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More shameless self-promotion that is, I hope, at least entertaining

Three weeks ago, I gave a talk to the National Capital Area Skeptics at the National Science Foundation in Arlington, VA. The topic was one near and dear to my heart, namely quackademic medicine.

I was informed the other day that the video had finally been posted. Unfortunately, there were some problems with the sound in a couple of places, which our intrepid NCAS video editor did his best to fix. Overall, however, the sound quality seems decent. The video even includes the Q&A session. In case you’re interested, the guy who asks the question about mercury in vaccines and autism is Paul Offit’s very own stalker Jake Crosby. I feel honored to think that Jake now apparently lumps me in the same category as Paul Offit, whom I admire greatly. Enjoy.

Posted in: Clinical Trials, Energy Medicine, Homeopathy, Medical Academia, Science and Medicine

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50 thoughts on “More shameless self-promotion that is, I hope, at least entertaining

  1. Janet says:

    The guy’s point about nutrition (toward the end of questions) was very valid and gets to the heart of how CAM gets a foothold. If the patient asks about a “nutritional therapy” and the doctor replies that (s)he “doesn’t have much training in that”, it’s tantamount to telling the patient s(he) should go find the nearest CAM person who (apparently–to the patient anyway) claims that (s)he does have this “special knowledge.

    (Illustration–not anecdote– to follow. I’ve been making that distinction lately in my NY Times comments). My last visit to my gyn had the guy referring me to Gary Taubes’ latest book and crediting it as a “well-researched and documented” book. The gyn offered that he had “only a little” training in nutrition and found Taubes’ ideas, “exciting” and further shared that “it’s working for me, I’ve lost 20 lbs”. He seemed puzzled when I suggested that this might be because he was consuming fewer calories, not because of any magic nutrient combinations.

    Nutrition is an area where regular medicine could start to take back the basic underpinnings of CAM. I wouldn’t minimize the effect such a strategy could have. We need some action to turn this tide before it becomes a tsunami. Is there any reason why qualified physicians cannot offer people a list of credible nutritional resources for a start? Where people lose “faith” is when the MD shrugs off the questions entirely. Cardiologists are probably the best at including some nutritional elements to post-diagnostic discussion–and internists who deal with diabetes. It worked for me to be referred to a registered dietician, but obviously it doesn’t for most. Anecdote: My spouse was referred to an RD, but he lost interest when a 250 lb. shortish woman walked into the room. There’s a lot of room for co-opting the CAM claim to nutrition-based knowledge superiority.

  2. lizditz says:

    Thanks for posting this, Dr. Gorski. I’ve been reading SBM since the outset, but having the SBM vs EBM argument laid out in one neat hour-long package.

    I thought the cancer patient’s questions about nutrition were thought-provoking. Is it true that there’s no education on nutrition in medical school?

  3. Newcoaster says:

    @ Janet,Liz.

    Nutrition was taught at my medical school, though it was not given very many hours. I don’t remember how many but Ill guess 20. However, it was generally considered to be boring, and one of the classes with the lowest attendance, and least importance for exam purposes.

    Nutrition just didn’t generate much interest when we learning about exotic diseases, and dissecting cadavers in the anatomy lab. I am honest about my lack of knowledge..and interest…in nutrition and usually refer patients to clinical dietitians. The Quacks do have the advantage in one sense as they CLAIM greater knowledge, and give clients very specific and detailed advice, however useless it may actually be

  4. WilliamLawrenceUtridge says:

    Who is the lady that so strongly recommends SBM at about 1:01?

    The problem with trying to take back nutrition is that it’s so damned hard to do good research on it. How can you double-blind placebo-test 20 years of eating apples? Or if you want to be sexy, acai berries? How do you ensure patients consume 100 g per day for 7,000 days? The low-hanging fruit of nutrition (frank deficiency) has been plucked, and you’re left with the rather boring advice of Michael Pollan – eat food, not too much, mostly plants. There doesn’t seem to be any magic left in there, just incremental increases in understanding of increasingly obscure biochemical pathways that are mostly redundant to simply eating more plants and less meat. As my wife has often said – she lost weight the hard way, by eating less, going to bed hungry and exercising regularly. It sucked, but at the end, it worked and she has kept it off.

  5. Guy Chapman says:

    @Janet: I was recently diagnosed with coeliac disease and my holistic healer referred me to a dietician. This is my second referral to a dietician, the earlier one was to do with crashing energy levels during my cycle commute.

    My holistic healer is, of course, my doctor. I do not subscribe to the fiction that primary care physicians are somehow not “holistic”.

  6. MTDoc says:

    “nutrition” is fundamentally biochemistry and physiology, taught, at least in my day, in the first and/or second year of med school. This is followed by two more years of med school, another three or four years of residency with 80 hour work weeks, and maybe a couple of years of military service thrown in. When you finally get out in real world, the memory as well as the priority of nutrition has faded. But we do have competent RDs, who offer good advice, but as WLU noted, that advice isn’t very sexy. As for the overweight dietician, it brings to mind a saying from my youth, never trust a skinny cook.

  7. mousethatroared says:

    Guy Chapman “I do not subscribe to the fiction that primary care physicians are somehow not “holistic”.”

    Clearly the “disease focused” PCP is a stereotype that the alternative medicine folks like to trot out. There are many good holistic PCPs.

    BUT (sorry) I have noticed a couple of issues that sometimes come up when dealing with PCP (or specialists) that might come across as not being “holistic”.

    Firstly the process of a sick visit seems based on a model that focuses on one complaint. If you happen to have several complaints that occur together, the person who makes the appoint, then the nurse who does the initial interview, then the doctor all want to hear one complaint. Sometimes when you explain you have several complaints, folks seem to respond as if you are just throwing all your minor complaints + the kitchen sink at them to get a better deal . They want to know what your MAIN complaint is. But if all those complaints that occurred together are part of one condition, they might be missing the big picture.

    Secondly, I’ve had doctors who seem to want to treat the test results not the patient. I feel I get much better care when doctors are willing to consider the symptoms I report and the test results together to make treatment recommendations.

  8. NYUDDS says:

    When Dr. Gorski delivered his lecture, the TACT study he referred to (chelation) was not yet published. He was correct : the study was started, then stopped, then started again and brought to some stage of completion(?). If my memory serves me, it was stopped because of the money involved, about $30 million, and the fact that several subjects were not properly advised. It started with many questions: criminal, ethical and procedural. This is the sad story’s end although we have probably not heard the fat lady sing yet. The enabling actions that gave rise to NIH’s approval is also questionable.

    http://www.theheart.org/article/1326797.do

    http://www.medscape.com/viewarticle/781467?src=wnl_edit_medn_wir&uac=71548MZ&spon=34

  9. art malernee dvm says:

    Who is the lady that so strongly recommends SBM at about 1:01?>> I wondered the same thing.

  10. Chris says:

    I need to comment on the young man who asked about GMOs and intellectual property rights. While Monsanto has had a strangle hold on some methods genetically engineering plant genomes that are novel, the intellectual property rights for genetically modified plants is very old and established.

