A fungus among us in oncology? (2014 edition)

One of the more bizarre bits of cancer quackery that I’ve come across is that of an Italian doctor (who, like many cancer quacks, appears not to be a board-certified oncologist) named Tullio Simoncini, who claims that cancer is really a fungus and has even written a book about it, entitled, appropriately enough for this particular quackery, Cancer Is A Fungus. The first time I encountered Simoncini, about five years ago, I was floored by his arguments, not because of how bizarre they were (although that was part of it) because of their sheer stupidity. Seriously, Simoncini’s reasoning—if “reasoning” you can even call it—has to be the dumbest ever.

How can Simoncini reject all those decades of science, genomics, and painstaking study of cancer cells? For those of you who have forgotten how Simoncini justifies his claims, I’ll remind you with this video:

You can get an idea of just how dumb this video is by listening to Dr. Simoncini less than two minutes in as he opine that whenever he sees a cancerous tumor in the body, the lumps are “always white.” Simoncini emphasizes this amazing observation several times, so apparently important is it. Yes, that was the observation that supposedly led him to his idea that tumors are in fact due to fungus. He even shows images of thoracoscopy, pointing out that the tumor deposits are white, and of bronchoscopy of lung cancer, again marveling at how the tumor deposits are white. Of course, at the time, I pointed out that many fungi are not white; some are even brightly colored. Simoncini also must not have seen very many tumors, because not all tumors are white. In fact, many are not. Melanoma comes to mind, most of which are black. (Although some melanomas can lose their pigment and appear white, or amelanotic, this is less common.) Many tumors that I’ve seen personally as a cancer surgeon are reddish-colored, tan, or even greenish. Simoncini’s argument is, at its core, spectacularly stupid. There’s just no other way to put it that doesn’t involve breaking our NatGeo overlords’ strong suggestion that we avoid profanity, particularly the f-bomb, which should precede the word “stupid” in describing Simoncini’s quackery. Even worse is Simoncini’s proposed cure: Direct injections of sodium bicarbonate into the tumors, a treatment that has resulted in at least one death.

The reasons I’ve briefly revisited Tullio Simoncini are two-fold. First, a reader e-mailed me arguing that I shouldn’t be so dismissive of claims that cancer is a fungus, and, second, there’s a more “sophisticated” version of this same old cancer quackery that’s recently appeared on DrSircus.com in both an article entitled New Cancer/Fungus Theory and a video that is less obviously nonsensical on the surface but at its core just as silly as the five year old interview with Tullio Simoncini that I posted above:

The same video can be found here, along with more elaboration.

Yes, it’s the same guy, Doug Kaufmann, who interviewed Simoncini five years ago. I’m really sorry I hadn’t checked him out five years ago, because his Know The Cause website and video series are examples of pure quackery because, to him—or so it would seem—practically every chronic disease is caused by fungus. Diabetes? Fungus, of course! Malnutrition? It’s the fungus among us! Allergies, arthritis, heart health, women’s health? Fungus, of course! Just read his book! Asthma? Mold, of course! To get an idea of the “quality” of Kaufmann’s argument, let’s look at one of his citations ane how he describes it:

We will address those concerns, but let me start by giving you a “hot off the press” headline that my friend, Luke Curtis, MD, just sent me. It deals with 27 lung “cancer” patients who were later diagnosed with lung “fungus” instead of lung cancer. Mind you, this paper was just published. But the confusion that it confirms has been going on in medicine for as long as disease has been in existence. Doctors do not know what causes the majority of human diseases.

FUNGAL INFECTIONS MIMICKING PULMONARY MALIGNANCY RELEVANT SENTENCE
“Fungal infection can present with clinical and radiological features that are indistinguishable from thoracic malignancy, such as lung nodules or masses.”

TO YOU AND ME
It is impossible to tell lung fungus from lung cancer.

