Categories
Cancer Complementary and alternative medicine Movies Quackery Skepticism/critical thinking

The quack view of preventing breast cancer versus reality and Angelina Jolie, part 2

After yesterday, I really hadn’t planned on writing about Angelina Jolie and her decision to undergo bilateral mastectomies again, except perhaps as a more serious piece next week on my not-so-super-secret other blog where The Name of the Doctor is revealed on a weekly basis. As I mentioned yesterday, there are a number of issues about the decision that could use my professional attention, from the process, to the evidence, to the issue of how the surgery was handled. Oh, and if I do decide to do that I’m sure I won’t be able to resist a mention of some of the quackery that oozed out from underneath the darker recesses of the quackosphere, but the division of labor I enforce usually reserves the more “Insolent” takedowns for this blog. That means I can’t resist the pull of the other quacks who’ve descended upon Angelina Jolie in droves. As a result, I can’t resist taking a look at a carefully selected subset of them.

First, it was Mike Adams, as I mentioned yesterday. This is Mikey, though, and for Mikey too much is never enough. So he decided to go for another bite at the apple with a post entitled
How Angelina Jolie was duped by cancer doctors into self mutilation for breast cancer she never had. The first thing I noticed is that once Adams latches on to an analogy he never lets go. He’s a lot like a shark ripping into a kill or a Nile crocodile grabbing onto a hapless gazelle who wanders too close. In this case, the analogy is the same. I ignored it last time, but this time around I can’t:

With her breasts removed, she says her risk of breast cancer is now reduced to a mere 5 percent. The same bizarre logic can also be applied to men who cut off their testicles to “prevent testicular cancer” or people who cut out their colons to “prevent colorectal cancer.” But that would be insane, so nobody does that, because one of the most basic principles of medicine is that you don’t subject patients to the considerable risks and costs of surgery and anesthesia to remove organs that have no disease!

Wrong, Mike. Actually, people do remove their colons to prevent colorectal cancer. Adams is even more ignorant than I thought, apparently never having heard of, for example, familial adenomatous polyposis (FAP). It’s a condition in the colon in which there are numerous polyps that predispose patients with condition to colon cancer such that by age 40 or 50 the risk approaches 100%. The treatment? Prophylactic colectomy. Yes, that’s right, removal of the colon to prevent colorectal cancer. There’s also hereditary non polyposis colorectal cancer (HNPCC), which involves a mutation in a gene with a similar function to that of BRCA1, the gene in which Angelina Jolie had a mutation that predisposed to breast cancer, specifically a gene involved in the repair of DNA damage. The risk from HNPCC isn’t as high as it is for FAP, but it’s plenty high, more than high enough to justify prophylactic surgery to avoid colon cancer.

As for the example of testicular cancer, there are no known mutations that predispose to testicular cancer at nearly as high a risk as the risk for breast cancer conferred by BRCA1 and BRCA2 mutations or for colorectal cancer conferred by FAP or HNPCC mutations. Also, testicular cancer is a rather uncommon cancer compared to breast cancer and colon cancer, which means that the chance of getting it in the average man is much smaller than the risk of colorectal cancer. It’s a dumb example, comparing apples and oranges. Of course, dumb examples are Adams’ stock-in-trade.

Next up, Adams tries to make you think that he understands more about cancer than he actually does. First, he claims that women are being “lied to” and that the readers of the New York Times who read it. Then he writes:

The very idea that breast cancer is a “percent risk” is a complete lie. In reality, everyone has cancer micro-tumors in their bodies, including myself. Cancer is not a disease you just “get” like being randomly struck by lightning. It’s something you must “manage” or “prevent” day by day, meal by meal, through a lifestyle choice that involves vitamin D supplementation, nutrition, superfoods, vegetable juices and avoidance of cancer-causing chemicals and radiation.

So when a doctor says you have a “chance” of getting cancer, what he’s implying is that you have no control over cancer, and that’s an outright lie. Cancer quackery, in other words.

In fact, this is a very common theme among the quacks, namely that you have near-absolute control over whether you get cancer or not. For example, it’s echoed by one of my most despised cancer quacks, Robert O. Young, who has also jumped all over the Angelina Jolie case to write Acids From Lifestyle and Dietary Choice Causes Breast Cancer NOT the BRCA1 GENE. Yes, he even uses all caps in his titles, one true sign of a quack. To Young, The One True Cause of Breast Cancer is not any sort of gene mutation, but rather “acid” from diet and organochlorines. I can’t tell for sure. He can’t seem to make up his mind. What is clear based on the evidence is that, even if organochlorides are a major cause of breast cancer (and the evidence cited is not that strong), they are no way as potent a cause as BRCA1 mutations.

Meanwhile, Adams can’t resist flaunting his ignorance:

The very idea that breast cancer is a “percent risk” is a complete lie. In reality, everyone has cancer micro-tumors in their bodies, including myself. Cancer is not a disease you just “get” like being randomly struck by lightning. It’s something you must “manage” or “prevent” day by day, meal by meal, through a lifestyle choice that involves vitamin D supplementation, nutrition, superfoods, vegetable juices and avoidance of cancer-causing chemicals and radiation.

So when a doctor says you have a “chance” of getting cancer, what he’s implying is that you have no control over cancer, and that’s an outright lie. Cancer quackery, in other words.