    Several types of genetically modified plants are given patents and it is illegal to asexually propagate a patented plant. Any gardener who has bought hybrid plants that are cloned by grafting on to a root stock will have seen a label that says it is not cool to graft parts of the plant elsewhere. I have seen that warning on my Polka and Collette roses, plus my ill-fated four-in-one pluot (it turned out I lived too far north for it to live*). Though I could give as many as I wish from branches from three of my four-in-one pear tree (the Bosc, Comice and Red Barlett were out of patent), Liberty and Melrose as I wish. But not from the four pluot branches (which died ), one pear branch, nor the younger rose hybrids.

    I am really amazed how much I learn just because I have a garden. Even the parts that are not edible.

    * No, I was not happy when the Raintree Nursery catalog put in verbiage that pluots would not grow at our latitude a year after I bought the combo tree. Even though I bought the tree from them, and they are “local” by being in the same state! It is not a very big state, though it is just south of Canada.

  11. BillyJoe says:

    Guy,

    “I was recently diagnosed with coeliac disease and my holistic healer referred me to a dietician”

    Why wouldn’t you just google “gluten free diet”?
    The first link is from the Mayo clinic:
    http://www.mayoclinic.com/health/gluten-free-diet/my01140
    I’m not sure why you would pay a dietitian to tell you what you can find yourself for free.

  12. lilady says:

    Excellent presentation, Dr. Gorski. I’m sure Jake Crosby has had your picture in his “gallery”…now moved from the “To Be Stalked section” to the “Been Stalked section”. :-)

    JAMA has an analysis of the TACT study, authored by cardiologist *Steven Nissen, M.D. It is a scathing review of the study.

    http://jama.jamanetwork.com/article.aspx?articleid=1672219

    (Disclaimer: I’m not *shilling* for Dr. Nissen)

    *Dr. Nissen is the author of “Heart 411″ and Dr. Hall wrote a rave review of the book.

    http://www.sciencebasedmedicine.org/index.php/an-owners-manual-for-the-heart/

  13. David Gorski says:

    Yeah. One thing I notice about defenders of TACT (or cardiologists who should know better but can’t help but be intrigued by an “anomalous” result) is that they all seem to zero in on the SBM argument about prior probability as somehow being offensive and tend to downplay or even ignore all the other numerous problems with the study that almost certainly invalidate even its weak result. That sort of thing is going on over at my not-so-super-secret other blog in the comments.

  14. tjohnson_nb says:

    I find the sarcastic and mocking attitudes of contributors and followers of this site to be quite childish. If anything it merely reinforces my very negative opinion of mainstream medicine and probably many others who visit the site. What is the purpose of this site? Almost everyone here has virtually the same negative opinion of alternative medicine already so is it just mutual admiration society? This site certainly does not reflect the spirit of science, despite it’s fancy name – scientists shouldn’t poke fun at other theories no matter how improbable they are.

  15. WilliamLawrenceUtridge says:

    @tjohnson_nb

    You do not appear to understand the purpose of this site, or why alternative medicine is so roundly condemned. The purpose of this site is to discuss science based medicine, that unlike evidence based medicine, takes prior probability into account. Nearly all of “alternative”, “integrative” or “complementary” medicine has almost no prior probability (homeopathy simply can’t work; reiki has no reason it should work; acupuncture has no biological basis) and nearly all CAM modalities are inherently unproven. Herbalism, the notable exception, consists of impure, under-studied molecules of uncertain potencies and effects that can and should be purified, tested and applied in rational manner. Herbs indeed have adverse effects, numerous are actually quite poisonous.

    The reason most of the “regulars” have a negative opinion of alt med is because we understand science, evidence, biology, chemistry and physics (to greater and lesser degrees), and thus we all realize just how improbable most are. Some of us have even delved into the primary failing of evidence-based medicine, randomized controlled trials of improbable medicines, and pointed out why even supposedly good-quality evidence doesn’t actually support what its proponents claim it supports.

    Science is inherently critical, self-critical. Look into editorials and literature reviews of journal articles and you will find politely-worded but excoriating criticisms of their fellow scientists’ work. Science is about arriving at correct conclusions, not about preserving feelings of other scientists or lay people. If a proposed treatment has no reason to work, why should we pretend otherwise? To maintain the income stream of those who promote them? To give false hope to patients? To give the worried well a form of emotion-focused coping that erodes their ability to maintain their own health or actually puts it at risk?

    CAM plays very well with our underlying penchant for logical fallacies, for just-so stories, for explanations that make superficial sense while ignoring just how complicated, incomprehensible and badly designed the human body and biology is. Medicine is about curing diseases, increasing quality and quantity of life, and learning from its mistakes. It is far superior to the normally-worthless, often harmful “cures” of two centuries ago – “cures” that often haven’t changed despite two centuries of repeated revolutions in our understanding of life. Two centuries ago, the most recent of the popular “CAM” modalities, puts us at 1813. At that point, we didn’t know what bacteria were, viruses were around 100 years away, there was no scientific explanation of evolution, let alone genetics, and diseases were organized by symptom, not cause – leading to treating herpes and syphilis the same way because both cause fevers (I don’t know if syphilis causes fever, it is now so uncommon that I have never met someone with it; I do get cold sores though). Currently, we are now coding the genomes of specific cancers and are bordering on proteomics, the ability to understand the body at the protein-level – a functional level beyond that of genes which were themselves revolutionary in our understanding of the body. We can implant a sensor into quadriplegic people so they can independently control robotic arms and feed themselves.

    Meanwhile, numerous CAM modalities still believe that there is a vital energy responsible for life – an idea discredited with the synthesis of urea. Any CAM modalities that are proven to work are adopted (for instance, St. John’s Wort for depression, despite its effects on photosensitivity, propensity to cause mania, increase dementia in elderly patients and numerous interactions with medications), but CAM practitioners and promoters ask for a double-standard for their various nostroms (while drugs must be proven to work in a series of experiments starting with chemicals and moving up to human trials, CAM practitioners demand, often legislate, for the right to apply their untested interventions without any restraint) all the while decrying Big Pharma for its greed and mendacity.

    But please, let us know what particular intervention you think is unfairly maligned. I would be happy to point out why it is looked down upon by most practitioners. It would be helped if you looked into some of the basic skepticism on the topic however, I recommend Snake Oil Science, Trick or Treatment and Ben Goldacre’s Bad Science as very good books to start with.

  16. Janet says:

    @WLU

    I’m well aware of the difficulty with nutrition studies, but what I’m getting at has little to do with that. People (average people with little to no science cred), aren’t looking for perfectly conducted diet research, they’re looking for magic, but would benefit from some decent factual information. Mostly, they need support. I’m certainly not implying that docs become alties, but something needs to be developed for referrals to support opportunities beyond a referral to a RD only after a significant health condition appears. Taking an interest in people’s effort beyond declaring the need to “eat better” is what’s needed. There might be room here for a new type of assistant; a sort of a Weight Watchers support person. That’s what most of the alties are providing in one form or another and there’s no reason that real medicine can’t incorporate that.

