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Information, Awareness, Prevention / United to End Cancer

Misconceptions that are leading research in the wrong direction can be identified with an in-depth investigation. Two methods that can help to identify misconceptions are: a) by asking simple questions and b) MACRO misconceptions can be identified by analyzing past trends/results.

Misconceptions_2
Dear Scientist, Things “do not ADD UP”: For the world’s most deadly and costly calamity, CANCER (6.5M premature deaths/year, $1.4 trillion/year cost):

a) For 68 yearswe have known that early detection can avoidover 50% of deaths, but the cost of treating late detection has increased 100 times while reduction of cancer mortality is only 5%.

b) Data reveal NO difference in mortality rate in countrieswhich spend or do NOT spend money on eliminating cancer.

c) Taxpayer and donation money is funding projects which are known from the startare unable to reduce cancer deaths, and projects that would reduce cancer deaths ARE NOT FUNDED.

d) The best imaging technique (PET) is based on particle detection measuring sensitivity, but articles and funding are approved to increase PET spatial resolution to the detrimentof sensitivity.

e) A significant advance in early detection requires a breakthroughin particle detection, but the 3D-Flow-OPRT breakthrough has been ignored.

f) CERN-LHC must admit, 22 years after the invention of the 3D-Flow-OPRT, to having taken the wrongdirection, wasting $50B. Now they are making the same mistake with FPGA, wasting an additional $30B.

g) Cancer leaders must admit, 14 years after the invention of the 3D-CBS, to having taken the wrongdirection, resulting in the needless loss of millions of lives and trillions of dollars, wasted. Now they are making the same mistake with the EXPLORER, designed for research purposes, but which would not be able to save many lives due to its high cost and lower sensitivity compared to the 3D-CBS.

Because it is a scientist’s code of ethics and because you receive the public’s trust and are paid by taxpayers and donors, please support TRANSPARENCY in SCIENCE in PUBLIC WORKSHOPS to identify solutions that “ADD UP”, or resign from positions paid by taxpayers and donors and give control to competent scientists who agree to serve the public interest. Thank you.

1. INCONSISTENCIES:

1.1  Wasting $50 billion of taxpayer money and the time of 10,000 scientists; driving scientists in the wrong direction by providing a Level-1 trigger tool which uses the inferior threshold technique (TT) that cannot detect most of the 100,000 Higgs boson-like particles generated (less than 100 were captured) because of its incapability of accurately measuring all characteristics of new particles; ignoring the 3D-Flow-OPRT for Level-1 trigger that was invented 22 years ago and is breaking the speed barrier in real-time applications at hundreds of millions of events per second in the execution of object pattern recognition algorithms technique (OPRT) in a programmable way at the minimal cost per good signal captured.

1.2  Allowing millions of people to die prematurely and needlessly every year and the $1.4 trillion cancer costs wasted every year; increasing 100 fold the cost of cancer treatments during the past 50 years and obtaining only meager results (5% death reduction) in the same period; knowing for 68 years that early cancer detection could save over 50% of deaths, knowing that the best medical imaging devices are based on particle detection, knowing that the 3D-CBS technology, hundreds of time more efficient than current 5,000 PET was invented 14 years ago (with some techniques invented 22 years ago), knowing that millions of lives could have been saved, but funding other less efficient medical imaging devices that cannot reduce significantly cancer deaths.

2. ADMISSION OF THE FLAWS AND THEIR REMEDIES BLATANTLY IGNORED FOR DECADES, DAMAGING TAXPAYERS

2.1  On the first inconsistency, a) capturing less than 100 of the 100,000 Higgs boson-like particles generated, b) CMS leader Sridhara Dasu’s admission in slide 51 of his seminar given 01/09/2013 that CMS experiment failed to provide detailed measurements and the need to acquire more data in 2015-2016, c) Theoretical physicist Savas Dimopoulos’ statement in the movie “Particle fever” that he is waiting for more detailed measurements before making a stronger statement regarding the identity of the new boson, confirm there is a problem with the alleged discovery.

How can CERN claim a discovery with instrumentations incapable of making detailed, accurate measurements after admitting the need to replace key parts of their detectors and the need to acquire more data in 2015-16?

In 2012, CERN admitted that the OPERA experiment which appeared to show neutrinos travelling faster than the speed of light was flawed when it was proven that OPERA instrumentation was incapable of making accurate measurements. In 2010, why weren’t the LHC team who fixed the problems that melted 50 magnets in 2008 and who proved it could run at 3.5 TeV, awarded the Nobel Prize?

2.1.1  THE FLAWS: The flaws causing this waste of time and money were ADMITTED by the same authors of the CMS and Atlas experiments who claimed the discovery of the Higgs boson-like particle.

2.1.1.1  The front page of the CMS Technical Designed Report for the Level-1 Trigger Upgrade published on August 1, 2013, ISBN 978-92-9083-390-1 CERN-LHCC-2013-011, states: “To meet these requirements the electronics for the calorimeter, muon and global trigger systems will be replaced. The upgraded trigger system is planned to be available for CMS data taking from the start of the 2016 LHC run.” If it needs to be replaced, then this is ADMITTING it is flawed. On page 3 of the same document they are ADMITTING the limits of the current Level-1 trigger system, stating: “… a large increase in flexibility beyond that provided by the current trigger system.

2.1.1.2  Leaders of the main experiments at CERN, during their presentation at the 2013 IEEE-NSS conference, ADMITTED that their tools were inadequate to make accurate measurements and needed to be replaced. e.g. Atlas L1 Trigger states in slide 16: “no change to the detector is needed. Full replacement of front-end and back-end electronics” was needed instead. This was not because of aging radiation limits but actual limitations of the current Atlas trigger, which they ADMITTED. When A. Puig, the speaker who presented LHCb results, was questioned about the low efficiency of LHCb in capturing hadron which he presented in slide 6, he ADMITTED that the capability of executing a complex algorithm at the L0-Trigger (which is equivalent to L-1 trigger in other experiments) would have improved the low 50% efficiency of the Hadron’s trigger.

