David Gorski writing for Science-Based Medicine. This is a not an easy essay, though Dr. Gorski has labored to make it accessible to the lay reader. So the essay doesn’t benefit from summarization — here are a couple of sample excerpts to motivate the reader to spend some time with Gorski’s original:
Last week I participated in a panel discussion at NECSS with John Snyder, Kimball Atwood, and Steve Novella, who reported on the conference last Monday.
(…) I couldn’t help but think a bit about the juxtaposition of our discussion of the infiltration of quackademic medicine into medical academia with the hard core science being discussed at AACR. One session in particular at AACR highlighted what is one of the most significant differences between science-based medicine and the various forms of “alternative” medicine that we discuss here on SBM on such a regular basis. That difference, quite simply put, is the difference between the simple and the complex. “Alternative” medicine supporters often scoff at practitioners of science-based oncology, asking why we don’t have a “cure for cancer” yet—as if cancer were a single disease!—or why we haven’t made much more progress since President Richard Nixon declared “war on cancer” back in 1971. One part of the answer is that cancer is incredibly complicated. Not only is it not a single disease, but each variety of cancer is in and of itself incredibly complicated as well. To steal from Douglas Adams, cancer is complicated. You just won’t believe how vastly, hugely, mind-bogglingly complicated it is. I mean, you may think algebra is complicated, but that’s just peanuts to cancer.
(…) Right from the beginning, Dr. Brugge invoked Nixon’s war on cancer with a particularly appropriate observation, namely that the war has been far more difficult than anyone could possibly have ever envisioned in 1971. Back in 1971, in the wake of the discovery of the first oncogene, src, most scientists studied almost exclusively cancer cells, not appreciating the role of the surrounding matrix of normal cells and connective tissue in both preventing and modulating tumors. It’s true that, even back in 1971, scientists understood that the immune system has an important role in controlling cancer, but we lacked the tools to study this system in great detail. Since 1971, the list of discoveries about cancer has been long. Some examples include the discovery of many more oncogenes; tumor suppressor genes; the role of tumor angiogenesis in cancer; cancer stem cells; the rediscovery of the Warburg effect and metabolic derangements in cancer cells; and an enormous number of discoveries in tumor immunology. Each discovery helped us understand better how normal cells become tumors and how tumors grow, invade, and metastasize. But each discovery also led to additional complexities and more questions.
(…) It does however, when taken in context with other studies, suggest a great deal of complexity, where in some cases antioxidants prevent cancer and others may promote cancer.
Contrast this to the frequent alt-med claim that antioxidants prevent cancer and are virtually always good.
(…) Dr. [Lisa M.] Coussens’ talk is fascinating for what it revealed about the immune system and cancer. How many times have you heard “alternative medicine” believers and promoters brag that this nostrum or that potion “boosts the immune system”? As we’ve said before here, it’s a meaningless claim, because sometimes boosting the immune system is bad, as in autoimmune diseases. In cancer, it’s long been known that inflammation, particularly chronic inflammation, can lead to cancer. One of the most classic examples of this phenomenon is how gastroesophageal reflux disease (GERD) can lead to inflammation in the lower esophagus, which can lead to a change in the cells there known as Barrett’s esophagus, which can ultimately lead to esophageal cancer. Inflammation is a function of the immune system; consequently, when you take anti-inflammatories, you are suppressing part of the immune system on purpose in order to decrease inflammation. In any case, Dr. Coussens discussed how activation of certain parts of the immune system can suppress cancer development, while activation of other parts can promote tumor progression. This slide, taken on my iPhone, demonstrates the concept:
Please read the whole thing…