Dr. John McDougall’s speech to MDs at a conference, continued.
Chapter 8: A pill for every problem
I used to work at St. Helena Hospital. I was there for 16 years and it was a very good experience. I have very fond memories of it but one of the reasons that caused me to leave I’d like to share with you. I don’t go to these conferences. I don’t go. It’s an insult to my intelligence to have a drug rep sit and lecture me. But, I was at the hospital a few years back and I saw the title of a lecture. It was called “Diabetes is caused by fat, not sugar.”
So I gathered all of my staff together and we went down to the lunch room and we walked in and my first clue that there was a problem was the Pfizer rep is sitting in the back of the room. Well anyway, I sat down and listened for a whole hour to the presentation, and listened to the man tell me how to properly take care of a diabetic. And I counted the list of drugs he said I needed to use.
To care for a diabetic, I needed several types of oral medication, maybe some insulin. I needed to put them on a cholesterol lowering drug. I needed to put them on some calcium channel blockers, some ACE inhibitors. You always gotta be on ACE inhibitors to protect those kidneys, he said. And it went on and on and on and finally, I had a list of 20 drugs that a well-treated diabetic should be on.
And he made it sound really good because he gave it a sexy term, he called it polypharmacology. I waited until the end of the presentation and I raised my hand and said, “Hey, doctor, the title of your lecture is called 'Diabetes is caused by fat, not sugar.' Did I miss something? You didn’t mention diet once in the entire hour.”
He said “I gotcha here, didn’t I?”
And I said, “Yeah, you got me here but a lot of the drugs you mentioned, they kill diabetics. Like sulfonylureas, and calcium channel blockers.”
Around that time one of my mentors, John Hodkins, jumped up and apologized for my behavior, in a very politically correct way, might I mention. He was very good about it. He said, “This is Dr. McDougall, he writes health food books, you know, you’ll have to excuse him.”
Anyway, so I made a few other comments, and John (he’s a good friend, still is a good friend) and I were walking out of the room together. I looked over at John and said, “You know our colleagues don’t really believe that’s the way you treat a diabetic, do they?”
He said, “Yes, we do.” At that moment, I decided I didn’t want to be associated with my colleagues anymore because that’s not the way you take care of a diabetic, or any patient.
I mean, think about the patients you take care of. They’re not on one drug. They’re on a bag full of drugs. They’re on something for blood pressure like Norvasc, calcium channel blockers, which are very deadly. They increase the risk of dying of heart disease, cancer, breast cancer, suicide and bleeding. Blood sugar medication, cholesterol lowering medications, some for uric acid like Zyloprim. Homocysteine, that’s a good one, a folic acid.
We just saw two large reports that showed it increased the risk of heart disease and death by about 30%. Triglycerides like Lopid, you no longer put patients on Aspirin that you can buy 50 for a penny, do you? No, you’ve got to put them on a $4 aspirin called Plavix, which increases the risk of stroke and other problems.
But believe me, they paid for studies to make sure that we do those things. Something for your body fat like Orlistat, headaches like Darvoset, body aches, indigestion. Give them some antacid, they’re all on antacids, right?
Then, their constipation: put them on Miralax, something for diarrhea.
Then, they stink so bad from all the meat they eat so you have to put them on deodorants.
I forgot one prerogative; if they keep on complaining, and they keep coming back because you know you’re supposed to cure them as a doctor, when they complain so much you’re just sick and tired of listening to them, what do you do? Put them on an anti-depressant, right?
Drug Therapy: He showed a slide of a man, before and after, with a bag of drugs in his hand. I want to introduce you to a patient; this is somebody I’ve known for awhile. This man, he knew he had some problems, so he decided to go to the doctor and he was diagnosed with high blood pressure, type-2 diabetes, hyper cholesterolemia, hypertriglyceridemia, gout, mild kidney failure, overweight, mild osteoarthritis, constipation, and depression.
I’m not exaggerating, this is true. So, he went to the doctor for 2 years, paid the monthly office visit, paid thousands of dollars for medication, followed the advice strictly for 2 years and what I want to show you now is a picture of him 2 years later. He still has high blood pressure, type-2 diabetes, hypercholesterolemia, hypertriglyceridemia, gout, mild kidney failure, overweight, mild osteoarthritis, constipation and depression.
