Orac applies some Respectful Insolence™ to a comment spammer

I hate spammers.

On the scale of Internet scumbags, spammers rank just one notch above pedophiles (barely). When they're not busy flooding your e-mail In Box with ads for "herbal Viagra" or various pyramid schemes, they're cluttering up my blog with comment spam. Unfortunately, some spammers seem to have found a way to get around Blogger's Word Recognition feature. Normally, I just delete such spams without comment as soon as I see the e-mail notification that they have arrived. Also, if the posts to which the spam comments were added are over a month old, I usually shut down comments for them. Rarely have I considered it worth devoting precious blog space to slapping down a spammer.

Until now.

What makes this spammer different? Take a look (I left one spam intact to let you see):

Hi,
While I was searching through Blogger I came past your site, it is not really the information I was after about breast cancer research but I did stay to read your blog and found it interesting and well done. Keep up the good work and hopefully I will visit again sometime and also find the information on breast cancer research that I was looking for in my travels.
Regards,Regards,

Great. An altie spamming my blog! I got this same comment on 10 different comments in about an hour yesterday, and I just got a couple more this morning. Time to put off the straight medblogging I had intended for Monday (and then Tuesday) at least one more day. Damn.

From the page listed, I quickly found this link, with these claims (text maintained):

THIS INFORMATION COULD SAVE YOUR LIFE ... HOW OVER 2,000 PEOPLE CURED THEIR CANCER NATURALLY, USING THE TREATMENTS REVEALED IN THIS E-BOOK. DISCOVER OVER 350 GENTLE & NON-TOXIC CANCER TREATMENTS THAT NO-ONE ELSE WILL TELL YOU ABOUT!

It gets worse, though. Get a load of these claims:

Learn about more than 350 drug-free, natural cancer treatments used by thousands to cure their cancer:

• Documented proof these treatments work - with over 2,000 testimonials you can read for free
• Almost all treatments are non-specific, that is, they work with any cancer anywhere in the body
• Treatments based on little-known scientific studies and inventions
• Amazing insights revealed - people with advanced breast, prostate, colon and lung cancer do not live longer after receiving chemotherapy
• There are alternatives to harmful chemotherapy*
• Discover best-priced and inexpensive sources of the treatments - some are free!
• You can commence many treatments immediately
• All contained in a set of 4 e-Books and Reports quickly and easily downloadable to your computer
• Inexpensively priced to reach the maximum number of people who need the information
• 100% refund if you are not satisfied
• Order and download now and this vital information can be yours in less than 5 minutes!

Great. Same old overblown and unsupported altie claims for miracle cures, same use of testimonials rather than evidence, same ridiculous claims of a treatment that works for "any cancer anywhere in the body." Do these people work with Hulda Clark or something? All of the above claims are so obviously without scientific support or clinical trial evidence to back them up and are all the sort of snake oil that I've debunked time and time again, that I didn't really want to bother with them at first, even if the company selling them is a spammer that irritated me by spamming my blog.

And then I saw this link on the site:

There exists a technology that can detect an issue YEARS before a tumor can be seen on X-ray or palpated during an exam. This technology has been approved by the FDA as an adjunctive screening tool since 1982 and offers NO RADIATION, NO COMPRESSION AND NO PAIN. For women who are refusing to have a mammogram or those who want clinical correlation for an existing problem, digital infrared thermal imaging may be of interest.

There are very strict protocols both for testing and interpreting. Perhaps due to these guidelines, thermography (as with all digital technology) has exploded in its technique and capabilities. Thermal cameras detect heat emitted from the body and display it as a picture on a computer monitor. These images are unique to the person and remain stable over time. It is because of these characteristics that thermal imaging is a valuable and effective screening tool. Tumors or other breast diseases measures warmer than surrounding tissue and can thereby alert a physician to a problem before a tumor is actually palpable.