While it’s true that all of us have “cancer micro-tumors” within our bodies, it’s a complete misunderstanding of risk. The observation that we all have cancerous cells within our bodies says nothing about the risk that one or more of them will progress to a macroscopic cancer that will actually threaten health and life, nor does it mean that you have to “manage” or “prevent” cancer day by day. Yes, there are cancers that are greatly influenced by lifestyle (lung cancer being caused by smoking is perhaps the strongest example), but there are also cancers that have a clear genetic cause. BRCA1-caused breast cancers and ovarian cancers are examples of these, and all the “lifestyle interventions” in the world won’t significantly decrease the risk of cancer. Well, all save one, but the quacks won’t like it. I’m referring, of course, to Tamoxifen, a product of what Adams would view as the evil of big pharma. Adams further claims:

Indole-3-carbinol (I3C), by the way, a natural chemical found in cruciferous vegetables like broccoli and cabbage, offers powerful prevention against BRCA1 gene expression. But you don’t hear cancer doctors telling women to “eat more cabbage” because that doesn’t make the cancer industry any money. You can buy I3C as a potent nutritional supplement from a variety of sources. It’s literally cancer prevention in a capsule.

So the whole “chance” argument is pure quackery. There is no chance involved in whether you get cancer. It’s all cause and effect. You are either living a pro-cancer lifestyle and therefore growing cancer, or you’re living an anti-cancer lifestyle and keeping cancer in check so that it never becomes a problem. Cause and effect is what results in either the growth of cancer tumors or the prevention of cancer tumors. There is no “luck” involved.

First off, Adams gets it wrong (as usual). I3C doesn’t suppress BRCA1 expression. Rather, it increases it. That’s how it’s thought to work to potentially decrease the risk of certain cancers. As one of my readers pointed out, making more BRCA1 doesn’t do much good if the BRCA1 produced is not functional because of a mutation. The second part of Adams’ “argument” (if you can call it that) is even more ridiculous. Every biological process involves a stochastic process; i.e., chance. The claim that there is no “luck” involved betrays such a profound ignorance of biological processes that it’s hard to fathom how Adams can walk and breathe at the same time.

One also can’t help but note that Adams once again takes the opportunity to flog his quack New Cancer Solutions Healing Summit, just as he did last time.

Sadly, Adams is not alone in his denialism of biology. Remember Sayer Ji? He’s the guy who claimed that vaccines are “transhumanism” that subverts evolution and made one of the most spectacularly clueless arguments against evidence-based medicine I’ve ever seen, dismissing it as a “coin flip.” This time around, he’s denying that genes cause cancer, the same way that Adams did yesterday, but he tries to put a “science-y” sounding gloss on the statement:

Despite the commonplace refusal of so-called ‘evidence-based medicine’ to acknowledge the actual evidence of genetics, we moved into a Post-Genomic era over a decade ago following the completion of first draft of the entire human genome in 2000. At that moment, the central dogma of molecular biology – that our DNA controls protein expression, and therefore disease risk – was disproved. Our genome was found to contain roughly 20,000 genetic instructions – not even enough to account for the 100,000 proteins in the human body!

As a result, we must now accept that factors beyond the control of the gene, known as epigenetic factors, and largely determined by a combination of nutrition, psychospiritual states that feed back into our physiology, lifestyle factors, and environmental exposures, constitute as high as 95% of what determines any disease risk. In fact, even the psychological trauma associated with being diagnosed with cancer can drive malignancy via adrenaline-mediated multi-drug resistance,[i] and according to a recent NEJM study, lead up to a 26-fold increased risk of heart-related deaths in the seven days following diagnosis.[ii]

Epigenetics. You keep using that word. I do not think that it means what you think it means.

Yes, when I spoke about how quacks view the word “epigenetics” in much the same way that the view the word “quantum,” basically as a simile for the word “magic.” In the quacks’ eye view, epigenetics is capable of anything, and we can magically control our own gene expression through diet, exercise, and even just thinking happy thoughts, all of which, it is claimed, alter gene activity through epigenetics. Yes, if diet can’t change your gene expression to whatever you like it through epigenetics, then wishing makes it so through happy thoughts. Except that it doesn’t.

Ji also beats on a straw man, namely the belief that you either “have the gene” or don’t when it comes to BRCA1 and BRCA2. Of course, because popular understanding of how BRCA1 mutations predispose to cancer are simplistic does not mean that that’s what physicians tell their patients. Indeed, whenever BRCA1 and BRCA2 mutations are reported, the risk associated with the specific mutation(s) detected is listed alongside the result. Some BRCA mutations confer high risk of breast and ovarian cancer, such as the 87% risk that Angelina Jolie was told that she had. Some confer much less risk. Some are referred to as being of “uncertain significance,” which means we don’t really know how much of a risk they do or do not confer. Ji twists himself in knots (the same way he twists science and logic in knots) when he perseverates over an observation that there is actually a BRCA2 mutation that is associated with a lower risk of cancer. There is a problem, though. The main point of the editorial cited was not that BRCA testing doesn’t matter but that family history should trump gene testing. Of course, that is exactly the way that most genetic counselors practice; they don’t blow off a negative BRCA test in a patient with a strong family history of cancer. Such patients are still treated as being at high risk. The whole point is a bit of a straw man.

Ji is also enamored of the concept of overdiagnosis, just like Mike Adams. Only, he expresses it differently:

Another concerning blind spot in the framing of Jolie’s decision is that approximately 70,000 breast cancers (31% of annual breast cancers diagnoses) are misdiagnosed by the vast breast cancer ‘awareness’ and treatment complex each year.[vi] These are not just so-called “zero stage” breast cancers such as Ductal Carcinoma In Situ (DCIS), which arguably should be reclassified as non-cancerous normal variations in breast morphology, but 50% are known as early-stage “invasive” breast cancers [view NEJM study video analysis here].

