Do you think your Oncologist prescribes drugs based on “scientific evidence”?

Journal of Clinical Oncology, 2013, Mar 20; 31(9): 1134–1139
Prevalence of Off-Label Use and Spending in 2010 Among Patent-Protected Chemotherapies in a Population-Based Cohort of Medical Oncologists. By: Conti et al
“The extent of inappropriate chemotherapy use is a public policy concern because of the cost and potential harms to patients from the use of toxic agents with little likelihood of clinical benefit.” [1-4 ]

1. Shrank WH, Asch SM, Adams J, et al: The quality of pharmacologic care for adults in the United States. Med Care 44:936-945, 2006
2. Chassin MR, Galvin RW: The urgent need to improve health care quality: Institute of Medicine National Roundtable on Health Care Quality. JAMA 280:1000-1005, 1998
3. Laetz T, Silberman G: Reimbursement policies constrain the practice of oncology. JAMA 266: 2996-2999, 1991 [Erratum: 267: 3287, 1992]
4. Giordano SH, Lin YL, Kuo YF, et al: Decline in the use of anthracyclines for breast cancer. J Clin Oncol 30:2232-2239, 2012

A 2008 study found that 81% of oncologists had used chemotherapy drugs “*off-label”.
Journal of Clinical Oncology, 2008, December 20, vol. 26, no. 36, pages; 5994-6000
Self-Reported Practices and Attitudes of US Oncologists Regarding Off-Protocol Therapy
By: Jeffrey Peppercorn, Harold Burstein, Franklin G. Miller, Eric Winer, and Steve Joffe
“…Ninety-three percent reported ever discussing and 81% ever prescribing…”
*off-la·bel, adjective- relating to the prescription of a drug for a condition for which it has NOT been officially approved.

Oncologists promote chemotherapy as “evidence-based medicine” because it’s approved by the FDA. But when 30-80% of chemotherapies are prescribed off-label, outside of their intended use, on cancers they have never been approved to treat, where is the evidence?!

American Cancer Society, 2015, March 17 Bulletin titled; Off-label Drug Use
“Studies have reported that about half of the chemotherapy drugs used are given for conditions not listed on the FDA-approved drug label.”

The National Cancer Institute has stated, “Frequently the standard of care for a particular type or stage of cancer involves the off-label use of one or more drugs.” From; Off-Label Drug Use in Cancer Treatment, Posted: January 1, 2014

Journal of The American Medical Association, 2007;297(2):205-208
A new era of unapproved drugs: The case of Abigail Alliance v. Von Eschenbach. By: Jacobson & Parmet
“The idea that the way to save lives is through unapproved drugs offers the illusion of choice and the reality of false hope—not an acceptable basis for public policy.”

Archives of Internal Medicine, 2006,166(9):1021-1026
Off-label Prescribing Among Office-Based Physicians, By: Radley et al
A total of approximately 150 million audited prescriptions were prescribed “*off label”.
“Using data from a nationally representative survey of office based physicians, we found that about 21% of all estimated uses for commonly prescribed medications were off label, and that 15% of all estimated uses lacked scientific evidence of therapeutic efficacy…Among off-label mentions, most (73%) lacked evidence of clinical efficacy, and less than one third (27%) were supported by strong scientific evidence.
*off-la·bel, adjective- relating to the prescription of a drug for a condition for which it has NOT been officially approved.

New South Wales Department of Health, September 2003
Off-Label Use of Registered Medicines and Use of Medicines under the Personal Importation Scheme in NSW Public Hospitals
A Discussion Paper
“In a survey of 130 patients conducted at the Peter MacCallum Cancer Institute in Melbourne in January 2001, there were 1351 medication orders of which 17.9% were for off-label uses. Of these, 8.7% were used for off-label indications, 10.3% for off-label dose and 2.8% for off-label route. Ninety two per cent of patients received at least one medicine that was prescribed off-label or that was unlicensed.”

