Junk Science? Number 65: Chemotherapy doesn’t work very well because you’re fat!

Over at Chris Woo’s blog – sorry, Chris Woollams’ blog – the untraceable pseudonymous “Sam Wilson” has written a piece that perfectly exemplifies the reality disconnects that underly so much of what the UK’s No.1 1 cancer researcher (source: Chris Woo) writes.

Junk Science? Number 65: Chemotherapy doesn’t work very well because you’re fat!

No, seriously. It’s your own fault your chemotherapy didn’t work very well. According to a September research study in the American Society of Clinical Oncology’s (ASCO) Journal of Clinical Oncology, the amount of chemotherapy drugs should increase with body weight.

Not just in September, Chris. There’s an August 2012 practice guideline, an April 2012 study, it’s on cancer.net – it’s almost as if someone has been doing some science and this has influenced clinical practice.

Oh, wait…

Here’s a curious thing, though. While most of the coverage in the press is from September 2013, the actual publications all seem to be earlier. Since Chris didn’t cite the paper it’s not actually possible to check – maybe this paper does say that it was prompted by big pharma challenging weight-based dose caps, but all the published research I find is about retrospective studies that indicate a systemic problem with under-dosing for obese patients, particularly in liquid tumours where chemo is the primary (rather than an adjuvant) therapy.

The fatter you are, the more drugs you will need. At least that’s what Big Pharma is now saying ably supported by a number of top oncologists in America. Apparently, their concern is that as waistlines increase, people are being ‘under-treated’ by as much as 85 per cent!! No wonder the drugs didn’t work.

No, it’s not what “big pharma” say. As far as the evidence shows, big pharma never challenged the dose caps that were in use for a long time, the changed recommendation (i.e. removing the dose caps that limited dose for obese patients) came form epidemiological work done by oncologists in practice. They found that obese patients were performing worse and checked whether the evidence for weigh-based dose capping was sound. It isn’t.

There’s a slight biochemical hic-cough with this view. You may be fatter, but it is unlikely that your tumour will be much bigger than a thin person’s, nor that it is growing any faster, and the organ it has attacked may be no bigger either. If it is growing faster, all the recent research suggests that this is because a fat person’s blood glucose levels are likely to be higher than those of a thin person – but that’s a different issue requiring a different solution. Conversely, Calorie Restriction seems to make chemo more effective as we covered earlier in 2013. But there again, as CANCERactive covered at the time, Big Pharma thinks doses of chemo should be higher with Calorie Restriction too (?).

So, what, they should ignore the findings? Or tell obese cancer patients to go away and not get cancer until they are thinner? The only reason for opposing the new guideline is a philosophical hatred of chemotherapy. Coincidentally, Dr. Gorski (who, unlike “the UK’s no. 1 cancer researcher”, is actually a cancer researcher) wrote about this yesterday.

No, “all the recent research” doesn’t suggest the tumour is growing faster because of higher glucose levels, the research shows that the disturbed insulin/glucose balance in obese people may be a trigger and that this may have an important role in their higher cancer rates.

What Chris is alluding to here of course is the “evil glucose” theory; the idea that because most (but by no means all) cancer cells only metabolise glucose, thus starving the body of glucose will treat the cancer. He seems to think that this is better than increasing doses of chemo based on solid science showing the weight-based dose limits to be wrong – essentially substituting religion for science.

Unfortunately, according to people who are (unlike the UK’s No. 1 cancer researcher) actually cancer researchers, “Many scientists have tried killing cancer cells by taking away their favorite food, a sugar called glucose. Unfortunately, this treatment approach not only fails to work, it backfires—glucose-starved tumors actually get more aggressive.” (source).

So True Believers in cancer starvation diets, may actually be actively killing patients, while rejecting science that is likely to contribute to their survival. Nothing new here, just another data point in the long-running saga of why science is always better than religion when assessing medical claims.

So, what the heck?! Fat and high blood glucose, or, thin and low blood glucose? ‘Supersize’ them now’ is the cry from Big Pharma.

No, Chris, this is a very specific finding from a very specific piece of research. It says that weight-based dose caps for chemotherpeutic agents, may result in obese patients being underdosed. Since doctors are paid to treat, not given a cut of the drugs cost, there is no remotely credible reason to suspect this is anything other than an honest piece of research by diligent doctors doing what they are paid to do: trying to improve the effectiveness of treatment.

Hijacking it in order to support a simplistic agenda-based alternative is ridiculous and makes you look like a fool.

As to whether dietary glucose may have a role in cancer management, I think that quite likely – but as Mencken said, for every complex problem there is an answer that is clear, simple and wrong. Starving a tumour that is PKCζ deficient, could actively kill the patient. Maybe it’s beter to wait until actual cancer researchers are done investigating this and have come up with some evidence-based treatments.

Chris. You’re wrong about laetrile, Hoxsey, Gerson, Burzynski, escharotics, ellagic acid and pretty much everything else, but if you tirelessly advocate every single quack treatment based on simplistic understanding of every single misleadingly vivid early finding, you will of course occasionally back a misleadingly vivid early finding that turns out to have a germ of useful therapeutic science. Guess what? That still won’t make you right. You’re the cancer version of Psychic Sally, remembering the hits and rationalising away the misses.

Actually, given recent hilarious nonsense, you’re probably closer to Psychic Bob.

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