MY TAKE
Unfortunately, the doctors who diagnose lung cancer are unaware of the fact that cancer mimics fungal infections. Unless one of the researchers who wrote the above paper are present during your lung cancer diagnosis, 100% of “lung nodules or masses” are diagnosed as “cancer” and 100% of you will begin invasive cancer treatment. I would certainly recommend that you tell your doctors to “fully rule-out fungus” as a causative factor before cancer therapies are initiated.

First off, this was not a study. This was a letter to the American Journal of Roentgenology entitled Fungal Infection Mimicking Lung Cancer: A Potential Cause of Misdiagnosis. Second, did Kaufmann or Sircus even read the letter? It’s only one page long; so it’s not that much to ask. In it, the authors, Marcos Duarte Guimariles, Edson Marchior, and Myrna Cobos Barco Godoy were commenting on an earlier article examining a variety of conditions mimicking lung cancer on CT imaging, citing a study of 2,908 patients with suspicious lung lesions who underwent biopsy that found that 37 (not 27) of them, or 1.3% ended up with a final diagnosis of infection, of which fungi were the most common pathogens, making up 46% of the 1.3%, or 0.6% of the diagnoses. In other words, the veyr article cited is not strong evidence that fungi are a major cause of lung cancer. Moreover, remember, it’s not as though doctors don’t know this. Certain fungal infections have long been known to mimic the appearance of lung cancer on CT, and in areas where such pathogenic fungi are endemic ruling them out is always on the differential diagnosis of lung masses. That’s why we biopsy tumors before instituting definitive treatment! It is not, as Kaufmann claims, “impossible” to tell lung fungus from lung cancer. It is quite doable. All it takes is a biopsy plus a culture. True, the culture can sometimes be tricky, and it can sometimes be difficult to get an adequate specimen, but “impossible to tell”? Not so much.

Don’t get me wrong. It’s entirely possible to misdiagnose malignancy when in fact a patient has a fungal infection. Indeed, that is what appears to have happened to Suzanne Somers, who, if her book Knockout is to be believed, was apparently misdiagnosed with metastatic cancer when in reality she had disseminated coccidioidomycosis (also known as Valley Fever), which is endemic in many areas of the southwestern United States, Mexico, Central and South America. It’s also a common cause of fungal pneumonia, although usually it only causes relatively mild disease. Around my neck of the woods, histoplasmosis is the fungal infection that nearly everyone’s been exposed to. Whatever really happened in Somers’ misdiagnosis—and we have no medical records, just Somers’ account—it seems likely that the oncologist consulted to treat her was a wee bit too eager to start treating with chemotherapy without a tissue diagnosis. In oncology, tissue is king (and queen). Rare is the oncologist who will begin cytotoxic chemotherapy without a tissue diagnosis. True, in rare circumstances it might be necessary, but these situations are the exception rather than the rule. Perhaps the most common of such exceptions include malignancies of the brain. Sometimes biopsy of these masses is too risky, and they have such a characteristic MRI appearance that treating without a tissue diagnosis is sometimes necessary. Indeed, it’s very likely that false positives for cancer on imaging could explain many of Stanislaw Burzynski’s “success stories.”

But back to the video. Perhaps the most hilarious part is the introduction, where Kaufmann states how fascinating 60 and 70 year old books about cancer are. He’s actually correct about that, but not in the way he means in the video. I find the history of how diseases were treated to be incredibly engrossing. For instance, I have a 1938 Marine Corpsman Manual that I inherited when my uncle died in the late 1980s. Reading how blood transfusions were administered back then in battlefield aid stations and hospitals near the front lines, how various common diseases seen in Marines were treated, and even how corpses were dressed for transportation home is of enormous interest to me from a historical standpoint. Similarly, reading about how cancer used to be treated and what doctors and scientists thought were its causes 70 years ago ais also fascinating from a historical standpoint. But to use such books to argue that what we know about cancer now is wrong? Not so much. Yet that is exactly what Kaufmann is doing when he holds up an old text and asks, “What did these texts know that today’s medical textbooks really didn’t know?”