Medical doctors who interpret the breast scans are board certified thermologists. Thermography is not limited by breast density and is ideal for women who have had cosmetic or reconstructive surgery. Thermography, because it analyzes a developing process, may identify a problem several years before mammography. DITI may allow women time and opportunity to support their immune system, change their lifestyle and give their body the best chance to alter their fate.

DITI has an average sensitivity and specificity of 90%. An abnormal thermogram carries a 10x greater risk for cancer. A persistently abnormal thermogram carries a 22x greater risk for cancer. Thermography, as well as mammography is a personal choice for women. This decision ideally should be made in collaboration between you and your physician. However, thermography does not require a physician’s order.

The company's name is Proactive Health Solutions, and it's selling a technology called Digital Infrared Thermography Imaging (a.k.a. DITI).

Oh, boy. These guys sure spammed the wrong blog this time! I do breast surgery for a living, as well as cancer research, after all, and I don't like claims that are unsupported by evidence. In fact, I detest such claims so much that I started a blog, a large percentage of whose content is devoted to shooting down dubious health claims. Clearly, it's time to apply some of Orac's brand of Respectful Insolence™ to this obnoxious spammer.

First, to be fair, I should mention that thermography has indeed been the subject of legitimate study as a means of diagnosing breast cancer for decades. The reason thermography might work is because tumors have increased blood flow (angiogenesis) compared to normal tissue. Its problem has always been a lack of resolution and specificity. Recent advances in computing power and detection technology may have made thermography more attractive as a test to detect breast cancer. (Indeed, I've even been involved in a research protocol that looked at a device that uses infrared light to do something similar to DITI, but with a clever twist.) However, even with better technology, there are still some major hurdles to overcome, and thermography is nowhere near ready for prime time.

Judging from its spamming (or from its hiring a spammer to advertise its wares) and the statements on its website, though, this company is probably not interested in determining whether or not thermography is a useful tool to detect breast cancer. It's interested in making a buck by selling a screening test that has not yet been validated in large clinical trials and is not covered by insurance companies, much as the breast MRI companies did a couple of years ago selling MRI as a screening test. Proactive Health claims a 90% sensitivity and 90% specificity for thermography but does not cite any articles in the peer-reviewed literature to support these estimates, which, if true, would definitely be better than mammography. Indeed, I searched PubMed and was unable to find a single reference to support such an extravagant claim for the sensitivity and specificity of thermography. I also know from personal experience and my knowledge of the literature that thermography as a technology to detect breast is cancer is still very much an experimental modality. In fact, although thermography was FDA approved in 1982 as a supplement to mammography, it never gained widespread acceptance because of its many limitations. These days, the only modalities that are FDA-approved for screening for breast cancer are screening and diagnostic mammography, and the only FDA-approved adjuncts to mammography are ultrasound, MRI, scintimammography (seldom used these days--in fact, I've never ordered one), and electric impedance imaging (almost never used either).

So, what are the problems with thermography and technologies based on thermography, like DITI or computerized thermal imaging? For one thing, they're very difficult to read, something Proactive's literature seems to acknowledge. Also, the literature shows that, because of the lack of spatial resolution, they produce a lot of false positives, making the claim of 90% specificity seem highly unlikely. Finally, unlike mammography, it can't detect microcalcifications, which are sometimes a harbinger of breast cancer and are detected quite well by mammography. Another thing to consider is that, because thermography doesn't produce the fine spacial resolution that mammography, ultrasound, and particularly MRI can, one has to wonder what its value could possibly be compared to MRI, which can detect increased blood flow in tumors quite well and give a nice detailed picture of it. This article says it best:

While thermography may be appealing to some women because it is a pain-free exam, most physicians do not recommend thermal imaging. Scientific research over the last 20 years has shown that thermography is not reliable for detecting breast cancer. In 1977, the Beahrs Committee of the National Cancer Institute (NCI) recommended that thermography be discontinued as a routine screening modality in the NCI’s Breast Cancer Detection Demonstration Project.

