[ed note: Michael Jorrin is not a doctor but we like to call him “Doc Gumshoe,” he writes non-investment pieces for us about medical hype and health issues from time to time — today he indulged me by taking on a pitch from a health newsletter that caught my eye]
The promotional piece – endless and repetitive as these all seem to be – starts out with the banner headline:
“I WANT TO CANCEL YOUR COLONOSCOPY FOREVER!”
Doesn’t sound a bit bad, does it? No more nasty prep, no more risks related to anaesthesia or, perish the thought, an accidental perforation of the colon. So even for those of us who are constitutionally skeptical, the temptation to continue reading, and listening, is irresistible.
The hype presents our hero, Dr Marc Micozzi, who has a veritable encyclopedia of cancer cures, “guaranteed” to be effective. As usual, these cures are being suppressed by the all-powerful conspiracy, which in this case involves the National Cancer Institute (NCI), the National Institutes of Health (NIH), the Food and Drug Administration (FDA), and the Centers for Disease Control (CDC), all of which are in cahoots with the pharmaceutical industry and the medical establishment.
In order to get Dr Micozzi’s free book of cancer answers, you have to subscribe to a newsletter which costs $78 for 12 issues. You can cancel at any time, of course, and you can keep Dr Micozzi’s free book. I did not subscribe to his newsletter, but a bit of poking about got me a copy of his “Classified Cancer Answers,” which I’ll give you a look at in this piece.
But first, let’s think about this notion of “canceling your colonoscopy forever.” Is that really a good idea?
Doc Gumshoe’s reaction is a loud NO!
Critics of colonoscopy point to three main categories of objections. First, that the procedure involves risks; second, that there is no definitive hard evidence that undergoing a colonoscopy reduces your chances of having colon cancer; and third, that there are alternative procedures to screen for colon cancer.
Okay. The risks, such as they are, are really small. There are certainly risks involving anaesthesia, but these are almost always effectively managed during the procedure itself. The scary risk, perforation of the bowel, is rare – a 2009 study put the risk of perforation at about 8 in 10,000 procedures, and the risk of death at 6 in 100,000.
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Regarding the lack of hard evidence, what that basically means is that there has been no controlled clinical study that compared sufficiently long-term outcomes in patients who have had colonoscopies with those who have not had colonoscopies. But the clinical evidence is exceedingly strong nonetheless. Colon cancers develop from polyps; if the polyps are removed – as they are in a colonoscopy – the cancers do not occur. And the statistical evidence is strong as well – colon cancer rates have been dropping by about 3% per year, just as colonoscopy rates have been increasing. I know, that’s post hoc propter hoc, but why else?
So what about these alternative procedures? One is a simple test for occult fecal blood (that’s the one Dr Micozzi’s promotional piece hypes as the one “you can do yourself at home”). Yes, if there’s blood in the feces, it might come from a polyp that has become cancerous. Or it might come from hemorrhoids. But if there’s blood in the feces, the next step is a colonoscopy, because you have to find out where it comes from. Another alternative is a sigmoidoscopy, which only checks the descending colon – the scope doesn’t have to make that tricky turn into the transverse colon, and the patient doesn’t require more than mild sedation. But because of this, sigmoidoscopy misses a third to a half of potentially pre-cancerous polyps. Finally there are “virtual” colonoscopies – external imaging of the colon. However, if these procedures find polyps, the next step is a real colonoscopy, so we’re right back where we started from.
From Doc Gumshoe’s perspective, the only good reason to cancel your colonoscopy forever is if you have it on good authority that you’re due to be struck by lightning the next time the sky clouds over.
A bit more about our hero, Dr Marc Micozzi
Here’s what I gleaned from Wikipedia:
Micozzi served as a researcher and physician for the National Institutes of Health (NIH) and Walter Reed Medical Center; and the College of Physicians of Philadelphia. He also is an adjunct professor for the Department of Pharmacology at Georgetown University School of Medicine in Washington, D.C.
Micozzi was the founding editor-in-chief of The Journal of Alternative and Complementary Medicine: Research on Paradigm, Practice and Policy, CAM’s first scholarly journal. He also organized and edited the first US textbook in his field, Fundamentals of Complementary & Alternative Medicine, which was published in 1996. The fourth edition of the textbook was published in 2011.
