I am not sure what this article is about. All of current medicine runs on hype, or more precisely, acceptance of poor standards, and the industry includes academic and medical researcher. The ability to generate on line publications has caused proliferation of highly profitable publishing operations which could not keep going without significant lowering of standards. And it is not just the recent open access journals who are essentially what used to be called vanity press by charging authors high fees. The most prestigious journals publish highly questionable papers and many secondary sources included one published by science broadcast the results uncritically.  The absence of universally accepted neutral authority— American Heart, American Diabetes and even the NIH have strong bias — means that everything must be read with suspicion..

Cancer probably generates the least hype, at least in the sense, that most of us — professionals and patients alike — are not optimistic about the state of of cancer treatment.  For uncertainty, medical nutrition is the worst — Harvard School of Public Health told us that red meat causes diabetes and BMJ called for physicians to undertake vigilante activity against red meat. That red meat consumption went down substantially during the diabetes epidemic does not seem to change anything.

Along with the expanding number of journals and flood of publications, we have proliferation of critiques of those publications but these have little effect. There is a whole industry of exposés of the literature — like the current article — some of which are on target but all of which can be ignored. The problem is a breakdown in standards and a peer-review system that is outmoded in a field where there is controversy and poor agreement of what constitutes acceptable practice.

The question of inadequate diagnostic tests is a somewhat separate issue but here, too, criticism is widespread but may have limited effect. Explaining the astounding statistical errors in mammograms is standard in teaching statistics (e.g. Gigerenzer’s Calculated Risks…) and has become a internet parlor game — Google “YouTube mammogram statistical error” and you will find dozens of examples. I have used the example in lectures myself. I usually add “no oncologist would take action based on a mammogram alone” but I am not so sure. Certainly the Susan Komen website underestimates the potential error “(https://ww5.komen.org/BreastCancer/AccuracyofMammograms.html).

One of the features of the hype and corruption is the acceptance of terms that are value judgements as if they were statements of facts. “Evidence Based Medicine” never explains, by analogy with a court of law, who decided on the admissibility of the evidence. And if we knew which diets were “healthy” we wouldn’t have the current confusion. Along these lines,  I am not sure that the “conservative” approach offered as a solution in this piece holds much promise. Medicine tends to consider a conservative approach the use of established practice, whether or not it has the desired outcome, the main point of the article.  A conservative approach may entail reluctance to examine new ideas. My own field, application of ketogenic diets shows great promise, notwithstanding that most researchers in the field are explicit about about how little data we really have. There is hype in support and also in opposition but the latter seems like more of a threat: one of the reasons we think ketogenic diets may be helpful for cancer is the relation of cancer to diabetes and the role of insulin and energy metabolism. The data establish ketogenic  diets as the first approach in diabetes. The resistance of the medical community to the idea suggests the limits of a conservative approach.

John Horgan does an excellent good job in highlighting how the pharmaceutical industry has corrupted cancer diagnosis and treatment.  It is important to recognize that over 1,600 people die each day from cancer in the US according to the recent article from the American Cancer Society (https://doi.org/10.3322/caac.21590).  In China, over 8,000 people die each day from cancer.  There is no way that these numbers can be sugar coated.  These daily cancer death rates exceed that expected for a worst-case scenario with the current coronavirus pandemic.  

I have first-hand knowledge of a pharmaceutical company (KAZIA) that continues to treat glioblastoma patients with a drug (CDC-0084) that was shown to have “Zero Response Rate” in reducing glioblastoma in preclinical studies and in a phase 1 clinical trial.  This information was presented at the Boston Glioblastoma Drug Development Summit (Dec. 10-11, https://glioblastoma-drugdevelopment.com).  Many other presentations at this meeting involved drugs that produce significant patient harm with little if any therapeutic benefit.  Is it moral to treat cancer patients with drugs that have no therapeutic benefit and are disconnected to the known biology of the disease?  Have some oncologist forgotten the passage from their PRAYER OF MAIMONIDES? “Do not allow thirst for profit, ambition for renown and admiration, to interfere with my profession, for these are the enemies of truth and of love for mankind and they can lead astray in the great task of attending to the welfare of Thy creatures.”  

