For your Information--Do you believe this?
Just now, I received this email message from the Society for Integrative Oncology, forwarding this unbelievable article from a Gina Kolada, "reporter", New York Times. Do you believe it is possible to be this ignorant and misinformed, yet be employed as a reporter for the New York Times?
Or what could be Ms. Kolada's motivations for writing such blatant falsehoods?
Medicines to Deter Some Cancers Are Not Taken by Gina Kolata New York Times - November 12, 2009 Many Americans do not think twice about taking medicines to prevent heart disease and stroke. But cancer is different. Much of what Americans do in the name of warding off cancer has not been shown to matter, and some things are actually harmful. Yet the few medicines proved to deter cancer are widely ignored....................
Read full article:
By 1998, the results were in. Tamoxifen cut the breast cancer rate in half. Similar studies in Britain and Italy, also involving high-risk women who had not had breast cancer, came to similar conclusions. And women did not have to take the drug for a lifetime - they needed just five years of therapy.
Dr. Vogel was ecstatic.
"If I had told you in 1990 that in 10 years I would have a pill that would cut the risk of breast cancer in half, you wouldn't have believed me," he said.
But, he said, to his shock, "The world said, So what?"
"We were met with shoulder shrugs and harrumphs," Dr. Vogel said. Sales of tamoxifen, worldwide, "didn't budge." [Comment from Yazmin: Hooray, Hooray, so members of the public CAN think for themselves, Hum?]
Maybe, Dr. Vogel thought, the problem was that internists and gynecologists were not comfortable prescribing a drug used to treat cancer patients. Then, in 1999, he had a chance to do another breast cancer prevention trial, this time of an osteoporosis drug, raloxifene, or Evista, which did not have the cancer drug taint. It was to be compared with tamoxifen.
The $110 million study, involving 19,000 women, ended in 2006. The two drugs were found to be equally effective in preventing breast cancer, but with raloxifene there was no excess uterine cancer and the clotting risk was 30 percent less.
"It was a spectacular [Comment from Yazmin: Excuse me?] clinical trial," Dr. Vogel said. But, he added, "Once again, the world met the result with a shrug and a harrumph."
"Those were your tax dollars and mine," he added. "You can't do too many $110 million studies."
He cannot understand why no one cares, but some doctors say they see a number of problems. It is usually not the cost; tamoxifen is about 30 cents a day and raloxifene $3.30 a day. It is doctors' practices and women's concerns.
Most doctors, said Dr. Therese B. Bevers, medical director of the Cancer Prevention Center at M. D. Anderson, do not take the first step - calculating a woman's lifetime risk of getting breast cancer - in part because that can lead to the next step, spending an hour or so discussing cancer risk and drug risks and benefits.
Dr. Bevers suggests the drugs for women whose lifetime odds exceeds 20 percent [Comment from Yazmin: Here, this "reporter" is actually helping the notion of pushing Tamoxifen ON WOMEN WHO NEVER HAD BREAST CANCER IN THE FIRST PLACE, IN ORDER TO PREVENT IT??] That could include, for example, a 55-year-old woman who began menstruating early (increasing the risk), had her first child late (again increasing the risk), and whose mother and sister got breast cancer. About half the time, though, women with that kind of risk turn down the drugs, Dr. Bevers said. "The No. 1 reason I hear is, ‘Oh, I just don't like to take medications,' " she added.
Others, like Cecilia Anderson, who is 57 and lives in Houston, worry about side effects. "I felt like my quality of life was in question," she said. "I am busy, I am out there. I totally love my life and don't want it to be compromised." Her lifetime risk of breast cancer is 20.5 percent, compared with an average risk of 9.8 percent for a woman her age. Ms. Anderson declined the drugs. "I live a different lifestyle," she said. "I eat organic foods, I exercise. Through all of that comes a spiritual element as well. Mind, body, and spirit are all connected."