    As I’ve said many times, here and elsewhere,and confirms your wife’s experience,I lost weight the “simple” way (eat less and–wait for it–be hungry sometimes). Simple? Yes. Easy? NO. I’ve kept most of it off for over six years now, but it’s an ongoing struggle as aging metabolism keeps making it even more challenging. The point is that my doctor never mentions my weight, asks about my habits or says anything at all related to the subject, other than to tell me not to worry about it if I’ve gained a couple of pounds at a visit–which I ignore, and promptly start measuring all portions again.

  17. Janet says:

    @LizDitz and Newcoaster

    I’ve never been concerned that doctors may not directly study nutrition for more than 20 hours and I’m sure it could well be “boring”. They DO study biology, chemistry, biochemistry,and other sciences that cover the basics of what sustains life (the most basic definition of nutrition, no?). How average people think of “nutrition”, though, is another matter. People are looking, unfortunately, for magical ways to eat what they want without getting fat. They are looking for ways to avoid the scarier diseases of aging and genetic determination by eating the “right” things.

    This is where the alties move in with their magic. They make the accusation that doctors don’t study nutrition as a sort of “gateway” argument (that few seem to rebut) to discredit medicine along with the “drugs are evil/BigPharma” gambit. Then, of course, they offer myriad “alternatives”.

    It is my goal in reading this blog to try to move beyond complaining about CAM and start thinking about combatting it. Nutrition and its companion, weight management, I think is a good place for doctors to demonstrate that they DO have the basic skills to help people with nutrition/weight. But they have to do more than shrug and confess openly to a lack of knowledge. Perhaps medical school should make every MD also an RD?

  18. Sawyer says:

    It wasn’t covered in detail but several times during the talk Dr. Gorski referenced CAM-sympathetic definitions from the Cochrane Review. What the hell is going on there? I suppose as long as the quality of their studies is top notch they are still doing a good job overall, but I’m wary of any organization that is unwilling to call out BS on alternative medicine. Are there CAM advocates currently involved with the Cochrane Collaboration?

  19. ConspicuousCarl says:

    1. Can anyone give us an example of nutrition advice which should be given to cancer patients which is not just normal healthy nutrition advice? Maybe there is some, but it has to be offered in the argument because the field of fighting cancer with food is pretty weak. The sugar claim is the first to pop up (often, not just here), and it is wrong.

    2. Any TACT defenders who don’t like prior probability should be required to explain why the trial used EDTA instead of orange soda.

    3. tjohnson_nbon said “scientists shouldn’t poke fun at other theories no matter how improbable they are.” This is just your dogma. Any evidence behind your preference?

    4. Jake Crosby! I wonder how we might satisfy tjohnson’s demand that we not mock people when Jake Crosby’s name is becoming a joke by itself. Gorski asks Crosby a simple question (to which Crosby MUST know the answer if he has been following vaccines and autism), and during Crosby’s silent delay it is so obvious that he is trying to come up with a way to answer the question without destroying his own hypothesis.

  20. mousethatroared says:

    ConspicuousCarl – “1. Can anyone give us an example of nutrition advice which should be given to cancer patients which is not just normal healthy nutrition advice? Maybe there is some, but it has to be offered in the argument because the field of fighting cancer with food is pretty weak. The sugar claim is the first to pop up (often, not just here), and it is wrong.”

    I’m no expert, but just from personal experience of family members with cancer, it seems that nutrition advice for folks for cancer has to be individualized to their condition and symptoms. The people I’ve known, the main problems were dehydration, weight loss, swallowing problems, lack of appetite and nausea. Advice for ways to cope with those issues would be helpful.

  21. mousethatroared says:

    I like Janet’s idea of nutrition support or support group – maybe led by at RD? At one time I found the support aspect Weight Watcher’s quite helpful, I like hearing other people’s tips and mental devices for success. Although the commercialism of WW eventually turned me off. It’s possible that some medical networks already have something like that in place…one of our local hospital networks seems to have a lot of “healthy living” type classes and workshops, but I’ve never taken one, so I’m not sure of the quality.

  22. Narad says:

    scientists shouldn’t poke fun at other theories no matter how improbable they are

    “How do you tell a good string theorist from a bad one?
    “The good one predicts nothing, and the bad one predicts everything.”

  23. NeilFeldman says:

    I tried to log in yesterday to comment about nutrition but was unable to register. I am the fellow in the audience suffering from stage IV renal cancer who asked that nutrition question (about 1 hr 10 minutes in).

    This is not trivial issue. So as not take up undue bandwidth let me say:

    I currently take the maximum amount of an anti-angiogenic drug (Dr. Gorski’s personal area of interest) called Sutent. There is no doubt in my mind that this mainstream medication has saved (prolonged) my life. But what is being ignored by most oncologists regarding proper diet and nutrition strikes me as extremely disturbing.

    Nutrition is far too important a topic to be ignored simply because the current crop of medical experts claim that they were not sufficiently “trained” in this particular field. I don’t believe that excuse should be tolerated by any patients who actually expect far more than hearing what the next drug might be in store for them.

    My “chemo” includes each and every little thing I put in or on my body. So why should that idea be considered radical?

    To the question put by Conspicuous Carl about wanting an example… Well, I have a 60+ document that outlines the science and rationale behind the latest nutrition information that I could cull from PubMed, etc. Far too long to post here. Regardless – does the concept of nutrition solely have to “prove” that it has efficacy in “curing” cancer? How about the fact that it can help minimize the awful side effects of chemo or targeted therapies? Or that it can help those same therapies better target tumor cells while not disturbing healthy ones?

    I realize what I am about to state is purely anecdotal. I do not offer it as “proof” – I offer it as “food for thought” (pun intended). I take a drug that is “dreaded” by many others because of its awful side effects. Yet, in over 7 months of being on it, I have had no significant side effects while taking it at its maximum+ dosage. This, for me, is primarily due to the diet that I follow. And yes, I do supplement that diet with a few choice supplements – based on credible cutting edge research (such as turmeric, resveratrol, vitamin D, etc.).

    Before slamming me for my approach – I only subscribe to SBM whenever possible. Regardless, I believe that nutrition and proper diet is NOT too “complicated” for any mainstream medical professionals to learn and to immediately offer to their suffering patients today.

  24. ConspicuousCarl says:

    mousethatroared and NeilFeldman:

    I was interpreting the question too narrowly, assuming it was only about diet as it relates to cures. Indeed, diet advice for managing side effects does count as something a doctor should be able to tell you (though the example as offered in the video, possibly just for the sake of brevity, sounded more like “what do I eat if I have cancer”, not “what do I eat if I have side effect ___.”).

    NeilFeldman only:

    Some of the stuff in that 60-page document might be the things I thought we were talking about.

  25. pmoran says:

    @NeilFeldman, — 60 pages of information on the effect of diet upon cancer has to be padded out with studies of extreme nutritional interventions with test tube cultures of cancer cells (where anything “works” give you give enough!) and animal studies (where, tragically, even spectacular effects are not usually reproduced in humans).

    There are thousands of such studies, yet, like CC, I cannot recall any of the effects being replicated with established human invasive cancer. For the same reason I cannot understand an oncologist saying he is not “trained” in nutrition and cancer. He would be immersed in the very same scientific literature.

    Am I wrong? It should not take too long to inform us as to any human studies that show otherwise.