How many of these women, having received a mammography-detected diagnosis of breast cancer and then a follow up BRCA test, believed that the gene must have therefore “caused” the “cancer”? The popularization of this crude way of understanding natural, sometimes self-limiting variations in breast morphology as cases of “breast cancer” is itself a malignancy that should be prevented and treated with healthy doses of the very ‘evidence’ that the so-called ‘evidence-based’ medical system claims to possess as a differentiating factor from other, more ancient, plant- and nutrition-based medical traditions.

Uh, no. While it is true that overdiagnosis is a big issue in cancer screening right now, just because there is significant overdiagnosis of cancer does not mean that the imputation of causation to BRCA1 mutations for cancers that might be overdiagnosed is incorrect. Moreover, it goes way too far to advocate reclassifying DCIS as “noncancerous normal variations in breast morphology.” It is not, and it is known to be a lesion that progresses to invasive breast cancer with a high frequency. That many DCIS lesions never progress and some even regress does not make them a “normal variant.” Ji refers to the NEJM study of overdiagnosis in breast cancer published in December, but he clearly doesn’t understand its significance.

It’s clear that Angelina Jolie’s decision to try to lower her very high risk of breast cancer will be the gift that keeps on giving—to quacks. They despise the concept of prophylactic surgery almost as much as they despise the concept of genetic predisposition to disease.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

499 replies on “The quack view of preventing breast cancer versus reality and Angelina Jolie, part 2”

Why do these quacks always refer to breast surgery as “mutilation”? It’s a horribly negative connotation that I’m certain makes many women delay seeing a doctor about a breast lump. (In fact, wasn’t there a French TV presenter some years ago who turned down surgery for a breast lump precisely because of that, turned to a variety of quacks and ended up dying from metasized breast cancer?)
Notice how it always seems to be the male quacks who call it that. Yet when do we hear Mikey & co object to breast enhancement surgery as “mutilation”?

No-one seems to consider prostate surgery or radiotherapy as “mutilation”. Funny that.

Why do these quacks always refer to breast surgery as “mutilation”? It’s a horribly negative connotation that I’m certain makes many women delay seeing a doctor about a breast lump. (In fact, wasn’t there a French TV presenter some years ago who turned down surgery for a breast lump precisely because of that, turned to a variety of quacks and ended up dying from metasized breast cancer?)

I don’t know about the French TV presenter, but there was a Dutch actress, who also turned down surgery and ended with a faith healer telling her she hadn’t cancer and went to several quacks. In the end she died.
http://anaximperator.wordpress.com/2009/05/10/faith-healer-on-trial/

I wonder if Jolie and Pitt vaccinated their kids??

Naww!! They are white, rich and have influence — ‘smart’ people around them to give them the scope. Hee,hee, hee!…..

Our genome was found to contain roughly 20,000 genetic instructions – not even enough to account for the 100,000 proteins in the human body!

Excuse me, some ignoramus just tramped on my field of expertise and I have to go lie down.
But short answer for any curious lurker: between intron alternative splicing, mRNA modifications and post-translational modifications of the proteins, just 20,000 genes could go a long way toward making hundreds of thousands of proteins. And they do, the protein content of a cell is insanely complicated.

@ Sophia8

Why do these quacks always refer to breast surgery as “mutilation”?[…]Notice how it always seems to be the male quacks who call it that.

I think you answered your own question. Women seen as sex objects, or maybe more generously, seen from the outside, not necessarily as a piece of furniture, but still defined by their secondary sexual characteristics. Whatever you do, don’t touch the boobs.
(now I’m thinking of it, I didn’t see as much outrage about the possibility of a woman asking to have her ovaries removed – you don’t see it, and who cares if she couldn’t have children anymore?)
To be fair, breasts are not a trivial part of women, be it from an individual (or so I have been told) or a cultural/societal point of view. It’s understandable it may be a polarizing issue.

It’s interesting that the male organ counterpart to breasts most of us come with are testicules. They don’t have the same physiological function (feeding children versus making children, respectively), but they both share a similar cosmetic/societal function – to define that is female or male.

Yet, the outcry against surgery is very irrational, if not outright selfish. Better for the person these quacks/naysayers are talking to to keep their outside sexual integrity than be “maimed”, even if this may ultimately do them harm.
Death before dishonor.

Renate: Yes, that was the case I was thinking of; I misremember her nationality. Poor woman.

@1: Why do these quacks always refer to breast surgery as “mutilation”?

They refer to all surgery as mutilation. However, society-wide there’s a tendency to see mastectomy or even breast-reduction surgery as mutilation, while breast enlargement is cosmetic.

Does anyone know where I can find the numbers (USA/worldwide) of the quantity of women who did preventive Mastectomy?

If someone hasn’t mentioned it elsewhere, Ms. Jolie recently announced she’s having an oophorectomy, as well.

fusilier
James 2:24

Our genome was found to contain roughly 20,000 genetic instructions – not even enough to account for the 100,000 proteins in the human body!

Excuse me, some ignoramus just tramped on my field of expertise and I have to go lie down.
But short answer for any curious lurker: between intron alternative splicing, mRNA modifications and post-translational modifications of the proteins, just 20,000 genes could go a long way toward making hundreds of thousands of proteins. And they do, the protein content of a cell is insanely complicated.