I’ll answer that question for Kaufmann: A lot of information and beliefs about cancer that were later shown not to be true, that’s what. Sure, there is information in those books that has stood the test of time, and that information can still be found in modern cancer textbooks like DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. I’m talking about things like how Gompertzian growth, chemotherapy kill curves, radiation sensitivity, and a whole lot of other science about cancer cells, to which modern editions add new understanding developed by science over the decades of why cancer cells behave this way.

Apparently the bulk of this video comes from a talk that Kaufmann gave at the 41st Annual Cancer Convention of the Cancer Control Society, held August 31 to September 2, 2013 in Universal City, CA. It advertises:

LEARN ABOUT THE PREVENTION & CONTROL OF CANCER THROUGH NUTRITION, TESTS & NON-TOXIC CANCER THERAPIES SUCH AS LAETRILE, GERSON, HOXSEY, KOCH, ENZYMES & IMMUNOTHERAPY FROM MEDICAL DOCTORS, CLINICAL RESEARCHERS,NUTRITIONISTS & AUTHORS.

IN ADDITION, LEARN ABOUT CHELATION, DMSO, OXYGEN, HERBAL, CELLULAR & ELECTRO-MAGNETIC THERAPIES.

It also featured movies about Hoxsey cancer therapy, and the Cancer Control Society hosts bus tours to Tijuana Cancer Clinics. The Doctors’ Symposium part of the program includes talks on laetrile, high dose vitamin C therapy, insulin potentiation therapy, ultraviolet blood irradiation, live blood cell examination, and a whole panoply of cancer quackery. The main program itself reads like a who’s who of lesser-known cancer quacks, like Lorraine Day.

Right off the bat, Kaufmann claims that “it’s no longer’mycotoxicosis’; we now call it ‘cancer,'” claiming that if we inject fungus into laboratory animals they all get cancer. Really? That’s a new one on me. Be that as it may, I love how Kaufmann delves into false equivalency, first saying that some “believe” or “claim” that gene mutations cause cancer. Well, yes, but it’s more complicated than that, as any discussion of modern ideas of carcinogenesis would reveal. Next up, Kaufmann says that some claim that “gene fusions” initiate cancer growth, referencing a Cancer Cell article from 2010. I believe he means this article, in which gene fusions contributing to prostate cancer are described. Then Kaufmann says that “I say” that fungus “mimicks cancer” and that “cancer” is a misdiagnosis. That’s nice, but where’s the science? There is none, at least none that isn’t grossly cherry picked and misunderstood. In fact, he does the same thing as he did with the article about fungal infections being misdiagnosed as lung cancers and cites a textbook from 1957 in which pulmonary coccidiomycosis is “suggestive of metastatic malignancy” (shades of Suzanne Somers!) and that cutaneous blastomycosis is frequently mistaken for skin cancer. Wow! To me all that means is that the perils of misdiagnosing a fungal infection as cancer were well known 57 years ago. Hilariously, he even cites a quote in which it is noted that disseminated histoplasmosis is found to coexist with hematologic malignancies at a rate much higher than would be expected by coincidence. Gee, you don’t think that might be because patients with hematologic malignancies might be immune-suppressed, do you? Yes, Kaufmann appears to be confusing the chicken and the egg. Even Dr. Sircus’s drone acknowledges the issue, although he uses scare quotes to make you doubt:

“Fungal infections cannot only be extremely contagious, but they also go hand in hand with leukemia—every oncologist knows this. And these infections are devastating: once a child who has become a bone marrow transplant recipient gets a “secondary” fungal infection, his chances of living, despite all the anti-fungals in the world, are only 20%, at best,” writes Dr. David Holland.

So what is Kaufmann’s “theory”? It seems to be that fungal DNA fuses with human DNA and causes cancer:

According to my hypothesis, cancer begins when the DNA from Fungus and the DNA from our white blood cells merge to form a new hybrid “tumor, or sac.” This hybrid attains a life of it’s own now, bypassing our immune defenses because it is 50% human, and therefore just enough to be recognized as “self.”