    That said, you are right that this is an intense preoccupation of cancer patients. They all ask what they should eat — or their spouse/partner does. We perhaps should react more sympathetically to the understanding that they will be bombarded by information suggesting that their life hangs upon their dietary choices. Sugar is, of course, the main villain in CAM circles.

  26. pmoran says:

    Yeah. One thing I notice about defenders of TACT (or cardiologists who should know better but can’t help but be intrigued by an “anomalous” result) is that they all seem to zero in on the SBM argument about prior probability as somehow being offensive and tend to downplay or even ignore all the other numerous problems with the study that almost certainly invalidate even its weak result. That sort of thing is going on over at my not-so-super-secret other blog in the comments.

    I am aware of all the arguments against investigating implausible CAM claims, but I wonder whether there are bound to be circumstances where we feel obliged to investigate a question simply because the public is asking that of us, through their level of patronage and the damage being done.

    When scientific consensus is not having the desired impact, what else can we do? If well-performed the studies will not only reveal the truth but also confirm in the general pubic mind the predictive power of current scientific understanding.

    It seems that the studies performed in Italy on the equally implausible Di Bella cancer treatment were necessary. They have been effective in dampening interest in a treatment that was bankrupting the country (as if that was needed :-)) and threatening to exhaust world stocks of somatostatin. In Australia a study of the Holt (microwave) treatment by the NHMRC seems to have had the same effect. Such studies may not stop the CAM claims but they may influence public interest in them.

  27. elburto says:

    @tJohnson – Science is factual information. Experiments that produce cold hard statistics, that can be replicated by anyone using the same methodology. It’s not debatable, you can’t have subjective facts.

    Woo, on the other hand, is designed to appeal to someone’s need to feel special and unique, to make you feel good. Infinitely subjective, illogical, totally lacking in proof, proper stats, and predictable outcomes.

    Science-Based medicine can help people get better, have fewer symptoms, recover from debilitating diseases and conditions, by using proven methods.

    Woo makes them feel better, with “personalised treatment” and a sense of warm, fuzzy, superiority about using “natural” methods.

    @Janet –

    There might be room here for a new type of assistant; a sort of a Weight Watchers support person

    Here in the UK (as this isn’t just Science-Based American Medicine, although it usually feels like it!*) GP practices run weight-loss groups. The emphasis is on lifestyle change through healthy eating and regular exercise, not dieting, which is strongly discouraged due to the metabolic havoc it creates.

    Dieticians and practice nurses work together so that patients attend a group meeting once a week, and can have one-on-one appointments with their practice nurse whenever they want to book one. Each person has the ability to have their personal plan tailored to their existing medical conditions, medication requirements etc.

    GP surgeries are ranked and incentivised based on how many services such as the weight-management, smoking cessation, alcohol reduction, hypertension management, sexual health, and chronic illness management (mostly asthma and diabetes) clinics/services they offer.

    Because these schemes are run at the patient’s own GP practice any medical issues/concerns that occur can be tackled appropriately by medical professionals known to the service users. So if a diabetic is attending the weight-management clinic and needs help altering their medication regimen due to weight-loss, it’s easy enough to get sound advice and, if necessary, a change in their prescribed meds.

    Obviously the disjointed (not to mention expensive) US system doesn’t have the integration needed for this sort of system to work on a local level, which is a shame. That’s obviously a big difference with nationalised/socialised medicine, that everyone’s money can be better spent by avoiding the ultimate endpoints of certain health issues, rather than treating them as they arise and saying “If only we could have prevented this…”.

    *That is not a personal dig, just a general observation.

    Responses and comments here (and partly on Dr Gorski’s friend’s blog) always go down the line of “Doctors do X”, “People don’t have access to [service]” and “Seeing a [medical service provider] is expensive”.

    That’s true of profit-based medicine, but the actual science we’re discussing here is universal. That often gets lost as discussion turns to how that science is implemented in the US.

    I know that non-USians are outnumbered here, but those of us who are here are committed to crushing $CAM and promoting SBM too. It’s an international necessity if we want to banish the fraudulent “cures” and science-denial that leads to ‘Medicins sans Medicine’ offering homeopathy to earthquake victims in Haiti, and all manner of disgusting sub-human scum teaching HIV/AIDS denial across Africa, and offering “treatment” like vitamin C or red cabbage, or producing heinous “documentaries” like ‘House of Numbers’ that claim that there is no African AIDS pandemic, just malnutrition. Not to mention the whole polio eradication balls-up, and anti-vaxxers in general.

    SBM needs to be a force for good on a global scale, to stop death and unnecessary suffering internationally, from the horrific (and terrifying) measles epidemic here, to victims of Chopra and Duesberg elsewhere.

  28. NeilFeldman says:

    @ConspicuousCarl: My 60+ page document outlines the science and rationale behind what I dub a “proper” diet and “appropriate” supplements for renal cancer sufferers. It really applies to anyone else fighting cancer as well. It also explains exactly what I have been doing since I was diagnosed with metastatic renal cancer back in July 2012. Since this is about an N=1 clinical trial (with myself as the guinea pig) I have undergone much more extensive blood tests than most mRCC patients might be accustomed to. That way I have been able to monitor what, if any, effect my diet and these supplements might be having. Here is just one example. I monitor my C-reactive protein level (a measure of inflammation in the body). I have watched it drop from a high of = 44mg/L back in August (which was extraordinarily scary and high) to where it is today at = 0.3mg/L (anything below 1.0mg/L is considered optimal). Yet this particular test is not considered “standard” – even though I can cite the peer reviewed studies that are investigating this test a marker for mRCC tumor progression, etc.

    A prognosis of metastatic renal cancer as recently as perhaps 5 or 10 years ago was effectively a swift death sentence for the majority of us. That has changed. But the anti-angiogenic TKI or mTOR drugs now available to us can only prolong life – they do not offer long-term remission. As such, I spend my time asking a simple question: what will SBM telling patients like me 20 years from now? Because, quite frankly, I do not have 20 years left to find out.

    So you all can debate what constitutes “official” proof at your leisure – I can’t. No do I wish to waste my time (or life) going over to the dark side of the sCAMer’s. But if mainstream medicine is going to continue to ignore the vital importance of this topic (i.e. approaching cancer as a metabolic disease; not just as genomic one) then what choice is left to those of us who are researching this topic simply because our lives might depend on it?

    @pmoran: If we are only going to accept as valid RCT studies on humans then I guess I am doomed. It will not happen to any large extent in my remaining lifetime. They are far too expensive a proposition – with only the promise of small financial return, if any.

  29. WilliamLawrenceUtridge says:

    @Narad – Ha! Good one.

    @NeilFeldman

    First a general comment. I’ve never understood the idea that nutrition has a role in curing cancer (beyond the idea that you need to eat well to support health, but I don’t see why that should be any different from a normal, USDA diet). With the disclaimer that I haven’t any experience with any individual cancers (and noting that “cancer” is not a unitary concept, so some could respond to certain aspects of diet while not necessarily justifying it as a general approach).