Wasn’t that “100,000 proteins” figure pretty much estimated by counting spots on a 2D gel? Of course it would take an ignoramus to ignore post-transcriptional and -translational events. Ignorance, fortunately, is curable but if he is being deliberately wrong to make a point than that is just inexcusable.

If someone were told, after all, that because of genetics/family history there was an 87% chance that they’d die in their 50’s of appendicitus, no one would critiize them if they elected to have a prophylactic appendectomy–especially if we had the capability as we do following breast surgery to perform reconstructive surgery to the pointthere’d be no comestic evidence they’d had their appendix removed.

If I knew that otherwise the odds were a greater than one in 5 I wouldn’t live long enough to see my kids grow up, graduate college, get married, etc. the list of non-essential body parts I’d willingly sacrifice to eliminate the threat is actually pretty extensive…

Nigel @12: “Lappe JM” gets plenty of results. She certainly looks like a legitimate researcher but I’ll leave it to experts to decide whether she’s shown that Vit D has a role to play in cancer prevention.

Oh, look guys, Greg the infantivore maniacal lizard is here!

Heliantus brings up an important point: women being seen from the outside.

Mike, Gary and Sayer Ji are men commenting about how a woman “disfigured” herself. Not one of these woo-meisters address how surgery enables a woman to live a more peaceful life, not constantly worrying about if she’ll get cancer. Ms Jolie discusses how she wants to give her children re-assurance that she’ll be around but it also enables HER to live with less fear. What’s wrong with that?

By surveying woo, I’ve learned that it often focuses on external appearances: they’re selling youth and beauty to an audience which may be primarily female. If you skim through their websites’ stores you’ll find many formulae that affect looks: improved skin and hair, weight control and quasi- hormonal assistance for the menopausal (or boner-deficient). Products like “Rock Hard” or “Eternal” ( GN), diverse phyto-estrogens or the antler velvet once shilled by Adams, as well as skin and hair products that seek to re-capture your past glories.

There’s more insidious disdain that I’ve detected in their messaging: women age quicker than men do. The consequences of female aging are de-cried- in great detail- whilst the woo-meister parades photos of his seemingly endless youth ( see GN facebook/ Adams used to pose on HealthRanger.com). As I mentioned, this can be subtle- they don’t want to frighten potential female customers away.

Paternalism embedded in superficiality. Many woo-meisters believe in life energy ( or essence) that bubbles within as a portable fountain of youth- and yes, they can help you to unleash its healing waters.

‘Ladies, if you do what I say and use my products, even you, despite your present decrepitude, can be pleasing to me.
Of course, you can never presume to be on my level but at least you won’t be as miserable and undesirable as you are now following your own devices.’

Events with low probability and events with high probability are equivalent, so long as their probabilities are somewhere between 0 and 1. The losses associated with the events are irrelevant. I’ll call these Ji’s axiom, and the Ranger postulate but which is which I haven’t decided yet. I would not recommend the resulting theory to be used in decision making.

have to remember we’re talking about a) one study and b) the reduction in cancer incidence seen in this study cannot be attributed to the vitamin D and calcium administered rather than other differences between the groups. the subjects were recruited from a rural area of Nebraska by means of random telephone dialing, resulting in a pretty homogenous subject pool (for example, the paper notes that all the subjects were white.) Also, subjects were randomly assigned to treatment groups with no attempt to match subjects across groups with respect to possible confounders (other than estrogen use).

The study has to be considered in the context of all other studies which have found no benefit from increased vitamin D and calcium, as well as the fact that some studies suggest elevated vitamine D levels are associated with an increased risk of developing pancreatic cancer.

So, promising? Potentially.

Support for conducting more large scale clinical studies, particularly in more diverse subject groups with matching to eliminate potential confounders? Absolutely.

But evidence that supplementary vitiamin C and calcium can prevent or cure cancer, as so many alt med advocates trumpet? Not hardly..

sophia8 said…
“Nigel @12: “Lappe JM” gets plenty of results.”
I meant results on this blog!

@ Nigel Kinbrum: A wee bit cranky this morning, eh?

If you want “Results on this blog”, here’s a link and commentary from the National Cancer Institute, to the Lappe study:

http://www.cancer.gov/cancertopics/factsheet/prevention/vitamin-D

“Randomized clinical trials designed to investigate the effects of vitamin D intake on bone health have suggested that higher vitamin D intakes may reduce the risk of cancer. One study involved nearly 1,200 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―a relatively large dose) or a placebo for 4 years. The women who took the supplements had a 60 percent lower overall incidence of cancer (6); however, the study did not include a vitamin D-only group. Moreover, the primary outcome of the study was fracture incidence; it was not designed to measure cancer incidence. This limits the ability to draw conclusions about the effect of vitamin D intake on cancer risk.”

BTW Nigeepoo, I’m not going to do research for your blog:

http://nigeepoo.blogspot.com/

@ JGC:

However, this is exactly the sort of research that is being quoted at PRN and Natural News, amongst other woo sites.
Tons of studies, accepted uncritically.

lilady said…
“@ Nigel Kinbrum: A wee bit cranky this morning, eh?”
Yes, you are a wee bit. Do I know you from somewhere? 😉

“BTW Nigeepoo, I’m not going to do research for your blog:
http://nigeepoo.blogspot.com/
I wasn’t asking you to, but thank you for posting a link to it.