Annals of Oncology, 2007, 18: 1923–1925
The off-label use of drugs in oncology: a position paper by the European Society for Medical Oncology (ESMO), By: P. G. Casali
“All drugs need to be given a marketing authorization by a relevant regulatory body in order for patients to receive them… In fact, by prescribing a drug off-label, the physician is asked to take a special responsibility. Formally, he is prescribing something which the regulatory body has not stated is safe and effective…off-label uses of drugs might be viewed as illegal…”

Journal of Oncology Practice, September 2005, vol. 1, no. 3: pages 102-105
“Off-Label” Indications for Oncology Drug Use and Drug Compendia: History and Current Status
“Today 50% to 75% of all uses of drugs and biologics in cancer care in the United States are off-label…”

Journal of Clinical Oncology, 2013, vol. 31, no. 9: pages 1125-1127
Off-Label Use of Cancer Drugs: A Benchmark Is Established, By: Monika K. Krzyzanowska
“…the main criticism of off-label prescribing has been the concern that it jeopardizes patient safety because the full risk-benefit ratio is often not completely understood in circumstances where off-label prescribing occurs.”

Medical Journal of Australia, 2006; 185: 544–548
Off-label use of medicines: consensus recommendations for evaluating appropriateness, By: Gazarian et al.
“…only a small proportion of off-label prescribing may be justified by scientific evidence…In addition, the legal and ethical ramifications of such prescribing appear to be a source of confusion, with variability in opinions and practice among prescribers and professional organisations.”

Canadian Standing Senate Committee on Social Affairs, Science and Technology, January 2014
Prescription Pharmaceuticals in Canada Off-Label Use
“…a recent study that found 11%, or one in nine, prescriptions were for an off-label indication… the researchers reported that 79% of the off-label prescriptions were not supported by strong scientific evidence. Strong scientific evidence was defined as including at least one randomized, controlled clinical trial (RCT)…Of particular concern, this study measured a 43% increase in ADRs [Adverse Drug Reactions] for off-label use over on-label use of prescription drugs.”

United States General Accounting Office, September 1991, Report to the Chairman, Committee on Labor and Human Resources, U.S. Senate
GAO/PEMD-91-14 Reimbursement Policies for Off-Label Drugs
Page 3- “GAO found that off-label use of anticancer drugs is widespread. A third of all drug administrations to cancer patients were off-label, and more than half of the patients received at least one off-label drug. The extent of off-label use varied by therapeutic intent, stage of disease, and type of cancer. In general, off-label use was higher where there was no consensus on the best therapy for a specific cancer.”

New England Journal of Medicine, 2008; 358: 1727-1732
Pharmaceutical Promotion to Physicians and First Amendment Rights, By: Aaron S. Kesselheim, M.D., J.D., and Jerry Avorn, M.D.
“…recent research indicates that nearly half of all prescriptions in some drug classes may be off-label, and more than 70% of off-label uses may have insufficient scientific support.”

Supportive Care in Cancer, May 2004, Volume 12, Issue 5, pp 302-305
Off-label prescribing in oncology, By: Susan G. Poole, & Michael J. Dooley
“In our experience, the frequent practice of off-label prescribing in oncology poses added difficulties to an already complex medication regimen. There are limited published data on off-label prescribing in oncology..[and yet]..up to one-half of all chemotherapy is used for an off-label indication.”

Journal of the American Medical Association, 2008;300(9): pages 1069-1071
Industry-Sponsored Clinical Research A Broken System
By: Dr. Marcia Angell, M.D., Harvard Medical School, former editor-in-chief of the New England Journal of Medicine.
“…physicians learn to use drugs for off-label uses without good evidence of effectiveness. Although it is illegal for companies to market drugs for off-label uses, faculty “thought leaders” on company speakers’ bureaus regularly promote off-label uses in the guise of education or research.”