And Kolada goes on and on:
Studies' Complications
Then came the studies of finasteride and dutasteride for prostate cancer. The drugs block the conversion of testosterone to dihydrotestosterone, a hormone that prostate cancers need to grow. They are on the market to shrink the prostate in older men, whose prostates often enlarge. (Finasteride is also sold to grow hair - but the dose is one-fifth the dose that shrinks prostates and that dose has not been tested for cancer prevention.) Doctors can prescribe the drugs for cancer prevention but, at this point, that is not on their label
Still in shock (comment from Yazmin)
Comments
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DR. ABRAMS'S GREAT RESPONSE:
Hi Gina,
I am here in NYC becoming President of the Society for Integrative Oncology. I had just enough time to scan your front page article before heading to the NY Academy of Medicine for the meeting. And I was at the American Institute for Cancer Research Nutrition and Cancer meeting in DC last week. Not surprisingly I was disappointed with your article, especially as we try to move to a system of health care delivery that might promote health and well-being as opposed to disease management. Your observations that the only things that work to reduce cancer risk are pharmaceutical prescription drugs and that lifestyle modification is futile is a real blow to the attempt to have the American public become more responsible for their health. Studies of diet, and exercise as well, are much more difficult and problematic to conduct than a randomized, placebo-controlled intervention involving a swallowed pill! Nonetheless, to only highlight the negative when just last week the Journal of Clinical Oncology ran an article on how lifestyle (nutrition and physical activity) decrease the risk of second breast cancers. Meyerhardt from the Dana Farber has been very prolific writing articles which clearly demonstrate the detriment of the "Western" diet and the benefits of physical activity - especially in colon cancer!
Even though I disagree with your thrust, hopefully your article will stimulate the same sort of questioning that you aroused in me so that there may be a net benefit. To lull your readership into believing that what they eat or how much they move won't affect their cancer risk reduction is unfortunate! Especially at this critical juncture in our health care reform attempt.
We have disagreed in the past as well. I was just struck by the timing of your article which I will critique during my acceptance speech this afternnon!
Good to communicate again anyway!
With all due respect,
I remain,
Donald I. Abrams, MD
Chief, Hematology-Oncology
San Francisco General Hospital
Integrative Oncology -
Yes, I had read that article in the NY Times. It is so pathetically one-sided and ignorant. I was actually surprised that they ran an article like this as recently they have run other articles that were more positive toward altneratives and integrative medicine - especially in relation to cancer.
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Email sent by Yazmin to that Kolada:
Dear Ms. Kolada:
I am a member of the the Society for Integrative Oncology, and I am hereby responding to your article in the New York Time, entitled: "Medicine to Deter some Cancers are not Taken". I would like to express my disappointment at seeing such falsehoods and disinformation under your byline. When you write things like: "....Tamoxifen cut breast cancer risk by half...." How come you are not providing members of the public with the ABSOLUTE statistics for this "risk-reduction," and instead, limit yourself to the RELATIVE statistic? Absolute statistics are what we, patients, are interested in, because those are the statistics for real survival. We are not interested in cooked-up statistics such as "surrogate end-points," ect... which, when examined more carefully, provide survival rates in terms of months only.
I am also noting that you are pushing giving this powerful drug, Tamoxifen, to women who never had breast cancer in the first place. What is your motivation for such dangerous recommendations, considering that Tamoxifen has been shown to be able to cause aggressive uterine cancer, and life-threatening blood clots, to cite just a few side-effects?
As for your misguided representation of the role of nutrition and supplementation in the true prevention of cancer, Dr. Abrams' professional response will suffice.
Nevertheless, I would like to join Dr. Abrams in thanking you for helping stimulate further thinking in the general public about the very personal issue of choices in cancer treatment, and treatment in general.
Regards,
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nice one Yazmin!!!!
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Nice Yazmin. Great response!
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Way to go, Yazmin!
How do Dr. Susan Love and reporter Gina Kolata keep their jobs?
Tamoxifen does not reduce recurrence by 50%. If 100 women take Tamoxifen only two women will "benefit." 2%. That is the true absolute risk number. That is the real world number. It's not clear if there is any survival benefit at all. We're not making this up. This is what the mainstream oncologists report. Do oncologists read oncology journals?