My original question was for Orac. Are you answering questions on Orac’s behalf?

Of course it is–in the woo mindset, a single positive result supporting your preferred and predetermined position–no matter how marginal, dubious or otherwise meager–is always sufficient to completely invalid any amount of evidence demonstrating otherwise. They go into the argument already knowing the truth, after all. Hypochlorite isn’t bleach and cures damn near anything if you squirt it up your bum. Antineoplastons aren’t toxic or chemo, Water remembers. Big pharma is hiding the cure for financial gain.MARS WANTS OUR WOMEN!…(uhh, sorry–got carried away for a minute.)

Once you know the truth, theres’s nothing more to be said. “Evidence? We don’t need no steenkin’ evidence!”

…but surely you realize that instead of dircting it to Orac (via e-mail, for example) you posted it to an open forum.

And you’ve since received a couple of answers to that question. Is there some reason you find those answers unsatisfactory?

@ Nigel Kinbrum: You really don’t know how blogs *work*, do you?

You posed a general question and sophia8 replied. You, in turn, commented back at sophia8 in a snarky manner…because you were unable to find any results when you did a search on the internet.

So now, you have JGC’s comment and my link to the National Cancer Institute about the problems with Lappe’s conclusion; care to comment about the study’s limitations?

JGC said…
“Your question may have been to Orac…
…but surely you realize that instead of dircting it to Orac (via e-mail, for example) you posted it to an open forum.
And you’ve since received a couple of answers to that question. Is there some reason you find those answers unsatisfactory?”
I found lilady’s “answer” unsatisfactory. Your answer was satisfactory, thanks.

RE: Increasing serum Vit D increasing the RR for pancreatic cancer, see http://high-fat-nutrition.blogspot.com/2009/12/vitamin-d-and-uv-fluctuations.html

P.S. …and please don’t call me Shirley.

lilady said…
“@ Nigel Kinbrum: You really don’t know how blogs *work*, do you?”
Did you get out of bed the wrong side this morning?
“You posed a general question and sophia8 replied. You, in turn, commented back at sophia8 in a snarky manner.”
I did not. There was a misunderstanding and I clarified it. Any perceived snark is in your head. What’s your problem with me? Actually, I’m really not interested. Just go away and leave me alone.

@ Nigel Kinbrum:

You see, dearest Nigel, RI maintains a hierarchical structure somewhat resembling an onion wherein the innermost layer of devoted minions often respond to visitors at will because our esteemed and gracious host is usually otherwise engaged- as a doctor, professor and researcher. He will however, step in when necessary or whenever the whim strikes him.

If I were you, I would tread carefully amongst the guardians of the threshold, lilady being one, for it is unwise to invoke their anger, righteous or otherwise. Be forewarned.

I , myself, am rather like the tourguide pointing the way to Dante Alighieri in his travels. Godspeed.

By the way, “Nigeepoo”, taking supplemental vitamin D is not a proven way to prevent sunburn and is not an adequate method of protection from getting skin cancer (despite assertions in your blog).

Going for long drives with the top down and broiling gently without sunscreen on a repeated basis is dumb.

This topic came up on a list serve and a helpful medical Librarian, Susan Fowler offered some helpful research links:

In case you are wondering or have people asking you (as I did) where that 87% increased risk number that Angelina mentions in her NY Times editorial came from, I believe this is it…

U.S. Preventive Services Task Force. Genetic risk assessment and BRCA mutation testing for breast and ovarian cancer susceptibility; 2005.”These mutations increase a woman’s lifetime risk for breast cancer to 60% to 85%…”

Brose MS, Rebbeck TR, Calzone KA, Stopfer JE, Nathanson KL, Weber BL. Cancer risk estimates for BRCA1 mutation carriers identified in a risk evaluation program. J Natl Cancer Inst 2002;94:1365-72.

Thompson D, Easton DF. Cancer incidence in BRCA1 mutation carriers. J Natl Cancer Inst 2002;94:1358-65.

Gerd Antes offered a good article as well Average Risks of Breast and Ovarian Cancer Associated with BRCA1 or BRCA2 Mutations Detected in Case Series Unselected for Family History: A Combined Analysis of 22 Studies
Antoniou et a.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1180265/

…why you found my response to be satisfactory but lilady’s to be unsatisfactory. Could you explain?

Denice Walter said…
“@ Nigel Kinbrum:
You see, dearest Nigel, RI maintains a hierarchical structure somewhat resembling an onion wherein the innermost layer of devoted minions often respond to visitors at will because our esteemed and gracious host is usually otherwise engaged- as a doctor, professor and researcher. He will however, step in when necessary or whenever the whim strikes him.

If I were you, I would tread carefully amongst the guardians of the threshold, lilady being one, for it is unwise to invoke their anger, righteous or otherwise. Be forewarned.

I , myself, am rather like the tourguide pointing the way to Dante Alighieri in his travels. Godspeed.”
Denice, I like your style! I’ve been posting on forums for so long that I soon recognise the “resident sharks” with their “weird filters” and strawman fallacy arguments. I’m not the sort of person who treads carefully.

Dangerous Bacon said…
“By the way, “Nigeepoo”, taking supplemental vitamin D is not a proven way to prevent sunburn and is not an adequate method of protection from getting skin cancer (despite assertions in your blog).

