Outside the medical-scientific mainstream

Writing every day about a subject like prostate cancer is fascinating. However, it comes with one very real problem many times a week … what not to write about. Let me give you three examples.

The first has nothing to do with prostate cancer, but it has a great deal to do with the only means I have available to me to decide when something (however straightforward or weird) seems important enough to  publicize on The “New” Prostate Cancer InfoLink: my idiosyncratic mind!

In 1983, a young and brash Australian gasteroenterologist, went to a small meeting in Brussels, Belgium, to present a paper in which he argued the utterly groundbreaking hypothesis that ulcers were caused by bacteria, not by acid secretions in the stomach and intestines.

At the time, this idea was so revolutionary that the global gastroenterology community spent the next 10-15 years denying it. In 2005, Dr. Barry Marshall, who I was lucky enough to meet on a flight to that conference, was awarded the Nobel Prize for Medicine along with his co-discoverer (Robin Warren) of the relevant bacterium: now known as Helicobacter pyloris. In 1983, a small number of us at the conference really took this presentation seriously and like to think we had a little influence in helping Dr. Marshall’s ideas become more public. To that small number of people at that conference (where there may only have been about 300 people, mostly microbiologists, in total), Dr. Marshall’s presentation was an immediate revelation — even though we knew that his hypothesis still needed to be proven. It just made sense! There is absolutely no doubt in my mind that despite the lack of clinical evidence, IF this was a prostate cancer-type story today, I would have to write about it.

How did Dr. Marshall prove his hypothesis? He had to demonstrate all four of Koch’s postulates. In his first attempt to demonstrate these postulates he had to go back to Australia, actually infect himself with H. pyloris, get an ulcer, isolate H. pyloris from his own ulcer, and then cure himself of the ulcer (and the infection) with an antibiotic combination that no one would use to treat a gastric ulcer today! Despite a ground-breaking publication describing this first attempt in 1985, Marshall himself stated (in a review published in 1995) that only one of Koch’s four postulates had been fully demonstrated by that time.

Recently two pieces of research have been brought to my attention that (at least in theory) have similar potential to revolutionize the treatment of cancer, but are also far outside the scientific mainstream.

In the suburbs of Philadelphia, Dr. Nobutu Yamamoto of the Socrates Instute for Therapeutic Immunology (a scientist with a long and reputable scientific pedigree) has spent much of the past 20 years attempting to demonstrate the value of “vitamin D-binding protein-derived macrophage activating factor” ( more commonly known as Gc-MAF) in the treatment of several forms of cancer. Yamamoto’s research appears to suggest that minute quantities of Gc-MAF may be able to induce complete responses (cures?) in some patients with metastatic forms of cancer. And this biologic agent also appears to be usable with no evident side effects. For more information we refer you to a presentation given by Dr. Yamamoto in 2004 (slide 16 of that presentation presents data suggesting the efficacy of Gc-MAF in selected patients with prostate cancer), as well as to papers published by Yamamoto and Naraparaju in 1998 and by Yamamoto et al.  this year

Similarly in Tel Aviv, Israel, Dr. Dan Peer of the Department of Cell Research and Immunology at Tel Aviv University is currently attempting to demonstrate that the well-known antidepressant fluoxetine (Prozac) can be used in combination with doxorubicin (a widely used chemotherapeutic) to overcome chemotherapy resistance in people with colon cancer. According to Dr. Peer and his colleagues, in laboratory experiments, “Prozac enhanced doxorubicin’s efficacy more than 1,000%. Prozac, in effect, worked to block the cancer drug from leaving the interior of the cancer cell and poisoning the healthy non-cancerous cells that surrounded it.” In this case we refer you to a recent report on Medical News Today if you want to read more.

Either of these two pieces of science could have a revolutionary impact on the treatment of several forms of cancer, possibly even including prostate cancer. However, under normal circumstances I would be unlikely to report them on this blog because:

  • Until I saw the Yamamoto presentation referenced above, I was aware of no evidence that either form of treatment had demonstrated any impact in prostate cancer
  • In neither case has there been any form of clinical trial comparing the innovative therapy to a current standard form of care
  • If we tried to report every possible piece of scientific information of this type, the daily blog alone would probably require a minimum of 3-4 full time researcher/writers (and we don’t have the resources … yet)

This doesn’t mean that we aren’t interested in such science. Of course we are. It means only that we, like any “business” must focus on our core priorities to be successful, and the core priorities of The “New” Prostate Cancer InfoLink are threefold:

  • We seek to make good, sound, basic information about prostate cancer available to anyone who can read the English language reasonably well
  • We try to offer a source of current, evolving knowledge that will be of assistance to any prostate cancer patient and his family, whether he be newly diagnosed or terminal
  • We seek to link the less experienced patient to more experienced patients through our Social Network, so that the less experienced can “bypass” the potholes so often tripped into by patients soon after their diagnosis, when their fear is a driving factor in their decision processes

So what about new science that is “outside the mainstream?”