2.1.2  THE REMEDY: That the 3D-Flow-OPRT would have remedied these inadequacies by accurately measuring all characteristics of the new particles in a cost-effective way, was admitted in several letters from top leaders in the field and by those who spoke against it in the past. Despite the 3D-Flow-OPRT having passed several public international scientific reviews, and its feasibility and functionality being proven in hardware, it has been ignored for 22 years by influential scientists who are handling taxpayer money. Now, CERN is about the make the same mistake again when it decided to adopt the lower preforming and costly FPGA-OPRT.

2.1.2.1  The same document CMS Technical Designed Report for the Level-1 Trigger Upgrade, published August 1, 2013, on page 13, first paragraph of Section 2.2.1 clearly states that the “trigger threshold” (TT) technique used in the current detector cannot provide those detailed measurements and agrees that THE REMEDY is to replace the Level-1 Trigger with the capability to execute “object identification algorithms” (OPRT). The major scientific review held at FERMILab in 1993, recognized that the 3D-Flow-OPRT invention was a REMEDY to the traditional, limited Threshold-Technique (TT) Level-1 Trigger because it gave a more powerful tool to experimenters who could execute Object Pattern Recognition Algorithms (OPRT) in a programmable way at Level-1 Trigger. The reviewers stated in their final report that the 3D-Flow is a “unique concept” and that “experimenters would probably think clever uses not now possible”. The 3D-Flow concept was proven feasible and functional in hardware and was presented at the 2001 and 2003 IEEE-NSS conferences. Even Wesley Smith, who in 1993 was the only leader in the field who disagreed that programmability was needed at the Level-1 Trigger, recanted the claims he had made in 1993 in a meeting with Crosetto at CERN on August 27, 2008.

2.1.2.2  At the 2013 IEEE-NSS-MIC-RTSD conference, leaders of the Atlas experiment at the presentation N5-4: “ATLAS Upgrades…” on slide 16 state the need for a “full replacement of front-end and back-end electronics”. These leaders were aware from 1993 that the 3D-Flow was a REMEDY to the problems they faced when they began acquiring data in 2010. For example, in 1993, former Atlas Deputy Spokesman Andy Lankford was asked by SSC Director to write the charges to the reviewers who would review Crosetto’s 3D-Flow invention in December 1993. One of the reviewers has been a leader at CERN Atlas experiment for the past 20 years. On August 27, 2008, Crosetto met Nick Ellis, leader of the Atlas Trigger for many years (e.g. in 1992 they compared their different approaches at the Conference “Computing in High Energy Physics” in Annecy), asking if the 3D-Flow technology-independent, flexible, modular, programmable, and capable of executing object, pattern recognition algorithms at Level-1 Trigger (OPRT) could have satisfied the Level-1 Trigger requirements of all current modern experiments. He agreed it would have been a REMEDY for all their challenging problems. Perhaps A. Puig, who presented the low 50% efficiency of the LHCb Hadron’s trigger at the 2013 IEEE-NSS Conference, was unaware that in 1999 the LHCb 3D-Flow base-line Level-0 Trigger had the capability of summing 3 x 3, 4 x 4, etc. cells, could identify the shape of objects (OPRT) in a programmable form and would have been the REMEDY for the low efficiency he described. However, it was replaced with the old approach, a less efficient hardwired trigger proposed by Orsay and Bologna and used in HERA-B experiments that identifies clusters summing only 2 x 2 cells and compares with the threshold (TT), as stated on page 105 of LHCb official document, CERN-LHCC 98-4. The choice to adopt a less efficient trigger and their statement “…gives only a small loss of energy…” on page 105 of the CERN-LHCC 98-4 document, in regard to the 2×2 vs. 3×3 cluster, TT vs. OPRT, with no programmability proved they were wrong and that they wasted time and money. If they really want to improve efficiency, they need to replace their LHCb Level-0 Trigger (which is equivalent to Level-1 Trigger in other experiments) with the 3D-Flow-OPRT trigger which they failed to implement in 1999. The reason for the poor choice of replacement of the Level-0 Trigger in 1999 was because funding was not assigned to the project/approach/invention that had more scientific merit and could be identified through TRANSPARENCY in SCIENCE.  Instead, funding was assigned, and in most cases still is assigned, to those who have more power in handling tax money.

2.2  On the second inconsistency a) in letting die prematurely and needlessly millions of people every year and wasting $1.4 trillion per year, b) increasing 100 fold the cost of cancer treatment and not obtaining significant results, in knowing for 68 years what can reduce cancer deaths and cost and going in the direction of what is increasing cost without reducing cancer deaths. How can any cancer institution, cancer industry (drug, medical imaging, etc.), research center, scientist, etc. who receives and spends millions of dollars to fight cancer, beyond prolonging some lives an average of a few months at a high cost and suffering, claim success when they cannot demonstrate a significant reduction of cancer deaths and cost on a sample population?

2.2.1  THE FLAWS causing the loss of millions of lives and trillions of dollars are ADMITTED by the same people who are protagonists in the fight against cancer: scientists, doctors, funding agencies, industries, cancer organizations, media, etc., for those who have a hard time understanding the laws of nature from calculations and logical reasoning, experimental results would show the flaws and they would be forced to ADMIT; and for those who have an even harder time understanding the results on paper, they can look among family and loved ones and would have to ADMIT the flaws in the approach used to fight cancer by counting the premature deaths.

2.2.1.1  Meager results in cancer death reduction from using drugs at a late stage of cancer, extending life on average a few months, is an ADMISSION that the approach of investing almost exclusively on developmental drugs for late stage cancer is flawed.