United States Congress. Advertising, marketing and promotional practices of the pharmaceutical industry: Hearing before the committee on labor and human resources. 101st Congress, 2nd Session. Washington, DC: U.S. Government Printing Office; 1991. Senator Edward M. Kennedy on p-154 “…why did Abbott sponsor an all-expenses-paid symposium at Disneyworld for doctors and spouses, devoted entirely to unapproved uses of Lupron?”

The practice of off-label drug prescribing violates the very foundation of “evidence-based medicine.” It makes a mockery of the claim that all medications are based on “good science”.

So how many off-label prescriptions are actually happening?

ACS Chemical Neuroscience, 2012, 3, 630−631
The Top Prescription Drugs of 2011 in the United States: Antipsychotics and Antidepressants Once Again Lead CNS Therapeutics
By: Dr. Craig W. Lindsley, Ph.D., Editor-in-Chief
“Total prescription drug sales in the United States increased from $308.6 billion in 2010 to $319.9 billion in 2011 (an∼3.5% increase despite pressure from generics), with a concomitant increase in prescriptions dispensed (3.99 billion in 2010 compared to 4.02 billion in 2011).”

So 4.02 billion total prescriptions were written in 2011 alone in the U.S.

Consumer Reports, Shopper’s guide to prescription drugs- number 6 “Off-Label” drug use. Produced by Consumers Union and Consumer Reports Best Buy Drugs, a public information project supported by grants from the Engelberg Foundation and the National Library of Medicine of the National Institutes of Health. “One in five prescriptions in the U.S. is for a use not approved by the FDA. And most of those (about 75 percent) are for a use that lacks any evidence or rigorous studies to back it up.”

Dr. Allen Roses, Glaxo-SmithKline’s worldwide vice-president of genetics-

“The vast majority of drugs – more than 90 per cent – only work in 30 or 50 per cent of the people.”

Response rates
Therapeutic area: drug efficacy rate in per cent

  • Alzheimer’s: 30
  • Analgesics (Cox-2): 80
  • Asthma: 60
  • Cardiac Arrythmias: 60
  • Depression (SSRI): 62
  • Diabetes: 57
  • Hepatits C (HCV): 47
  • Incontinence: 40
  • Migraine (acute): 52
  • Migraine (prophylaxis)50
  • Oncology: 25
  • Rheumatoid arthritis50
  • Schizophrenia: 60

BBC News

The Independent

The Independent 2

New Zealand Herald

Royal Pharmaceutical Journal

So out of more than 4 billion prescriptions written each year in the United States, over 600 million are “off-label” prescriptions that utterly lack FDA-approved efficacy and scientific proof. In addition, most drugs are admitted not to work at all most of the time. Science based medicine is really not so “scientific” after all…

Shouldn’t the medical technology we use be rooted in a foundation of good and tested science? The answer is yes, but this just doesn’t happen most of the time. Is Modern Medicine Really Scientific?

The United States Congressional Office of Technology Assessment reviewed current medical practice in the United States in 1978 to determine how much day to day practice was tested by the scientific method. Its report, Assessing the Efficacy and Safety of Medical Technologies, astonished those who believe in the myth of modern scentific medicine. It concluded that “only 10 to 20 percent of all procedures currently used in medical practice have been shown to be efficacious [effective] by controlled trial.” In other words, 80 to 90 percent of what doctors do is scientifically unproven guesswork. By this government-supported definition, most of modern medicine is quackery.

As time goes by, the song remains the same…

British Medical Journal, 1991 Oct 5; 303(6806):798-9
Where is the wisdom. ..? The poverty of medical evidence
By: Dr. Richard Smith, former editor of the British Medical Journal and chief executive of the BMJ publishing Group for 13 years.
“Only about 15% of medical interventions are supported by solid evidence…This is partly because only 1% of the articles in medical journals are scientifically sound, and partly because many treatments have never been assessed at all.”