    Nutrition does appear to have a role in preventing cancer through antioxidants that prevent oxidation of DNA (though nothing for non-oxidant chemical or radioactive damage). But curing cancer? Once cancer is established, what mechanism could repair or revert the damaged DNA within a nucleus to its original status? It seems like expecting the solution to getting thrown out of a car is to put the battered body back into the car seat and attaching the seatbelt. But it’s not – treatment for a car accident (and cancer) is completely different from prevention.

    Regardless – does the concept of nutrition solely have to “prove” that it has efficacy in “curing” cancer?

    Um, kinda, to be recommended for widespread use. That’s what science is about. But it also depends. If you really are genuinely eating just a healthy diet, all you’re missing out on is possibly variety and flavour. Stephen Barrett has been asked what he would do if he were diagnosed with an incurable cancer, and his response was to eat pizza and ice cream and spend time with his family.

    If your food has an effect on your cancer, then it is acting like a drug, not like a food, and it could be studied, purified, standardized and probably improved as a chemotherapeutic agent. Another thought, is that if food is having a chemical effect beyond mere food, then it could also oppose the effectiveness of your chemotherapy and make it less effective.

    How about the fact that it can help minimize the awful side effects of chemo or targeted therapies? Or that it can help those same therapies better target tumor cells while not disturbing healthy ones? I realize what I am about to state is purely anecdotal. I do not offer it as “proof” – I offer it as “food for thought” (pun intended). I take a drug that is “dreaded” by many others because of its awful side effects. Yet, in over 7 months of being on it, I have had no significant side effects while taking it at its maximum+ dosage.

    But until tested, how do you know this is the case? If you feel relatively good, can it be attributed to diet, antinausea medication or your unique genome interacting with the drug?

    At best, you have an n=1 hypothesis-generating activity with a large number of potential confounds:
    - your genome
    - your supplements (broken down by the number of supplements)
    - your diet (broken down by those foods you eat regularly and in quantity)

    The amount of time and money it would take to test this would be extensive. Perhaps its worthwhile, but you’ll never really know without testing. You recognize this, and you are probably following a healthy diet, and you are probably aren’t putting your heath further at risk. But doctors can’t recommend extensive diet changes on the basis of n=1 studies, and I don’t know if it’s fair to demand of any doctor (either in their office or at a talk on scientific skepticism) that they have an opinion or be able to give an answer to either a broad or specific issue without them being a specialist in the area. Science is about small research findings accumulating over long spans of time, with scientists having to specialize, sub-specialize and sub-sub-specialize. Unless your oncologist happens to be conducting research on one (of the many) compounds you attribute your recovery and lack of symptoms to, they probably aren’t aware of the research on the area because they’re sub-sub-specializing on another area of cancer research.

    Doctors shouldn’t recommend unproven treatments, because they must first do no harm. Doc Spock casually recommended babies sleeping on their stomachs because there was no research. Hundreds of thousands of babies died of SIDS because of this. “In my experience” is a dangerous series of words because individual human experience is deceptive.

  30. NeilFeldman says:

    @WilliamLawrenceUtridge:

    Actually I agree with much of what you say. Please go back and read my comments – I do NOT claim diet and nutrition can “cure” cancer. I fully agree that diet and nutrition may PREVENT cancer. In a short conversation with Dr. Gorski after his talk he admitted the same to me. However, if you agree that there may be circumstances where you can prevent cancer from taking hold in the first place – who is to say you cannot help prevent new metastases from developing as well? I have metastatic cancer. That is what is threatening me with early death – not the primary tumor which was surgically removed from me over 2 years ago.

    Now please go back and listen to what I said during that Q&A session. All I was pleading for was to put nutrition squarely back into the SBM firmament. And indeed this is slowly starting to occur. There are, for example, “theoretical” reasons to explore the efficacy of a ketogenic diet as a way to enhance standard targeted or chemotherapies. No, I am not trying to start a debate about the merits of this kind of approach. I am just saying they are certainly worth investigating – preferably by medical professionals – and, of course, there are many others.

    Finally I am aware that I personally might just be genomically “lucky” in suffering no significant side effects. However, I truly doubt it. But my detailed reasoning cannot be stated in a short posting (that is why my document is so long). Meanwhile, I not only have no side effects. I have also shown “dramatic” response (so far) to the drug combinations that I am following under my oncologists direction. However, he also supports my diet/supplement regime because I have proven that it “does no harm” and, more importantly, that it does not interfere with the metabolism of the targeted drugs that I take.

    Incidentally, it is only those prescribed drugs that CAN do me some harm – in the form of attacking my thyroid or weakening my heart’s ejection rate or damaging my stomach lining, etc. However, those risks are certainly small compared to the gain.

    These targeted drugs all have various side effects. I will have to take them for the rest of my life. So why should I not be quite interested to learn about any credible approaches that are based PRIMARILY on diet (not supplements) that might mitigate those SE’s?

  31. WilliamLawrenceUtridge says:

    who is to say you cannot help prevent new metastases from developing as well? I have metastatic cancer. That is what is threatening me with early death – not the primary tumor which was surgically removed from me over 2 years ago.

    Since a metastasis is, as far as I know, essentially a tiny piece of cancer that breaks off of a lager tumor, I still don’t see the role for nutrition beyond merely supporting overall body health. That bit of tissue is already cancerous, you are again into a “treatment” space, not a preventive one, unless there are foods or drugs that prevent these small tumors from attaching to other tissues.

    All I was pleading for was to put nutrition squarely back into the SBM firmament. And indeed this is slowly starting to occur. There are, for example, “theoretical” reasons to explore the efficacy of a ketogenic diet as a way to enhance standard targeted or chemotherapies. No, I am not trying to start a debate about the merits of this kind of approach. I am just saying they are certainly worth investigating – preferably by medical professionals – and, of course, there are many others.

    Sure, nutrition should be science-based, and for the most part it is. But “diets” are far harder to study than “ingredients”. A ketogenic diet, from the tiny amount I know about it, might be helpful. On the other hand, it might be harmful. And tumors, which are evolutionary beasts in their own right, could evolve right around such approaches. But there are numerous different types of cancers, diets, nutrients and foods. To investigate them all is time consuming and expensive. I appreciate that you don’t have the time necessary to wait for science to pursue them – but you might be a case study of someone who offers the potential for future treatments.

    Finally I am aware that I personally might just be genomically “lucky” in suffering no significant side effects. However, I truly doubt it. But my detailed reasoning cannot be stated in a short posting (that is why my document is so long). Meanwhile, I not only have no side effects. I have also shown “dramatic” response (so far) to the drug combinations that I am following under my oncologists direction. However, he also supports my diet/supplement regime because I have proven that it “does no harm” and, more importantly, that it does not interfere with the metabolism of the targeted drugs that I take.

    Which is sound. Unfortunately (mostly for the rest of the world) you will never know if it was the drugs or the diet or both that lead to your survival. I do hope you survive to your normal lifespan and die peacefully in your sleep at the age of 102. Also do I hope that the diet is part of the reason, and it leads to a new way of treating cancers, because medicine could always use another effective weapon in its quiver.

  32. tjohnson_nb says:

    WilliamLawrenceUtridge wrote “Medicine is about curing diseases, increasing quality and quantity of life, and learning from its mistakes.”