2.2.1.2  Raising and spending money to fight cancer without asking those people who request and spend money for an estimate in cancer death and cost reduction that they expect to attain with their project when measured on a sample population, and obtaining no reduction in cancer deaths after raising and spending trillions of dollars, is an ADMISSION that the approach is flawed (even for those who do not understand the details of the proposed project). Everyone finds it logical to ask what they get in return when they pay for an item, so why shouldn’t the same simple rule apply when cancer organizations, scientists, etc. ask for money to fight cancer? Shouldn’t they be asked to measure the effectiveness of their project by comparing the rate of reduction of cancer deaths on a sample population before and after?

2.2.1.3  Government funding agencies (and all entities who do the same) advertise early detection as reported at this link, and publish results which show that cancers detected early have significantly higher survival rates (from 90% to 98%) and yet they deny any dialogue which would support advancing cancer screening technology; this is an ADMISSION that the approach they follow is flawed. How can early detection be improved if advancing cancer screening technology to make it more cost-effective is denied?

2.2.1.4  If funding agencies who assign millions of dollars to improve PET spatial and time resolution to the detriment of higher sensitivity and lower examination cost were to ask their scientists to perform calculations and logical reasoning before assigning the grants, they would be forced to ADMIT that this approach is flawed. Scientists would also be forced to ADMIT their approach is wrong if asked to explain how their project can reduce cancer death. For example, read at this link the answers from S. Bertolucci and C. Joram, Managing Director and Chief Engineer of the Axial-PET project, when Crosetto asked them to explain how their approach was reducing cancer deaths and cost. The Axial-PET project has very high spatial resolution and low efficiency. CERN Director of Research, Bertolucci, first declared his incompetence in Medical Imaging, than he blamed Joram and then he blamed the doctors from Marseille who specified the characteristics of the Axial-PET. Joram instead answered that the Axial-PET is not a cancer project although Bertolucci’s committee assigned the first prize to the Axial-PET at the “Physics for Health” workshop at CERN in 2010 (thus, Bertolucci was assigning the prize to himself because he was the Managing Director of the Axial-PET).  Another example is when Crosetto asked C. Levin a series of 4 questions after his presentation at the 2013 IEEE-NSS-MIC-RTSD conference, to explain how his very high spatial resolution PET module could reduce cancer deaths and cost. Levin had to ADMIT it could not reduce cancer deaths and cost because the efficiency of his PET module was too low, the radiation to the patient too high, and the examination cost too expensive.

2.2.1.5  More specific to early cancer detection, the flaw of not supporting high sensitivity in PET has been ADMITTED in 2013 by the same scientists who for the past 13 years obstructed the 3D-CBS having high sensitivity when they became authors of the high sensitivity EXPLORER device. Still, they have yet to admit the flaw of not supporting a low examination cost because the high examination cost with the EXPLORER would not be conducive for screening for early detection, while the 3D-CBS, more sensitive and ten times less expensive, could be effective to reduce cancer deaths through screening. The limitation of the EXPLORER touches on the root of the problem described in the first inconsistency of building technology incapable of accurately capturing all possible signals from the radiation associated to tumor markers at the lowest cost per good signal captured.

2.2.2  THE REMEDY is the 3D-CBS which can save millions of lives through an effective early cancer detection by capturing all possible signals from tumor markers at the lowest cost per good signal captured. It does this by using the best medical imaging technique that can recognize at the molecular level the mutation of the very first normal cells into cancerous cells. Several public reviews, letters, documents and comparisons of the 3D-CBS with other projects have forced even those scientists who in the past were against the 3D-CBS approach, to ADMIT its superiority. Why is it then not funded?

2.2.2.1  In 2013, the same scientists who for 13 years had obstructed Crosetto from presenting his work at conferences, who had rejected his papers on his innovative ultra-sensitive 3D-CBS technology, now agree that the REMEDY to PET efficiency is not high spatial or time resolution, but a very high sensitive PET device when they presented the EXPLORER at the 2013 IEEE-NSS-MIC Conference. On their slide No. 5 they ADMIT it is: “Not a New Idea!” and cite Crosetto’s 2003 publication (although Crosetto had already published two books and two articles presented at the IEEE-NSS-MIC conference in 2000). Slide No. 5 also acknowledges two other publications, including one from “Borasi et al., Eur J. Nucl. Med. Mol. Imaging 2010; 37;1629-32” that provides an overview of PET with added detector length (FOV) which states “The first proposal for a truly ‘total-body’ PET system (120–160 cm AFOV) came from Crosetto,” citing Crosetto’s article published in 2000, and RECOGNIZING his 3D-CBS technology as a valuable invention. It is not the shape (round, cylindrical, diamond, etc.) of a pill that makes a difference but what is inside. Crosetto, at the 2013 IEEE-NSS-MIC-RTSD Conference, asked one of the most senior scientists, Benjamin M. W. Tsui, who has been on many panels that review grant proposals and assign funds (also at NIH), if he was aware of any PET with a long FOV requiring low radiation, having a low examination cost and effective for early cancer detection because of its very high sensitivity. His answer was “NO”, but he mentioned reviewing a PET having a long FOV several years ago (it was not Crosetto’s 3D-CBS) that had no scientific support, so he could not evaluate it and it was not funded.

2.2.2.2  Because PET technology is based on particle detection, a significant improvement in early cancer detection requires a breakthrough invention advancing the field of particle detection. The reason for the ultra-high sensitivity, low radiation dose, low examination cost that the 3D-CBS technology has and the other PET devices don’t have is because the 3D-CBS uses Crosetto’s 3D-Flow breakthrough invention not known before. This allowed him to open the door to make additional specific inventions in the 3D-CBS detector assembly, coupling detector to the electronics, real-time algorithms, etc., making screening of all organs in a single cost-effective examination. Crosetto’s invention created a revolution that scientists and industries could not have conceived possible before his invention. For example, when the President of Siemens Nuclear Medicine and their Director of PET went for an all-day meeting at Crosetto’s location on November 6, 2002, Siemens Director of Advanced Research and the Director of the electronic group repeated several times, also in follow-up conference calls, that having built 31 prototypes, they could state for sure that the efficiency of their PET could not be improved by improving the electronics. However, a few years after the meeting they had to recant this statement when they announced on their website that by improving the electronics, they were able to increase the efficiency of their PET by 70%. Likewise, Steve DeRenzo, who in 2000 wrote a negative review of Crosetto’s book stating that PET efficiency will increase by improving the crystal detectors and that there was no need to improve the electronics, was proven wrong by several articles published by several authors after Crosetto published two books and two articles in the year 2000. These articles stated how PET efficiency would increase by improving the electronics, which also opens the door to improve the efficiency in other areas of the PET device.

