1. Scientists have conducted a series of pioneering experiments demonstrating a new way of making tumor cells far more susceptible to attack and also the possibility to lower dosage levels to a point where toxic side effects from the drugs are unlikely to occur.

Microarrays (gene chips) can examine gene expression in up to 50,000 different genes at once. It's mainly used for screening/gene discovery work. Out of 50,000 genes, maybe 15 or 20 may be involved in determining sensitivity/resistance to a given drug.

So you screen 50,000 genes to discover an association and then you focus in on only a few hundred or so for more careful study by some other method (the "gold standard" for sensitivity and reproducibility is called real time polymerase chain reaction, or RT-PCR) to determine sensitivity/resistance.

In this latest experiment, scientists screened a total of more than 21,000 genes and found that 87 can influence a tumor cell's sensitivity to chemotherapy.

Genes make proteins, the molecules that comprise and maintain all the body's tissues. Genes produce their effect by sending molecules called messenger RNA to the protein-making machinery of a cell. They set the protein-making machinery in motion through this gofer messenger RNA (or mRNA).

The technique called RNA interference (RNA-i) allows scientists to "silence" certain genes. In RNA interference, certain molecules trigger the destruction of RNA from a particular gene, so that no protein is produced. Thus, the gene is effectively silenced.

RNA interference is important for regulating the activity of genes (a fundamental mechanism for controlling the flow of genetic information). RNA interference (or RNAi) is a mechanism that interferes with mRNA, a natural molecular switch, regulating gene expression in plants, animals and humans, by "silencing" over-active or malfunctioning genes.

Tissue culture methods (Cell Function Analysis) have played a major part in the work of more than a third of the winners of the Nobel prize for medicine since 1953, including RNA interference (the 2006 winner), the nature of oncogenes (1989), growth factors (1986), monoclonal antibodies (1984), tumor viruses (1975), and virus genetics (1965).

The ability to transfect (introducing foreign DNA into a cell) cultured cells with DNA gene sequences has allowed us to assign functions to different genes and understand the mechanisms that activate or redress their function. It has made gene therapy and stem cell research possible.

http://www.therapeuticsdaily.com:80/news/article.cfm?contentvalue=1310293&contenttype=sentryarticle&channelID=28

Posted at 12:57PM on Apr 17th 2007 by Gregory D. Pawelski

2. Dr Anthea Martin, science information officer at Cancer Research UK, said: "If this 'gene blocking' technique could be used in patients, it may mean that lower doses of paclitaxel could be given, which would still be effective and reduce side effects.

"However, the study has only looked at isolated cancer cells in the laboratory - this is a great first step, but we don't know if the technique will work in tumours. This will take more research, and we look forward to future developments."

Further research on animals is needed; the first clinical trials on cancer patients can only begin in no fewer than three to five years.

Again, taxpayers should not pay for unproven "petri dish" tests that, as yet, prove no benefit. Patience is needed as are research dollars.

Posted at 6:00PM on Apr 19th 2007 by hchcec

3. I'd agree that gene profiling tests, important in order to identify new therapeutic targets and thereby to develop useful drugs, is still years away from working successfully in predicting treatment response for individual patients. Perhaps this is because they are performed on dead, preserved cells that were never actually exposed to the chemotherapy drugs whose activity they are trying to assess. However, it will never, for very practical reasons be as effective as the cell culture method, which exists today and is not hampered by the problems associated with gene expression tests.

Cell culture assay measures the net effect of all processes within the cancer, acting with and against each other in real time, and it tests living cells actually exposed to drugs and drug combinations of interest. It is a perfectly appropriate medical service, worthy of coverage on a non-investigational basis. And they abandon the artificial distinction between "resistance" testing and "sensitivity" testing and are providing coverage for the whole FDA-approved kit.

Tens of thousands of individual patient specimens are currently being submitted for testing by more than 1,000 clinical oncologists, surgeons and pathologists annually in the U.S. It is certainly each practitioner's prerogative to order these tests. It seems probable that a self-educated oncologist, genuinely on the cutting-edge would tend to be aggressive in actual treatment beyond mere rhetoric, and make use of running tests on a "fresh" tumor specimen before selecting a chemotherapy option.

