that something be done have resulted in mammogram screening being given extra funding in many countries, despite the absence of any scientifically acceptable evidence that mammograms save lives.

Cancer experts justify the use of screening by pointing out that results of randomised trials show that women offered screening have a reduced mortality when compared to those not offered screening. Claims for reduced mortality range from 0 - 30 percent depending on the bias of the researcher. These claims rely on ignoring the equal increase in mortality from other causes caused by the post-screening treatments, particularly radiotherapy. When all causes of death are considered there are no randomised trials that demonstrate any net benefit of screening. (see Benjamin DJ, "The Efficacy of Surgical Treatment of Breast Cancer", Medical Hypotheses 1996. 47. 389-397). None of these findings were reported in the Australian press except for The Herald Sun (Melbourne). This is despite an AAP release dated 4 November 1996 entitled "Mammograms don't save lives - scientist".

A similar finding for surgery and radiotherapy was reported by the Early Breast Cancer Trialists' Collaborative Group in the New England Journal of Medicine on 30 November 1995 after reviewing results of all 36 randomised trials involving 28,405 women with early breast cancer. The 6% decrease in deaths from breast cancer was accompanied by a 24% increase in deaths due to other treatment-related causes. Again the finger was pointed at the damage caused by the radiotherapy. There were no net saving of lives in either older or younger women. This finding again went unreported in the Sydney press. This situation was identified as long ago as 1975 by journalist Daniel Greenberg in his article "A Critical Look at Cancer Coverage" (Columbia University Journalism Review, Jan/Feb 1975, 40-44), which was reprinted in The Washington Post on 19 January 1975.

An analysis of mortality rates for the different forms of cancer over the 20 years from 1950-1970 showed that surgical treatment could not have had any effect on survival for any form of cancer (Benjamin DJ, "The Efficacy of Surgical Treatment of Cancer", Medical Hypotheses 1993. 40. 129-138). Similar analyses by John Bailar III, a member of the US President's Cancer Advisory Panel, have confirmed this situation for the period 1970-1994 (Bailar JC and Gornik HL, "Cancer Undefeated", New England Journal of Medicine [29 May] 1997; 336 [22]. 1569-74). None of this information appeared in The Sydney Morning Herald for example.

The myth of the efficacy of cancer treatment has been perpetuated by journalists from newspapers publishing news releases from cancer specialists with vested interests without questioning their claims. After all they are experts aren't they?

How could this happen? The answer lies in developments in the last century when most state governments conferred on the allopathic school of medicine a strict monopoly on the treatment of cancer, without any evidence that they could treat cancer successfully. Over the years legislation in NSW, for example, has changed slowly from a situation where it was illegal for anyone who was not a medical practitioner to provide any service to a cancer patient, to the present one where it is illegal for anyone other than a doctor to claim to have a cure for cancer.

The allopathic school of medicine is based on the principles that all disease arises from external causes, and therefore must be fought by applying external solutions such as drugs, an assumption influenced greatly by the claims of Louis Pasteur and the later discovery of penicillin. Modern developments in the drug industry have reinforced this approach to the treatment of cancer with marketing pressures leading to a situation where chemotherapy, shown to help fewer than 4 percent of cancer patients (a few systemic cancers such as leukemias and lymphomas in children) is now used for about 80 percent of cancer patients. Court cases on medical negligence in the field of cancer are decided on the basis of "evidence" that is no more than the opinion of experts without any scientific evidence to back it up.

An editorial in the British Medical Journal on 5 October 1991 "Where is the wisdom?... The poverty of medical evidence" pointed out that only 15 percent of medical interventions are supported by solid scientific evidence. The figure for cancer is closer to 6 percent. This is not the picture that is being painted by the Australian newspapers.

As a result we have a situation where there is about $500 billion spent on cancer research and treatment every year throughout the world based on a set of treatments that for the most part don't work. The figure for the US is about $200 billion. For Australia it is about $2 billion. Yet there is not a single newspaper in the country prepared to investigate this situation.