We recently published a paper describing in detail how the current standard of care for glioblastoma contributes to the rapid recurrence and demise of most patients (https://doi.org/10.1007/s11064-019-02795-4).  All people should know this information, as the take-home message would also apply to the treatment of most metastatic cancers.  Indeed, a recent study showed hyperprogressive disease in lung cancer patients treated with the PD-1/PD-L1 immunotherapy drugs that are regularly hyped in the media as successful treatments for a broad range of cancers (JAMA Oncol. doi:10.1001/jamaoncol.2018.3676).  In other words, the immunotherapy killed some of the patients faster than did the standard of care or even the disease itself.  Paul Alan (Microsoft c-founder) and Blake Nordstrom (Nordstrom’s department stores) both died within weeks of receiving their treatment for lymphoma (WSJ, October 16, 2018, page A2; and January 3, 2019, page B3, respectively).  As immunotherapy drugs are highly expensive, I predict that treatment-associated death from these drugs will be greater for wealthy people than for poor people.  On the other hand, more poor people than wealthy people will suffer the consequences of financial toxicity, a new form of cancer-associated toxicity arising from drug price gouging (McGiniss, A., eScholarship@BC).  Has the new morality become drug profit over patient outcome?

It is my opinion that many of the NCCN guidelines contribute to the current cancer crisis in not recognizing that cancer is primarily a metabolic disease and not a genetic disease.  The recommended NCCN guidelines put cancer patients at risk for spreading tumor cells or for causing significant harm to normal body physiology.  Our recently accepted paper in the journal Frontiers in Nutrition (doi:10.3389/fnut.2020.00021) describes how breast tissue biopsies create inflammatory oncotaxis that can facilitate the spread of breast tumor cells.  Biopsies are also known to spread other cancers as well (PMID:8751221; DOI: https://doi.org/10.1378/chest.118.4.936).  Cancer spread through tissue biopsy is an unintended consequence of guidelines that are disconnected from the known biology of tumors.  Travis Christofferson reviews evidence in his new book, Curable, showing that breast tumor recurrence is similar in patients receiving radical mastectomy vs simple mastectomy, yet many breast cancer patients continue to receive disfiguring radical mastectomies (pages 59-69). Is it possible that some oncologists do not read or possibly ignore information in peer-reviewed medical journals?  

Although most oncologists practice their craft with well-meaning intentions, most are unfamiliar with the emerging evidence that cancer is primarily a metabolic disease driven by the fermentation of glucose and glutamine.  Non-toxic, cost-effective therapies can be developed rapidly based on this new knowledge of cancer biology.  It is my view that cancer deaths can be reduced by 50% in about 10 years once this knowledge becomes more widely recognized and acted upon.

I can therefore endorse the opinion of John Horgan and applaud CrossFit for initiating the discussion on this important topic.

Thomas N. Seyfried, 
Professor.

To address the comments above, the truth is that in a lot of cases, survival rates with current standard of care therapies are not impressing anyone, despite the money and efforts that go into research. In order for medicine to move forward, there has to be a little bit of devil’s advocate play, and cancer is no exception. In regard to the comments on alternative therapies, I don’t think CF has ever once discussed anything that hasn’t been backed by research. It is true that the majority of cancers have abnormal mitochondrial structure and function, which means potential exploitation with metabolic therapies, ketosis being one of them. With that said, it has to be recognized where ketogenic therapies are appropriate and where maybe they aren’t but there has to be room for discussions like these to promote exploration for new and novel therapies, otherwise we won’t get the answers to these questions. This probably applies to screening programs and diagnoses, too.

It’s also worth mentioning that alternative medicine is different than complementary - this is pulled directly from the paper that Craig linked to: 

“It is important to note that complementary and integrative medicine are not the same as AM as defined in our study (13). Whereas complementary and integrative medicine incorporate a wide range of therapies that complement conventional medicine, AM is an unproven therapy that was given in place of conventional treatment.”

It’s not fair to put metabolic therapies in the same boat as alternative therapies like those listed above (“alkaline diets, homeopathy, etc.”)

So, I would disagree that these articles are misleading. They are opening up room for discussion around metabolic-based non-toxic therapies. And this isn’t to discredit standard of care cancer therapies, but rather improve on them, and possibly use strategies that enhance their efficacy and mitigate side effects.

