Dr. Nagourney's Blog

Cancer Patients Want to Win, but is the Playing Field Level?

By Robert A. Nagourney, MD

Anyone diagnosed with cancer knows the drill.

After the initial shock, many go to the internet in pursuit of honest and reliable information. But how are they to know what constitutes honest and reliable information?

Most people seek "peer-reviewed" literature.

The term applies to studies that have been vetted by experts and are then published with their stamp of approval. However lofty the goals of this process may have been at its origins in the 17th century, the intervening 350 years haven’t been kind.

This was the topic of an editorial by Christopher Tancock (When Reviewing Goes Wrong: The Ugly Side of Peer Review, March 23, 2018, Elsevier) who examined the pitfalls of the contemporary peer-review in an era of "publish or perish", urgent funding needs and shrinking research dollars.

One problem he finds is fake reviewers. Here the author surreptitiously has the paper submitted to himself by using sham e-mails, ultimately reviewing his own paper.

A second pitfall is conflict of interest where the reviewer is a competitor.

The next is bias, where the editor holds a personal dislike for the author or their work and proceeds to eviscerate an otherwise sound paper.

Among the most egregious is the stealing of papers where the reviewer turns down the paper and then immediately submits their own version of the manuscript based on similar findings.

I was reminded of this by one of my own papers submitted with my colleagues in Sao Paulo, Brazil.

We had identified a novel treatment for a rare tumor and collaborated with the Children's Hospital of Oakland Research Institute to analyze mechanisms.

The paper was submitted but initially rejected. It has since been accepted and published by a different journal. While I do not demand that every paper of mine or anyone else's gets published, the first journal’s editorial comments were disturbing.

For background, we had discovered an effective drug for a patient with an advanced malignancy who had failed intensive, multi-agent chemotherapy. It was solely by the application of our laboratory technique (EVA-PCD) to the patient’s own tumor tissue that we were able to identify the treatment which provided a durable remission now approaching 3 years.  

Curiously the reviewer who turned down the paper cited one of my references to conclude that we had not applied the described technique. I quote "The listed reference looks at an in vitro cytometric profiling technique, which is not what this case is presenting".

I realized that he was quoting “cytometric profiling technique” from one of my own papers and had come to the conclusion that I was not doing “what I do”.

Presumably the reviewer had hastily examined the references and only looked at the first authors.

Had he done his job, he would have seen that the senior author, responsible for the work was me. It was odd to have my own work used as the rationale for not publishing my work.

Peer reviewers often turn down papers but we hope that they do so for legitimate reasons. In this case, the reviewer had decided he did not want to publish our paper and used a transparently false argument to deny its publication.

As I have published many peer-reviewed papers, this was not the first time I have had this type of experience.

Some years ago, one of my papers was literally excoriated by a reviewer.

Undaunted, I submitted the exact same manuscript, unchanged, to a second extremely famous journal. The second reviewer stated, "I enjoyed the paper, publish it as is" and it was immediately published. 

How could two highly regarded editorial boards have such distinctly different opinions of the exact same paper?

Among the problems is the fact that there is no opportunity to challenge a review. That is no one reviews the reviewers.

Second, the review process is blinded so authors cannot confront their accusers. Finally, editorial board decisions are final. A paper that has been turned down is turned down without recourse.  

How often does good work go unreported?  How fair is the peer review process?

More importantly, how dangerous is the peer review process as it is practiced today to the advancement of science?

When cancer patients seek truth, they depend upon the reviewing process to provide it.

If the reviewers do not give an honest opinion of the merit of the work but instead base their decisions upon their own personal opinion of the investigator or whether findings fit into their own particular area of interest; we have a problem.

One need only attend a cancer symposium or examine the “conflict of interest” statement attached to the CVs of most academics to note the laundry list of corporate sponsors, pharmaceutical grants and speakers bureaus that these unbiased professionals bring to the table.

Cancer patients need to consider this when they accept the opinion of reviewers.

While usually well intended, members of the academic community are prone to the same biases and shortcomings that plague all other humans. When these arbiters of truth do not accept something unfamiliar to them, it does not mean that it won’t ultimately be proven true.

One option is for patients to seek the assistance and input of one of a growing number of medical advocates like Mark Renneker, Gwen Stritter, John Laird, Dave Schlosser, Ralph Moss, Marcia Horn, Mark Roby or many others, or to consult with practitioners like Brian Lawenda and Keith Block who serve as patient champions when offering their opinions and advice.

Another is to use objective measures of tumor biology like those that we apply to remove the subjectivity (and bias) from treatment selection.

From Vitamin D supplementation to acupuncture, from immunotherapy and virotherapy to integrative care, the so-called experts have been wrong enough times to warrant careful consideration of their opinions when matters of life and death loom.

For most cancer patients time is not on their side.

Opinion leaders should take that into consideration when they offer advice on new and potentially important discoveries.   

As always, I appreciate your thoughts and comments.

 

Dr. Robert Nagourney, has been internationally recognized as a pioneer in cancer research and personalized cancer treatment for over 20 years.  He is a TEDX SPEAKER, author of the book OUTLIVING CANCER, a practicing oncologist and triple board certified in Internal Medicine, Medical Oncology and Hematology helping cancer patients from around the world at his Nagourney Cancer Institute in Long Beach, California.  For more info go to NAGOURNEYCANCERINSTITUTE.COM 

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