In 1995, the United States Congressional Office of Technology Assessment compared medical technology in eight countries (Australia, Canada, France, Germany, Netherlands, Sweden, United Kingdom, and the United States) and again noted that few medical procedures in the U.S. had been subjected to clinical trial. The same study also reported that infant mortality was high and life expectancy was low, compared to other developed countries.

Journal of Evaluation in Clinical Practice, (2007), 13, 481–503
Medicine and evidence: knowledge and action in clinical practice, By: A. Miles et al.
“A fundamental assumption of EBM (Evidence Based Medicine)… is that doctors who practise it provide superior clinical care compared to those who do not…so far no convincing direct evidence exists that shows that this assumption is correct…It is noteworthy that the advocates of EBM (Evidence Based Medicine) have consistently avoided the organisation of, or involvement in, this most fundamental of scientific processes – the testing of an hypothesis…its advocates do not cite this one, single fundamental and serious deficiency – the complete lack of an evidentiary basis of EBM (Evidence Based Medicine).”

BMJ Clinical Evidence comprises a database of high-quality, rigorously developed systematic overviews assessing the benefits and harms of treatments”, and has proceeded to categorise the effectiveness of 3000 treatments with an astonishing and in fact shocking outcome. The data exhibited reflects to what extent treatments are evidence-based. The outcome of this categorisation has shown that a mere 11% of trials and studies show beneficial outcome, 24% are considered likely to be beneficial with the remaining 65% ranging from questionable, of unknown effectiveness, to ineffective or harmful. Accessed February 2016

Pseudo-Evidence Based Medicine: When Biomedical Research Becomes an Adjunct of Pharmaceutical Marketing.
In Free Knowledge¸ editors: Patricia W. Elliott and Daryl Hepting, University of Regina Press, 2015, pp. 26-42
By: Professor Arthur Schafer, University of Manitoba
“When the evidence on which evidence-based medicine relies has been massaged or otherwise tainted, then it scarcely provides a reliable tool for medical decision making. In the interests of truth-in-advertising, perhaps the medicine practised in this era of corporate-university partnerships should be referred to as ‘pseudo-evidence-based medicine’.”

oncology-mindsetOncology Mindset

chemo-originsChemo origins

how-successful-are-clinical-trialsHow successful are clinical trials?

excited-about-a-clinical-trial-not-so-fastExcited about a clinical trial? Not so fast

chemotherapy-really-is-poisonChemotherapy really is poison

chemotherapy-is-a-waste-of-moneyChemotherapy is a Waste of Money

chemotherapy-is-not-effective-for-90-percent-of-cancersChemotherapy is Not Effective for 90 Percent of Cancers

chemotherapy-can-boost-cancer-growth-foxChemotherapy can boost cancer growth Fox

chemotherapy-chemist-secretsChemotherapy Chemist Secrets

chemo-will-only-to-cure-2-percent-this-yearChemo will only to cure 2 percent this year

chemo-surgery-and-radiation-are-not-very-effectiveChemo surgery and radiation are not very effective

chemo-is-carcinogenicChemo is carcinogenic

chemo-and-radiation-are-non-specificChemo and radiation are non specific

chemo-and-radiation-are-killing-cancer-patientsChemo and radiation are killing cancer patients

chemo-scientific-american-john-cairnsChemo Scientific American John Cairns

chemo-radiation-and-surgery-are-largely-ineffectiveChemo Radiation and Surgery are largely ineffective

chemo-kills-just-as-many-people-as-cancerChemo Kills Just as Many People as Cancer

chemo-journeyChemo Journey

chemo-drugs-threats-to-health-care-workersChemo Drugs Threats to Health Care Workers

cancer-drugs-are-very-expensiveCancer drugs are very expensive

cbs-news-optimism-about-chemoCBS news optimism about chemo

blind-obedience-can-kill-you-question-your-doctorBlind obedience can kill you question your doctor

blind-faith-in-science-is-often-misplacedBlind faith in science is often misplaced

big-pharma-big-money_documentary-on-the-money-and-corruption-of-big-pharmaceutical-companiesBig Pharma Big Money Documentary on the Money and Corruption of Big Pharmaceutical Companies