Ok, here’s the trick question. What do you see different about this man? Nothing. He’s just as fat and sick as he was two years before. Now I ask you about your friends, your relatives, your patients. You tell me what happened when they underwent good medical care. Nothing. They’re still fat and sick and now they’re carrying around a bag full of drugs, and that is it. And, if you’re a doctor, you must believe you are doing some good, because you cannot see it.
Treatment of Heart Disease: Surgery: OK, let’s talk about some of the real serious problems going on in medicine. Let’s talk about the treatment of heart disease with surgery.
Can’t work. Doesn’t work. Studies show it doesn’t work.
We’re talking about the angioplasty business and they do a million of those a year in this country. We’re talking about bypass, which they only do 400,000 a year in this country. Combined, it’s a $100,000 billion a year business and 80% of a hospital’s income comes from heart disease.
Now, there have been some studies to look at the benefits of surgery compared to medical therapy. There have been three major studies done; they were all done before 1990. There will be no further studies done. They have already looked at the situation and expressed the results and it doesn’t work.
The vast majority of people, 90% +, survive no longer with surgical therapy than they do with medical therapy.
You say, "What about the exceptions, like the ‘widow maker,” left main coronary artery disease?" CASS study says they don’t live any longer.
What about left main equivalents, when all main vessels are blocked up? Well, CASS study says they don’t live any longer with surgery than medical therapy.
The CASS study, the most recent one done, says it doesn’t matter what the anatomy looks like. Doesn’t matter if it’s left main, doesn’t matter how many vessels are diseased. What matters is what has happened to the left ventricle. What they did was they played the game, and they set the rules. They saw that those people with left ventricle damage expressed by a rejection fraction 50% or less, have an 18% increased survival over 10 years. And, they brag about it.
Bypasses have been done since 1968 and angioplasty has been done since 1978, but there is not a single study showing that angioplasty prolongs lives. Not a single study. They do a million a year, and they get away with it. Can’t possibly work.
A recent article - I encourage you to read it, you can find it online, it was July 18, 2005 in Business Week magazine. The title of the article is “Is Heart Surgery Worth It?” It’s a review for the treatment of heart surgery. It’s basically the review I wrote in 1985 for heart surgery: “Does it work?” In fact, one of the key people who were interviewed in this article, a Dr. Hadler, who is a professor at University of North Carolina at Chapel Hill, says “bypass surgery should have been relegated to the archives 15 years ago. I'd say 20 years ago. Read it. I hand this out to my patients. It’s a great review. It’s well written. Uncontested. It’s the truth.
Now, why can’t bypass surgery and angioplasty work? It’s because they don’t treat the killing part of the disease. The killing part of the disease is not the large blockages, the killing part of the disease is the tiny, fat-filled plaques that are volatile and bust and cause a blood clot to form. That’s why we call heart attacks coronary artery thrombosis, because essentially all of them are caused by this mechanism. It’s the little tiny pimples in the inside of the artery that burst like the pimples on a teenager’s face, and as a result the products of injury are released and the blood clots, and that’s why you have the acute coronary syndrome. That’s why. Bypass surgery doesn’t tweak those. Bypass surgery treats the big blockages that are filled with scar tissue and calcium which may be causing chest pain, but they’re solid as a rock.
In fact, to add insult to injury, the day after a bypass surgery or a heart attack, what do we do for the patient? We serve them the same foods that brought them there in the first place. Here you have this teaching moment. The doctor walks in and the patient looks at the doctor with frightened eyes and says, “I’d eat cardboard not to come back here, what should I do?”
“I don’t know, but you better eat that cheeseburger. You need the protein to heal your wound.” And, at every coronary unit, they serve them the same foods that brought them there in the first place. They started them on drugs as soon as they had a heart attack. Of course that doesn’t work, but how about doing something really radical like feeding them a healthy diet after they had a heart attack? That might be novel!