And here’s what Wikipedia itself says about the entry about Micozzi:
This biographical article is written like a résumé. Please help improve it by revising it to be neutral and encyclopedic. (December 2013)
This article may rely excessively on sources too closely associated with the subject, preventing the article from being verifiable and neutral. Please help improve it by replacing them with more appropriate citations to reliable, independent, third-party sources. (December 2013)
And here’s how “Classified Cancer Answers” starts out:
“The proven cancer revelation— pushed aside for profits!
“In 1984, a staff scientist for the NCI and colleague of mine was on the verge of a medical epiphany. She had gathered a towering pile of PROVEN research regarding a downright ordinary substance: Vitamin C.
“She was a part of the ‘crash program’ to uncover as much as we could on the relationship between diet, nutrients, and cancer. And had taken it upon herself to gather and review a decade’s worth of small, but very
sound studies on vitamin C. And what she found was staggering.
“In fact, this tireless researcher reviewed over 46 separate epidemiological studies. She found that 33 of them revealed vitamin C offered significant protection against cancer…particularly for esophageal, pancreatic, stomach, lung, and breast cancers.
“Thirty-three out of 46.
“That’s a 71% rate of positive results! “
But, Micozzi goes on to say, the NCI and the NIH didn’t pay any attention to these revolutionary findings:
“When this dedicated researcher finished her work, was she congratulated? Was she asked to present her findings to an expanded panel of her superiors? Was she even listened to?
“No. As she told me, they weren’t interested. Imagine, the NIH, the guardian of this nation’s health and well-being, wasn’t interested in her findings.
“Why would the NIH shelve this once-in-a-lifetime discovery? Why would they pass on this sound research that could change the face of cancer treatment? Did the NIH already have a ‘cancer plan’ and this once-in-a-lifetime discovery just didn’t fall in line?”
What were those positive results? Micozzi does not say. They may have been in vitro results, for example, Vitamin C kills cancer cells in a test-tube. What we know for sure is that they were not results of clinical trials in which Vitamin C was shown either to cure or prevent cancer in human patients.
But according to Micozzi, the NIH had its own reasons for not looking further into Vitamin C. They were hot on the trail of something else, something we probably remember: beta-carotene. And they were unwilling to pay attention to another hot lead that would divert resources from the pursuit of their favorite candidate – despite the fact that Vitamin C was being proclaimed by none other than the eminent Linus Pauling as being a likely cancer treatment.
A small digression about beta-carotene
Yes, in the mid 1980s there was a lot of interest in beta-carotene as an effective cancer preventative. Beta-carotene is an A vitamin, and there was evidence of a correlation between physiologic levels of beta-carotene and some forms of cancer. The evidence certainly justified a closer look, but the closer look failed to show that taking beta-carotene actually prevented cancer.
And are the NCI/NIH susceptible to being short-sighted? Certainly they are. At present, what’s taking up most of the air – and most of the money! – at the Cancer Institute is gene sequencing. They have gotten exceedingly good at this, and in some cases, they have achieved excellent results. They can sequence the genome of a specific cancer in an individual patient, engineer cells from that individual’s immune system to target those specific cancer cells, and in some cases have been able to halt and even reverse the progress of the cancer in that individual patient. There are those who say that this is not an approach to cancer treatment that can work in the general population, and that it is diverting attention and funds from approaches that might be more generally applicable.
Micozzi charges that the NCI perhaps had unsavory reasons for favoring beta-carotene:
“In this particular case — a member of the National Cancer Institute advisory board happened to be a senior science officer at a manufacturer of synthetic beta-carotene. The shameful dots should be easy enough to connect. If the rug were pulled out from under beta-carotene, too much would be lost.”
… but back to Linus Pauling and Vitamin C
“All the while, sealing the fate of a TRUE CANCER ANSWER to sit on the shelf, collect dust, and be kept from you.
“One day I asked another scientist how the NCI could continue to ignore all the evidence about vitamin C. He explained that two-time Nobel Prize winner Linus Pauling had given vitamin C a ‘bad name.’ In the government’s eyes, he was too vocal about its benefits. And the NCI couldn’t afford to be seen as ‘kooky’ or ‘fringy.’