Lookie here: http://jco.ascopubs.org/cgi/content/full/20/15/3328
This is from the Society of Clinical Oncology.
TAMOXIFEN
Clinical Evidence Relevant to Tamoxifen's Effect on Breast Cancer Risk Reduction Tamoxifen's influence on breast cancer in risk reduction trials. Tamoxifen is the only agent approved by the United States Foodand Drug Administration (FDA) for breast cancer risk reduction.Four randomized trials are prospectively evaluating tamoxifen(Nolvadex; AstraZeneca, Wilmington, DE) for breast cancer riskreduction.4-7 At the last technology assessment, three trialshad reported outcome with 479 breast cancers observed. A meta-analysisof these studies, of which the National Surgical Breast andBowel Project (NSABP) P-1 trial contributed the largest propositionof entered patients, identified a significant 42% reductionin relative risk (RR) of developing breast cancer associatedwith tamoxifen use (RR, 0.58; 95% confidence interval [CI],0.38 to 0.84).8The absolute risk reduction in these trials was less than 2per 100 women given tamoxifen for 5 years. The absolute riskreduction anticipated in an individual woman depends on hercalculated breast cancer risk, with women at higher risk havinggreater potential benefit. For instance, the average 65-year-oldwoman with no family history has an anticipated risk reductionof 1 per 100, while a 50-year-old woman with two affected siblingsand two prior biopsies but no germline mutation has an anticipatedrisk reduction of approximately 2.5 per 100.
The initial report of the International Breast Cancer InterventionStudy (IBIS-1) comparing tamoxifen with placebo and updatesof the two other European chemoprevention tamoxifen trials7substantially increase information regarding tamoxifen'sinfluence on breast cancer risk (Tables 2 and 3). Currently,738 breast cancers have been reported in the four randomizedtamoxifen trials, 54% more than available at the last technologyassessment.
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How did this reporter get a job with the New York Times? I also wonder.....
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This article is so ridiculous I don't even know where to begin!! It would actually be quite funny if it weren't so sickening!!!
GREAT response to the "journalist," Yazmin... Anom, you should send that to this person too!!
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Interesting. I found this article about Gina Kolata. It talks about how she slants her articles to fit her predetermined view. When she begins interviewing people for her articles, she does not use information from those who do not agree with her point of view. And, she selectively uses quotes so that they will support her position.
http://www.mindfully.org/Reform/Gina-Kolata-Dowie6jul98.htm
I remember listening to a radio show in the NY area years ago. It may still be on the air but I haven't listened in a long time. The host was Gary Null who has written many books on nutrition. I I remember him ranting about Gina Kolata on numerous occasions for various articles she had written that were negative about health and nutrition.
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AH HA!
I just knew there was something going on about that Gina Kolata. It is so unfortunate that people like her would be allowed to persist in journalism.....
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Oh and did any one pick up on the cost of Tamoxifen in this article?.....I sure would love ot find a pharmacy willing to sell me a bottle of Tamoxifen for 30 cents a day!.....
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Yes, I had seen the price mentioned by Kolada for Tamoxifen. Indeed, I was wondering, as well....
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How many doctors tell their patients the Journal of Clinical Oncology found only 2% absolute benefit for Tamoxifen?
Or do the doctors claim: "Tamoxifen will decrease your risk of recurrence by 50%"?
http://jco.ascopubs.org/cgi/content/abstract/20/15/3328
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Yup, always the relative risk, not the absolute risk. Not many people would take it if they knew the absolute risk. Although some do believe that a 2% benefit is better than nothing. Considering all of the side effects, I am NOT one of them!
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Where is the difference between invoking the 50% relative risk number and outright fraud?
Are there any legal minds on the forum? Bioethics professors must have talked about this, no?
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Where is the difference between invoking the 50% relative risk number and outright fraud?
Before I found this forum, I was convinced I was the only patient in the whole wide world to be bewieldered and bothered by this questioning.
I have several girlfriends who chose to take Tamoxifen, even after being informed (by me, among others) of this little detail: Absolute versus Relative risk. Some people simply think: "if I don't obey the Doctor, I am going to die."