Posted at 4:57PM on Apr 19th 2007 by Gregory D. Pawelski

4. Also, a very good way to make the developers of cell culture tests wealthy.

At this point in time, there is no evidence that cell culture tests benefit patients. These self-educated oncologists submit with the knowledge that their is no evidence of benefit. And while, in many cases, patients spend thousands on these tests, these very same oncologists tell their patients that we have no idea whether it will help or not.

You'll read that there is benefit on perhaps hundreds of blogs by this one AND ONLY individual, yet make no mistake, there is, at this time no evidence at all.

A GOOGLE search like this
http://www.google.com/search?hl=en&safe=off&client=firefox-a&rls=org.mozilla%3Aen-US%3Aofficial&hs=rgz&q=cell+culture+tests+pawelski&btnG=Search
returns hundreds of identical posts by the above individual.

I wouldn't call it trolling, but there are thousands of postings just like the above, but only by one, on the internet.

The researchers WHO ACTUALLY DO THE WORK IN THE FIELD certainly know the importance of evidence-based medicine. It's stated in the article.

We need to take a deep breath here, support the research, and allow the experts to help us take on cancer.

Posted at 8:35PM on Apr 19th 2007 by hchcec

5. Good point about how choice of drug selection makes the trialists wealthy. It is a fact that the choice of chemotherapy correlates signficantly with reimbursement to the treating oncologist. (Jacobson, M.,O'Malley, A.J., Earle, C.C., et al. Health Affairs 25(2):437-443, 2006).

Three decades of prospective, randomized trials have failed to define the most optimum treatment regimens. In this environment, oncologists tend to choose treatments based on the advantage to the oncologist, more so than to the patient.

No one has ever suggested the need to perform prospective, randomized trials between treatments chosen in the presence and absence of the profit motive. Perhaps these kinds of trials should be done, because progress in the most important forms of cancer with regard to drug selection has been negligible.

What more important progress may occur will likely come from radically new drugs and from biologically individualized drug selection, rather than from countless iterations of empiric trials with the old drugs (like taxanes).

Medicare has finally come to realize that selecting treatments on the basis of tumor biology rather than on reimbursement to the treating oncologist is not only good science and good medicine, but good medical economics.

While the above poster has you trolling on Google, take a closer look at "Chemotherapy Drug Concession" - "Reimbursements Sway Oncologists' Drug Choices" - "Drug Selection in Cancer Treatment"

Balance is much needed to the flow of cancer information which is largely controlled by people with their own biases and self interests.

Posted at 8:35PM on Apr 19th 2007 by Gregory D. Pawelski

6. Fortunately, thousands of postings to hundreds of blogs about cell culture assays by one individual on the entire internet does nothing to make cell culture assays effective as is indicated by the fact that there is not even one study to show effectiveness. Yet individuals, like those at Rational Therapeutics still want you to spend money on their tests. If you do go to their site, you will see not one study, just anecdotes.

Only research by scientists in the field will result in the truth.

Until then, a cancer patient should not in the least feel guilty about not spending hard-earned money on a completely unproven method of cancer treatment.

Posted at 8:49PM on Apr 19th 2007 by hchcec

7. Good review papers exist on cell culture assays and are increasingly appreciated, understood, and applied by private sector and European clinicians and scientists. This literature is not understood by many NCI investigators and by NCI-funded university investigators.

NCI studies never determine if "fresh" tumor assays worked. All of the considerable literature which supports the use of these assays in patient management has been based on true fresh tumor (non-passaged) cell assays.

Some years ago, NCI made an attempt to study "assay-directed" therapy of lung cancer. The study was a failure because they used established permanent cell lines (instead of fresh cells) to do the work. The result was a dismal 11% response.

The NCI used "cell lines" because the major expertise of the investigators who carried out any study was in the creation of cancer cell lines, and they wanted to see if they could perform assays on these cell lines to use in patient therapy. The results were that they were able to test successfully only 22% of specimens received, including only 7% of primary lesions.