“Better to be just plain wrong. Meanwhile, Linus Pauling single-handedly held as many Nobel Prizes as the entire scientific bureaucracy of NIH put together. But the NCI prefers to be ‘often wrong, but never in doubt.'”
Yes, it is true that Linus Pauling had won two Nobel Prizes. But neither one had the least connection with Vitamin C. In 1954 Pauling was awarded the Nobel Prize for his achievement in deciphering protein structures – the particular electronic bonds that weld complex proteins together and determine their shape. And, by the way, it is the shape of proteins (and other molecules) that largely determine their properties – how they fit, in three dimensions, with other molecules. It is a branch of science to which Pauling made immense contributions. He was a bit ahead of the curve, for example, when it came to describing the structure of DNA. He knew it was helix, but he was pretty sure it was a triple helix. Of course, James Watson and Francis Crick came away with the blue ribbon when DNA was found to be a double helix, as they predicted.
As close as Pauling came to medical science was when he identified the single genetic mutation that caused sickle cell anemia. It was later found – but not by Pauling – that the reason that this mutation persisted in large numbers of people in certain parts of the world is that in addition to causing sickle cell anemia, it also confers relative immunity from malaria, so the mutation has a survival benefit.
And, by the way, Pauling’s second Nobel was the Peace Prize, which he won in 1962. Nothing to do with Vitamin C.
But Pauling was convinced that Vitamin C had near-magical disease-fighting properties. This certainty of Pauling’s was based on a pretty well-observed correlation, specifically, that the immune response in humans tends to deplete Vitamin C levels. A conclusion following from this correlation is that when the immune response is invoked – for example, we have an infection – it’s a good idea to supplement our Vitamin C levels and bring them back at least to normal.
So far so good. The next step in the reasoning is something of a leap: if supplementing our Vitamin C levels when we have infections helps us to get rid of the infection, wouldn’t it also be a good idea to increase the Vitamin C level all the time, so that we fight off the infection before it takes hold?
And, by the way, even though almost all animal species synthesize their own Vitamin C, we are among the few that do not. We share that shortcoming with our simian relatives, who, however, get all the Vitamin C they need from their diet.
Pauling began to push Vitamin C as an actual cure for cancer in the 1970s. He was of course very well known indeed by then, and his advocacy for Vitamin C as a cancer cure got a lot of attention. He and a colleague published a couple of papers in the late 1970s in which they claimed that Vitamin C treatment significantly prolonged the lives of terminal patients. These papers were severely criticized at the time on procedural grounds. They compared two patient cohorts – one much more severely ill, which got the placebo, and one much less severely ill, which got Vitamin C – so it was no wonder that the Vitamin C patients lived longer, since they were less severely ill in the first place. Later on, in 1986 , the Mayo Clinic published a big study in the New England Journal of Medicine, comparing Vitamin C with placebo in cancer patients, and found zero benefit. Pauling then engaged in a protracted feud with the Mayo Clinic, accusing them of fraud and deception.
However, in this matter of Vitamin C as a cancer cure, invoking the holy name of Linus Pauling is nothing more than an appeal to authority, and in no way constitutes reliance on evidence. If the great Linus Pauling, who won two Nobel Prizes, says so, it must be so, regardless of the evidence!
Micozzi points to another NCI goof
This particular goof was a sin of omission. There was a period in our history when iron supplements were all the rage. Some of you may have heard of Geritol, which was advertised and promoted over the moon in the post World War II years. Micozzi is correct in pointing out that for most people, iron supplementation is entirely unnecessary, and for some it can actually be harmful.
The NCI failure in this case was that when a researcher – another Nobel Prize winner, Dr Barry Blumberg – wanted to publish data about possible harmful effects of iron supplements, the NCI refused to give him access to the data. Why? Because it would contradict the CDC’s policy of persuading pregnant women and women of child-bearing age to take iron supplements.
So, what cancer-fighting tactics does Micozzi favor?
In general, Micozzi seems to favor three fairly distinct tactics:
- Strengthening the immune system, which he calls the cornerstone of the natural approach, as opposed “to standard cancer treatments that are actually harmful to the immune system and to other healthy human cells.” Grant him his grain of truth: standard chemotherapy is certainly rough on patients in many ways. But these standard agents do target and kill cancer cells and significantly extend the lives of many patients, whereas so far the evidence for strengthening the immune system as a means of treating established cancer is non-existent.