    Fair enough, I think my problem is I’m looking for prevention of disease and modern medicine does not seem interested in that. For example, I subscribe to the theory that we humans would be better off, in terms of disease prevention, producing our own Vit C, like most other mammals – put forth by Pauling and Rath et al. Now who would have motivation to investigate this type of theory? How much would it cost to do a long term study of people taking megadoses of Vit C everyday and who would pay for it? You would think that health care insurer’s would be very interested in something that could reduce disease and so reduce claims. Obviously doctors and drug companies do not have any incentive to investigate – they make billions off disease. I think what we really need is a system where doctors get paid by how HEALTHY their patients are, rather than how sick they are – like doctors would be on payroll and get bonuses for low claims amounts. I know one thing – all this name-calling is not going to help anything.

  33. Chris says:

    tjohnson_np:

    I think my problem is I’m looking for prevention of disease and modern medicine does not seem interested in that.

    Perhaps reading this will help:
    http://www.historyofvaccines.org/

    Perhaps you are used to the luxury of living in an era where your chances of living past childhood have increased due to not getting tetanus, diphtheria, measles, etc, and not likely to be felled by waterborne diseases due to living where the water from your tap is pretty much clean, and the sewer system keeps microbes away from your food plants. Also, you can be pretty sure that the food you eat will not give you food poisoning (though E-coli does show up on produce every so often, and you are responsible for keeping your ownn kitchen clean). Perhaps you should read some fiction or history of the past century, like The Jungle by Upton Sinclair, The American Plague by Molly Crosby, Pox, An American History by Michael Willrich or even the reason for the first sled race with Balto the dog that started the annual Iditarod, it was not done just for fun.

    How much would it cost to do a long term study of people taking megadoses of Vit C everyday and who would pay for it?

    Have you heard of PubMed? It is this really cool index that lets you check out studies on various things, like Vitamin C supplementation:
    http://www.ncbi.nlm.nih.gov/pubmed/?term=vitamin+c+supplementation

    Obviously doctors and drug companies do not have any incentive to investigate – they make billions off disease.

    I am sure that if that were truly true then they would be the most vehement voices against vaccines, modern sanitation systems, food safety rules, exercise, anti-smoking campaigns, sensible diets and the rest of preventative medicine you are ignoring.

  34. elburto says:

    what we really need in the USis a system where doctors get paid by how HEALTHY their patients are, rather than how sick they are

    FTFY.

    At the risk of repeating myself, it’s foolish to generalise medicine/healthcare in terms of what happens in the US alone. That’s especially true given the unique combination of factors at work there, such as for-profit care and direct to consumer advertising of prescription pharmaceuticals, stark income disparities, etc.

    If you read my comment (it’s only four or five upthread from this) you’ll see that there are schemes in places with socialised healthcare. that do pay doctors for reducing the following factors in their registered patients:

    obesity

    drink/drug/nicotine addiction

    uncontrolled hypertension

    undiagnosed /treated dementia

    undiagnosed/treated mental illness

    unmanaged chronic illness (asthma, diabetes etc)

    teenage pregnancy and repeat teenage pregnancy

    and others.

    It’s been done for years here, and in other countries. There are programs to identify women at risk of spontaneous abortion, especially stillbirth, and to reduce that risk, likewise to recognise/empower victims of domestic violence.

    This is the danger of focusing on one practice in one country, and saying “What if we…?”. You run the risk of both ignoring the successes *and* repeating the mistakes made elsewhere.

    See also- antivax groups insisting that tracking the progress of immunised children vs that of their unvaccinated peers would “prove” that vaccinations cause autism, while insisting that researchers would be too scared to do so. When the existence of an entire country (Norway) that measures those, and other childhood variables is brought up, along with their results that show no difference between the two groups, the baying crowds at first seem somehow stunned that there’s a big world out there, and then declare “Those kids aren’t American, those results don’t count”.

  35. BillyJoe says:

    NeilFeldman,

    It is difficult to respond because of your condition and criticism seems unkind, but to me you represent a sizeable proportion of sceptics whose scepticism stops when it comes to themselves and their own ilness. In a nut shell, there is no point in using any treatments that don’t have an evidence base. Otherwise you end up like that guy who wants to live forever and therefore takes everything that could theoretically promote longevity. He takes 30 supplements a day and has an intravenous infusion once a week. And he doesn’t even have an ilness, he just a
    wants to live longer. The point is, why do any of these things when the chances of them being useful is essentially zero. Even treatments that should theoretically work, mostly do not pan out. The present state of play is that there is no good evidence that diet and supplements have any role to play in treating cancer or prolonging the life of those with cancer. So why not save yourself the burden of all those supplements and dietary rigidity and relax and enjoy whatever you feel like eating. And instead of spending all that wasted energy on your 64 page tome, why don’t you just relax and enjoy time with your family and friends.

  36. BillyJoe says:

    TJ,

    Chris and elburto have adequately responded to you. My advice is to stay away from the websites of the alternative medicine crowd. They will provide you with nothing but misinformation that distorts your perspective. I know, I’ve been there. There is a lot wrong with the practice of medicine and pharmaceutical companies, but it is counterproductive to exaggerate this problem beyond recognition by spreading the lies (even though you have not recognised them as such) that you have picked up on the Internet.

  37. pmoran says:

    @pmoran: If we are only going to accept as valid RCT studies on humans then I guess I am doomed. It will not happen to any large extent in my remaining lifetime. They are far too expensive a proposition – with only the promise of small financial return, if any.

    Simple phase l/ll studies would not cost a lot and they should quickly reveal a major benefit from ANY intervention. The NCCAM has plenty of funds for such purposes. Larger and more complex studies would be needed for more subtle effects such as life prolongation.

    The scientific literature is also not the only guide we have. “Alternative” medicine has its own chaotic, informal “system” of testing out cancer treatments. This produces hundreds of thousands of poorly documented N =1 studies, wherein each patient acts as their own “control”. This “system” takes note of any promising avenues within recent medical research and tests them out, wherever possible, with great enthusiasm (along with many unpromising but fashionable ones such as “Detox”). Any promising dietary intervention or nutrient would be seized upon as certainly as night follows day.

    The resultant data is of very poor quality, but there is a lot of it. Cancer patients and CAM practitioners then rummage around picking the eyes out of it for people like Dr Gorski and I to examine. We would thus almost certainly be the first to be aware of any “metabolic” intervention that seemed to be associated with genuine cancer remission or cure. Any convincing remission would be correlated with this one here and that one over there. It would not take many with the desired qualities to spark our interest. We may have our biases, but not inhuman ones that oppose research into anything showing real promise for cancer.

    The “alternative” system can provide moderately useful information in other ways, unfortunately so far of a negative kind, whenever good records are kept and results are published — rare events. See http://www.users.on.net/~pmoran/cancer/Alternative_studies.htm . Nearly all those pateints would have been on special diets and loads of nutrients.

  38. weing says:

    @tjohnson_nb

    “I know one thing – all this name-calling is not going to help anything.”

