Oddly enough, I’m more tired this morning than I was on Friday.
That’s the sort of thing that happens when I actually do as much work over the weekend as I often do on two typical weekdays. The reason is that I’ve suddenly found myself with an unexpected promotion, and–oh, by the way–there’s stuff that needs to be done on Monday. Consequently, my originally intended topic for Monday will have to wait until Tuesday or Wednesday, mainly because it might require a bit of thought. That’s OK. It’ll wait. Besides, it’ll be much more useful and educational if I have a little time to think about it. Who knows? Maybe I can do a post as useful and interesting as the one I did about Steve Jobs a couple of months ago.
Besides, the resident woo-friendly antivaccinationist “columnist” at the Chicago Tribune, Julie Deardorff, didn’t disappoint yesterday. In fact, I had been beginning to wonder if perhaps she had started to turn away from the dark side, as I hadn’t seen anything really credulous from her in a while. Granted, that could just be because I haven’t been monitoring her the way I used to a while back. I don’t know. But yesterday she rose to heights to which she has seldom aspired before–or, perhaps I should say she sank to depths to which she has seldom sunk before–as she decided to do an article on how you can supposedly treat cancer with “natural” diets. True to form, she falls for every bit of woo that comes her way. Equally true to form, she falls for the oldest “cancer testimonial” bit in the book, one that I’ve written about multiple times before, including very recently and far, far back in the depths of time, all the way at the very dawn of this blog.
Why am I not surprised?
Ms. Deardorff begins:
David Servan-Schreiber was 31 when he was diagnosed with a walnut-size brain tumor and given 6 months to live. After surgery and chemotherapy, the young neuroscientist asked his oncologist if he should change his diet.
“Eat whatever you like,” his doctor told him. “It won’t make much of a difference.”
Servan-Schreiber thought otherwise. For the next 15 years, he threw himself into researching the body’s natural defenses; today he believes dietary and other lifestyle changes are powerful and underutilized cancer-fighting tools.
“Cancer lies dormant in all of us,” he wrote in his new book, “Anticancer: A New Way of Life” (Viking, $25.95). “But our bodies are also equipped with a number of mechanisms that detect and keep such [defective] cells in check.”
That’s true enough, as far as it goes, but looking at the claims it looks as though they go too far. Dr. Servan-Screiber is clearly a highly intelligent man, but he wouldn’t be the first person whom serious disease led down the path of dubious conclusions. Moreover, what saved his life is almost certainly not the dietary manipulations and other woo in his book, but good old-fashioned surgery and radiation therapy. In other words, he’s almost certainly an outlier. There’s nothing magical about that, and like many outliers who happened to have tried “alternative” treatments in addition to conventional treatments, he attributes his survival largely to the woo rather than the conventional treatment. Without reading the book, it’s hard for me to say how valid his conclusions are, but from the description by Deardorff, they sound overblown at best and highly dubious at worst:
Cancer rears its ugly head when things get out of balance, Servan-Schreiber said in an interview. And that can happen if the bad guys that promote the growth of cancer cells (tobacco, excessive alcohol, excessive sugar, hydrogenated fats, environmental pollutants) outnumber the good guys that support our natural defenses (cancer-fighting phytochemicals found in fruits, vegetables, herbs and teas; physical activity; and stress management techniques).
But conventional treatment, while indispensable, focuses on a single target: destroying cancer cells. Doctors rarely address the other side: teaching patients how to fortify themselves using nutrition, exercise and stress management techniques to create an inhospitable environment for cancer.
There’s no doubt that diet is a risk factor for certain types of cancer, but it’s also not a risk factor for others. For example, there clearly are dietary factors that can increase or decrease the risk of developing colon cancer. Alcohol, for instance, is a risk factor for certain cancers, such as pharyngeal (throat), laryngeal (voice box), esophageal, liver, and breast, and possibly colorectal. There is evidence linking intake of fruit and vegetables to lowered cancer risk. Putting it all together, though, a lot of the risks due to diet tend to come more from being obese, which increases the risk of some cancers, rather than the actual diet itself. From my perspective, eating a healthy, well-balanced diet is more important than any one food or nutrient. There is also some evidence that, for example, vitamin D might lower the risk of some cancers, but it’s not clear that that risk reduction doesn’t come at a price, given that vitamin D does not appear to reduce the overall risk of death from cancer in the general population.