Going for long drives with the top down and broiling gently without sunscreen on a repeated basis is dumb.”
Thank you for actually reading what I wrote before criticising it. You are allowed to leave comments on my blog. If you want to have a discussion about what I wrote there, please do so there, not here.

…I’d suggest you’ll want to see Circulating 25-Hydroxyvitamin D and Risk of Pancreatic Cancer ( http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892543/ )

From the abstract:

No significant associations were observed for participants with lower 25(OH)D status. However, a high 25(OH)D concentration (≥100 nmol/L) was associated with a statistically significant 2-fold increase in pancreatic cancer risk overall (odds ratio = 2.12, 95% confidence interval: 1.23, 3.64). Given this result, recommendations to increase vitamin D concentrations in healthy persons for the prevention of cancer should be carefully considered.

JGC said…
“I’m curious…
…why you found my response to be satisfactory but lilady’s to be unsatisfactory. Could you explain?”
No.

I must say that I find the DDoS story hilarious. How does one perform a SYN flood against a particular Blogspot target, Nigel? The lack of a unique A record seems to pose a bit of a problem here.

Narad said…
“I must say that I find the DDoS story hilarious. How does one perform a SYN flood against a particular Blogspot target, Nigel? The lack of a unique A record seems to pose a bit of a problem here.”
It was against my home computer, you idiot. I thought that that fact was obvious, bearing in mind that I wrote “my downlink speed”. Why are you discussing things that I wrote there, over here?

Hey, Denice Walter.

There are quite a few devoted minions here, aren’t there? 😀

Cheers, Nige

It was against my home computer, you idiot.

Show me the logs, Nigel. What is the size of your static CIDR block?

Okay, I got as far as your clever insertion of “The Name of the Doctor” and just had a total geekout. Don’t tell me you’re one of the lucky few who preordered and consequently already know the secret! And if you do, please, for the love of all that is holy, do not reveal it!!!! The Great Auntie Beeb has promised us an extra Smith and Tennant video if everybody is good and doesn’t reveal it! And I don’t want spoilers before this weekend! And . . . and . . . and . . . .

AAAAAAAAAAAAAAAAAIGH! THREE MORE DAYS! THREE MORE DAYS! I AM GOING TO EXPLODE!

Okay. I’m going to go read some Dr Who stuff to calm down, and then I can come back and read this article properly. Maybe. 😉

Narad said…
“It was against my home computer, you idiot.
Show me the logs, Nigel. What is the size of your static CIDR block?”
What part of “If you want to have a discussion about what I wrote there, please do so there, not here.” did you not understand?

Yes, i did read the link you posted. I don’t see how the evidence support’s Vieth’s conclusion sustained vitamin D supplementation to achieve a constant mean circulating concentration of 130 nmol/L–more than 4 times greater than the level seen in by Stolzenberg-Solomon et al to cause a 2-fold increased risk of developing pancreatic cancer–would somehow eliminate or reduce that increase in risk. The only data he presents offers evidence of differential risk not associated with circulating vitamin D level, or even really with differential UV exposure, but with living in different geographic regions. Can you say “condounders”, boys and girls? I thought you could…

Should be:

Yes, i did read the link you posted. I don’t see how the evidence support’s Vieth’s conclusion sustained vitamin D supplementation to achieve a constant mean circulating concentration of 130 nmol/L–more than 4 times greater than the level seen in by Stolzenberg-Solomon et al to cause a 2-fold increased risk of developing pancreatic cancer–would somehow eliminate or reduce that increase in risk. The only data he presents offers evidence of differential risk not associated with circulating vitamin D level, or even really with differential UV exposure, but with living in different geographic regions. Can you say “condounders”, boys and girls? I thought you could…

What part of “If you want to have a discussion about what I wrote there, please do so there, not here.” did you not understand?

Hey, you popped in here. It seems entirely fair to take a look at your reasoning skills.

JGC said…
“Yes, i did read the link you posted. I don’t see how the evidence support’s Vieth’s conclusion sustained vitamin D supplementation to achieve a constant mean circulating concentration of 130 nmol/L…”
It’s the variation in 25(OH)D level that’s the problem. Taking huge, intermittent doses of Vit D is bad, even if the mean 25(OH)D level is O.K. Why do some studies give huge, intermittent doses of Vitamin D to subjects? No study gives a month’s-worth of “X” to subjects in one go, unless “X” happens to be Vitamin D.

Other studies (e.g. WHI) use homoeopathic Vitamin D doses (400iu/day) and find that it’s ineffective. No sh*t, Sherlock!

Orac said…
“Nigel seems…familiar to me. Methinks an old troll might have returned.”
Orac, I haven’t commented on here before (to the best of my knowledge). Any similarity to an old troll is purely coincidental.

This is your blog. Am I not allowed to defend myself against “resident sharks” who aren’t you?

Anyway, I asked a question about Joan M Lappe’s study on post-menopausal women. Now that I have your attention, would you like to comment on it?

So do I conclude her response wasn’t unsatisfactory but you’re discounting it anyway, that it was unsatisfactory but ‘just because’, or that it was unsatisfactory and you don’t even know why yourself? Decisions, decisions…

Narad said…
“Hey, you popped in here. It seems entirely fair to take a look at your reasoning skills.”
From what I’ve seen so far, your reading comprehension skills suck. I will only discuss things that I wrote on my blog, on my blog, not on here. /discussion

It’s the variation in 25(OH)D level that’s the problem.