2.2.2.3  Crosetto’s 3D-CBS technology remedy targeted to early cancer detection has had rigorous in-depth examinations, has been compared to other projects and has been approved by several public scientific reviews, each lasting an entire day.  Letters from CERN Division Leader and by top leaders in different fields show their approval and support.  In 2003, for example, it passed an open, public (via web) scientific review by experts including an oncologist, Director of PET center, physicists, the inventor of the pocket calculator, etc. In 2006, it passed an onsite 4-day inspection by ABO Project which compiled a questionnaire.  In 2008, it was presented at the World Laboratory and at several hospitals, universities and at CERN.  In 2009, it was presented at BNL (Brookhaven National Laboratory) and at a forum at the University of Pavia, Italy. In 2010, it was presented at the workshop “Physics for Health” at CERN. In 2011, it won the Leonardo da Vinci Prize competition for the most efficient solution in particle detection targeted to early cancer diagnosis, held at the University of Pavia. In 2012, it was presented at the World Cancer Congress, and in 2013, a poster and article were presented at the IEEE-NSS-MIC-RTSD Conference.

3  MISCONCEPTIONS:

Here is a list of two ways to identify misconceptions.

3.1  MISCONCEPTIONS IDENTIFIED BY ASKING SIMPLE QUESTIONS: To identify misconceptions, it is sufficient to try to answer the questions that link a plan, and/or action to the publicly declared results that one wants to achieve. If logical reasoning and calculations cannot prove a plan or action leads to the declared results then there must be a misconception somewhere along the way. The evidence of the existence or non-existence of misconceptions will eventually surface anyway through experimental results showing that the target was or was not achieved. Misconceptions can be identified by asking simple questions, for example:

3.1.1  “Is TT or 3D-Flow-OPRT Level-1 Trigger in HEP experiments the best approach to discover new particles and reduce HEP experiments cost?

misconception was identified when experimental results proved that using the TT Level-1 Trigger had wasted $50 billion and 20 years of work by 10,000 scientists who had instrumentations incapable of performing accurate measurements of all characteristics of the new particles, forcing them in 2013 to decide to replace the Level-1 Trigger.

The REMEDY would have been TRANSPARENCY in SCIENCE implementing open, public workshops and accountability.

3.1.2  “Is FPGA-OPRT or 3D-Flow-OPRT the best approach to discover new particles and reduce HEP experiments cost?”

A lack of Transparency in Science is leading to a misconception that will waste an additional $30 billion in the next 10 years when the less efficient and more costly FPGA-OPRT is adopted instead of the more powerful and more economical 3D-Flow-OPRT. The REMEDY is therefore TRANSPARENCY in SCIENCE implementing open, public workshops and accountability.

3.1.3  “Is a misconception to assume that PET spatial and time resolution to the detriment of high sensitivity and low examination cost is the best trend to fund so as to reduce cancer deaths and cost?”

Yes, it has been a misconception during the past two decades and still is for many funding agencies and scientists although experimental results prove the contrary.

After Crosetto has explained for over a decade that improving PET spatial and time resolution to the detriment of high sensitivity and low examination cost IS FLAWED, many authors of the EXPLORER device who prevented Crosetto from presenting his ultra-sensitive and low examination cost 3D-CBS technology to conferences and who rejected his papers, are now recanting their trend toward achieving less than 1 mm spatial resolution and less than 200 picoseconds time resolution and follow Crosetto’s trend proposing a very high sensitivity PET scanner (the EXPLORER) with the limited goal of achieving  3 mm spatial resolution and 400 picoseconds time resolution. However, their EXPLORER cannot be used to save many lives because its cost is ten times the 3D-CBS, which uses breakthrough invention in particle detection that Crosetto developed and patented over the past years.

The fact that they are giving up the main stream trend they have created in the past decades, means that it is clear that repressing, suppressing and obstructing Crosetto’s 3D-CBS project has damaged advancement in science, wasted taxpayers money and needless loss of cancer patients lives that could have been saved with the ultrasensitive, lower cost 3D-CBS.

Their implicit ADMISSION that Crosetto’s claims, calculations and logical reasoning were CORRECT should have stopped the funding to researchers who still pursue PET sub-millimeter and 200 picosecond resolution to the detriment of high sensitivity and low examination cost, and Crosetto’s papers should finally have been approved at conferences and the other flawed papers rejected. Instead, at the 2014 IEEE-NSS-MIC-RTSD Conference, the only paper submitted by Crosetto on the ultrasensitive, low cost 3D-CBS was rejected and Craig Levin who is still pursuing less than 1 mm PET resolution PET Modules, had 17 papers approved and millions of dollars continue to flow toward that direction. Furthermore, the EXPLORER which is ten times more expensive and less sensitive than the 3D-CBS is receiving Government funding while the 3D-CBS goes unfunded because Crosetto is not in the circle of friends who are approving each others papers and funding.

WE ARE APPROACHING A CRITICAL MASS OF ABSURDITY

These misconceptions and inconsistencies are not a “disease” confined to the specific cases of Craig Levin and the authors of the EXPLORER, but it is a much more serious “disease” that has already metastasized, affecting the health of SCIENCE in several disciplines and it will require a much stronger intervention for a cure and support of TRANSPARENCY in SCIENCE, implementing public scientific procedures aimed to understand the laws of nature to make the scientific truth for the benefit of humanity prevail.