- Preventing cancer cells from getting the blood supply they need to grow, or anti-angiogenesis. Micozzi claims that despite the “heroic efforts” of Dr Judah Volkman, who first proposed this mechanism back in 1971, there isn’t as much research done in this area as in antioxidants and immune support. I think there Micozzi is flat-out wrong. Anti-angiogenesis is central to cancer research today. There are 3,246 current studies in cancer angiogenesis, and the success of some drugs, such as those that target vascular endothelial growth factor (VEGF), is based on inhibiting angiogenesis. An example is Avastin (bevacizumab), from Genenetech/Roche.
- Mobilizing what Micozzi calls “the antioxidant brigade.” Combating free-radicals with antioxidants is a central concern of the entire natural/alternative health movement, based on the belief that the causes of many or even most cancers are free radicals, which cause oxidative stress and give rise to the birth of cancer cells . Micozzi, however, is quite modest in what benefits he actually attributes to antioxidants:
“Antioxidant supplements can help the body recover from the effects of cancer treatment as well as helping to prevent the recurrence of cancer.”
However, he’s clearly in the natural/alternative camp:
“Natural substances are not toxic to cells but act differently by influencing the correct growth of cells. And, in some cases (particularly with certain Ayurvedic and Chinese herbal combinations), they can even help cancerous cells return to homeostasis—a normal, stable, healthy state.”
As for his claim that “natural substances are not toxic to cells,” Doc Gumshoe’s skeptical eyes narrow. There must be thousands of natural substances that are highly toxic to cells. “Natural” is not synonymous with “benign.” (By the way, for a more comprehensive look at Doc Gumshoe’s views on the matter, check out The Antioxidant Paradox & the Goldilocks Principle from last Summer.)
Micozzi goes on to name just about every supplement you’ve ever heard of. I’ll list them briefly here. However, it’s interesting that, although he usually introduces them with fanfare – “the best cancer treatments you’ve never heard of …” “the Mother’s Day cancer-crusher” – the actual claims he makes are quite modest, and he prefaces these claims with the following statement:
“Since such ingredients are all ‘natural products,’ many of them are widely available on the open market. However, additional research is needed to establish the correct doses and combinations of these ingredients to have the most beneficial effects. In addition, different formulations of these ingredients on the open market vary widely in their potency and quality.”
Dr Micozzi’s list& some benefits he claims (in his own words)
- Acetyl-L-Carnitine (ALC): “It can help you overcome fatigue and improves the function of the brain and nervous system. This can be very helpful for those recovering from cancer.”
- Alpha Lipoid Acid (ALA): “has been shown to have anticancer effects by activating glutathione peroxidase (another potent antioxidant in the body) and decreasing oxidative stress in cancer patients. One recent study found that ALA could initiate cell death in lung cancer cells.”
- Co-enzyme Q10: “In the laboratory, coenzyme Q10 has been shown to prevent cancer and reduce cancer cell growth. It can also improve white blood cell and immune system function.”
- Vitamin C: “Thanks to the complete misdirection of the NIH, the research on all the potential mechanisms of action of vitamin C is still lacking…. A protective effect of ascorbic acid in colorectal cancer could exist by its prevention of fecal nitrosamines or against other fecal mutagens. In addition, a mechanism has been proposed whereby vitamin C inhibits DNA synthesis and spread of preneoplastic cells.”
- Lentinen and other mushroom extracts: “Mushrooms, such as shiitake, used for cancer in traditional Asian medicine, appear to contain a substance called polysaccharides. These polysaccharides appear to activate the immune system NK cells. In addition, some mushroom extracts have been shown in the laboratory to directly kill cancer cells, but leave normal cells alone.”
- Resveratrol: “In laboratory studies, it has shown anti-cancer effects by inhibiting the growth of over 12 different types of cancer cells, including prostate, breast, colon, pancreas, and ovarian carcinomas.”
Genistein: “In one study, genistein was found to inhibit blood vessel formation in melanoma cells both in vivo and in vitro.”
- Piperine (Piper nigrum), the active compound in black pepper: “Research has shown it can boost the bioavailability of the cancer-fighter curcumin substantially. This is important, since curcumin is not easily absorbed by the body.”