Vieth offers no data demonstrating that variation in 25(OH)D level is a problem , however, does he? he simply assumes it is, despite teh fact that what he’s actually following are differences in risk ratio between groups living in different geographic locations.

Other studies (e.g. WHI) use homoeopathic Vitamin D doses (400iu/day) and find that it’s ineffective.

A homeopathic dose of vitamin C would be 0 iu/day, wouldn’t it?

JGC said…
“Nigel @ #35
“So do I conclude her response wasn’t unsatisfactory but you’re discounting it anyway, that it was unsatisfactory but ‘just because’, or that it was unsatisfactory and you don’t even know why yourself? Decisions, decisions…”
No comment. I’m awaiting a response from you about the effect of excessive fluctuations in serum 25(OH)D level on the RR for pancreatic cancer.

JGC said…
“Vieth offers no data demonstrating that variation in 25(OH)D level is a problem , however, does he? he simply assumes it is, despite teh fact that what he’s actually following are differences in risk ratio between groups living in different geographic locations.”
Excessive variation in serum 25(OH)D level due to the giving of huge, intermittent doses of Vitamin D is a plausible explanation.
“A homeopathic dose of vitamin C would be 0 iu/day, wouldn’t it?”
I see your “sense of humour” bypass operation was a total success.

JGC said…
“We have no resident sharks on this blog”
Said one of them.

Can you cite a paper, then, offering data supporting the premise excessive fluctuations in serum 25(OH)D level impact the RR for pancreatic cancer which I could consider?

As I’ve pointed out a couple times now, neither the blog you provided a link to or the actual Vieth paper the blog cites do so.

JGC said…
“Can you cite a paper, then, offering data supporting the premise excessive fluctuations in serum 25(OH)D level impact the RR for pancreatic cancer which I could consider?
As I’ve pointed out a couple times now, neither the blog you provided a link to or the actual Vieth paper the blog cites do so.”
No. It’s a plausible explanation, that’s all. You still haven’t answered my question as to why the people that run studies feel the need to give a month’s-worth (or 3, or 6, or even 12) of Vitamin D to subjects in one go. Try that with insulin and let me know how you get on.

I’m hardly a shark, unless you’re using shark as shorthand for ‘someone who remains unconvinced in the absence of credible supporting evidence”.

@JGC: You’re obviously trolling, as you haven’t answered my question and you’re just flanneling, now. Bye!

If by ‘a month’s worth in one go’ you’re talking about a quantity administered as a single bolus, it would be to achieve a specific circulating level of 25(OH)D within the time frame of observation.

Same as is done with insulin, in fact: one tailors the amount of insulin taken withindividual meals, based on the total carbs consumed. to maintain an appropriate lood glucose level.

Said one of them.

Careful, Nigel, we may hire a Russian botnet to take you offline for 30 minutes.

Okay, I’m back, I’m calmed down, and I’ve read the rest of this article now. But there seems to be a rather peculiar fight going on in the comments that has little to do with the article, so I’m going to go back to reading speculation about who Clara Oswin Oswald actually is……

i just did answer the question: if doen it would be to acheive a specified circulating level within the time-frame of observations.

But I haven’t offered any studies where this was doen, have I? The study I linked to, which found a 2-fold increased risk of pancreatic cancer assoicated with circulating Vitamin D levels greater than 25nmol/L was a case control study which measured circulating levels without administering supplemental vitamin D (whether a day’s worth or a month’s worth or whatever).

I suspect you’re reconsidering whether my or lilady’s response was the more satisfactory right about now…

This idea that you can prevent cancer (and when I see the word prevent, I know there’s a quack around) with diet/lifestyle/prayer/fill in the blank-is that it blames the victim. Back in the days when I volunteered at a women’s crisis center, rule #1 (after making sure everyone is safe) was to never Blame the Victim.
And these quacks violate rule #1.

@JGC: You’re being intellectually-dishonest. You know damn well what I mean when I write “You still haven’t answered my question as to why the people that run studies feel the need to give a month’s-worth (or 3, or 6, or even 12) of Vitamin D to subjects in one go. Try that with insulin and let me know how you get on.”
I don’t continue discussions with intellectually-dishonest people. Goodbye.
P.S. Vitamin D has a half-life in the body of ~60 days. Therefore, dosing shouldn’t be less frequent than 1 dose every 30 days maximum.

“There is no chance involved in whether you get cancer. It’s all cause and effect.”

Am I a terrible person for hope that Mike Adams gets cancer after reading that? Because after I read that my first thought was “god I hope that man get’s riddled with cancer.” It’s a good thing I am not narcissistic enough to think that my thoughts have any effects on the world or else I’d be feeling very guilty right now (currently I am only a little guilty).

Wow that last comment is riddle with typos. Sorry guys I should no better to comment and try to kill a fly at the same time.

I don’t continue discussions with intellectually-dishonest people. Goodbye.

This seems to be turning into a pattern.

I’m not being dishonest, intellectually or otherwise: I answered your irrelevant question (irrelevant because the evidence for an increased risk of pancreatic cancer did not involve studies invovling supplemental vitamin D at any concentration) to the best of my ability.

I note you’ve continue to ignore my request to provide actual evidence ‘excessive fluctuations’ in circulating vitamin D levels actually is associated with an increased cancer risk ratio.