be-confident-on-your-chosen-treatmentBe confident on your chosen treatment

audio-after-3-rounds-of-chemo-failure-a-4th-round-is-just-stupidAfter 3 rounds of chemo failure a 4th round is just stupid

am-i-doing-what-is-best-for-the-patientAm I doing what is best for the patient

all-chemotherapy-agents-are-carcinogenicsAll chemotherapy agents are carcinogenics

abc-news-the-prevalence-of-hospital-errorsABC news the prevalence of hospital errors

60-minutes-the-fight-against-counterfeit-drugs60 Minutes the fight against counterfeit drugs

chris-wark-medicine-is-not-science-basedChris Wark Medicine is NOT Science Based

does-chemo-cause-cancer-gonzalesDoes chemo cause cancer Gonzales

does-it-make-sense-to-use-carcinogens-to-treat-cancerDoes it make sense to use carcinogens to treat cancer

chemotherapy-boosting-cancer-growthChemotherapy Boosting Cancer Growth

dr-desaulniers-2-percent-chemo-effective-rateDr Desaulniers 2 percent chemo effective rate

dr-gonzalez-explains-why-chemo-is-so-ineffectiveDr Gonzalez Explains why chemo is so ineffective

high-priced-chemo-limited-benefit-youre-deadHigh priced chemo limited benefit YOURE DEAD

dr-lodi-conventional-medicine-doesnt-workDr Lodi Conventional medicine doesnt work

even-us-doctors-buy-unapproved-and-fake-cancer-drugsEven US doctors buy unapproved and fake cancer drugs

fda-has-never-approved-chemo-or-radiation-for-childrenFDA has never approved chemo or radiation for children

is-chemotherapy-harmful-to-the-immune-systemIs chemotherapy harmful to the immune system

is-chemo-really-97-percent-ineffectiveIs Chemo really 97 percent ineffective

half-of-all-drugs-are-recalledHalf of all drugs are recalled

chris-wark-chemotherapy-causes-more-cancerChris Wark Chemotherapy Causes More Cancer

dr-jimenez-chemo-3-percentDr Jimenez chemo 3 percent

audio-cancer-docs-talk-about-ineffective-chemoAudio Cancer docs talk about ineffective chemo

how-effective-is-chemotherapy-for-most-patientsHow effective is chemotherapy for most patients

abc-news-counterfeit-cancer-drugsABC news Counterfeit Cancer Drugs


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You expressly agree that your use of, or inability to use, the service is at your sole risk. The service and all products and services delivered to you through the service are (except as expressly stated by us) provided ‘as is’ and ‘as available’ for your use, without any representation, warranties or conditions of any kind, either express or implied, including all implied warranties or conditions of merchantability, merchantable quality, fitness for a particular purpose, durability, title, and non-infringement.

In no case shall anyone affiliated with including our directors, officers, employees, affiliates, agents, contractors, interns, suppliers, service providers or licensors be liable for any injury, loss, claim, or any direct, indirect, incidental, punitive, special, or consequential damages of any kind, including, without limitation lost profits, lost revenue, lost savings, loss of data, replacement costs, or any similar damages, whether based in contract, tort (including negligence), strict liability or otherwise, arising from your use of any of the service or any products procured using the service, or for any other claim related in any way to your use of the service or any product, including, but not limited to, any errors or omissions in any content, or any loss or damage of any kind incurred as a result of the use of the service or any content (or product) posted, transmitted, or otherwise made available via the service, even if advised of their possibility. Because some states or jurisdictions do not allow the exclusion or the limitation of liability for consequential or incidental damages, in such states or jurisdictions, our liability shall be limited to the maximum extent permitted by law.