This contrasts with a 75% overall success rate reported by earlier investigators who used the same assay system in "fresh" tumors and a routinely obtained > 95% success rate using improved methods available today.

Then there were sophistcated programs to discover gene expression microarrays which predict for responsiveness to drug therapy. However, the limitations and non-applicability of the NCI efforts, failed to realize that the way to identify informative gene expression patterns is to have a "gold standard" and the (cell-death) cell culture assays are by far the most powerful, efficient, useful "gold standard" to have, adding the potential value of the assays to individualize cancer therapy.

Many have hoped that molecular tests would hold the key to success, however, cell culture assays have contributed to the molecular understanding of chemosensitivity and resistance.

Posted at 10:01PM on Apr 19th 2007 by Gregory D. Pawelski

8. Charlie Rose had his latest installment of his 12-part Science Series, focusing on the importance of scientific research in human health. Episode Four was an in-depth discussion of the latest research in cancer. Always glad to see an authoritative, informational program being sponsored by a huge drug company with billions riding on the behavior patterns of physicians and patients - it ensures that the reporting will be completely free from any sort of bias. Packing the panel with academicians whose entire careers are utterly dependent upon mega-trials funded 100% by the same drug company further reinforces patients' confidence that the information conveyed will be balanced and fair.

Perhaps they, oncology research fellows and others, see the hand writing is on the wall. In an effort to establish cancer treatment guidelines, even the Community Oncology Alliance's (COA) QSP Committee recommends that CMS broaden acceptable guidelines, and not limit the guidelines for "individual" practice use. According to its' chair, ASCO has technology assessments that are very limited and updates which are not timely (and as we now know, not 'open' and accurate). NCCN guidelines are fine but many practices use other guidelines or develop evidence based treatment guidelines for their own individual practices or modify guidelines based on evidence which they use as their defined evidence based standards for their practices. The self educated oncologist doesn't "submit" to the status-quo. They can think for themselves.

Posted at 9:49AM on Apr 21st 2007 by Gregory D. Pawelski

9. Packing the panel with academicians whose ENTIRE careers are UTTERLY DEPENDENT upon MEGA-trials funded 100% by the SAME drug company.

Yes. The President of Hopkins, Sloan Kettering and Dana Farber are interviewed. They are evil academicians.

I stopped reading after this over-the-top, misleading proclamation. You've become almost a caricature of yourself.

So tell me....what have you done in the laboratory lately?

Here's the link (the above poster rarely includes links to "studies" mentioned in his posts)for those interested in a very good discussion.
Click on episode 4:
http://www.pfizer.com/pfizer/think/mn_think_cr_science.jsp

Posted at 10:14AM on Apr 22nd 2007 by hchcec

10. There is so much misinformation about the cell culture assay tests being perpetuated. All the important progress in cell culture assays has come outside of NCI-sponsored university-based research and it strikes at the heart of the standard NCI/university clinical research paradigms. That's why many doctors have not yet made the effort to learn about this. Because of the efforts of a dedicated private sector and the availability of media such as the Internet, the NCI and NCI-oriented institutions will soon find themselves in the position of having to make the effort to learn and to be forced to provide sound reasons if they choose not to use these tests in the management of individual patients.

Conventionally, what clinical oncologists have been attempting to do is to define the "best" treatment to give to the "average" patient with a given disease, otherwise known as the lowest common denominator theory of cancer chemotherapy (roll-the-dice). For 30 years they have been attempting to define the best drugs to give to the average patient, with no real progress with regard to identifying better chemotherapy regimens for the average patient. It is a scientifically bankrupt paradigm which has not fostered either efficient or humane progress in cancer chemotherapy. As I said above, balance is much needed to the flow of cancer information which is largely controlled by people with their own biases and self interests.

Posted at 10:13AM on Apr 22nd 2007 by Gregory D. Pawelski

11. "There is so much misinformation about the cell culture assay tests being perpetuated."