What an aura the Father-Doctor still has.......
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"Oh and did any one pick up on the cost of Tamoxifen in this article?.....I sure would love ot find a pharmacy willing to sell me a bottle of Tamoxifen for 30 cents a day!....."
If anyone really is interested, you might check at WalMart. They're selling tamoxifen for 30 cents a day, or even less if you get a 90-day supply. A 30-day supply of the 20-mg tablets is $9.00, and a 90-day supply is $24.00: http://walmartstores.com/FactsNews/NewsRoom/8248.aspx
As for the comments about tamoxifen providing just 2% absolute benefit: The "2%" number would be true for women whose absolute risk of BC was just 4% in the first place, with tamoxifen giving them a 50% reduction in BC risk. If a woman's risk of developing BC was greater than 4% (which would be true for some women), the absolute benefit of tamoxifen would be greater than 2%.
It's also worth noting that the ASCO paper that was cited in an earlier post is from an article published in 2002 that included data only through March 2002. People who are really interested in the effectiveness of tamoxifen might benefit from looking for papers published more recently than that.
We now return you to your regularly scheduled programming.
otter
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Thank you for returning us to our regular programming. That's very generous of you, indeed.
But before blazing a blue streak to Wal-Mart, perhaps some would like to know about this:
Please see this medical review (only one among many similar ones), titled, this way:
Tamoxifen Continues to Prevent Breast Cancer for Years After Therapy Is Stopped (From Medscape Medical News): http://www.medscape.com/viewarticle/549550
Nevertheless, please read all the way to the BOTTOM of the study, and you will see this, in Medscape's own words:
But Higher Mortality in Tamoxifen Group
"......However, overall the mortality was higher in the group of women who took tamoxifen for 10 years than those who took placebo, although the difference was not statistically significant. In total, there were 65 deaths with tamoxifen vs 55 with placebo (P = .36), with cause of mortality outlined in the table.
Table: Death and Cause of Death in Tamoxifen Study(please see table in link, which I cannot paste here)...."
So it goes back to what we discuss regularly here in this part of the forum: While chemotherapy, for example, DOES shrink tumors, it appears that only about 2% or less of the patients will get the ultimate benefit out of it (which is: SURVIVE long term: Google "Aussie oncologists," or see different discussions here on the forum). But every time a new chemotherapy compound shrinks tumors a little more than the previous one, we get all the BIG newspaper titles: SO AND SO SHRINKS CANCER TUMORS BY SUCH AND SUCH (there is no small print explaining that the figures are in RELATIVE statistics, not ABSOLUTE statistics)"
....And so we are told, in big headlines, that the wonder drug, Tamoxifen, is able to block tumors for 10 years and more....But it takes getting to the bottom of the page to see that here again, tumor-blocking and the benefit that WE patients are looking for (real survival), is 2 different matters.
Statistically, of course, this is not a total lie: Tamoxifen CAN indeed block tumors, when it actually works (on about 1% of patients in ABSOLUTE statistics). But how about OVERALL (real) survival?
Barbara Brenner (President, Breast Cancer Action) calls this amazing phenomenon: "disease substitution."
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Otter, you write: As for the comments about tamoxifen providing just 2% absolute benefit: The "2%" number would be true for women whose absolute risk of BC was just 4% in the first place, with tamoxifen giving them a 50% reduction in BC risk. If a woman's risk of developing BC was greater than 4% (which would be true for some women), the absolute benefit of tamoxifen would be greater than 2%. "
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Otter, where are you getting this interpretation from? We are talking about Tamoxifen as an adjuvant therapy to diagnosed breast cancer patients, not giving Tamox to prevent BrCa to undiagnosed women who have risk. These are two totally different treatment groups.
*There is never, repeat, absolutely never an absolute risk reduction of 50%. Tamoxifen's benefit benefit ranges from 1% TO 2.5%. That means if 100 breast cancer patients take tamoxifen, 2 will be less likely to get a local recurrence in the first 5 years.
If they don't take Tamox the number rises to 4 out of a 100 risk recurrence.