Since then, studies have failed to show a clear benefit of thermal imaging in helping to detect breast cancer. In their 1998 document, "Evaluation of Common Breast Problems: Guidance for Primary Care Providers," Barbara Smith, MD, PhD and her colleagues wrote, "currently, thermography has no role in breast cancer screening or diagnostic evaluation." Several other reports have drawn similar conclusions. That is not to say that improved thermography technology may not one day aid in the breast cancer diagnostic process (see computerized thermal imaging sections below); however, at the moment, thermography is not widely accepted as an effective means of detecting breast cancer.

Indeed, it It might not be so bad if this company were only selling thermography as a possible adjunct to mammography, but that's not the impression I get from its literature. Indeed, Proactive Health Solutions seems to be implicitly selling it as a replacement for mammography. Oh, the e-mail I got when I registered on the site says that, honestly, really, and truly, they aren't saying that thermography should replace mammography at all, but this statement makes me wonder:

Many women are now refusing to have another mammogram for various personal reasons. Although that is a personal decision, we do not encourage this practice. In fact, when both breast thermography and mammography are used together, detection rates improve up to 95-98%.

Nudge, nudge, wink, wink. Orac's translation: "We're not actually saying that it's OK for you to give up mammography, but, if you happen to decide you want to, we think thermography is just super as an alternative and would love to sell it to you. Know what I mean?" Nudge, nudge, wink, wink. Say no more.

I wonder what studies demonstrate such an astounding sensitivity when the two techniques are combined. It doesn't help my skepticism any to see that this technique is being marketed through a site that pushes all sorts of altie nonsense and includes the standard "cover your ass" disclaimer: "Do not delay in seeking advice from a qualified licensed medical professional about treatment for your cancer. The information is provided for educational and informational purposes only, and is not intended to be a substitute for the diagnosis, treatment and advice of a qualified licensed medical professional. We are not doctors, and shall have neither liability nor responsibility to any person or entity with respect to any loss, damage, or injury caused or alleged to be caused directly or indirectly by the information provided." It also doesn't help (me, at least) that there are claims that one can diagnose fibromyalgia and chronic fatigue syndrome using thermography, all presented without any references in the peer-reviewed literature to support them.

With new advances in technology, detectors, and imaging, could thermography turn out to be a useful adjunct to mammography and other imaging studies? There's certainly that possibility, but my opinion is that that particular ship sailed long ago. Other technologies have taken over its potential niche, like MRI, a study that can do more or less what thermography does (measure blood flow) and produce much more detailed images. There's a big difference between a technology having the potential to be useful and its actually having been shown to be useful. Before any test can be widely used to screen an asymptomatic population for a disease like cancer, it has to be validated in large trials to show its level of sensitivity and specificity in the population at large with the existing prevalence of the disease in question. Thermography hasn't, meaning it's very premature to be marketing it to women or to be claiming that it is more sensitive and specific than the existing standard, mammography.

In any case, Proactive Health Solutions is marketing its thermal imaging technology using a site that pushes all sorts of medical misinformation and through comment spamming of blogs, leading me to ask: If its technology is so great, why is it resorting to such lowlife spamming techniques to market it?



ADDENDUM: I've been laying down a lot of Respectful Insolence (and not-so-respectful insolence) lately. Perhaps too much. After all, there is such a thing as too much of a good thing. It might be time for a change of pace tomorrow...

ADDENDUM #2:To anyone from either company who might be annoyed by my little smackdown: Remember that you fired the first shot by spamming my blog. (In actuality, I toned down the final post in comparison to the first version that emerged from my keyboard.) If you hadn't spammed me, chances are that, even if I had somehow come across your websites, I probably wouldn't have bothered with them. In any case, I could have been much nastier. As far as I'm concerned, spammers and comment spammers are among the lowest of Internet scumbags; so perhaps it's a misguided sense of restraint that prevented me from really unloading.