Thursday, November 05, 2009

You're Ill! POW! You're Cured!

The 30 Second Skinny DITI is being increasingly offered as a method of early detection of breast cancer, despite little evidence that it is even as effective as traditional mammography. It is also marketed at women in low-risk groups, meaning a greater chance that clients will test positive for abnormalities when none are there. Research suggests it may only be useful in conjunction with mammography.

Something that has recently swum into the Beacon's purview is the use of Digital Infrared Thermal Imaging as a diagnostic tool for breast cancer. Remarkable claims have been made for this technology, the chief one being that it is capable of detecting cancer eight to ten years before traditional mammography.

Here's Healthy Life Essex on the subject. Note that they offer up DITI as a means of avoiding problems inherent with mass screening programs, despite the fact that the problems of mass screening aren't based on the technology as such, but what happens to the numbers of false positive and false negative results when applying the technology to a large number of people.

Here's Whollistic Medicine's penny's worth, too, complete with technical looking thermal pictures of some boobs. Whollistic tell us that "An abnormal infrared thermal image is the single most important marker of high risk for developing breast cancer, much more so than a family history of breast cancer." Pretty serious and useful technology, then?

Well, a search of Pub Med for the terms "digital infrared thermal imaging diagnosis breast cancer" came up with a grand total of four studies. One looked solely at women who had reached the biopsy stage and suggested that DITI is "a valuable adjunct to mammography and ultrasound, especially in women with dense breast parenchyma."

A second dealt with the technology itself. A third looked at the use of DITI in monitoring tumour growth in nude mice. Success with our mammalian cousins led the researchers to conclude that "thermographic imaging might have considerable potential in monitoring human tumor xenografts and their response to anticancer drugs." A fourth, dating back to 1998, discussed technological advances and suggested DITI may be useful. It is rational conjecture, but does not reflect clinical research into the use of DITI as a diagnostic tool.

I was a little over-selective in my search terms, and there exists more research out there, but nothing I've turned up makes the suggestion that DITI can detect cancers a decade before more established methods. Perhaps I have overlooked them; but do keep in mind that DITI only really started making a comeback in the 1990s, which doesn't offer very much possibility of such research existing. One would need to run a trial whereby women were routinely screened (proponents of DITI look for changes over time in scans as a means of detection), the "signature" of breast cancer identified retrospectively, and then for it to be applied in practice on a further trial group to establish the efficacy of the diagnostic procedure.

But the practitioners offering DITI as a diagnostic tool aren't all that bothered about evidence. The Essex article refers to practitioners Billy and Wendy Bradford, who run the Beechwood Clinic, Cambridge. £175 covers your "baseline" scan and 90 day scan. You're then charged a further £175 a year. Annual scans are, of course, advised. Other services on offer are reflexology and Indian Head Massage.

Whollistic Medicine is run by Dr. Shamim Daya and also offers acupuncture, bio-identical hormones, flower therapy, and Electro-lymphatic therapy (which runs on inert gas and quantum mechanics).

Here's a chiropractor offering DITI.

Here's a homeopathist offering DITI.

You get my point.

But what I find most interesting about this is the unique marketing opportunity DITI poses for CAM. We use phsyical examination, mammography and biopsy to detect cancers. Infrared Imaging claims to pre-empt this process by a decade, and it is being sold by people who are willing to make claims about treatments for which there is no evidence of efficacy.

So say someone undergoes DITI scanning and is told that they should see their GP as the scan suggests they have cancer. Note that, strictly speaking, practitioners themselves can't diagnose. The customer goes to their GP who, understandably, cannot detect a cancer. DITI operators trade in "peace of mind". That's why the scans are targeted at younger women (well, that and the Kylie effect) for whom mammography isn't a very good test. DITI offers the comfort of a "certain" negative result.

But if someone tests positive, then they are stuck. No medical doctor will treat a cancer that isn't there. So if the customer is "refused treatment" their first port of call will no doubt be the DITI clinic, who will then be in the choice situation of treating a cancer that isn't there with medicine that doesn't work.

They say the perfect con is one where the mark never realises he's been duped, and maybe even feels better for it. When you allow practitioners to diagnose cancers no-one else can detect, and then allow them to offer treatments for them, and can even have those treatments appear to work, then you have pretty much achieved perfection.

EDIT - It appears that most, if not all, machines used in private practices for this kind of diagnostic work are produced by an American company called Meditherm. Their site has an impressive list of studies demonstrating the efficacy of the technology. Of the few that refer to cancer, most are looking at its use in monitoring known cases of breast cancer, and therefore not about the efficacy of its diagnostics. One, however, really did catch my eye, namely Thermography in screening for breast cancer (K L Williams, B H Phillips, P A Jones, S A Beaman, and P J Fleming, 1990). This is exactly the kind of trial I'm interested in seeing, as it looks at the correlation between patients presenting abnormal thermal images, and them going on to develop breast cancer. It has a decent sized sample of 10,238 women, and followed them over a five year period. It found that "71.6% of the women who developed breast cancer had had a normal thermogram at the time of examination, as did 73% of those who did not," and concluded "Thermography is not sufficiently sensitive to be used as a screening test for breast cancer, nor is it useful as an indicator of risk of developing the disease within five years."

Now, this study took place prior to 1990, and it was only really after 1990 that technological advances led to people looking again at the technology, but sadly there does not appear to be any trial similar to that by Williams et al, and without that we don't really know whether it works. What does bother me, however, is that this trial, disproving the approach, is slipped in, unlinked and out of context, into a snowball style bibliography that is supposed to convince people less anal than I that DITI is a worthwhile pursuit. This amounts to sloppiness or a deliberate attempt to mislead.

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