October 2003

Hunger for Knowledge

By Michael J. Katin, MD

There are now only several days left until the California recall vote and only several weeks until the 45th annual meeting of the American Society for Therapeutic Radiology and Oncology. Recalling that in 1971 President Nixon declared war on cancer, it's depressing that 32 years later we're not getting together to celebrate victory and find out what we're all doing now that we have had to find new professions. Rep. Charles Rangel recently noted that the army unit in which he served in Korea 53 years ago is still there, and it's looking more and more as if we'll be in Iraq until Alan Jackson can tell it from Iran. Fortunately, just when it's about time to concede to the mitotic figures, a discovery comes along to give us all hope.

Truly speaking, for years it has been recognized that over-indulgence in food has been counterproductive to longevity although certainly much more fun in the short term. The great Thomas Tusser (1524-1580) advised to "Make hunger thy sauce, as a medicine for health." I'm not sure exactly what he meant, but Benjamin Franklin (1706-1955) expressed it more succinctly: "To lengthen thy life, lessen thy meals." Their conclusions may have been based on empiricism, but as early as in the 1930's experiments documented that food restriction in rats and mice led to substantial extension in lifespan and it was later observed that there was a decreased incidence of tumors (McCay, CM, Crowell, MF, Maynard, LA J Nutrition 10:36-79, 1935; McCay, CM, Ellis, GH, Barnes, LL, Smith, CAH, Sperling, G, J Nutrition 18:15- 25, 1939). Further studies were done on the results of food restriction, although many of these were inconclusive until the realization that many of the rodents were binging on Rocky Road ice cream just before bedtime. Once this was controlled, there were unquestionable data connecting reduction in food intake with reduction in neoplasms (Ross, MH, Bras, G, J Natl Cancer Inst 47:1095-1113, 1971).

These revelations were politely ignored for the next 30 years as our consumer society indulged in super-sizing everything we could get into our mouths. It may now be payback time. The Goliath Casket company is in fat city selling mega-sized caskets. The Federal Aviation Agency is exploring corrections in calculations to accommodate the fact that the average passenger weighs substantially more than years ago; this may have been a contributing factor to the January 8 crash of Midwest Air Flight 5481. Now a long article in the New England Journal of Medicine claims that a high body-mass index is clearly associated with an elevated risk of cancer.

This prospective review (Calle, EE, Rodriguez, C, Walker-Thurmond, K, Thun, MJ, N Engl J Med 348:1625- 1638, 2003) concludes that obesity in men and women in the United States could account for 14% and 20%, respectively, of deaths from cancer. Statisticians and vested interests (see subsequent letters from R. MacDonald and R. Limbaugh) can undoubtedly find fault in the methods used by Calle et al., but the truth hurts. It's not easy to give up Krispy Kremes and Fritos.

Does this phenomenon extend to other countries as well? Undoubtedly. A review of the literature on countries with relative caloric deficits per capita produces an amazing number of studies which, if not done and the money spent on buying food for these countries, would have solved the problem. It is also recognized that there can be a problem of distribution within a country, and that the average caloric intake or income does not necessarily reflect the problems of subgroups within that population. Skipping over this, then, the list of the bottom 10 countries by per capita income includes Sierra Leone, Tanzania, Ethiopia, Somalia, Cambodia, Democratic Republic of the Congo, Rwanda, Comoros, Burundi, and a tie between Eritrea and Yemen for the tenth position. I personally surveyed the ASTRO membership directory and found a grand total of zero members from these 11 countries. I next checked the ASCO membership directory and, once again, zero, nought, nada, zilch. The only logical conclusion: there is no cancer in these countries!

I think it is warranted for the ASTRO leadership to recognize this important connection between food and cancer. All the meetings are smoke-free, reflecting the knowledge of the connection between tobacco use and cancer. I would suggest three symbolic acts that would call attention of the ASTRO attendees to this new realization:

  1. Doorways into all meeting rooms should be reduced to 30 inches wide immediately and then decreased 4 inches yearly for the next 3 years
  2. Vote ASTRO Gold Medal awards to Richard Simmons, Dr. Phil, and Oprah
  3. Venders will be providing glasses of ipecac instead of cappuccino at their displays.

It's a question of whether to pass up snacks all
day or go with those receiving taxol,
and will folks watch out for carbs that fatten 'em,
so they'll have no need for carboplatinum?

email: mkatin@radiotherapy.com