The misinformation is that cell culture assay tests benefit patients. There is no evidence that this is true and until that evidence is available I will continue to say that there is no evidence.

You will notice that the above poster will not post links to evidence because there is none. But, he will make cancer patients feel guilty about not spending thousands for the test from these companies.

Posted at 10:13AM on Apr 22nd 2007 by hchcec

12. Recent findings presented at the American Society of Clinical Oncology (ASCO) Gastrointestinal Cancers Symposium in Orlando, Florida concluded that Functional Profiling (whole cell profiling) with cell culture assays is relevant for the study of both "conventional" and "targeted" antineoplastic drug agents.

Cell Culture Assays with "cell-death" endpoints can show disease-specific drug activity, are useful clinical and research tools for "conventional" and "targeted" drugs, and provide unique information complementary to that provided by "molecular" tests. There have been more than 25 peer-reviewed publicatons showing significant correlations between cell-death assay results and patient response and survival.

The Whole Cell Profiling technique is a cell-death endpoint assay in which drug effect upon cancer cells is visualized directly. Photomicrographs of actual tumor cells sometime show that the exact same identical individual culture well, shows some clusters have taken up vast amounts of a drug, while right next door, clusters of the same size, same appearance, same everything haven't taken up any of the drug.

So it doesn't matter if there is a "target" molecule (protein or receptor) in the cell that the targeted drug is going after, if the drug either won't "get in" in the first place or if it gets pumped out/extruded or if it gets immediately metabolized inside the cell, drug resistance is multifactorial. The advantage of the Whole Cell Profiling technique is that it can show this in the "population" of cells.

The Whole Cell Profiling technique makes the statistically significant association between prospectively reported test results and patient survival. It can correlate test results which are obtained in the lab and reported to physicians prior to patient treatment, with significantly longer or shorter overall patient survival depending upon whether the drug was found to be effective or ineffective at killing the patient's tumor cells in the laboratory.

This could help solve the problem of knowing which patients can tolerate costly, new treatments and their harmful side-effects. These "smart" drugs are a really exciting element of cancer medicine, but do not work for everyone, and a test to determine the efficacy of these drugs in a patient could be the first crucial step in personalizing treatment to the individual.

http://www.asco.org/portal/site/ASCO/menuitem.64cfbd0f85cb37b2eda2be0aee37a01d/?vgnextoid=09f8201eb61a7010VgnVCM100000ed730ad1RCRD&vmview=vm_search_results_view&selectedConfs=&SearchFilter=Speaker&SearchTerm=weisenthal

Click on "Slides" to presentation relating to testing for antitumor and antiangiogenic activity of Iressa, Tarceva, Sutent, Nexavar, and Avastin in primary cultures of fresh human tumors.

http://www.medicarenhic.com:80/cal_prov/articles/chemoassaytest_0107.htm

http://www.weisenthal.org/medicare_lcd_final.pdf

Posted at 12:49PM on Apr 22nd 2007 by Gregory D. Pawelski

13. The extensive slide presentation linked above concludes with THIS STATEMENT from Wiesenthal:

"Clinical trials ARE REQUIRED to ESTABLISH the degree to which the observed IN VITRO drug effects reported in this abstract can be used to engineer treatment outcomes in cancer patients."

Remember, a variety of studies have reported a correlation between in vitro prediction or response and clinical response. While these studies may have internal validity, they CANNOT answer the question of whether patients given assay-guided therapy or empiric therapy have different outcomes.

Wiesenthal, the researcher, and Pawelski, the poster, believe in the potential of cell culture assays yet ONLY Wiesenthal knows we need clinical data and we have none.

Thank goodness the scientists in the field know we need data before we want someone to buy into these tests and buy the tests.

Again, Mr. Pawelski, and Pawelski ONLY as seen here,

http://www.google.com/search?hl=en&safe=off&client=firefox-a&rls=org.mozilla:en-US:official&hs=Xid&sa=X&oi=spell&resnum=0&ct=result&cd=1&q=pawelski+cell+culture+assay&spell=1


is touting the benefit of these tests in hundreds of blogs, including this one, with no data to back the claims.

