From the great Hebrew poet, Solomon Ibn Gabirol : “At the head of all understanding – is realizing what is and what cannot be, and the consoling of what is not in our power to change.”
I am not a believer in the “Life sucks and then you die” philosophy. I’ve been lucky in both life and love, so I believe that life doesn’t suck, but I do know we all will die. Some of us sooner, some of us later, but no matter how hard we try to control it, we all die. Of something. What a lot of people don’t know, though, is there is a certain degree of random chance, or luck, if you will, in who gets what diseases. Who, and why, someone gets a disease is often most honestly and accurately answered with a shrug of the physician’s shoulders. While there are many things we can do to reduce our risk of contracting certain diseases or conditions, there is no pill, exercise regimen, or dietary restrictions that will help us beat what research has proven to be the utter randomness of some of our fates. I have written previously about dietary fads, dietary supplement scams, and extreme exercise programs that are promoted as sure ways to prolong life, prevent cancer, beat heart disease, and create world peace. Believe me, as a Type A personality, I understand the need to feel like you’re in control of your health and, ultimately, your fate; and, as a physician, I admit I have succumbed to doing something, sometimes anything, to try to cure a patient even when I knew that no treatment could possibly make a difference. As intelligent, thoughtful, consuming individuals, we are vulnerable to “buying in” to the notion that we can control the outcome of our own health. And we can, but only within certain defined limits. I am a firm believer that knowing these limits, and then facing them with our eyes wide-open, saves wasteful efforts, money, guilt, heartache, and frustration.
A groundbreaking study was published last week that analyzed the causes of one such fate, cancer. See here. The study asked the question: Is cancer a result of your genetics, environmental exposures, or just plain bad luck? This was such a relevant and attention-grabbing study that its results were published on the front page of the Wall Street Journal, see here, and it is an excellent discussion of how cancer occurs. Using statistical analysis, this study found that the majority of cancers are caused by bad luck. Really?? Does that sound like medical science to you? Fortunately or unfortunately, depending on your viewpoint, it is. “If two-thirds of cancer incidence across tissues is explained by random DNA mutations that occur when stem cells divide, then changing our lifestyle and habits will be a huge help in preventing certain cancers, but this may not be as effective for a variety of others.” There is no lifestyle, diet, supplement or exercise regimen that is either a “good luck producer” or a “bad luck remover.” Where does that leave us? It does not necessarily leave us completely helpless to the whims of the stem cell mitotic process. There certainly are behaviors and environmental exposures that increase your risk of contracting about one-third of all cancers. For example, less than 1% of people who develop small cell cancer of the lung are lifelong non-smokers, see here. So if you don’t smoke, you have pretty much eliminated your risk of getting small cell cancer of the lung. However, another type of lung cancer, called carcinoid tumors of the lung, is not associated with smoking at all. You cannot change your chances of getting this form of cancer by not smoking. Similarly, there is a direct correlation between sun exposure and melanoma, and between exposure to asbestos and the incidence of mesothelioma. In other words, one-third of all cancers are associated with things over which we DO have some control, but the other two-thirds are “bad luck cancers.” Before I discuss what can be done to prevent cancer deaths, I am going to discuss what isn’t worth doing.
There are those who argue – aggressively — that dietary supplements, especially antioxidants, can reduce the incidence of cancer, and American consumers spend billions of dollars on these supplements every year. The theory behind this pseudo-science is that free radicals occur in our bodies, and their damaging effect on human cells results in cancer. Antioxidants reduce the amount of free radicals in our bodies, and thus reduce the risk of developing cancer, or so the corollary goes. It makes sense. Here is an objective, scientific review of antioxidant studies, and the results aren’t encouraging. Three of the most heavily promoted antioxidants sold in the US are beta carotene, vitamin E, and vitamin C. Millions of Americans take these supplements, individually or in combination, to prevent disease. But let’s look at some actual scientific trials, not advertisements from GNC, “studies” from Herbalife, or rants from True Believers. These well-designed double-blind studies show no significant reduction in cancers in people taking these supplements. One particular study, see here, looked at heavy smokers, the ones who are most likely to get lung cancer. 30,000 men in this blinded study were given vitamin E, or beta carotene, a combination of both, or neither. The study results clearly indicated that vitamin E was not effective in reducing the incidence of lung cancer in smokers at all. The participants who took vitamin E had no different outcomes than the participants who didn’t take vitamin E. However, beta carotene did have a significant effect on the incidence of lung cancer. In fact, the more the participants smoked, the greater the effect of beta carotene on the incidence of lung cancers. The subjects who took beta carotene and were heavy smokers actually had an increase in the incidence of lung cancer. The Antioxidant Truthers argue that these types of studies used the wrong doses of antioxidants, and that is why the antioxidants did not show benefit. Since dietary supplements aren’t regulated by the FDA, manufacturers can claim almost anything they want. And remember that tried and true medical factoid, “I read it on the internet, so it must be true!” And what would the manufacturers do if their own studies showed lack of effect? Do you think they would actually kill their cash cow? My takeaway from this is that just because something has a theoretical basis, that doesn’t make it fact. The scientific method is to develop theories and then do studies to see if the theories are correct. While it might make sense to you on some level, believing something and actually knowing something are two different things. Look at the data objectively. If you discover you are wasting your time and your money, or maybe even doing harm to yourself or your loved ones, it’s time to rethink those beliefs.