    I agree. So, why are you doing it? You seem ready to spend resources to test your pet ideas. I suggest you do what Chris suggests. I am reminded of an old saying. “A month in the lab will save you an afternoon in the library”

  39. Chris says:

    Thanks, BillyJoe and Weing. And I even forgot the other preventative measure done for medicine: vector control. One primary example is William Gorgas’ work in Panama, where I spent part of my high school years without fear of mosquito borne diseases.

    I don’t know how I forgot insect control to deal with plague (fleas), typhus (lice), and others.

  40. pmoran says:

    I subscribe to the theory that we humans would be better off, in terms of disease prevention, producing our own Vit C, like most other mammals – put forth by Pauling and Rath et al. Now who would have motivation to investigate this type of theory? How much would it cost to do a long term study of people taking megadoses of Vit C everyday and who would pay for it?

    Is there any point to such a study, now that it is known, as Pauling and Rath did not, that in dosages over about 500 mgm a day vitamin C is hardly absorbed or retained at all. Over that level increases in dose contribute little to plasma or tissue stores.

    See:– New insights into the physiology and pharmacology of vitamin C
    Sebastian J. Padayatty, Mark Levine
    CMAJ 2001;164(3):353-5

  41. Chris says:

    pmoran:

    Is there any point to such a study, now that it is known, as Pauling and Rath did not, that in dosages over about 500 mgm a day vitamin C is hardly absorbed or retained at all. Over that level increases in dose contribute little to plasma or tissue stores.

    But it creates some very expensive urine!

  42. NeilFeldman says:

    @BillyJoe: “And instead of spending all that wasted energy on your 64 page tome, why don’t you just relax and enjoy time with your family and friends.”

    Wow. Thank you so much for suggesting I give up my interest(s) in nutrition and eating a healthy diet (whatever that means). It really has been such a burden. And what a relief to know that I no longer need give any thought to the profound implications of some ideas promulgated by those obviously quackademically deluded doctors. Like, for example, those of Dr. Craig Thompson (CEO of Memorial Sloan Kettering Cancer Cancer) found here:

    http://www.youtube.com/watch?v=WUlE1VHGA40

    Or those of Dr. William Li of the Angiogenesis Foundation (http://www.angio.org/) and elucidated here:

    http://www.youtube.com/watch?v=C_5Z31mUmtc

    Or even those of Dr. Terry Wahls, currently conducting preliminary clinical trails on her diet/supplement therapy for treating advanced MS (Please, of course I know that is not cancer – I said I was looking at the “implications” of such these kinds of approaches):

    http://www.youtube.com/watch?v=KLjgBLwH3Wc

    I only posted video links because I do assume you know how to conduct your way around PubMed – if you were the least bit motivated, that is. However, I do understand that to do so might keep you from otherwise enjoying your life with your family and friends.

    But I digress. I so look forward to eating whatever I want now and discarding my burdensome list of supplements which, indeed, were costing me just shy of $100/month. That really is far too much a price to pay not to “enjoy”: fatigue, loss of all taste, mouth sores, hand-foot syndrome, nausea, intense stomach pains, diarrhea, dysphonia, hypothyrodism, weight loss, etc., etc. Really, it is a great idea – as I do so like how these drugs have turned my eyebrows (and other strategic hair) white. It gives me a rather distinguished look, don’t you think?

    However, since I am not longer a bona fide skeptic – can I ask for all those donations I have been making to CSICOP for all these years back? I think I may need the money to finance my trip down to Houston to meet with a certain doctor I keep reading about who claims he has cured cancer.

    Or was your advice not to pay any attention to nutrition and diet and for me to stop wasting my time on the subject really just an April Fools joke? Good one. I almost fell for it.

    @PMoran: Not one of those studies in your link is of interest to me. Nor is it at all what I am advocating when I plead for medical professionals to take the topic of proper nutrition as seriously as their oncology.

    I guess I may no longer be considered a skeptic in some people’s estimation. But ever since starting on my targeted therapy and changing my diet I haven’t felt better than in 20 years. I am content to settle for that. Meanwhile I will continue to explain to others – in detail – what I have been doing and why – simply because I care about their suffering unnecessarily.

  43. tjohnson_nb says:

    I think NeilFeldman is touching on what I have been trying to say – treating disease is more that just treating symptoms. Surgery, radiation and chemotherapy may be relatively good emergency measures for cancer but what do they do to address underlying causes? I suspect in 50 yrs we will look back and wonder at the way we treat cancer today.

  44. tjohnson_nb says:

    pmoran wrote :”Is there any point to such a study, now that it is known, as Pauling and Rath did not, that in dosages over about 500 mgm a day vitamin C is hardly absorbed or retained at all. Over that level increases in dose contribute little to plasma or tissue stores. ”

    See http://www.canceraction.org.gg/system/files/Hickey-Liposomal%20vit%20C.pdf

    “The shape of the vitamin C response curve results primarily from the rate of oral
    absorption, combined with an excretion half-life of approximately 30 minutes. A
    secondary effect concerns its absorption and release from body tissue compartments.
    Oral absorption of vitamin C is a two-phase, non-linear process; bodily levels are
    dependent on current intakes. Low intakes produce plasma levels below about 70 μM/L,
    with a long-half life, consistent with resistance to acute scurvy.[7] Higher single doses
    produce transient increases in plasma concentration, which the NIH group predicted to
    be limited to a maximum of 220 μM/L.[8]“

  45. WilliamLawrenceUtridge says:

    Neil, you are in a unique situation. Your supplement choices are probably harmless and probably cost you only money. Your dietary choices cost you only different flavours you might otherwise like. Scientifically your diet could not be recommended, but without evidence of harm it can not be advised against either. You are essentially undertaking an n=1 trial and may be spending the rest of your life doing it. My sympathies, I hope it works and you become a famed case study in long-term survival after metastases. In a similar situation I might be tempted to undertake a similar n=1 trial (or I might decide to eat nothing but pizza and ice cream for as long as I can). I don’t judge or condemn you for what you are doing – you are faced with an unenvious choice of two uncertain outcomes maximizing your quantity of life versus your enjoyment of it (in the form of what you choose to eat). It’s your time and you get to spend it as you want; I’m very pleased your hope is guiding you towards seriously investigating the scientific literature rather than loons and quacks. Best wishes. Incidentally, you might be interested in this page from the Mayo Clinic.

    @tjohnson_nb

    I think NeilFeldman is touching on what I have been trying to say – treating disease is more that just treating symptoms. Surgery, radiation and chemotherapy may be relatively good emergency measures for cancer but what do they do to address underlying causes? I suspect in 50 yrs we will look back and wonder at the way we treat cancer today.

    Surgery, radiation and chemotherapy do nothing to address underlying causes because they are not preventive interventions. They are treatments for when cancer has already occurred. To pick an analogy, after someone is shot, does locking up the gun help them in any way?

    Science does much to address underlying causes. That’s why we have dietary recommendations like eating unprocessed foods with lots of fruits and vegetables, we are urged to avoid smoking (the #1 preventable cause of fatal cancers), get pap smears, get both boys and girls the HPV vaccine (which genuinely prevents cancer!), for high-risk women have the option of preventative mastectomies, as well as the more questionable recommendations like avoiding acrylamide, and that plastic in water bottles, and doubtless numerous other recommendations that don’t come to mind. Yes, in 50 years we will look back and regret all the lives lost because we lacked the knowledge. But right now, we’re now. We don’t have that knowledge now, so we do the best we can.