You understand and agree that no singular individual, group of individuals or entity in any form whatsoever is responsible or liable in any manner for any content generated on, for, or as a result of the existence of this site, since this is a community generated site. You understand and agree that as this is a community generated site, and as a result of this, there is no good way to control what users and contributors post on or through the sites and cannot be responsible for any offensive, inappropriate, obscene, unlawful, infringing or otherwise objectionable or even illegal user generated content you may encounter on the sites or, in connection with your use of the sites.

You understand and agree with the following statement made on behalf of, “We, on behalf of our directors, officers, employees, agents, suppliers, licensors, contributors and service providers, exclude and disclaim liability for any losses and expenses of whatever nature and howsoever arising including, without limitation, any direct, indirect, general, special, punitive, incidental or consequential damages; loss of use: loss of data; loss caused by a virus: loss of income or profit: loss of or damage to property: loss of life: claims of third parties: or other losses of any kind or character, or the inability to use, the site or the content even if we have been advised of the possibility of such damages or losses, arising out of or in connection with the use of this site or any web site with which it is linked.”



You agree to indemnify, defend and hold harmless and our parent, subsidiaries, affiliates, partners, officers, directors, agents, contractors, licensors, service providers, subcontractors, suppliers, interns and employees, harmless from any claim or demand, including reasonable attorneys’ fees, made by any third-party due to or arising out of your breach of these Terms of Use or the documents they incorporate by reference, or your violation of any law or the rights of a third-party.



In the event that any provision of these Terms of Use is determined to be unlawful, void or unenforceable, such provision shall nonetheless be enforceable to the fullest extent permitted by applicable law, and the unenforceable portion shall be deemed to be severed from these Terms of Use, such determination shall not affect the validity and enforceability of any other remaining provisions.



The obligations and liabilities of the parties incurred prior to the termination date shall survive the termination of this agreement for all purposes.

These Terms of Use are effective unless and until terminated by us. You may terminate use of the site, but this Terms of Use shall survive in perpetuity.

If in our sole judgment you fail, or we suspect that you have failed, to comply with any term or provision of these Terms of Use, we also may terminate this agreement at any time without notice and you will remain liable for all amounts due up to and including the date of termination; and/or accordingly may deny you access to our Services (or any part thereof).



The information supplied through this website, or by any representative or agent of Dr. Farrah, whether by telephone, in person verbal, email, letter, image, text, facsimile or any other conceivable form of communication, is for informational purposes only and does not constitute medical, legal or other professional advice. Health-related information provided through this website is not a substitute for medical advice and should not be used to diagnose or treat health problems or to prescribe any medical devices or other remedies. The receipt of any questions or feedback that you submit in any form to any Dr. Farrah medium does not create a professional relationship and does not create any privacy interests.
You agree to indemnify, defend and hold harmless and our parent, subsidiaries, affiliates, partners, officers, directors, agents, contractors, licensors, service providers, subcontractors, suppliers, interns and employees, harmless from any claim or demand, including reasonable attorneys’ fees, made by any third-party due to or arising out of your breach of these Terms of Service or the documents they incorporate by reference, or your violation of any law or the rights of a third-party.



These Terms of Use and any separate agreements whereby we provide you Services shall be governed by and construed in accordance with the laws of the Republic of Panama.



You can review the most current version of the Terms of Use at any time at this page.

We reserve the right, at our sole discretion, to update, change or replace any part of these Terms of Use by posting updates and changes to our website. It is your responsibility to check our website periodically for changes. Your continued use of or access to our website or the Service following the posting of any changes to these Terms of Use constitutes acceptance of those changes.



Questions about the Terms of Use should be sent to us at

Upon agreeing to these terms and conditions, you gain access to the website and assume total responsibility for any and all actions undertaken by you as a result of your access to the website. You agree and understand that the terms of this agreement shall be binding upon you, your respective heirs, successors, assigns and legal representatives. You understand and agree that all provisions of this Terms of Use agreement that by their nature should survive termination shall survive termination, including, without limitation, ownership provisions, warranty disclaimers, indemnity, licensing in perpetuity and limitations of liability.