Cancer patients should know this.

Posted at 12:49PM on Apr 22nd 2007 by hchcec

14. Psychologists with their own lack of self-esteem makes for strange bedfellows. Perhaps oncology research fellows and others do see the hand-writing on the wall?

I know it is not me or that I write about cell culture assays. She criticizes numerous people on this and many other web sites. She can keep the ball! She couldn't handle the proof.

She criticizes me for scaring cancer patients, that it makes them feel guilty. Oncologists that scare cancer patients into chemotherapy is what's disingenuous.

Cancer treatment does not only involve chemotherapy, very little of it does. There are a multitude of cancer modalities to treat cancer, traditional treatments, experimental therapies, integrative treatment, and alternative therapies.

There are Oncotype DX, MammaPrint, Lung Metagene Predictor and others that will spare the 60% to 80% of cancer patients who would unlikely have a recurrence and don't need chemotherapy. For those patients who would be at a higher risk of recurrence (the 20% to 40%), there are cell culture assays to help find what treatments have the best opportunity of being successful (that surely wouldn't make the developers of cell culture tests wealthy).

If she thinks there is no clinical data to support cell culture assays, why do you think Medicare would pay for such a test? Medicare contractor, National Heritage Insurance Company, has that data. Proof of improvements in treatment outcomes. Not like Aetna's recent reimbursement policy that requires "anticipated" or "expected" improvements in treatment outcomes with genetic tests.

But this is what you can expect from someone who has no knowledge of cell culture assays. She didn't even go through the material.

Posted at 12:48PM on Apr 22nd 2007 by Gregory D. Pawelski

15. I've read this blog off and on recently and am fed up with the constant, wateful personal attacks and arrogance of hchcec. It is patently unfair for them to personally attack anyone else's thoughtful opinions or information which just doesn't meet with the personal opinions of one person, particularly if that one person surely isn't the world's expert on what is/isn't acceptable treatment. Patients today MUST be able to have any and all information and opinions available to them in order to make choices and ask questions of their healthcare providers.

Posted at 2:41PM on Apr 22nd 2007 by Reader

16. What she (HCHCEC) fails to tell you is none of the available laboratory tests used in the selection of treatments for cancer patients have ever been tested for EFFICACY. This includes estrogen receptor, progesterone receptor, Her2/neu, immunohistochemical staining for tumor classification, bacterial culture and sensitivity testing, CT, MRI and Pet Scans to measure tumor response to treatment, as opposed to merely ACCURATE, before they are used in clinical decisons regarding treatment selection.

The precedent of tests such as estrogen receptor, progesterone receptor, Her2/neu, BCR-ABL, C-KIT, CD-20, etc., and panels of immunohistochemical stains for subclassifying tumor, all used to select chemotherapy, do so in precisely the same manner as a cell culture assay is used. There are medical tests, such as serial CT, MRI, and/or PET scans, performed for the purpose of monitoring the size of the tumor to determine if it is shrinking or growing with chemotherapy. The purpose of this testing is to determine if chemotherapy with specific drugs should be continued or changed to different drugs. Thus, these radiographic tests are also used as an aid in making clinical decisions about the choice of chemotherapy.

What Weisenthal is saying is that he is willing to break that unyielding mold and test his cell culture assay for EFFICACY, as they do for drug approval. Remember, Taxol was approved by the FDA in 1992 with only 30% EFFICACY. Knowing that upfront, many cancer patients would not take the drug (particularly when there are so many other drugs). In fact, the NCI "state of the art" web sites tells us no data support the superiority of any particular regimen. So it would appear that published reports of clinical trials provide precious little in the way of guidance.