For example: 

⁃PI3K inhibitors are shown to be more effective when you lower insulin with a ketogenic diet (https://www.cancer.gov/news-events/cancer-currents-blog/2018/pi3k-resistance-ketogenic-diet-diabetes-drug)
⁃The anti-tumour effects of radiation have been shown to improve when paired with a ketogenic diet (https://www.sciencedaily.com/releases/2012/12/121204112610.htm)
⁃Most cancer types do respond to ketogenic therapies as you can see in figure 1 of this paper (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5842847/)
⁃There is a clinical trial currently looking at the combination of a ketogenic and chemo in breast cancer (https://clinicaltrials.gov/ct2/show/NCT03535701) 
⁃“Increased metabolic oxidative stress in cancer cells would in turn be predicted to selectively sensitize cancer cells to conventional radiation and chemotherapies.” (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4215472/)

So, at the end of the day, it’s important to talk about these nuances and keep in mind the cancer type when considering treatment and screening, as it appears here that breast cancer and prostate cancer need improved screening procedures as this article highlights.

Another fun cancer article to discuss.  Does CrossFit.com speak with any Oncologists before writing cancer-specific articles to maybe get educated opinions or information?  These are articles are very misleading as Stephen P. pointed out in his comment.

All of the cancer articles posted on CF.com talk about metabolic processes, discrediting accepted science, using ketosis as a cure-all to cancer (most studies quoted on-site have applied to glioblastomas only), and also going against NCCN Guidelines for cancer therapy.  Information about NCCN Guidelines can be found here if you do not know about them - https://www.nccn.org/patients/clinical/default.aspx.  Please go and try to discredit NCCN Guidelines.  I'll wait...

Cancer cells can be normal looking in appearance to the body (I'm over-simplifying this) and  sometimes the only difference that makes them cancerous is becoming immortal.  Overpopulation of a growth becomes a tumor and that can compromise someone.  Targeted therapy is difficult to differentiate normal cells versus cancerous cells when they both have so many of the same features.  Failure of therapy is high in late-stage, aggressive cancers.  This may be one of the reasons.  See further down for another reason.

Alternative therapies do not work.  The article, "Use of Alternative Medicine for Cancer and Its Impact on Survival" by S Johnson et al (https://doi.org/10.1093/jnci/djx145) shows using alternative medicine as a poor choice for cancer patients in terms of survival.  I have seen so many patients decline accepted treatment at Stage I to come back to see me when they have a fungating breast mass erupting out of their chest wall, lymphadenopathy in the pelvis that is so large it is causing edema in the leg(s) making it difficult to walk, or innumerable bony metastases with excruciating bone pain and pathologic fractures.

Proper screening tools and tests that are interpreted correctly and in the context of a specific patient are extremely helpful in stopping cancer early in the disease process.  Most cancers do not just disappear.  Late-stage cancers in the chest, abdomen, and pelvis are extremely hard to treat and cure because symptoms do not show until you have a mass the size of a softball or bigger (for example).  A patient cannot see this mass sticking out of the body.  It does not lead them to see a doctor until way too late.  By this point, the tumor burden is extremely large and the chances of local invasion, lymphatic spread, and metastases are very high. 

CrossFit.com is a treasure trove of helpful, useful, and life-changing information.  But you need to temper what is published sometimes so that people are not misled. 

This article may give some people the impression that early diagnosis and treatments don't work and that they should seek alternative treatments.

However, peer-reviewed research consistently supports the effectiveness of early diagnosis and treatment.  

It's not fair to correlate the issues endemic of a profit-based healthcare system with the effectiveness of proper detection and treatment.

Alternative treatments, in the vast majority of cases is ineffective and don't pass muster under review, and take in significant profits on the sale of false hope (alkaline diets, homeopathy, etc).  These pseudo Sciences would be a better focus of scrutiny than giving false impressions of effective scientific research.

Wodapalooza wrap up: our team got 101st out of over 140 teams in the Scaled division.  We met for the first time at the event.  The worm was evil.  Iron plates for team Deadlifts was interesting.  In all The events this were were in the mold of the 2019 CrossFit games.  Overall a very well ran event.