So, you have a situation where what they’re bypassing is non-lethal disease. What they’re doing angioplasty on is non-lethal disease. It’s not the part that kills. The part that kills is the little pimple next to the big plaque that pops and causes the blood to clot. It really needs to be clear that that’s the problem.
And, of course, when you go in there with your angioplasty catheter, what do you do? You blow up the balloon, you cut with a laser or a knife and what do you do? You create products of injury, and the consequence is the blood clots. So, in 40-50% of the people treated, their artery completely closes down in five months.
Of course, now we have stints, right? So, now it’s only 20% due to self-proliferation. There are other problems with that, but enough said.
Treatment of Heart Disease: Diet and Lifestyle: (slide of cleared arteries) OK, now this is a reversal of disease. This is not concrete in a person’s arteries. Cholesterol and fat, they go into the plaques, they create the inflammation. When you change your diet, what happens is you change the equation so more cholesterol and fat come out of the plaque. The surface tension is decreased, you’re less likely to pop the pimple, burst the volatile plaque. You bathe the plaque with clearer blood, healthier blood, so it stabilizes the membranes.
The other thing you do once you eat a healthy diet is you remove the strongest clotting factors people come in contact with. That’s animal fat. Animal fat makes the platelets very adhesive, makes the clotting factors very aggressive, particularly clotting factor 7.
So, you just set them up for a clot by feeding the rich American diet. As soon as you change their diet, I’m talking hours after you change their diet, they realize the benefits. The risk reduction is there. So, diet and lifestyle, they reduce the major risk factors for heart disease, like cholesterol and triglycerides, high blood pressure, obesity, insulin resistance.
Going back to Dr. Dean Ornish, he said, “According to the PET scans, 99% of the patients stopped or reversed the progression of coronary heart disease.”
When we understand that this is a diet and lifestyle artery disease, we get to treat a whole bunch of problems; it’s not just the heart arteries. There are all kinds of different arteries over the body that are compromised by atherosclerosis. The arteries; they either supply insufficient amounts of blood or they close down and as a result they cause common diseases.
For example, you close the arteries to the eye and you get ocular degeneration. You close the arteries to the ears and people go deaf, they get tinnitus and vertigo. Close the arteries to the brain; you get a stroke, to the heart; you get heart attacks. You close the arteries that feed the aorta and you have an aneurism. Close the arteries to the bowel, you got bowel infarction, you close the arteries to the spine and you get back pain, you get degenerative disk disease.
I mean, the clue to us should be degenerative. I mean, that’s the clue to what causes this. It’s degenerative. It’s not like someone picks up a VW or a piano and their disk ruptures. It’s like they turn or take a step and the degenerative disk pops. It’s a vascular problem. You close the arteries to the legs, they get intermittent claudication. You close them down really badly, you get gangrene. Now, a real motivator here is you close the arteries to the penis, you become impotent.
Cancer - I’d like to talk about cancer for a couple of minutes. Prevention by screening and treatment of common cancers with medications, radiation and/or surgery cannot possibly work. If you understand the natural history, just like you understand the natural history of coronary artery disease, you understand why it can’t work. If you understand the natural history of cancer then you understand why present therapies and screenings cannot work. It’s impossible.
Now, I have to qualify before I go on here, that there are some real important exceptions. And that is, when we find pre-cancerous changes, that means before cancer, I believe we can make a difference when it comes to screening. For example, when we do PAP smears, and I do recommend PAP smears every 3-5 years up until the age of 50. Colon polyps, those are pre-cancerous lesions, I think if we take those out, we can reduce the risk of colon cancer.
It’s interesting. My son is at Ohio State University first year medical school. He called me, very upset, because he went to a lecture on preventing colon cancer. He said, ”Dad, that whole lecture, they didn’t mention diet once. All they talked about was colonoscopies.” But the title of the lecture was “preventing colon cancer.”
I said, “Get used to it, kid.” Leukoplakia in the mouth and skin changes, you can catch melanoma early enough, I think so. But you see, these are superficial changes prior to them turning into cancer. You can make a difference.
I also want to point out that we have treatments for cancers that do work. These are cancers like childhood cancers and testicular cancer, lymphomas and leukemia. We do have treatments that we should be very proud of.