Look at what criteria are being applied to evaluate emerging forms of testing, such as molecular-based testing used to select drugs such as gefitinib, erlotinib, bevacizumab, etc. As well as tests such as the Oncotype DX test, used to make chemotherapy decisions in breast cancer. Look at what criteria have been applied by regulatory agencies, such as the FDA, in the approval of cancer chemotherapy sensitivity test kits. What is found is that the criteria applied has been ACCURACY and what has never been applied is EFFICACY. And yet the ASCO working group review (Schrag, D. et al. J Clin ONcol 22:3631, 2004) specifically EXCLUDED from consideration all papers and data dealing with test ACCURACY and considered only papers addessing the issue of test EFFICACY.

Why is information lacking regarding the EFFICACY of virtually all medical tests? It's simply that medical treatments (e.g. drugs, devices) are hugely profitable commodities, which justify the huge costs of prospective, randomized clinical trials (the ones that those on the Charlie Rose panel whose entire careers are utterly dependent upon funded 100% by big-pharmaca). Medical tests provide vastly less profit. In the case of Cell Culture Assay Tests, the technologies are all non-proprietary, public domain. How many prospective, randomized trials are carried out to test one generic drug against another? The only such studies performed are rare, government-sponsored trials.

The cost of performing a Cell Culture Assay Test is truly insignificant compared to the costs associated with infusion chemotherapy. In the absence of the assays, oncologists will base their drug selections on reimbursement more than on any other single factor. Those oncologists who order the assay do so at their own personal financial disadvantage. Absent the testing, they are free to choose what for them is the most remunerative therapy. When they order the tests, they do so either because they themselves want to choose the treatment which is most likely to work or that this is what their patients want.

Either way, they are forced to consider information going beyond reimbursement. The worst case scenario, cost-wise, is that the treatment chosen with the benefit of cell culture assay information will be the same, expensive treatment that they'd otherwise choose on the basis of reimbursement. In a better case scenario, treatment based on cell culture assay information will be more efficacious therapeutically; although it may not be the most remunerative to the oncologist, it will benefit the patient, be less expensive, and save money for the health care system.

Posted at 6:19PM on Apr 22nd 2007 by Gregory D. Pawelski

17. I don't use adhominems,Reader, as you have done.
Pawelski presents cell culture assay information on blog after blog as beneficial. This is false, at this time. Wiesenthal, whom he quotes daily, even says there is, as yet , no data that it's beneficial for the patient. I'm happy that he offers you information you desire. No problem with that, as long as it's accurate. As he blogs daily on perhaps hundreds of blogs, someone has to start calling him on the data. Research is being done, but there is not one lick of evidence that cell culture assays benefit cancer patients, sir. He says chemotherapy, given in the standard way, is incorrect, and ONLY through cell culture assay testing, is chemotherapy correct.

Sorry, but this isn't true, and that's why it has, as of March, been stated that

"The enthusiasm for chemosensitivity assays, in general, has diminished over the years, due to the poor positive predictive values."

http://www.regence.com/trgmedpol/lab/lab06.html

There's no need to get mad at me. I am not silencing Pawelski. I am merely calling him on his misstatements of benefit.

Hopefully, cancer patients, frightened into thinking that their oncologists do not have their best interests in mind, they only care about money, they're undereducated, the heads of Hopkins, Dana Farber, and Sloan Kettering (who's "entire careers are utterly dependent upon mega-trials funded 100% by the same drug company"), are drug co. shills, will hear another opinion.

I mean, sir, isn't it frightening enough to have a diagnosis of cancer, at at the same time, read on this blog that that there is a scandal out there, one that results in your early demise?

Sorry, I don't buy the conspiracy theories.
I like facts.

Posted at 6:18PM on Apr 22nd 2007 by hchcec

18. Mr. Pawelski states that

"Absent the testing, they are free to choose what for them is the most remunerative therapy."

So, if your oncologist does not choose the testing, he or she ONLY chooses what will make him or her money, according to Pawelski.

How does that make you feel today?

