The Dunning-Kruger effect, leading to false beliefs about nearly everything since the dawn of humanity.

The Dunning-Kruger effect, leading to false beliefs about nearly everything since the dawn of humanity.

An economic analyst, Mike “Mish” Shedlock, wrote a blog post to describe how he beat prostate cancer. When laymen and patients write about cancer, they are likely to get some things wrong. Mish’s story is full of typical misunderstandings and misinterpretations.

He interpreted his experience in his own way and did his own research into the medical literature, something he was not qualified to do. Prostate cancer is a very complex subject, and understanding the implications of published studies for treating patients can be difficult even for experts. In typical Dunning-Kruger fashion, he rejected the advice of his doctors, thinking he could do better.

What his tests showed

Mish had been getting prostate-specific antigen (PSA) tests every couple of years. He believes this is a routine test recommended for men as they get older. It’s not that simple: the PSA test has its uses, but when used as a routine-screening test on the entire population of older males, it is likely to do more harm than good. The U.S. Preventive Services Task Force (USPSTF) says there is insufficient evidence to recommend routine screening. I’ve written before about the prostate screening controversy.

He thinks any reading under 3.0 (or 4.0 or 2.5) is normal. It’s not that simple: there are no defined normal levels for PSA. Low levels can be seen in patients with cancer, and high levels can be a sign of a number of other things, like inflammation or the benign prostate enlargement (BPH) that men frequently develop as they get older. Whatever the level, what is most significant is not the level itself, but a rise over time. After two readings in the 1-2 range, Mish had a reading of 6.65 followed by a reading of 7.13, and his doctor recommended a biopsy.

The biopsy showed cancer. Actually, out of 12 biopsy samples only one showed cancer, and that was only in 10% of that sample. The Gleason score was 6. That score is intermediate, between low-grade, well-differentiated tumors that are less likely to progress and high-grade, poorly-differentiated cancers that are more aggressive. With a Gleason score of 6 and a PSA of 7, his cancer would be considered Stage 1, the earliest stage.

Treatment options

For Stage 1 cancer, there are three treatment options: surgery, radiation, and active surveillance. Many of these cancers are so slow growing that the patient will die of something else before the cancer ever causes symptoms or metastasizes. The prevalence of prostate cancer detectable on autopsies rises with age to eventually become almost universal; men are far more likely to die with prostate cancer than of prostate cancer. And the surgery has a high rate of complications, such as incontinence and impotence. The wisest course in many cases is not to treat but to monitor the patient, with the understanding that treatment may be indicated at a later time if there are signs of progression.

Mish’s surgeon strongly recommended surgery, with an estimated price tag of $20,000. His regular doctor recommended radiation therapy, which can be even more expensive and also has a high risk of complications. Mish says he did his own research and found a third option: wait and see. Most doctors would have explained all three options and let the patient participate in the decision. It doesn’t sound like Mish was given the information he needed to give informed consent.

He chose the surveillance option, but he wasn’t content to just sit back and wait. After 60 hours of research, he settled on a cocktail of the ten “most promising things” that he thought would help fight his cancer. His doctor was against the idea but agreed to go along as long as he continued PSA monitoring. He told the oncologist he was going to have a PSA test every month; the oncologist tried to dissuade him, arguing that every six months would be often enough. More frequent monitoring would just detect more meaningless fluctuations. Unfortunately he expressed that by telling Mish the test “wasn’t that reliable,” and Mish misunderstood. He assumed “the more unreliable a test is, the more tests one should take to weed out erroneous outlier results.” But then he got an outlier result and he didn’t weed it out. A scant month later, his score had skyrocketed to 17.65. The oncologist would not have repeated the test that soon, since PSA levels are known to go up after biopsy. A month after that, it had dropped to 2.39, well below the pre-biopsy level and well within the “normal” range. And it stayed down. Eight months after that one high reading, it was down to 1.94. The surgeon wanted another biopsy because of the one high reading. Mish was worried that despite the now low-normal readings, his cancer might have progressed without showing on the test because his cocktail of alternative treatments might have artificially lowered the PSA readings. So he agreed to another biopsy, and this one showed no evidence of cancer.