The 50% (relative risk) number comes because 2% is 50% less than 4%.
http://jco.ascopubs.org/cgi/content/full/20/15/3328
Can I explain this better?
anom
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Yaz, thank you for that awesome link!
Overall survival is what we want, not "benefit" or "relative risk."
There was a reason back in the 1990s why the UK couldn't figure out why we Yanks were precscribed Tamoxifen.
anom
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"Otter, where are you getting this interpretation from? We are talking about Tamoxifen as an adjuvant therapy to diagnosed breast cancer patients, not giving Tamox to prevent BrCa to undiagnosed women who have risk. These are two totally different treatment groups."
Sure, I understand that those are completely different groups. I was under the impression that this thread was mainly a critique of the accuracy (or stupidity) of the NYT article; and the ASCO paper was cited as a source of information about "absolute" vs. "relative" benefits of tamoxifen.
But, who is talking about tamoxifen as adjuvant therapy, rather than as a primary preventive?
Not the NYT column -- it's subject was cancer deterrerence -- that is, primary prevention, not prevention of recurrence in someone who has already been diagnosed and treated for cancer. Tamoxifen was mentioned in the column as one of "the few medicines proved to deter cancer...".
The subject of the 2002 ASCO paper was also the primary prevention of breast cancer. The studies cited in that paper focused almost entirely on the use of tamoxifen, raloxifene, and other strategies, to prevent the development of BC in at-risk women -- not on their use to prevent BC recurrence in women who'd already been diagnosed and treated. The ASCO paper did cite some of the clinical trials where the main endpoint was recurrence risk, but the parts of those studies that were used as evidence by the authors of the 2002 ASCO paper were the parts involving development of contralateral BC, not the development of a local recurrence or mets. When contralateral BC occurs more than 6 months after the first tumor, it's usually due to a new primary.
I read the NYT column two weeks ago, when it first came out. Personally, I thought the column was not very well-written. I think the 2002 ASCO paper may be too old to be relevant to a serious evaluation of the risks and benefits of tamoxifen as a primary preventive. But, since I have a skewed opinion about things relative to most of the participants in this forum, I try to resist posting my opinions here. I was simply offering facts, where certain facts had been questioned.
I phrased my post the way I did because both the NYT column and the 2002 ASCO paper were focusing on prevention of the initial development of BC, not on preventing recurrence. But the mathematical issue of "relative" vs. "absoulte" benefit of treatment isn't treatment-specific. The point is, and I agree: a claim of 50% reduction in relative risk doesn't mean much if you don't know what the person's absolute risk is. That argument cuts both ways, though. If the absolute risk of cancer is estimated to be very low (say, 4%), then a treatment offering a 50% reduction in that risk indeed offers a very small (probably trivial) benefit -- just 2%. But if someone's absolute risk is much higher -- say, 26%, which would be true for some women -- then a treatment that provides a 50% decrease in that risk -- a treatment that drops the absolute risk down to 13% -- might be seen as a significant benefit.
Someone questioned whether it was possible to find a drugstore that sold tamoxifen for less than 30 cents per day; and I pointed out a source. I don't care if anyone buys it at WalMart, or if someone is boycotting WalMart and refuses to shop there. I don't care if someone thinks tamoxifen doesn't work at all and thinks my suggestion is irrelevant. All I was doing was answering a question about the cost and availability of tamoxifen.
And, I noted that the treatment recommendations and literature sources in an oncology paper that was published in 2002 might be a bit out-of-date. I guess that was an opinion, and I didn't want to offer opinions. So, take that one, or leave it.