One would expect that after Craig Levin answered Crosetto’s four questions after his talk at the 2013 IEEE-NSS-MIC-RTSD Conference bringing to surface the misconception that his 1 mm resolution PET Module had very low efficiency, high cost and high radiation dose to the patient that could not be used for early cancer detection, it would be absurd to continue to approve his papers and waste more money in funding his project knowing clearly that it is not helping to significantly reduce cancer deaths.

Similarly, once the authors of the EXPLORER admitted their misconceptions that drove the trend for the past decades of improving PET in the wrong direction and now reversed it from 1 mm, 200 picoseconds resolution and very low efficiency to 3 mm and 400 picoseconds resolution and very high efficiency, one would expect that the leaders in science would welcome and find it essential to implement Crosetto’s two workshops that would bring to the surface other misconceptions and that his papers would be approved and the 3D-Flow and 3D-CBS projects funded. Instead, the open knowledge of the misconceptions and their remedies that would cure the inconsistencies are blatantly swept under the rug for the sake of power and money, which ends up oppressing the public.

The REMEDY would have been TRANSPARENCY in SCIENCE implementing open, public workshops and accountability.

3.1.4 “Who is requesting an increase in PET spatial and time resolution to the detriment of high sensitivity and low cost and who is approving this request?”

3.1.4.1 Who is requesting it?

The current cancer industry is requesting to improve PET spatial and time resolution to the detriment of high sensitivity and low examination cost because their interest is to have some kind of support to sell their products (chemotherapy, radiotherapy, medical imaging devices).

A tumor shrinking as a result of taking a drug is intuitively good news for patients, as well as exciting news and a selling point for the pharmaceutical company that owns the drug. This is one of the key endpoints, or goals in clinical trials. The drug company, the clinical trial system and all cancer businesses are eager to get proof of the slightest shrinkage of a tumor by measuring it to the highest possible precision.  Even the minutest measurable decrease is something to brag about. Therefore, it is understandable why they are interested in and now pushing for funding instrumentation (directly or by exercising pressure on government agencies to allocate money for such devices) that can show the slightest change in size when using their drug and why they ask the developer of any instrumentation, based on any measuring technique, just to provide a high spatial resolution to distinguish any small change in size.

While we can understand their desire for asking to measure a parameter that increases their sales and to provide money to scientists, the fault lies with scientists who should provide their ethical and professional knowledge of which measuring technique is more suitable to accurately measure this parameter without putting patients’ health and lives at risk.

You would not go to City Hall to pay your water bill with detailed photos of your indoor plumbing, nor would you ask the water meter manufacturer to improve their meters so you can measure more accurately the size of your indoor pipes. They would immediately respond that you are trying to use the wrong instrument and would advise a caliper to measure the dimensions.

Should you insist on they improve the water meter so you can better measure the size of all pipes, engineers and/or physicists should explain to you how a water meter works: the basic operating principle consists of a wheel that turns by the flow of the water providing you a number related to the turns of the wheel.  Although there could be a way to relate the size of your indoor pipes with the flow of the water, measuring dimensions with the water meter would be subject to many errors and engineers would make it clear that there are other measuring techniques more suitable to measure that parameter (dimensions of pipes).

Water meters’ basic operating principle is to measure consumption of water within a unit of time, the basic operating principle of PET is to measure abnormal consumption of nutrients by body cells (or other abnormal biological processes) within a unit of time; it is not designed to measure dimensions of tumors.

Should a drug company insist on asking for an improvement of PET devices that would more accurately measure the size of the tumor, engineers and/or physicists should explain to them how the technology works. Positron Emission Technology works by tracking anomalies in biological processes by capturing and counting, within the unit of time, signals from tumor markers and providing a number related to the biological activity of the tumor. Is it a benign tumor, dormant, or is it very active? For example, because cancer cells take up to 70 times more nutrient than normal cells, glucose molecules are tagged with a radioisotope (positron). The combination of nutrient and radioisotope is called tumor marker, which is emitting signals that are detected by PET devices. Counting the signals emitted from the tumor markers within the unit of time provides the information if the tumor is benign, dormant or very active.

Although there could be a way to relate the size of a tumor measuring the “x”, “y”, “z” coordinates of signals captured, that could be used to measure tumor dimensions with PET, this would be subject to many errors, and engineers should make it clear that other measuring techniques are more suitable to measure that parameter (tumor dimensions). Here is a more detailed explanation of the errors: The positron travels a distance of 1.4 mm (FDG) to 13.8 mm (Rubidium-82) before encountering an electron and emitting two photons in almost opposite directions. The instrumentation called PET is detecting these two photons which clearly cannot provide the precise spatial information of the original tumor marker because it cannot know in which direction the positron travelled the distance of 1.4 mm (or 13.8 mm), and then there is the additional error of the photon angle that is not 180 degrees. This should clarify why PET developers and manufacturers should focus on capturing as many photons as possible rather than improving spatial resolution because intrinsic errors will always exist which cannot be eliminated due to these natural phenomena.

3.1.4.2 Who is approving their request?

Scientists, physicists and engineers are responsible for approving or rejecting requests from doctors and the cancer business.

For each parameter there is an appropriate instrument that can measure it, and scientists, physicists and engineers have an ethical duty to provide professional information about the measuring technique of an instrument if they realize someone intends to use an improper one to measure a parameter. They have an ethical duty to protect the consumer from commercial advertisement that is in the interest of the profit from their sale rather than to benefit the consumer. For example, a scale can accurately measure weight and not body fat because it does not have accurate information on how hydrated you are, when you last ate, exercised, if your feet are calloused or dirty, etc. The goal of gaining more profit from the sale of scales is achieved by expending effort toward the measurements of body fat with the wrong instrumentation. Similarly the goal of gaining more profit from the cancer business and from the sale of chemotherapy drugs is achieved by expending effort toward the measurement of tumor dimension with the wrong instrument (PET).