We will always do our best to watch out for it. We are always interested in hearing about it. If it is known (or clearly appears to be) to be bad science or just misleading hype, we will have no fear of saying that that is our opinion. And if we get lucky enough to meet the “prostate cancer equivalent” of Dr. Barry Marshall on another plane to another conference somewhere in the next 20 years, we promise we will be the first to shout it from the rooftops!

In the meantime, I shall do my best to find out some more about Gc-MAF. So far I have seen just one slide that says it has an effect in prostate cancer … and that is all I can tell you!

8 Responses

  1. Mike: My concern is that unless there are funds available to carry the research forward it may not be possible to test whether these relatively inexpensive or readily available off-label usages of existing meds are effective and safe. As Dr Peer said “instead, he suggests that researchers join forces internationally to implement retrospective studies of all the types of cancer treatment in which Prozac was prescribed. And further clinical experiments to validate the use of Prozac with chemotherapy is also needed, he stresses.

    “The next step is to take the files of chemo patients and determine whether they received Prozac for their depression,” says Dr. Peer. “This will streamline the understanding in the scientific community of whether, how and for which cancer-fighting drugs Prozac can be an effective partner. It will also give us invaluable information on how to design new drugs.”

    The question is will there be the will or the funds to carry this potential indication of a benefit forward? How long would this take and once these studies are completed will we have to wait until a clinical trial is completed before it is used in practice? Is there an incentive for any drug company to get involved in this type of research? What role does the expiration of patents or patentability play in what research is done?

  2. Why not have a section called “Out of the Mainstream” or “From Left Field’ in which these kind of stories can be reported? It is just as important to know what doesn’t work as to know what does, and might work.

    Knowledge is relative. I think the important point is to discuss all reports sensibly, recognize the weaknesses and omissions from each piece of ‘knowledge’ and note these.

    What I think many researchers forget is that there is no “one size fits all” approach in medicine, people are different, with different chemical makeup so that what works for one may not work for another.

    Knowledge is knowledge, good and bad; the secret is telling the difference.

  3. Dear Mr. Innes: If you are aware of two or three experienced searchers of the cancer literature who wish to take on such a task (at no charge), and who can demonstrate their ability to address the possible relevance of such “Out of Left Field” studies to prostate cancer, I am more than willing to work with them to develop such a section for The “New” Prostate Cancer InfoLink. I believe the world’s cancer researchers now churn out well in excess of 1,000 articles every day (exclusive of abstracts of presentations at scientific meetings). It’s beyond my capabilities, and I don’t know anyone who would take this on with a relevant skill level who would do it for free.

    I don’t disagree with your premise. It is simply beyond our scope. Just trying to monitor and make sense of the relevant uro-oncology and related prostate cancer literature is hard enough!

  4. Kathy: In this particular case, I think you are over-reacting. It ought to be extremely simple for a well-defined group of clinical researchers to develop a registry trial to evaluate the potential of fluoxetine in the proposed combination with doxorubicin and get a grant from somewhere to study the outcomes over time. However, there is also absolutely no doubt that we need to become much better at deciding what clinical trials are worth pursuing. Many trials being carried out today are a waste of time, money, and sometimes patients’ lives!

  5. Yamamoto published the full text of a paper on treatment of prostate cancer this year.

    I’m not sure what qualifies this as outside the mainstream. It appears to be solid science-medicine, from a team of collaborators working on the problem for a long time.

    As you note, and many other examples bear out, new scientific knowledge comes to a few early, but building scientific consensus takes many years. That cervical cancer was caused by HPV virus was known to the discoverer 25 years ago. But only this year, when a preventive vaccine has been widely accepted, did he receive his Nobel Prize in Medicine.

  6. Dear Mr. Swarm: I think you misunderstand my meaning of “outside the mainstream.” Apparently my intent was not clear. Mea culpa.

    I am not in any way suggesting that Dr. Yamamoto’s research is anything other than solid science. What I am suggesting is that it is contrary to accepted science.

    The example you give of the development of vaccine treatment of cancer was widely accepted in the scientific community well over 15 years ago, which is how long it has taken Merck and GlaxoSmithKline to bring their competing vaccines to market, and the principle that cervical cancer might be caused by HPV was accepted some time before that. In other words, this example was (again) not contrary to accepted wisdom.

    One of the fascinating things about science today is that frequently, in fact, many people in different centers come to similar and related discoveries at very close to the same time, which is why prizes like the Nobel Prize are much more commonly shared today than they were in the past.

    Thank you very much for pointing us all to the full text of the Yamamoto article. I shall read this article this morning and adjust the commentary I wrote yesterday accordingly.

  7. Anything new on this? I communicated with the researcher last November and it seemed there was no interest from mainstream oncology.


  8. We are not aware of any new data related to Gc-MAF

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