Mish’s cocktail

Here’s what he took:

  1. Resveratrol: 250 mg twice daily
  2. Indole-3-Carbinol: 200mg twice daily
  3. Bromelain: 500mg twice daily
  4. Querceten: 300mg twice daily
  5. Turmeric extract: 300 mg twice daily
  6. Vitamin D3: 5,000 IU twice daily
  7. Vitamin K2: 100mcg twice daily
  8. Vitamin B12: 100mcg twice daily
  9. Selenium: 50mcg twice daily
  10. Sodium bicarbonate orally: One half teaspoon twice daily – one hour in the morning right after waking, and again in the evening right before bed – empty stomach

I’ll review these in reverse order:

  • Number 10 clearly contributed nothing; it is foolishness based on Robert O. Young’s nonsensical “pH Miracle” myth.
  • Number 9 may have been counterproductive. There are studies indicating that selenium supplements increase the risk of prostate cancer.
  • Numbers 6-8 are indicated for people with a deficiency of those vitamins, but it is preferable to get them through diet rather than through pills.
  • Number 5, turmeric, has shown promise in preclinical studies, but the concentration needed for its anticancer effects may not be achievable in the human body with supplements.
  • For numbers 2 and 4, indole-3-carbinol and quercetin, a search of PubMed found some rat and lab studies, but no evidence of clinical benefit for human prostate cancer.
  • For number 3, bromelain, PubMed listed no studies about prostate cancer at all.
  • For number 1, resveratrol, there are indeed some studies, but they are far from convincing.

Mish attributes his success mainly to the first four. He particularly has confidence in resveratrol based on some positive studies he found, but he is cherry-picking to find what he wants to believe. It’s easy to find positive studies to support almost anything. If you look for negative studies you can find those too, for instance this one that showed decreased survival with resveratrol. I wonder if his research also dug up the fact that many of the positive resveratrol studies by the most prolific resveratrol researcher were deliberately falsified. He was found guilty of outright fabrication of data, and he was charged with fraud and fired. I consulted PubMed and found two systematic reviews of resveratrol and other phytochemicals. The first concluded:

[it is] impossible to make definite statements or conclusions on the clinical efficacy in cancer patients because of the great variability and differences of the study designs, small patient numbers, short treatment duration and lack of a standardised drug formulation. Although some results from these clinical studies seem encouraging, reliable or long-term data on tumor recurrence, disease progression and survival are unknown. At present, there is no convincing clinical proof or evidence that the cited phytochemicals might be used in an attempt to cure cancer of the prostate.

The other review concluded:

…at present there is no clinical evidence that phytochemicals might have a therapeutic use in prostate cancer in relation to reduction of tumor progression or improved survival. The question about an improved immune function or quality of life remains open. Potentially the use of phytochemicals could play a role in a preventive setting.

And pharmacokinetic studies of doses up to 5 grams per day have demonstratedpoor bioavailability of resveratrol.

In my opinion, Mish’s “research” only demonstrates his incompetence to do research. He went in with an agenda, looking for anything that “might” help and ignoring evidence that it might not. Without a medical or scientific background, he has no way to put the studies he finds into context or to evaluate their credibility, so his judgment is flawed.

What may really have happened

It’s possible to put an entirely different interpretation on the facts Mish provides. Here’s a devil’s advocate version of his story:

There was no need to do PSA screening tests in the first place. The initial elevated readings that led to the biopsy were not signs of cancer; he had a transient rise due to some other, unimportant, cause. The 17.65 reading was an outlier, probably caused by the recent biopsy. The biopsy was not necessary, and the one sample that showed 10% cancer may have only reflected a small focus of disease that would never have caused him any problems. His cocktail of supplements had no effect. In fact, it’s possible that some elements of the cocktail might have been harmful in some way.

Mish (along with a lot of other men) might have been better off if he had never been screened with PSA tests.

Conclusion

Mish thinks he “beat cancer” with his cocktail of diet supplements; we can’t rule out that possibility, but I think it is highly unlikely. I don’t think his cocktail made a bit of difference. I think he fooled himself. The cocktail fed him false hope, gave him a false sense of control, and provided the virtuous feeling that he was “doing something” rather than passively waiting for what the future would bring.

Fortunately he is still under the care of his regular doctor, who tolerated his experimentation and continued to monitor his condition. The negative biopsy doesn’t mean that his cancer is gone. If it isn’t, we can hope that it won’t progress; and we can hope that if it does, he will get the appropriate treatment.


Note: the original title of this post and the accompanying picture were interpreted by readers as mocking the patient and making fun of him, which was not the author’s intention. The title has been changed and the picture removed in response.

 

Posted by Harriet Hall

Harriet Hall, MD also known as The SkepDoc, is a retired family physician who writes about pseudoscience and questionable medical practices. She received her BA and MD from the University of Washington, did her internship in the Air Force (the second female ever to do so),  and was the first female graduate of the Air Force family practice residency at Eglin Air Force Base. During a long career as an Air Force physician, she held various positions from flight surgeon to DBMS (Director of Base Medical Services) and did everything from delivering babies to taking the controls of a B-52. She retired with the rank of Colonel.  In 2008 she published her memoirs, Women Aren't Supposed to Fly.