Physicists and Engineers should explain to doctors and cancer businesses how Positron Emission Technology (PET), invented 60 years ago, works, and which parameters can be improved to provide information that is not now available to doctors and that they could not even think would be possible to have. This additional information will greatly help them in their diagnosis and prognosis. It will also avoid physicists from having to explain improper upgrades and use of PET (which should be called “degrades” when it lowers the sensitivity and increases cost), as one would explain that a wrench should not be used to drive nails and a hammer should not be used to loosen bolts.

Ideally a PET should be very sensitive, very efficient (efficiency is defined as the number of good signals captured divided by the number of signals emitted by the tumor marker) and detect within a unit of time, all possible signals from the tumor markers at the lowest cost per good signal captured in order not to jeopardize the patient’s safetyhealth and economic burden.

Less efficient devices need higher doses of radiation, cannot find small tumors and have a higher examination cost. The signals from the tumor markers are providing information relative to an abnormal biological process which indicates the presence of the mutation of normal cells into cancerous cells.

How can the PET instrument measure the dimension of the smallest tumor if it only has the capability of capturing one signal out of 10,000 emitted by the tumor markers? After understanding how PET technology works, doctors would realize the absurdity of requesting physicists and engineers of PET to improve the capability of measuring tumor dimensions more accurately to the detriment of sensitivity and cost.  This would be just as absurd as the person asking to improve a water meter in order to more accurately measure the dimensions of the pipe system of their house.

If signals are not first captured, you do not have data to provide any measurement. The alternative to administer from 30 to 60 times the radiation dose to the patient, compared to what would be necessary with a more efficient 3D-CBS should not be acceptable by the ethics of a doctor because his patient, after a few PET examinations, will have a higher risk to be killed by the radiation than by the tumor. Furthermore, the current 5,000 PET devices have also shown not to be effective in reducing cancer deaths because it cannot find small tumors. The reason is because a 1 mm tumor will not generate enough signals showing anomalous biological processes in specific areas of the patient’s body. Current PET devices detecting only 1 out of 10,000 signals generated by the tumor markers, require a large tumor that will generate hundreds of thousands signals from tumor markers before a few are captured. Also the 1 mm resolution PET Module by Craig Levin will not be able to detect small tumors unless a radiation dose sixteen to 30 times the one accepted by the International Commission of Radiation Protection is administered to the patient, nullifying the whole purpose to save a patient’s life.

3.1.4.3 Is the goal of shrinking the tumor, measuring the shrinkage, etc. serving the cancer the cancer patient or the cancer business? Do we understand what is killing the patient? Is that the endpoint, the goal in clinical trials?

Although it is understandable that the desire of doctors, drug companies and the cancer business is to know whether a drug shrunk the tumor – for example, from  ½” to ¼”, in the end, it is not a localized tumor that kills the patient but the process of metastasis. The proof is that one of the best chemotherapy drugs, Avastin, that can shrink tumors, has shown after ten years of data collection from those who used it, that on average it has only prolonged life for 4.4 months, and most of the patients were killed by the metastasis process and not by the localized tumor that shrunk.

Therefore, it is essential to fund an ultrasensitive, low examination cost 3D-CBS technology that is detecting cancer in asymptomatic people and cancer survivors at an early stage when it is localized, and can be removed with surgery, burned with pin-pointed radiation or cured with drugs that have shown efficacy when used in early detection.

Crosetto has explained these flaws very clearly for more than a decade in books (e.g. 2005 “How to Win Cancer”), articles (e.g. 2008 article published by World Scientific “Astroparticle, Particle and Space Physics, Detector and Medical Applications”), at conferences (e.g. 2007 at the International Conference on Advanced Technology and Particle Physics –ICATPP), with seminars at hospitals (e.g. 2008 at Southwestern Medical Center in Dallas, Texas and at many other hospitals in Italy, Switzerland), and research centers (e.g. 2009 at Brookhaven National Laboratory which has been video recorded as well as for most of the other presentations).

However, the pressure from drug companies, cancer businesses, reviewers of articles and funding agencies to increase the sales of their products have prevailed over ethics and honesty,  and scientists and funding agencies continue to assign millions of dollars in the direction of cancer research that is not reducing cancer deaths but just increasing cancer costs.

The REMEDY would have been TRANSPARENCY in SCIENCE by implementing open, public workshops where these scientists who are approving articles and funding for improving PET spatial and time resolution and rejecting articles and funding PET projects with very high sensitivity and lower cost, are made accountable to the ethics of the position of responsibility they hold, and are requested to explain why during the past years they have supported the technology that increases the sales of drugs instead of supporting the interest of taxpayers who are paying their salaries by supporting what saves lives and reduces healthcare costs? They should also provide scientific evidence demonstrating how they are pursuing with their decisions the understanding of the laws of nature and the scientific truth for the benefit of humanity.

The following is an analysis and possible explanation of the “disease” that finds its roots in the way SCIENCE has been transformed in a club of friends who approve each other’s articles and funding and in several other misconceptions in who has the responsibility to lead the direction of research to benefit humanity, etc.

Is it possible to work together to identify the misconceptions that would resolve the inconsistencies? Where are they and who are creating and supporting them? Leaders in science, research, health care, politicians, doctors, even laymen have these misconceptions which can be corrected only if they are addressed openly and publicly. The reader would also find the answers to the questions: “Who created the misconception that PET efficiency will be increased by improving spatial and time resolution to the detriment of high sensitivity and low examination cost and why was this misconception created? Why does this trend still continue and millions of dollars still wasted by going in the wrong direction?”

3.2 MACRO MISCONCEPTIONS IDENTIFIED BY ANALYZING PAST TRENDS/RESULTS: responsible for creating enormous inconsistencies preventing advancements in science for the benefit of mankind and damaging taxpayers and humanity.

3.2.1 Is there a misconception about who is responsible to lead the direction of research to benefit humanity?

3.2.1.1 THE FLAWS: Crosetto had confirmed from leaders of international conferences, program managers from government agencies, leaders at universities and research centers that “Research goals are defined by Industry”. Analyzing the comments received, the answer is “YES”, there is a misconception about who should be responsible and here are the facts proving it.