Ok, you have those qualifications firmly in mind for the rest of the discussion. John C. Bailar from the National Cancer Insitutute wrote a very important landmark paper which made a lot of people upset in 1997 in the new England Journal of Medicine. He said,”The risk of dying from cancer has increased by 6% from 1970 to 1994.
The war against cancer is far from over. Observed changes in mortality due to cancer primarily reflect changing incidence or early detection. The effect of new treatments for cancer on mortality has been largely disappointing. The most promising approach to control of cancer is a national commitment to prevention with a concomitant to rebalancing of focus and funding research,” which, of course, hasn’t happened.
Here are a couple of my heroes. Charles Wright is one of the most famous epidemiologists in the world, and C. Barber Mueller is the father of breast cancer surgery. I have known him for many years. I had a television show called “McDougall, M.D.” that we did about six years ago and it still plays worldwide.
I had them on the show and we talked about a lead article published in the British Lancet in 1995 that looked at various studies. There are actually six or eight, depending on how you divide them, of mammography breast cancer screenings. They looked at all those studies and said, “The benefit achieved is marginal, the harm caused is substantial, the costs incurred are enormous. We suggest that public funding of breast cancer screening at any age group is non-justifiable."
Yeah, this is heresy, but that’s what they said. And no one contested it in the letters to the editor. I still recommended mammography is 1995. I recommended it for women between the ages of 50 and 68. Not below 50 because it’s notorious for being a failure, and not after 68 because you don’t live long enough. It’s something that was detected to show any benefits. But I would still tell a woman that “You know you ought to get a mammogram" or if she asked, I’d tell her “there’s some evidence that there’s some benefit.”
And, I took that stand until Lancet came out with an article in 2000, and then they came out with their final report in 2001. The Cochrane Group is a group of Nordic scientists who are known for the evaluations of drugs and treatments without bias.
The couple of researchers wrote in the Lancet of 2001, “In 2000, we reported that there was no reliable evidence that screening for breast cancer reduced mortality. As we discuss here, a Cochrane review has not confirmed and strengthened our previous findings. The review also shows that breast cancer mortality is a misleading outcome measure and finally, we use date supplemental to those in the Cochrane review to show that screening leads to more aggressive treatment.” Well, that made a lot of people mad.
About a breast self-examination? I mean, who could think that breast self examination could bother anybody and it would be something you would avoid recommending.
But the Canadian task force on preventive medicine looked at the issue in 2001. They said, “There are two randomized controlled trials, a quasi-randomized trial, and large cohort study and several case-controlled trials, and they have failed to show a benefit for regular performance of breast self-examination or breast self-examination education, compared with no breast self-examination. In contrast, there is good evidence of harm from breast self-examination instruction, including significant increases in the number of physician visits for the evaluation of benign breast lesions and a significantly high rates of benign biopsies.”
So, what did they tell us to do for our patients? They told us not to recommend breast self examination.
They said it’s because there is a fair evidence of no benefit and good evidence of harm. There is fair evidence to recommend that routine teaching of breast self-examination be excluded from the periodic health examinations of women in this age group and so on and so on and so on. Can you imagine that?
Treatment: Little or no survival benefits: OK, we went over the treatments and looked at the survival benefits for various treatments.
We generally come down to these conclusions: For solid tumors, surgery provides no survival benefit.
Radiation provides no survival benefit. Oh, you can tell there may be a couple of exceptions, but the bulk of the literature shows this.
Hormone manipulation shows some for breast and prostate cancer, and that’s things like removing the ovaries or taking out the testicles, giving anti-estrogen treatments, and maybe even chemotherapy works by knocking out the ovaries. That’s my guess. With chemotherapy, the benefits are a little and the harms are substantial.
Let me explain why this is true. Once you know the mechanism underlying cancer, it’s all obvious why screening can’t work and nor can treatment: let’s talk about the mechanism of cancer growth.
Cells live in a neighborly manner. They are not allowed to divide anytime they want, if they divided any time they wanted under their own free will, we’d become misshapen masses in a matter of days. So, cells are allowed to divide under certain circumstances like if there’s a stimulus for growth from a brain signal, or hormone signal, that they’re allowed to grow.
