Johns Hopkins Pancreas Cancer Screening Clinic Publishes Flawed Study to Justify their Unproven Medical Experiment

A new study riddled with errors

The worst part of modern medicine is taking healthy people who are fine— feel and look well— and subjecting them to anxiety provoking testing that makes them patients without knowing you make them better off. It’s especially bad if you make money from it (via fees or donors).

This might be OK if you conducted a randomized trial to see if these people are better off, but its a problem if you don’t— if your study is low quality propaganda. Enter a recent paper in JAMA oncology.

The paper says they took 1731 high risk individuals— those with high risk of pancreas cancer— and followed them in clinics btw 1998 and 2021. 26 were diagnosed with pancreatic cancer. That’s a rate of finding cancer of 26/1731 of 1.5% over 23 years.

These are HIGH risk individuals so what is the rate of pancreas cancer in the general population. Surely it is much lower— like an order or magnitude lower?

1/56 = 1.8%

1/60 = 1.6%

The first failure of this program is that they are finding pancreas cancer ROUGHLY the same as the general population. Sure, they may be slightly higher, but they aren’t finding cancer in 10% or even 5%. Is this a“HIGH RISK” pancreas cancer clinic or just the worried well who can pay clinic?

Next, the authors subject the healthy people to unproven testing. Specifically, “ EUS, and abdominal contrast-enhanced CT or 1.5T or 3T contrast enhanced MRI with magnetic resonance cholangiopancreatography…”

By using this imaging, they find lesions to follow. They don’t tell us how many people had worrisome scans, how many they followed with subsequent imaging, how many got biopsies and surgeries and it was nothing. They restrict their paper to reporting on the 26 people in whom they found cancer, and don’t tell us about the false positives. This is poor form.

Next, the authors found 7/26 people (26%) with cancer diagnosed via their program had METASTATIC disease at diagnosis. It had already spread. There is no way on earth that screening helped these people. They just get a fatal diagnosis sooner than they otherwise would, but die on the same day. This speaks to just how foolish pancreas cancer screening is. A high percentage is metastatic the moment the primary is visible. It’s not a tumor amenable to early diagnosis.

Next, the authors compare the 26 people in whom they found something against matched SEER database people whose cancer was found the usual/ and often hard way/ symptoms, etc. There is a huge benefit, so they claim.

Of course, this comparison is ludicrous. First, it includes lead time. They are finding cancers likely years before they otherwise would. In the supplement they adjust for lead lime, 3, 6, and 12 months, and claim there is still a benefit, but if they adjust for years of lead time, then the benefit would vanish. They have no clue how much lead time they have.

Furthermore, these are not comparable people! Who are the types of people who would participate in such a clinic. DRG puts it well.

The authors brazenly push an unsupported statement at the end of the paper “a randomized clinical trial comparing surveillance vs no surveillance in high-risk individuals is not feasible.” Of course, it is feasible. And if you could actually find high risk people, i.e. those with >10% chance of pancreas cancer, the power calc would not be difficult. This is a false statement in the manuscript used to hide the program’s central failure.

The authors add “Furthermore, artificial intelligence is gaining momentum…” Lol, sure, you don’t have to always toss in buzzwords.

Overall, the research is a disservice to pancreas cancer patients. The cohort, despite extensive imaging, is not having tons of pancreas cancer, raising question of just how high risk they are. Many people who are told they have cancer— 1 in 4— are already metastatic. This is a cruel and useless diagnosis to make. Treatments are not curative in pancreas cancer and there is no evidence early treatment is superior. I suspect their lives will be filled with more chemotherapy and misery as a result. Finally, since, it is not randomized, authors don’t know whether they are helping or hurting these people.

In a sane world, the IRB would shut down this clinic. Sadly, we don’t live in that world, so as long as it makes money for Hopkins, and brings in rich donors, we can watch the downfall of American medicine.

The worst thing you can do as a doctor is make a health person a sick patient without knowing (with confidence) you benefit them. Shame these doctors don’t understand that.