There’s also little doubt that at least moderate exercise also decreases the risk of cancer. Indeed, I’ve even written about such studies before in the past. Exercise is also good to do just in general for cardiovascular health. None of this is rocket science or outside the mainstream. But inevitably, when someone like Dr. Servan-Schrieber decides that lifestyle is a cancer-fighting tool, he’s right to a point but takes it far beyond what evidence supports. In most cases, the alteration in cancer risk is relatively small in most cases, at least in comparison to the claims made for it. For example, there’s no evidence that diet is able to prevent cancer recurrence, at least not enough to justify this sort of statement:
“Cancer is all about residual cells left behind in the body,” said Dr. Keith Block, medical director of the Block Center for Integrative Cancer Treatment in Evanston, where nutrition and lifestyle modifications are an essential part of all treatment plans. “When you ignore the environment where cancer lives, the disease in those residual cells comes back to haunt at a more aggressive level. It’s irresponsible to send patients home without strategies and interventions to reduce the risk of recurrence.”
What often happens, however, is that patients are told to eat whatever they want–even though research has shown the traditional Western diet can promote cancer growth–as long as they take in enough calories. When Susie Sondag of Chicago was diagnosed with breast cancer in 1999 at age 29, her doctors told her to eat meat and starch and to take the high-calorie supplement Ensure to counteract any weight loss.
“My response was ‘thanks for sharing,'” said Sondag, who instead changed to a raw and vegetarian diet.
Actually, there was nothing that her doctors said that was wrong, and no evidence that a raw vegetarian diet would have made any difference. Of course, the reason that data doesn’t show what Ms. Deardorff wants is because it’s obviously the evil big pharma conspiracy at work:
If garlic, broccoli, green tea or jogging could be patented, things might be different. Large, high-quality clinical trials would be held and oncologists would write out an anti-cancer grocery list. But although there’s a great deal of scientific evidence showing an effect of foods on cancer growth, no one wants to fund the large, controlled trials because no profits can be made.
Let’s see. A quick search of PubMed for “cancer and exercise” revealed 4,665 articles, while a search for “cancer and diet” revealed 24,912 articles. Heck, there are 474 articles on “cancer and broccoli” alone and 1,150 on “cancer and green tea.” Searching Clinicaltrials.gov shows 29 studies looking at cancer and green tea, six studies of broccoli and cancer, including one looking at preventing lung cancer in smokers with broccoli sprout extract, and 168 studies looking at cancer and exercise. That’s why it irritates the hell out of me to hear the claim that no one studies this stuff. As for large “controlled” trials, for for a lot of this stuff, it’s very difficult to do truly controlled trials. Retrospective evidence is sometimes the best we can manage.
I have to admit, looking at Dr. Servan-Schrieber’s book and his website, I was curious exactly what kind of cancer he had. I couldn’t find it on his website or in the Amazon blurbs, which I found rather strange. If I were writing such a memoir, I’d say exactly what kind of brain cancer it was right off the bat and I’d point it out in every interview. Still, what’s maddening about him is that he mixes the sensible with the dubious. Here’s the sensible:
With respect to conventional treatment, I think every patient should have at least two different opinions from two different oncologists. Every doctor I know who has cancer seeks at least two different opinions, more often three or four. It’s normal to explore what are all the options available because there are so many.
Actually, going much beyond two or three opinions, except in the case of rare tumors, is more likely to confuse than enlighten, but in general the above is sensible. Here’s the questionable:
But doctors such as Servan-Schreiber and Block say that no one ever regretted trying, especially when there are no negative side effects to eating garlic, leeks and scallions. They also warn that false hopelessness is far worse than false hope. Because even fatalism has been scientifically proven to affect a cancer patient’s outcome.
Unfortunately, “Secret”-style wishful thinking aside, fatalism has not been “scientifically proven” to affect a cancer patient’s outcome. In fact, the latest research suggests that attitude does not affect a cancer patient’s chances of surviving his or her cancer. That’s not to say that having a positive attitude doesn’t have numerous other benefits, but improving the odds of survival is not among them. Dr. Servan-Schrieber has even gone so far as to write a book entitled Instinct to Heal, which advocates what he calls the “new emotion medicine” and methods that, he claims, can “cure stress, anxiety, and depression without drugs or psychotherapy.” These methods include clear woo such as heart coherence, eye movement desensitization and reprocessing, and even what he calls the control of qi through acupuncture. All of these are, of course, supported primarily by anecdotes.
It doesn’t surprise me that Julie Deardorff would lap up whatever someone like Dr. Servan-Schrieber dishes out, be it sensible and science-based or woo. Unfortunately, she can’t tell the difference. Of course, why should she? After all, an MD/PhD like Dr. Servan-Schrieber apparently can no longer tell the difference himself, something that I, as a fellow MD/PhD, find very sad.