Critics argue that simply because our white blood cells fail to gobble up fungus, this would be almost insignificant compared to what would occur if our cancer tumor suppressor gene (p53) became inactive during cancer cell invasion. The critics are correct!

Along with phagocytosis, our p53 gene plays one of the most important roles in protecting us against cancer. It not only stops cancer invasion, but it also kills tumor cells, thereby preventing cancer from even starting. But in over 50% of all cancers, scientists have discovered that the patient’s p53 gene was mutated and unable to stop cancer from initiating. According to the American Cancer Society, the p53 gene is the most studied of all genes because damage to this gene allows cells with damaged DNA, like cancer cells, to proliferate.

You know me. After hearing those dreaded 3 words, “you have cancer,” my first question would be, “doctor, what caused my p53 gene to mutate? Why didn’t it protect me? Of course, most doctors would respond by saying, “we don’t know what causes the p53 gene to mutate.” He may not, but now you will.

This is silly in the extreme. If this had happened, given today’s genomic technology scientists would have identified the fungal DNA sequences in human tumor cells a long time ago, probably back in the 1990s at the latest, and would have figured out that this was not due just to contaminants. And, if fungi were so promiscuous at causing mutations in p53 (formal name TP53), don’t you think there would be some serious evidence of it by now? As Kaufmann himself concedes, TP53 is one of the most highly studied genes in the genome. Although we certainly don’t know everything about it, we sure do know a whole lot about it. I mean, seriously. Kaufmann dazzles the rubes by asking whether they know that fungus has DNA like human DNA because fungi are eucaryotes, too. Gee, I think scientists figured that out…oh, decades ago! So he asks: If DNA from the two [fungus and human] should merge inside our bodies, what would the end result of that blend be?

It was at this point that I almost had to stop watching. Kaufmann was citing articles by someone named M. W. White in that woo journal to end all woo journals, Medical Hypotheses. His idea seems to be this:

Facts also support the conclusion that plant bacterial conidia (spores) derived, under duress, from one of the several groups belonging to the Ascomycete family or from the Staphylococcus aureus coagulase positive micro-organism are present intracellularly. It is this group of conidia, when formed, that survives as a primitive oval, spheroidal type of a unicell. They are identical in all respects to the various carbohydrate, protein, and fat molecules. Although these conidia have lost their original outside cell wall and all their enzymes and metabolites, they survive none the less as bacteria by retaining within their cytoplasm a genetically viable anion acceptor complex (oxidant), and their asexual procreative unit. It is this oxidant factor that survives within a sac or cell, as long as it is free of the atmospheric environment. Ultimately, with an ensuing circulating but compatible flow of blood by the host, there develops an annealing process whereby the genes of each species unite to form a plant animal intracellular hybridization. This somatic association accounts for the origin of the metabolic and respiratory anaerobiosis and also for the subsequent growth and pathophysiology that occurs in those living human beings suffering from the various malignant diseases.

Trust me on this. We have much better explanations now as to why cancer cells are so good at running on anaerobic metabolism, even when oxygen is available. Even Otto Warburg, who discovered the effect in 1928, had better ideas as to why this tumor cell characteristic might be.

My brain is hurting now. Basically, Kaufmann’s “hypothesis” seems to come down to:

  • Fungi can produce lost of human diseases
  • Fungi can cause inflammation, which can contribute to cancer
  • Fungus is in our food
  • Pathogenic fungi can make Aflatoxin b1, which commonly contaminate the grain supply and is a potential carcinogens

Therefore fungi can cause cancer!

Overall, the hypothesis is so confused and makes so little sense that it’s hard to believe anyone can take it seriously. None of this is to say that fungal infections might not predispose to cancer. We know that various chronic infections can do this, most likely due to chronic inflammation. However, Kaufmann’s take on this issue falls under the category of “so wrong it’s not even wrong.”

I will, however, give Kaufmann credit for sounding a bit more “science-y” than Tullio Simoncini does, but that’s about it. Barely.