    What you seem to be asking for is perfect knowledge about all causes of cancer, and the ability to prevent them. Yes, that would be delightful. Please let us know when you have all such answers, they will be invaluable and save a lot of time. Please ensure you include information about risk-free treatment options as well, we’re also interested in those.

  46. WilliamLawrenceUtridge says:

    @tjohnson

    The document you link to appears to be an unpublished paper. It gives the cursory appearance of being a peer-reviewed journal article, but it is not. It reports on only two subjects, making it virtually useless except as a case study. It is published by an agency that supports orthomolecular oncology. In case you didn’t know, orthomolecular medicine is predicated on the assumption that high doses of vitamins are a panacea for essentially every medical condition on the plant. In other words, they start with a hypothesis then shoehorn data to fit it. It is not an organization I would trust. They recommend a variety of supplements based on questionable data and no high-quality data (if such data existed, the intervention would be integrated into conventional medicine – once again demonstrating that CAM is either redundant or contrary to real medicine). A comparison I always like to make – you are essentially taking them on their word that supplements are potent cures for cancer or other diseases, on the basis of animal studies or small human trials. Would you take a new drug that had only been tested on rats? Because these guys mostly recommend major dietary changes or large doses of expensive supplements (for what you’re getting) on the basis of rat studies.

    Supplement manufacturers are just as happy to to sell you ineffective medicines as drug manufacturers, they just have much, much more lax restrictions.

    Vitamin C is a fairly well-understood molecule. Pauling recommended it only later in his career, coasting on his Nobel prizes (neither of which were for medicine; one was for peace). Most of science has advanced beyond the 1970s, when Pauling was claiming vitamin C could cure just about anything. Two points regarding vitamin C and cancer are worth noting. First, Pauling died of cancer (of the prostate) despite taking high doses of vitamin C on a regular basis. A single example does not prove much of course, but it’s still worth noting. Second, there is evidence that high-dose vitamin C might interfere with chemotherapy. This is bench research, so similar caveats apply. But it speaks to the risks of giving medical advice without evidence – you don’t know what the effects might be. Recommendations by orthomolecular loons to infuse vitamin C directly into the blood may result in their patients/victims developing chemotherapy-resistant cancer or dying from a disease that might otherwise be curable.

  47. NeilFeldman says:

    @WilliamLawrenceUtridge: Thanks for your thoughtful response. I think we are pretty much in full agreement. Regarding that link… were you under the impression that I thought that sugar causes cancer? That is not my position at all. This is more along the lines of what I am interested in:

    Tumors can and will always manage to get sufficient glucose even if the blood glucose level falls way below “normal”. And, of course, starving oneself of sufficient glucose will “work” insofar as it can kill both the tumor and the host. But that is not a very effective strategy as far as the host goes. :)

    But that brings up the issue of ketones. There are two features of the “Warburg Effect”. One – tumors need far more glucose to “run” on because they are primarily relying on aerobic glycolysis (i.e. fermentation) rather than oxidative phosphorylation (normal respiration). Aerobic glycolysis is not as “efficient” a source of energy release from glucose as is respiration – so much more glucose needs to be consumed by the tumor. However, it is a second observation from Dr. Warburg that is of primary interest here. Not only does aerobic glycolysis rely heavily on glucose for fuel but strictly glycolytic tumor cells cannot use fatty acids for their metabolism. So, the theory goes, if you can convert the body’s overall metabolism to run primarily on fatty acids (i.e. ketones – ketonic) and not on carbohydrates then you may give normal cells “back” an advantage that cancer cells already seem to have – their ability to survive in otherwise unfavorable environments.

    The possibility of using dietary carbohydrate restriction therapeutically to allow the host to compete against the tumor has been raised by several investigators, (see the following) but the idea still requires lots more scrutiny:

    “Effects of a ketogenic diet on tumor metabolism and nutritional status in pediatric oncology patients: two case reports.”
    http://www.ncbi.nlm.nih.gov/pubmed/7790697
    “OBJECTIVE: Establish dietary-induced ketosis in pediatric oncology patients to determine if a ketogenic state would decrease glucose availability to certain tumors, thereby potentially impairing tumor metabolism without adversely affecting the patient’s overall nutritional status.”

    “Is There a Role for Carbohydrate Restriction in the Treatment and Prevention of Cancer?”
    http://www.medscape.com/viewarticle/757713
    “ABSTRACT: Over the last years, evidence has accumulated suggesting that by systematically reducing the amount of dietary carbohydrates (CHOs) one could suppress, or at least delay, the emergence of cancer, and that proliferation of already existing tumor cells could be slowed down. This hypothesis is supported by the association between modern chronic diseases like the metabolic syndrome and the risk of developing or dying from cancer. CHOs or glucose, to which more complex carbohydrates are ultimately digested, can have direct and indirect effects on tumor cell proliferation: first, contrary to normal cells, most malignant cells depend on steady glucose availability in the blood for their energy and biomass generating demands and are not able to metabolize significant amounts of fatty acids or ketone bodies due to mitochondrial dysfunction. Second, high insulin and insulin-like growth factor (IGF)-1 levels resulting from chronic ingestion of CHO-rich Western diet meals, can directly promote tumor cell proliferation via the insulin/IGF1 signaling pathway. Third, ketone bodies that are elevated when insulin and blood glucose levels are low, have been found to negatively affect proliferation of different malignant cells in vitro or not to be usable by tumor cells for metabolic demands, and a multitude of mouse models have shown antitumorigenic properties of very low CHO ketogenic diets. In addition, many cancer patients exhibit an altered glucose metabolism characterized by insulin resistance and may profit from an increased protein and fat intake. In this review, we address the possible beneficial effects of low CHO diets on cancer prevention and treatment. Emphasis will be placed on the role of insulin and IGF1 signaling in tumorigenesis as well as altered dietary needs of cancer patients.”

    “Targeting energy metabolism in brain cancer: review and hypothesis”
    http://www.nutritionandmetabolism.com/content/2/1/30
    “ABSTRACT: Malignant brain tumors are a significant health problem in children and adults and are often unmanageable. As a metabolic disorder involving the dysregulation of glycolysis and respiration, malignant brain cancer is potentially manageable through changes in metabolic environment. A radically different approach to brain cancer management is proposed that combines metabolic control analysis with the evolutionarily conserved capacity of normal cells to survive extreme shifts in physiological environment. In contrast to malignant brain tumors that are largely dependent on glycolysis for energy, normal neurons and glia readily transition to ketone bodies (β-hydroxybutyrate) for energy in vivo when glucose levels are reduced. The bioenergetic transition from glucose to ketone bodies metabolically targets brain tumors through integrated anti-inflammatory, anti-angiogenic, and pro-apoptotic mechanisms. The approach focuses more on the genomic flexibility of normal cells than on the genomic defects of tumor cells and is supported from recent studies in orthotopic mouse brain tumor models and in human pediatric astrocytoma treated with dietary energy restriction and the ketogenic diet.”

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