The following lists some comments and suggestions Crosetto received from laymen, people who care about solving the cancer problem, leaders in the field and scientists, etc., about who should be responsible to lead the direction of research that would benefit humanity:

3.2.1.1.1 In general, laymen trust the leaders in the field, the experts, the scientists, the doctors, and expect the leaders to be convinced first.

3.2.1.1.2 Manufacturers of the device say they have no requests for a regular screening from the governments and/or the healthcare systems. PET examinations are only reimbursed for certain pathologies. PET manufacturers have developed MRI devices for breast examination more effective than mammograms, however, they claim there is no market for screening because it would be too expensive, and say that governments do not want to reimburse them.

3.2.1.1.3 Investors have a hard time understanding a breakthrough invention and they also put their trust in scientists. They are more likely to believe a large hospital, university or research center than a single individual.

3.2.1.1.4 Scientists have different attitudes. For example: at the 2013 IEEE-NSS-MIC-RTSD, one senior scientist stated to Crosetto: “You should convince scientists of the benefit of your approach. I know that it takes money to validate your concept. There is a huge industrial interest in this field. This is science, but it is going to be driven by industry. I know that you have interests in social goals, but most of the people are interested in making money and they want to know the benefit in improving image quality. I do not believe what I hear from PET manufacturers who fear that there will not be a market for screening. The nuclear market is set to expand 10% to 15% each year. It is growing, multimodality is where a lot of people are moving. People like Craig Levin, etc., are using their credibility to get funding. Normally people do not form a committee to identify the best project, people will protect their idea instead until they get sponsorship.”

Analyzing all these comments, suggestions, and answers, one can find contradictions that when resolved through the DIALOGUE will allow the cancer problem to be solved.

For instance, one statement puts the trust in the scientists who should understand the benefits of an approach, idea, or invention, before it is built; however, money is needed to validate a concept. Another statement says that science is going to be driven by industry; but, who is going to choose which project has more merit? Scientists or industry? Money should come with credibility; however, ideas should be protected by patents and not by secrecy, which prevents the identification of the best proposals, the most “credible”. So, to whom should trust be given? To science? To scientists? To the honest professionals? How can one trust scientists who copy somebody else’s ideas, form an agreement with like-minded scientists who handle taxpayers’ money and assign grants to each other, so that four grants (R01 CA170874, R01 EB16104, R01 EB009056, R01 CA113941), are assigned to build the EXPLORER PET device? How is it possible that the scientist who made the original invention of the 3D-CBS, who proceeded to patent the idea, has received no grants after nine years of applications at NIH, only because he wants to build a device for screening for early detection to save lives? Crosetto received clear statements from NIH senior officers since 1996, urging him to avoid mentioning the word “screening” for early cancer detection in his proposals.

The DIALOGUE should make it clear that all these scientists have already spent millions of dollars and did not provide results in reducing cancer deaths and cost. Now, concerning the EXPLORER PET, it is known from its design, even before construction, that the price of the device will be astronomical and therefore would not be conducive to a substantial death reduction because the examination would be unaffordable.

Crosetto has confidence that through a dialogue with these and any other scientists, there can be an understanding to be respectful of someone else’s research and objectives. Everyone could clarify their different goals to the public: Crosetto has the goal to significantly reduce cancer deaths and cost, while those building the EXPLORER PET device are limiting their goal to biomedical research, while the design proves it cannot save many lives. In a respectful dialogue among scientists, no one should deny scientific evidence.

As scientists, we should agree on the technical advantages of an approach that can provide a 10 picosecond time resolution versus a 500 picosecond time resolution; on the other hand, we should also agree using scientific analysis on the gain in lives saved and overall costs reduced using one circuit over another. A scientist would not deny scientific evidence of someone else’s research in order to prevent the layman from giving credibility to other researchers.

3.2.1.2 To avoid misconceptions and taking wrong directions in research, it is the responsibility of researchers and decision makers in the field to honestly provide the connection between their project, invention, or technological approach and the gain to mankind. In our case, it should be fair to state that the EXPLORER PET could be a tool fitting biological research, and it should also be fair for scientists to state that Crosetto’s 3D-CBS is at present the most powerful tool to significantly reduce cancer deaths and cost.

Facts listed in this document prove this.

3.2.1.2.1 Another example of misconception leading to inconsistencies in funding research that will not be in the best interest of taxpayers is when the rules of Government funding agencies  (e.g. CPRIT) require the applicant to contribute his own money towards 50% of the research cost. It is unlikely that an inventor or an academic researcher has $2 million in his pocket for a research project costing $4 million. Instead of funding projects/approaches/inventions with highest scientific merits, this criterion is subsidizing large companies (e.g. pharmaceutical) that have the $2 million. To be consistent with this criterion, all university research labs and research centers should be shut down because the misconception leads us to believe that only private industry know which research goal is important to pursue and how to conduct research effectively.

3.2.1.2.2 A former Program Manager of one of the major U.S. Government funding agencies told Crosetto that unless there is an interest from industry to market an invention, project, or idea, or the proposed idea is at a very high risk of not achieving the expected scientific results, the government funding agency will not fund it. He made the example that if industry is not interested in utilizing the 3D-CBS to save lives and reduce healthcare cost, because Crosetto proved that the expected scientific results can be achieved, then it would not be a high risk and this is a reason why it is not receiving funding from government agencies that have this criterion.

3.2.1.3 THE REMEDY: The following logical reasoning should convince even laymen who sometimes are discouraged by Government bureaucracy and research funded by taxpayers through public funding agencies, and who believe private industry will be more efficient in providing them benefits. Although there might be some truth about efficiency in private industry, there are many other drawbacks which should be considered in order not to go from the frying pan into the fire. It is open knowledge that the mission statement or Statue of a government agency is to implement research for the benefit of their citizens and humanity; while industries and private corporations mission is to maximize profit for their shareholders. The CEO of a company would have to lie to his shareholders or to humanity and citizens by telling one that his priority is to maximize profit and to the other that it is to maximize the reduction of cancer deaths and cost. Only one of these can be the priority, the other will be second. Shareholders would not be happy with their CEO and will fire him if he could be giving them a return of 100, but instead gives them only 10 because he cared more about humanity than them. It cannot be considered dishonest for a CEO to maximize profit for the shareholders because that is his job.