- Curcumin (Curcuma longa): “ In a review of over 728 curcumin analogs which covers the literature from 1815 to mid-2009, researchers showed that curcumin interfered with multiple cell signal pathways including the spread of cancer cells, angiogenesis, and inflammation.”
- Garlic (Allium sativa): “Unlike many other herbs, garlic, is also a biologically active food with presumed medicinal properties, including possible anti-cancer effects.”
- Sutherlandia frutescents (Cancer Bush): “Cancer bush contains a substance called L-canavanine. This potent compound has been shown to stop pancreatic cancer cells in their tracks. But beyond the technical aspects of this wonder-find, there lies a mysterious aspect that could make it the “back from the brink” cancer weapon patients have been praying for. And that’s the ability of the cancer bush to halt the deadly “wasting” process that so many terminally ill patients experience.”
- Chrysanthemum: “Chrysanthemum morifloriam flowers have demonstrated various anti-cancer effects specifically against prostate cancer, together with reishi mushroom (Ganoderma), licorice root (Glycyrrihi zaglabra), saw palmetto (Serenoa repens), and the adaptogen Sanchi Ginseng (Panax pseudoginseng). Chrysanthemum is included in a formulation called PC-CARE. Treatment with PC-CARE or similar formulations should be individually monitored and sought from a qualified and knowledgeable traditional Chinese medical practitioner. Such practitioners may be found in Chinatowns in major urban areas and even some modern university hospital settings in the U.S.”
So what’s Doc Gumshoe’s take on all this?
Dr Micozzi is not a nut and also not a total fraud. Nowhere in his gospel does he assert that there is real evidence that any of the “natural” remedies he’s describing actually cures or prevents cancer in human patients. There are in vitro (in the laboratory) and in vivo (in animals) suggestions of effects against cancerous cells. The remedies could have various effects; possible anti-cancer effects are noted; a substance appears to activate the NK cell system. And so forth. At the same time, Dr Micozzi boosts Chinese and Ayurvedic healing, and goes so far as to suggest that patients in the US seek out Chinese practitioners. What gives?
Dr Micozzi is angry and frustrated. He has had it up to the eyeballs with the bureaucracy and politics at the big Federal health agencies. He is disappointed with the slow and painful progress of cancer research, and he has bought into the alternative sloganeering that current cancer treatment consists of “cut, poison, and burn,” which is how the alternative segment maligns surgery, chemotherapy, and radiation therapy. Does he have a point? Certainly. Is it possible that some of the remedies he proposes may have genuine benefit? Also, certainly. But evidence that any of his “cancer answers” can replace current standard treatment forms is entirely lacking. And, in the meantime, current cancer treatment is at least holding its own in the face of a rapidly increasing population at risk. What I mean by that is that the total number of cancer deaths is diminishing slightly, but more people are at risk for cancer simply because the death rate from heart disease has declined so sharply, and we all die of something. So seen in that light, current cancer treatment is a relative success.
But what has happened with Dr Micozzi is that he has been taken over by a marketing machine that packages his mostly moderate support for alternative and non-Western healing practices in a wrapper of over-the-top hype. Some people will likely be taken in by the promise that they can cancel their colonoscopies forever. In this regard, Micozzi has lent himself to a scheme that can lead to substantial harm and even death for the susceptible.
In the meantime, lots of research is going on regarding the benefits of some of these alternative treatments. For example, at the moment there are 98 clinical trials going on with curcumin – not only in cancer, but in several other conditions. And these are being done by mainstream institutions – universities, foundations, pharma companies. The objective is to find genuine, reliable evidence that these remedies work. If the evidence holds up, mark my words, mainstream medicine will accept the alternative remedies as bona fide drugs.
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As always, Doc Gumshoe thanks his readers for comments of all flavors. Right now, I’m weighing a couple of subject for future pieces. On the one hand, there’s been a lot of talk about diabetes – this disease is affecting more and more of us, here and in other nations, and wreaking its ugly havoc on younger and younger people. At the same time, pharmaceutical companies keep introducing new agents for diabetes – and no questions, new agents are needed – with varying and debatable degrees of success. So, a look at what’s going on in diabetes? Another possibility is depression. The question is, how effective are any of the current treatments in restoring people to relatively normal function? Let me know which of these – or any other subjects – you’d like to hear about.