July 2011

The End of the World As We Know It

By Michael J. Katin, MD

This month, the United States will be celebrating the 235th anniversary of the Declaration of Independence, with thousands of fireworks displays costing tens of millions of dollars and all manufactured in the People's Republic of China. Buying the fireworks further strains the balance of trade, using up dollars that are able to be generated only because treasury bonds are purchased by the People's Republic of China, eventually costing us our independence. Oh, well, it was nice while it lasted. Look, another chrysanthemum!

As long as we're dissipating our resources, this celebration might be extended to include appreciation that the end of the world did not come about earlier this year.

Despite the absolute certainty expressed by Rev. Harold Camping, the beginning of the end times did not occur on May 21, 2011 (or if it did, nothing changed very much). However, another event has occurred to finally put an end to any idea that we have a clue about what goes on in the human body.

A study published in the American Journal of Epidemiology has correlated the risk of developing high-grade prostate cancer to blood levels of DHA, an omega-3 fatty acid. This report is the most recent of many to suggest that substances previously thought to be beneficial instead could be deleterious, if not deadly. Brasky et al. reported that analysis of blood specimens from men participating in the increasingly-controversial Prostate Cancer Prevention Trial indicated that a high blood level of DHA produces a risk of high-grade prostate cancer which is 2.5 times the risk for men with low levels. To make things even more interesting, high levels of trans-fatty acids reduced the risk by half . Has Mayor Bloomberg condemned the men of New York City to a future with prostate cancer due to his banning of trans-fats from the city?

This is seemingly in conflict with numerous studies of the incidence of prostate cancer in Alaskan Indians, Eskimos, Aleuts and Inuit populations unless, of course, there were a smaller number of cases with higher grade, which is not able to be obtained from epidemiologic studies currently available. It also may be that Alaskan Indians, Eskimos, Aleuts, and Inuit do not regularly participate in prostate screening events. For example, an analysis of 15,275 men participating in screening studies in New South Wales in 2006 included no persons of Alaskan Indian, Eskimo, Aleut, or Inuit origin!

Any urologist will tell you that the purpose of the heart is to pump blood to the prostate gland, making it even more unfortunate to have to choose between cardiac health and prostate cancer. At least having a good cardiac status might enhance tolerance of doclitaxel and sipuleucel-T.

As noted earlier, this is just the latest in many drugs and quasi-drugs that have been found to be potentially more harmful than beneficial. Procrit and Aranesp had been intended to make treatments work better by bolstering hematocrits, but it turned out that cancer cells might also benefit from this . Controlling blood sugar with Avandia could instead increase the risk of heart attack. Hormone replacement therapy in women was supposed to reduce the risk of heart attack and stroke; the opposite seems to be the case . It would take a full column to discuss the alleged risks of 5-aplpha reductase inhibitors for provoking prostate cancer .

Regardless, the number of prescription medications that have turned on us pales in comparison to the supplements and other natural products that have become suspect. We can remember when Linus Pauling vigorously promoted the use of megadoses of Vitamin C to prevent cancer. He died of prostate cancer on August 19, 1994. Beta-carotene was also supposed to protect us from cancer. It was also in 1994, interestingly, that the ATBC trial showed an 18% increase in lung cancer in male smokers in Finland who took beta-carotene compared to the control group. The "risk" of beta-carotene was later supported by the CARET study showing a 28% higher incidence of lung cancer in smokers and asbestos workers . Vitamin E had been studied in the ATBC trial and not found to be a harmful factor, but in the SELECT trial for prostate cancer prevention the use of Vitamin E produced a nonsignificant increase in prostate cancer Selenium, which had previously been thought to be a surefire preventative for prostate cancer, at least did not make things worse but didn't help, either. Of course, selenium turns out not to be all that safe, since it has been associated with elevated cholesterol levels

It appears that the spectrum has been covered, from alpha (alpha tocopherols) to omega (omega-3 fatty acids) in terms of our not knowing as much as we think about what's good for us. We've been through Hadacol , Vitameatavegamin , KM , Monavie, noni juice, goji juice, pomegranate juice, coconut water juice, and vitamin combinations of every kind . Things that were supposed to be bad for us may even turn out to be good. But when even the last borderline scientific mass media-hyped pseudo-nutritional concoction has been brought into disrepute, it may not mean the end of the world as we know it, but it certainly means the end of our thinking we know much about the world.

Both in and out of our professional lives, we are constantly subjected to disillusionment but we continue to go on. We have to wonder, though, what will disappoint us next .