1,25(OH)D is the biologically active form of vitamin D, circulating 1,25(OH)D has a plasma half life 4-6 hours. Also, it’s circulating levels are a thousand fold less than 25(OH)D, 25(OH)D which has a half-life of ~15 days (not 60) and that plus the longer half-life is why25(OH)D levels are measured when evaluating overall exposure level clinically. (Holick MF: Vitamin D status: measurement, interpretation, and clinical application. Ann Epidemiol 2009, 19:73-78)

Bottom line? If you dose every 30 days, you’re never going to achieve a steady-state circulating concentration.

As an exercise, you might want to model how dosing a compound that did have a 60 day half-life every 30 days would play out–you still won’t acheive a ‘non fluctuating’ level such as you seem to feel is so important for months.

Cripes, I go offline for several hours and return to see nigelpoo’s crappy posts defending his nutrition blog.

@ JGC: Well done. nigelpoo is p!ssed at me because I linked to his blog…enabling us to point at him and his pseudoscience.

I located the 1,100 page IOM report about Vitamin D and Calcium supplements http://www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D.aspx

Here’s the IOM’s press brief:

“….Health Effects of Vitamin D and Calcium Intake

The new reference values are based on much more information and higher-quality studies than were available when the values for these nutrients were first set in 1997. The committee assessed more than one thousand studies and
reports and listened to testimony from scientists and stakeholders before making its conclusions. It reviewed a range of health outcomes, including but not limited to cancer, cardiovascular disease and hypertension, diabetes and met
-bolic syndrome, falls, immune response, neuro-psychological functioning, physical performance, preeclampsia, and reproductive outcomes. This thorough review found that information about the health benefits beyond bone health—benefits often reported in the media—were from studies that provided often mixed and inconclusive results and could not be considered reliable. However, a strong body of evidence from rigorous testing substantiates the importance of vitamin D
and calcium in promoting bone health…”

I seem to recall that Orac blogged about the IOM Report regarding Vitamin D/Calcium supplements for cancer treatments…

http://respectfulinsolence.com/2012/05/08/supplements-not-mystical-anticancer-magic/

“….Finally, Martinez et al take on the case of vitamin D and calcium. Anyone who’s been reading CAM-friendly websites these days probably knows that vitamin D is currently viewed by many in the alternative medicine world as some sort of panacea that prevents all cancer. Heck, to listen to some CAM advocates tell it, vitamin D is supposedly so awesome that it prevents influenza more effectively than the influenza vaccine. Of course, as has been pointed out before, the picture is, as is usually the case, more complicated than that, and Martinez et al try to communicate that complexity, referencing the Institute of Medicine’s recent recommendations for vitamin D and calcium intake published in 2011, in which the IOM concluded that there is insufficient evidence to conclude that there is a causal association between low vitamin D intake or low blood 25 hydroxy (OH) vitamin D [25(OH)D] levels and cancer. Martinez et al sum up this data thusly:”

“There have been many epidemiological investigations of blood 25 hydroxy (OH) vitamin D [25(OH)D] concentrations and cancer-related endpoints (45-49), and meta-analyses of these have shown statistically significant inverse associations between serum 25(OH)D and colorectal adenoma (46,49) and colorectal cancer (45), whereas the results for prostate cancer have largely been null (45,48). For breast cancer, the relationship with serum 25(OH)D levels varies by study design; case-control studies generally demonstrate inverse associations, and prospective studies have been null (45,47,50); because blood levels are collected after the onset of cancer in case-control studies, the potential for bias in these studies must be considered (47,50). Clearly, clinical trials are needed to elucidate any preventive effect of vitamin D (51,52). To date, three short-term RCTs of vitamin D and cancer endpoints (52-55) have been completed; one showed no direct effect of vitamin D supplementation on cancer mortality (53), the second showed no reduction in breast or colorectal cancer incidence by a vitamin D/calcium combination (54,55), and the third showed a reduction in total cancer incidence by a calcium/vitamin D combination vs placebo (56). As concluded in a recent meta-analysis, because of the potential confounding inherent in observational studies and the limited data from clinical trials, evidence is currently insufficient to draw conclusions about the efficacy of vitamin D supplementation for cancer prevention (57).”

Who’s “intellectually dishonest”, nigelpoo?

At the risk of giving the scumbag’s website even more exposure, Mikey Adams has just posted the third installment of his Angelina Jolie trilogy “exposing” the conspiracy and outlining who will benefit financially from her decision.

He uses the new issue of People magazine as part of his evidence that this was all planned in advance, stating the magazine’s cover is determined three weeks in advance. I guess he’s never seen the issues that appear a couple of days after a major celebrity’s death, or big news (Tom Cruise divorce, for example). Yes, under usual circumstances they might loosely plan their covers a couple of weeks in advance but can deviate from the plan when news breaks.

He’s such a blathering idiot.

Well, for a first visit, it’s been interesting! Here is my analysis of various posters that I’ve engaged with:-

sophia8: O.K.
Denice Walter: O.K.
lilady: Starts fights based on imagined snark. Is either insane, or a troll.
JGC: Tries hard to be “clever”, but fails miserably. Does not give a straight answer to a straight question. Intellectually-dishonest, or a troll.
Narad: Has reading comprehension issues. Thick, or a troll.
Dangerous Bacon: Enjoys straw-men fallacies but O.K.
Orac: Doesn’t discourage trolling on his/her blog. When newbie arrives, is set upon by trolls and defends himself robustly, blog owner accuses newbie of being a possible troll.

Conclusion: I’m not wasting any more time commenting on here. If anyone disagrees with anything on my blog, leave a comment on my blog. Good night!

Comments are closed.

%d bloggers like this: