On the magical prevention of pancreatic cancer

I don’t know how I missed this article. I really don’t. It’s over a week old, and it’s exactly the sort of irritating cancer quackery that normally draws me irresistibly to it to slather it in a heapin’ helpin’ of not-so-Respectful Insolence. After all, being a cancer surgeon and all, I really, really hate cancer quackery, even more so than I detest other forms of quackery. I hate it even more when it comes from Mike Adams, creator of NaturalNews.com, that one-stop shop for all things quackery, anti-vaccine, and conspiracy. Basically, it’s an example of Mike Adams discovering something about cancer biology that scientists have known for decades, hyping it up as though he was the first person to realize it, and then drawing exactly the wrong conclusions about it. This time around, it’s Adams doing what Adams does best (completely misunderstanding science) in a post entitled Pancreatic cancer takes 20 years to grow into detectable tumors – here’s how to halt it today.

Before I go on, in all fairness I should point out that Adams takes a study that appeared in Nature a couple of weeks ago and runs off the cliff into the crazy with it, as only he can. At least, I’m pretty sure this must be the study; as usual, Adams doesn’t cite the actual article or provide a link to the study, but there’s only one recent study in Nature that appears to match the findings that Adams describes. This study, published by investigators at Johns Hopkins and Harvard, reports on the results of experiments in which they sequenced the genomes of seven metastases and compared them to the primary tumors. They found that the clonal populations of cells in the metastates reflected those in the primary tumor. Moreover, by doing a quantitative analysis of the timing of the evolution of pancreatic cancer from precursor lesions to metastases, the authors came up with an estimate that it takes at least a decade between the cancer-initiating mutation and the development of the the parental non-metastatic cell. In other words, there’s a decade between the first major mutation and the first frankly malignant cancer cell. They then estimated that it took the cancer an additional five years to develop the ability to metastasize and that patients usually died within two years after that. Part of the reason this is so interesting is that it provides insights into the biology of pancreatic cancer and why there are almost always metastases (or at least microscopic metastases) by the time the tumor is diagnosed.

Let’s see what Mike Adams can do to this fascinating biology:

This is a huge story for five very important reasons:

Reason #1) The idea thrown around by cancer doctors that cancer is a “spontaneous disease” that strikes randomly and without warning is pure bunk. In order to “get” cancer, you actually have to GROW cancer for two decades! It doesn’t just suddenly appear like magic.

Ugh. Here we go again. Adams thinks that, just because the effects of a random event can take nearly two decades to make themselves manifest as pancreatic cancer, it somehow means that the disease is not “random.” Here’s a hint: The time between the inciting event and the development of a disease is a separate issue. Adams is attacking a massive straw man anyway, as is his wont. No one says that cancer has to “appear like magic.” What science says is that cancer-initiating mutations occur in a stochastic fashion and that it takes more than one mutation to drive a normal cell into becoming cancerous. This is known as the “two hit” or “multiple hit” hypothesis. Also known as the Knudson hypothesis, this hypothesis states that multiple “hits” are required in both oncogenes (genes that, when too active or mutated to become too active, can cause cancer) and tumor suppressor genes (genes that normally keep cell growth in check and, when inactivated, can cause cancer).

Reason #2) When cancer doctors diagnose you with pancreatic cancer and say things like, “Good thing we caught it early!” they are full of bunk yet again. They didn’t catch it early — they caught it late! Almost 20 years too late.

I can’t recall ever having heard a doctor who treats pancreatic cancer say anything like “Good thing we caught it early!” except, perhaps, in a relative fashion, meaning that the tumor is at least still operable. That’s because even small pancreatic cancers that can be completely resected with a pancreaticoduodenectomy (a.k.a. the Whipple operation) will still within five years kill approximately 70-80% of these patients with “completely resected” tumors. Unlike Mike Adams, who apparently thinks that fairy dust and magic supplements will cure or prevent pancreatic cancer, real doctors know that pancreatic cancer is a deadly foe against which we (and the patient) lose far more often than we win. Any physician who takes care of pancreatic cancer patients will tell you how humbling that is. Moreover, contrary to Adams’ implication, real doctors already know that it takes at a minimum several years for pancreatic cancer to reach the point of causing symptoms or even being detectable on imaging.

Next, Adams makes a statement that is, shockingly, semi-reasonable. You know, of course, that that can’t last, and, sure enough, it doesn’t. But, first, let’s see what Adamas says:

Reason #3) If it takes 20 years to grow cancer tumors to the point where you get diagnosed with aggressive pancreatic cancer, then that means you have 20 years to change your lifestyle and stop the cancer!

Well, maybe. Here’s the problem. Well, actually, many problems. In order to stop pancreatic cancer that early, you have to know which specific dietary and lifestyle alterations can halt the progression of cancer, be it pancreatic or another kind. You also have to have a good handle on who’s actually harboring microscopic pancreatic cancer, or else you face the same problem we face with screening patients to detect cancer early and preventative therapies: You have to screen or treat a lot of patients who would never develop the disease in order to detect one cancer or prevent just one patient from getting it, respectively. Unfortunately, whatever Adams claims to the contrary, we don’t have the data to tell us what those interventions should be. For instance, we know that smoking increases the risk of pancreatic cancer; so stopping smoking is a good idea. We don’t, however, know what foods, drugs, or lifestyle alterations, if any, prevent or reverse developing pancreatic cancer.