If a cell gets injured, like we get a laceration; the cells next to that injury can proliferate and grow, and repair the injury. That’s fair, that’s what’s allowed to be done. We have these regulatory mechanisms to make sure this works correctly and properly so we stay in the form that we are.
Well cells get injured by things like radiation, products of cigarette smoke combustion and various toxins in our environment. As a consequence of injury, when it’s serious, most cells die.
Sometimes cells get injured, not bad enough to die, but bad enough to stop being neighborly. Then they start dividing at their own free will. That’s of course, the transition from normal to cancer. One cell always leads the way in the breast or prostate. One cell always leads the way. So, let’s take that cell.
Slide on doubling: The first cell begins, and the doubling time on average is 100 days for a solid tumor, be it breast, colon, prostate or lung. It’s every 100 days. So, 100 days later you have two cancer cells. Three and a half months later, you have four.
Now you’ve had cancer for a year and you’ve got 8-12 cancer cells lurking in a breast that contains 100 billion cells per breast, and a prostate that contains 100 billion cells, of course, obviously undetectable. Divisions continue, you go to 16, 32, 64.
You’ve had cancer for less than a year and you have less than 100 cells in your tumor mass. You couldn’t possibly find it. These are early stages, and if it’s truly cancer, then it starts to metastasize, and the tissues that go to it have a similar doubling rate as the original tumor.
No one dies of breast cancer or prostate cancer; they die of metastases in the lungs, bone, brain, etc. Well the divisions continue and finally you reach a tumor mass, after six years on average that contains a million cells the size of a period on a piece of paper, a lead tip. It’s undetectable by any current means. Yet, it has been growing for six years, it has amassed one million cells, if it’s truly cancer it has spread over 90% of the time and probably 100% of the time. It it’s truly cancer.
Lots of things that we treat that we tell the patient it’s cancer, it’s really not cancer. Anyway, so the divisions continue and finally you get to a detectable tumor mass, its one billion cells in size it’s a centimeter, it’s the size of the eraser of a pencil. At this size, the tumor is now able to increase the PSA level.
Prostate specific antigen increases only after the mass is a centimeter in size. In other words, it’s been growing an average of 10 years and contains one billion cells. It’s the size that you can feel on a digital rectal examination or breast self-examination. You may pick up a tumor mass 2-6 years earlier on mammography, but the truth is: because of the types of tumor masses that are picked up on mammography, the average length of doubling is about 14 years before you find them.
Two-thirds of the disease has occurred without the knowledge of the patients or the doctor. It has already expressed itself. Every oncologist and every doctor should know that. That’s the natural history of this disease. So how in the world are you going to treat a disease that has already expressed itself with local treatment like surgery and radiation? It’s impossible. That’s why they don’t survive any longer. It’d be nice if we had chemotherapy agents that work, it really would be.
But, by and large, the chemotherapy agents are ineffective and I gave you some exceptions and they are very toxic. Of course, that’s why chemotherapy is so popular. Everybody realizes its natural history, and local therapy doesn’t treat systemic disease. It couldn’t possibly do it. It’ll never work. But, we continue to do it.
You know, even after these kinds of realizations and even after the effort to change from a radical to a more conservative therapy in terms of prostate cancer and breast cancer, still these days, 65% of women are getting mastectomies. We had laws of informed consent in 18 states as long ago as 30 years, and yet 65% of women are getting mastectomies. By the way, this doubling time is on average every 100 days. But some women double their tumors every 24 days; some women double their tumors every 850 days.
I believe you can change that doubling time with a change in diet.
I published the first scientific study on the dietary treatment of breast cancer in 1982. Since then, there have been about 20 studies published in our best medical journals on the dietary treatment of breast cancer and other cancers. Everything says you can slow that doubling time. So, our goal should be to slow the doubling time, so that instead of a woman dying in 3 years, she dies in 12 years. Or maybe our goal should be to have all our patients with prostate and breast cancer die of their disease when they’re 95. We’re certainly not accomplishing that with present methods.
Next: Diet and Lifestyle Benefits
Peace and Love Be With You,