3.2.1.3.1 It is a different issue when the CEO is the owner of a company and he has a vision, the intelligence and the heart to maximize benefits to humanity.

3.2.1.3.2 The same is true for a philanthropist who does what he wants with his money;

However, the truth and the impact of their statement is ultimately confirmed by science, by competent scientists who understand the laws of nature and who provide advices based on calculation and logical reasoning that when funded are proved by experiments.

The REMEDY would have been TRANSPARENCY in SCIENCE implementing open, public workshops and accountability.

Why weren’t C. Levin, G. Elfakhri, K. Parodi, S. Cherry, W. Moses, J. Karp, S. DeRenzo, M. Phelps, C. Joram, T. Jones and others who received funding in Medical Imaging asked how their claim that increasing PET spatial and time resolution to the detriment of sensitivity is maximizing reduction in cancer deaths and cost and how would they support their claims in a public debate with Crosetto and other scientists before any more taxpayer and donation money would be assigned to them? A simple dialogue like the one between Crosetto and Bertolucci would lead them to realize that their claims do not add up or would force them to test their claims on a sample population so they will be convinced by experimental results that their project was a waste of money.

Levin’s proposal does not add up because, if one uses his “block detector” 1B with millimeter PET spatial resolution described in his article (http://miil.stanford.edu/publications/files/99_PUB.pdf) to build a 3D position-sensitive device with a 20 cm FOV and a 70 cm diameter, it would require: 4,505,600 of the 1x1x1 mm3 crystals, 70,400 connectors and 70,400 sensors (APDs). The sensitivity would be less than 50% of the current PET because the total crystal thickness is only 20 mm, equivalent to about 64% in stopping power efficiency. Many gaps of non-sensitive detectors between crystals (connectors, cables, etc.) do not absorb photons and further lower the efficiency by capturing less than 50% of the photons hitting the detector. If one wanted to increase photon sensitivity with a geometry comparable to Crosetto’s 3D-CBS device capturing more photons hitting the detector with a wide angle having a 150 cm FOV and 70 cm in diameter, using Levin’s “block detector” 1B with millimeter PET spatial resolution would require 31,539,200 crystals of 1x1x1 mm3, 492,800 connectors and 492,800 Sensors (APDs). Although the FOV is extended, because it captures less than 50% of the photons hitting the detector, it would most likely not be sensitive enough to detect tumors at their early stage and the radiation dose required might still be higher than 1 mSv. Clearly both approaches described above aiming to satisfy Levin’s statement to keep high spatial resolution with his “block detector” and increase efficiency are not practical (an estimate of $1 per crystal and per connector would total over $32 million just in material. Labor to assemble it and the cost of other parts could more than double that figure).

What could explain the fact that the one article submitted by Crosetto to the Medical Imaging Conference which presents a technique that maximizes the reduction of cancer deaths and cost by accurately capturing all possible signals from the tumor markers at the lowest cost per valid signal captured, was rejected, while 16 articles submitted by Craig Levin, presenting projects as the one described above, that increases health care costs and cannot provide scientific arguments supporting a reduction of cancer deaths, were accepted?

The answer is that Levin is among “the circle of friends” who approve each other’s articles and Crosetto is not.

In order to open everyone’s eyes on the uselessness of Levin’s project to improve healthcare, and to crumble his paper castle and deflate a balloon of air costing millions of dollars and years to many researchers, Crosetto asked Levin publicly a few simple questions after he presented his paper (M25-4) at the 2013 IEEE-MIC Conference on November 2, 2013.

Crosetto four questions were: (a) “What is the efficiency of your module in capturing signals from the tumor markers?” (b) “How much radiation do you need to administer to the patient receiving the breast examination?” (c) “How much did the entire project cost?” (d) “Do you see the possibility of commercialization as a better mammogram, and if so, what do you estimate the cancer death rate reduction would be if this project is tested on a sample population?”

Levin’s answers reveal that his project could never be suitable for reducing cancer deaths and cost. His answer to (a): 12% efficiency. His answer to (b) 10 mCi of FDG tracer, equivalent to over 10 times the radiation dose of 1 mSv accepted by the International Commission for Radiation Protection for screening examinations. This rules out the possibility of using Levin’s new device as an improved mammogram for screening and also answers (d) that it would not be useful for reducing cancer death, also because the cost would be prohibitive compared to the cost of a current mammogram. His answer to (c) was a few million dollars and seven researchers. His answer to (d) was that he still hopes to commercialize the product; however, he could not explain how it could benefit the patient or improve healthcare and reduce its cost.

The two-minute window of opportunity given Crosetto when he was allowed to ask Levin a few questions regarding his project was long enough to demonstrate the power of TRANSPARENCY in SCIENCE and shows how it can benefit taxpayers and patients. Had these same questions been asked by the funding agencies five years ago before Levin started his project, millions of dollars and years of time from several scientists would not have been wasted.

To fix these inconsistencies it would be necessary to identify the reviewers who assigned the funding to Levin for this project from the National Institute of Health, NIH grant R01CA119056, from the Department of Defense DOD grant W81XWH-10-1-03-93, from grants received from the National Science Foundation, from funding received from Stanford Graduate Fellowship, from the Department of Electrical Engineering, Bioengineering, Physics and Radiology at Stanford University, as reported by Levin on the first page of his article.

These reviewers should be informed about how Positron Emission Technology works, and what information is most relevant to doctors when measuring abnormal biological processes that this technique provides so as to facilitate the diagnosis, the prognosis, and reduce the number of false positives and false negatives.

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