Is this another example of John the Nihilist (I do like that title) recommending that you don’t smoke, and then just wishing you good luck with all the rest? Actually, no. What I am suggesting – and not even charging you for an office visit — is that you take a careful look at what we DO know from scientific data today, and don’t waste your time, energy, and money on things you, or very good salesmen, “believe” might help you live longer and healthier. I have given the example of antioxidants, but there are innumerable other supplements, diets, and extreme lifestyles that are freely promulgated with totally unsubstantiated claims. According to much scientific data, you are probably just wasting your time and money, when you should be focusing on things you actually can do to alter your outcome.
Remember the one-third of all cancers that do have a defined causal link and are not caused by bad luck? Focus on those cancers whose incidence can be successfully reduced by modifying your lifestyle. To give you just one example… Many cancers are caused by viruses. Human Papilloma Virus – HPV — is a sexually transmitted virus that causes virtually all cervical cancer in women, as well as many anal, vaginal, penile, mouth, and throat cancers. See here for more details. From a 2006 CDC bulletin when Gardasil, the new vaccine, was introduced : “HPV is the most common sexually transmitted infection in the United States, More than 20 million men and women in the United States are currently infected with HPV and there are 6.2 million new infections each year. HPV is most common in young women and men who are in their late teens and early 20s. By age 50, at least 80 percent of women will have acquired HPV infection. “ This vaccine is almost 100% effective in preventing the types of HPV infections that cause these cancers. See here for more details. Unfortunately, in 2010 a study done by the Mayo Clinic showed that 44% of parents of teenage daughters say they would not vaccinate their daughters to prevent HPV. See here for more information. Why won’t these parents take this simple, effective step to protect their children from these terrible cancers? The study states, “Among the reasons they [the parents] gave: the vaccine was not recommended; lack of knowledge; it is unnecessary; the vaccine is inappropriate for the child’s age; worry about safety/side effects; and the child isn’t sexually active.” When is the best time to give this vaccine? Before the initiation of sexual activity, so before there is even a chance of the child contracting HPV. The Mayo Clinic recommendation is to administer this vaccine at age 9. There has been strong vocal objection from many on the Religious Right about the HPV vaccine, and I found a number of quotes from people stating their “belief” (there’s that pesky word again!) that abstinence is the best way to prevent HPV and that parents who vaccinate their children are, in essence, giving them “permission” to be sexually active. I was happy to see that the Family Research Council, a prominent conservative Christian organization, now approves of the administration this vaccine, see here, but that is a recent development, and there are still many opposed to a clearly beneficial medical practice on moral grounds that are shaky, at best.
Abstinence is a fine, if elusive, contraceptive and HPV preventative. Parents and churches might like to believe their children are not going to be sexually active before marriage and will be monogamous forever after, but that is not necessarily the case. A study of middle and high school students who took a ”virginity until marriage” pledge found that five years after taking the pledge, their level of sexual activity was no less than those who did not pledge virginity. But – and here’s the kicker — the incidence of unprotected sex was much higher in the group that had taken the virginity pledge with much less birth control and condom usage for STD prevention. See the study here.
Even uber-Conservative Rick Perry, a Republican candidate for President, was for mandatory HPV vaccinations… before he decided he was against it. And, of course, the always-misinformed but 100% certain Michelle Bachman stated she believed that the vaccine caused mental retardation, see here. This should not be a political or a religious debate. If 100% of teenagers, female and male, were vaccinated for HPV, there would be no more cervical cancer, period, and that’s a scientific fact, not a belief. Think about that, for a moment, before you think about adopting a gluten-free diet to attempt to change your outcomes!
I can’t help myself – I have to tell another story. In 1987, a mom brought her 14-year-old daughter to my office. I don’t even remember why she was my patient — I have always had a rule that I didn’t treat anyone under the age of 18 as I am an internist, not a pediatrician or family practice doctor — but regardless, she was a patient in my office and, during the course of my routine evaluation, with my nurse present but not her mother, I asked her if she was sexually active—she was—and if she was using birth control—she wasn’t. I explained to her that she needed to be using birth control or she would get pregnant. We also talked about sexually transmitted diseases. She told me that her mother would not let her take the pill. I asked her if she would give me permission to talk to her mother about this in a general way so as to not let her mom know that she was sexually active. She agreed, and after an in-depth discussion with both the girl and her mom, I had to admit that I had failed. Her mother insisted that her daughter was not sexually active and that if she did, indeed, become sexually active, she would just have to face the consequences of a pregnancy. That would be the child’s penalty for not following her mom’s rule of abstinence. Wow! I was really floored. And yes, within a year this 14-year-old child was pregnant and had a baby. This is a similar thought process from the many parents who oppose the HPV vaccination. Cervical cancer is NOT a “bad luck” cancer; it is a “bad choice” cancer, and those are the ones over which we actually DO have some control.
I am traveling for the next few weeks so there will be no new posts until I get back. Next time I will discuss what we can do to contain the “bad luck” cancers, including a discussion of early detection preventative care, what works, and what doesn’t. Thanks for reading, and please know that I always value and enjoy reading your comments. Please share by clicking your favorite social media button below
- Just a Shot in the Arm
- My Science vs. Their Beliefs