Adams, of course, thinks that he knows. He claims that eating lots of sugar produces cancer; so you have to stop eating processed sugar in order to stop pancreatic cancer in its tracks. Now, there may well be good reasons to avoid processed sugars, but there’s no good evidence that doing so will cut your risk of pancreatic cancer. The risk factors for pancreatic cancer are pretty well known, too. They include increasing age, cigarette smoking; race (it’s more common in African Americans); diet (there are indications that high meat and fat intake are associated with increased risk, which makes sense because chronic pancreatitis is associated with pancreatic cancer and high fat diets are associated with pancreatitis); cirrhosis; surgery on the upper GI tract; certain chemical exposures (possibly); and known genetic mutations, like BRCA2 and HNPCC. Processed sugar isn’t one of them.

Neither is vitamin D deficiency, although Adams seems to tout that particular vitamin as being a virtual cancer cure-all (or, more appropriate, a cancer prevent-all). While it is true that certain observational studies regarding vitamin D and cancer have suggested a protective effect against cancer. There are even biologically plausible reasons to think that low vitamin D levels are associated with certain cancers and that supplementing vitamin D to boost its levels could well decrease the risk of certain cancers, even though it’s not clear yet whether vitamin D deficiency can cause or contribute to cancer or there are confounding factors that produce the correlations observed thus far. One randomized trial of nearly 1,179 healthy postmenopausal women who took daily supplements of calcium (1,400 mg or 1,500 mg) and vitamin D (25 μg vitamin D, or 1,100 IU) or a placebo for 4 years concluded that te women who took the supplements had a 60 percent lower overall incidence of cancer. Unfortunately, there was no vitamin D-only group, and the primary endpoint of the study was not the incidence of cancer, but rather osteoporotic fractures. Because cancer was not the primary endpoint, it’s hard to tell if this decrease was real, and it is not clear to me whether cancer incidence was an endpoint built into the original study or whether it was tacked on later, after the study was under way. In any case, although it is biologically plausible that vitamin D might decrease the risk of various cancers, it is by no means settled whether it does so or not, for which cancers it does it, and whether there are any risks to long term vitamin D supplementation that might make it less attractive as a preventative strategy. More importantly, even if vitamin D does decrease the risk of pancreatic cancer, it can’t possibly live up to Adams’ claims for it:

If you combine vitamin D and selenium nutrition with other anti-cancer nutrients such as fresh vegetable juice (on a daily basis), omega-3 fatty acids, a wide variety of fresh fruits (including citrus and berries), and even red wine (rich with resveratrol), you will create an internal biological environment in which cancer tumors just can’t grow at all.

This is especially true if you pursue a more alkaline diet that’s rich in vegetables and green foods rather than acidic substances such as sugar, fried foods and caffeine.

Combine all this with some regular exercise, good sleep, stress reduction habits and strict avoidance of cancer-causing chemicals, and you’ve got a recipe for blocking virtually all tumor growth in your body.

Because to Adams everything natural is good and anything “synthetic” is bad. You think I’m exaggerating when I characterize Adams’ views on this matter this way? Wonder no more:

Of course, for all this to work, it is VITAL that you avoid all synthetic chemicals: Do not take pharmaceuticals; do not use conventional perfumes, skin lotions, shampoos or other personal care products; do not use conventional laundry detergents (they’re filled with cancer-causing fragrance chemicals); do not use anti-bacterial soaps; do not cook on nonstick cookware; do not drink fluoride in your water… basically just get all the toxic chemicals out of your house and out of your life.

So let’s recap. According to Mike Adams, if you only get rid of all the processed sugar in your diet, start taking vitamin D supplements, go vegan, and start exercising, you don’t have to worry about pancreatic cancer (or, for that matter, any cancer). It’s so simple! Nothing natural can hurt you and nature doesn’t want you to die of pancreatic cancer. (Well, actually, it doesn’t care if you die of pancreatic cancer. As they say, life is a sexually transmitted terminal disease.) Don’t get me wrong. There’s nothing wrong with going vegan, except that it’s hard for most people to get adequate nutrition on a vegan diet because it takes a lot of work to do so, particularly to insure adequate protein intake. At the very least, there’s little doubt that eating more fruits and vegetables and less meat is healthier than the average American’s diet. Where Adams goes woo is when he attributes magical properties to these “natural” interventions, claiming that they can completely halt the progression of cancer or even render tissues completely inhospitable to cancer cells that may develop and try to grow there. Would that were true!

The appeal to magic doesn’t stop there, though. To Adams, if you use even a single synthetic chemical, it ruins everything! So powerful are the evil humors contained within “synthetic” chemicals that even a tiny bit will ruin all that natural goodness and lead you to get pancreatic cancer and all sorts of other horrifying diseases. What a wonderful out! If you do what Adams says and get pancreatic cancer anyway, he can just respond that you must have used something with “synthetic” chemicals. After all, unless you move to some remote area of the planet to live off the land, making your own tools, gathering and growing your own food, you will come in contact with those eeeevilll “synthetic” chemicals. It’s unavoidable in modern civilization. Adams’ conception of disease and medicine is the very image of Luddism, but, ironically, even though he would never admit it, his frightening people out of using anything that smacks of “synthetic” chemicals is an implicit admission that natural, whether “better” or not, is definitely not stronger if it can’t withstand even minor contact with them.

In fact, more than anything else, Adam’s “out” reminds me of a similar “out” that psychics and promoters of the paranormal use. Just substitute “skeptic” for those nasty chemicals. So powerful, apparently, is skepticism that even one skeptic can stop a psychic’s powers from working. You have to believe. Similarly, to Adams, so powerful is even a hint of “synthetic chemicals” that it will ruin all that “natural” living and make you sick.