Now I'm going back to my regularly scheduled programming. I need to get the turkey in the oven or dinner will be late.
otter
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You ladies are so knowledgeable, maybe you can help me understand this once and for all. I have already decided not to take Tamox...long story about why it was even suggested to me given that I am both post menopausal and have had HYSTY/OOPH...but I am still curious and have not been able to get a straight answer from my oncologist who "shut down" as soon as I said I had not started Tamox......Is Tamox mostly for local recurrrence?.....With an Oncotype score of 0..0% local recurrence and 3% distant recurrence-------how would Tamox "theoretically" change my risk? The Oncotype assumes 5 yrs of Tamox. So, without Tamox is my risk of local recurrence 2 X 0 ? Is my distant recurrence 2 X 3---= 6% distant recurrence? I am just still very curious about what my oncologist was thinking. I am being pressured by another doc who thinks I will die without the Tamox and yet neither doc has explained what my true risk is and how Tamox will reduce it. Way, Way back before the Oncotype test was done, my onco said chemo would reduce my risk by 5% and Tamox would reduce it another 5%. But, I was never clear on whether that meant local (I have had Bi-Lat Mast) or whether they meant distant recurrence. I would rest a lot easier if I could understand WHY they thought and still think that Tamox would make a significant difference for me. I just really need to KNOW things. As soon as I said I had not begun the Tamox, my oncologist said, "well clearly you've made your decision" and did not answer any of my questions and set up my next appt for the end of next summer. Apparently my one CA2729 test came back within range and I'm not sure how many times that should be run per year and what other tests I should be having. Any info from you learned ladies would be so welcome!!!!!
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Luna:
Indeed, this is puzzling and your situation goes to show how tricky the interpretation of statitics can be....
Perhaps one of these ladies will have a satisfacory answer to this question.
Meanwhile, here is another interesting discussion on Tamoxifen, here on this forum:
http://community.breastcancer.org/forum/78/topic/744598 (the titled is: tamoxifen vision problems after only 2-3 months)
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Good grief! How much estrogen can you be making with out overies?
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Luna5, my last visit with my MedOnc concluded with me feeling bad for her because I pressed her for answers she obviously did not have. after reading your post I asked myself why do I keep asking them when it is clear that they (A) Do not know or (B) Know and are unwilling to tell me because they want me to follow their protocol.
I recenlty came across a group of women who were willing to help me start a bc awareness program in my area. after talking to them at length I let them know of my decision not to pursue Rads or HT
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Luna5, last week I left my appointment with my MedOnc actually feeling bad for her because I pressed her for answers regarding risks, reoccurences and benefits which made her physically uncomfortable. After reading your post I asked myself why do I continue asking them when it is clear that they either do not know and are manufacturing stats or know and are unwilling to tell me anything that prevents me from following their protocol.
I recenlty came across a group of women who were willing to help me start a bc awareness program in my area. After speaking with them at length I informed them that I was not going to pursue Rads or HT and instead would try a natural approach. Their response was to reprimand me and to try to convince me to adopt the "tested and effective" methods for treating bc. They informed me that if I plan to start "any" type of support group which needed funding, I better learn to stick with the script. Screening, Surgery, Chemo, Rads, HT. Stick to the script and you won't get in trouble. Real eye opener. I never asked for funding, I only wanted the education and resources. Also, I respect everyones treatment choices. It's frustrating that mine are looked at with such cynacism.
I'm sure you can imagine how I felt about this but I believe thier attitude is the rule rather than the exception. I admitt that I expected more from my Rad and Med/Oncs because they took an oath to "do no harm". I expected them to assist in my healing process without reservation or to be hindred by ulterior motives. I belong to an HMO so I don't think it's going to happen.
This pretty much sums up my feellings.
Because if I depended on my HMO BC Team to educate me...I wouldn't know squat!
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Shish Carole, how flippin frustrating!!! "stick with the script" ummmmmm.....scary!!
L
ox
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I must say that I pay $9.40 for a month's supply of Tamoxifen so that is just about .30 a day.So she was at least right about that!
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even after the ovaries are removed, estrogen is still produced in the adrenal glands, skin, and fat. I continued on tamox 3.5 years after my ovaries were gone and now I take Evista for further preventative measures (high risk due to LCIS and family history of ILC).
anne
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Efflorescing, what "tested and effective" methods are they talking about?
Where did they get the impression that consensus-based medicine equals effective? Conventional med has a terrible track record. Tamoxifen is 2% effective-- it will benefit 2 women out of 100. Let them read the studies.
Geez, the placebo effect is higher than 2%!
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