Posted at 6:18PM on Apr 22nd 2007 by hchcec

19. I can split hairs as much as hchcec can.

ASCO Recommendations on Adjuvant Chemotherapy for Stage II Colon Cancer (JCO Vol 22; No. 16; Aug. 15, 2004)

Direct evidence from randomized controlled trials does not support the routine use of adjuvant chemotherapy for patients with stage II colon cancer. Patients and oncologists who accept the relative benefit in stage III disease as adequate indirect evidence of benefit for stage II disease are justified in considering the use of adjuvant chemotherapy, particularly for those patients with high-risk stage II disease. The ultimate clinical decision should be based on discussions with the patient about the nature of the evidence supporting treatment, the anticipated morbidity of treatment, the presence of high-risk prognostic features on individual prognosis, and patient preferences. Patients with stage II disease should be encouraged to participate in randomized trials.

The ASCO study showed no evidence of benefits for (empirically-selected) adjuvant chemotherapy in Stage II colon cancer, but even in the face of a negative study, said it was OK for individual oncologists and patients to make the decision whether or not they want to be treated.

And Deborah Schrag, the second author on the ASCO study that showed no evidence of benefit for (empirically-selected) adjuvant chemotherapy in Stage II colon cancer, but even in the face of a negative study, said that it was OK for individual oncologists and patients to make the decision whether or not they want to be treated. She wouldn't tell her colleagues not to give chemotherapy if they really wanted to. And she's talking about a treatment; not just about a test. The question gets asked in randomized studies. She does a big meta-analysis and still gets a negative result. But still says, well, OK, you can use it if/when you really want to, if it's OK with your patient. EFFICACY has been tested and refuted, but it's still OK to use treatment which has been proven to be non-efficacious.

ASCO points out, because the number of available chemotherapeutic agents has increased enormously over the past few years, the emphasis on the rationale for cell culture assays has never been stronger. But institutions that make a living predominately from clinical trials, no wonder ASCO has not supported the use of cell culture assays outside the clinical trial. Don't want to disturb the income flow (academic center-based oncologists deriving personal profit from the implementation of clinical trials). The same people who maintain that assay-directed therapy should not be used until "proven" in prospective randomized clinical trials are the same people who control the clinical trials system, the grant review study sections, and the journal editorial boards.

Cowards don't have the guts to leave their names when they insult you. I am a passionately informed writer, sharing knowledgeable information about cancer medicine. I would suggest hchcec actually do some research on Cell Function Analysis before she sets off on groupie tangents. While she coaxes you to troll Google about me, don't forget to read the dozens of other articles I write about (surgery, radiation necrosis, HBOT, leptomeningeal carcinomatous, taxol, whole brain radiation, etc.).

Posted at 8:50PM on Apr 22nd 2007 by Gregory D. Pawelski

20. adhominem:
1 : appealing to feelings or prejudices rather than intellect
2 : marked by an attack on an opponent's character rather than by an answer to the contentions made

Your word, not mine. Your behavior, not mine.

Fortunately, most intelligent, receptive people are not so threatened by ideas which dare to challenge and question one-size-fits-all, widgets-on-an-assembly-line medicine.

"I mean, sir..." I'm not a 'sir'.

"...isn't it frightening enough to have a diagnosis of cancer, at at the same time, read on this blog that that there is a scandal out there, one that results in your early demise?"

Well, gee, it's certainly not more comforting for them to see patient after patient succumb, not to the cancer, but to an early demise thanks to wrong-therapy/wrong-dose cookie-cutter treatment. Ignorance is NOT bliss.

"Sorry, I don't buy the conspiracy theories.
I like facts."

Your own comments always bite of conspiracy theories, a diversion to counter ideas other than yours. I suppose anyone who dared question and expose Vioxx, Ketek, Zyprexa and the endless list of harmful and/or deadly drugs would have also been on your target list as a paranoid ignoramus. After all, the drug companies and their 'factual' trials 'proved' that these blockbuster drugs were safe; the FDA studied the 'facts' and said they were safe and effective. Oops!

This is my last post, as I will not help feed your obsessive need to spend all your time trashing the ideas of others. I can still read and appreciate the rational input from others, with various opinions on the issue, and ignore the space wasted trying to keep attention on yourself.

Posted at 8:48PM on Apr 22nd 2007 by Reader