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[EDIT: I'm still getting emails asking how best to consume lemons for their anti-cancer effect here's a disclaimer: Lemons Are NOT A Therapeutic Agent For Cancer Treatment. It Is A Hoax. This Post Is NOT Medical Advice. If you Have Medical Questions Please See A Doctor. Also Please Read the FULL Post Which Continues Past The Green Text]

The surprising benefits of lemon!

Institute of Health Sciences, 819 N. L.L.C. Charles Street Baltimore , MD 1201.
This is the latest in medicine, effective for cancer!

Read carefully & you be the judge.
Lemon(Citrus) is a miraculous product to kill cancer cells. It is 10,000 times stronger than chemotherapy.
Why do we not know about that? Because there are laboratories interested in making a synthetic version that will bring them huge profits. You can now help a friend in need by letting him/her know that lemon juice is beneficial in preventing the disease. Its taste is pleasant and it does not produce the horrific effects of chemotherapy. How many people will die while this closely guarded secret is kept, so as not to jeopardize the beneficial multimillionaires large corporations? As you know, the lemon tree is known for its varieties of lemons and limes. You can eat the fruit in different ways: you can eat the pulp, juice press, prepare drinks, sorbets, pastries, etc… It is credited with many virtues, but the most interesting is the effect it produces on cysts and tumors. This plant is a proven remedy against cancers of all types. Some say it is very useful in all variants of cancer. It is considered also as an anti microbial spectrum against bacterial infections and fungi, effective against internal parasites and worms, it regulates blood pressure which is too high and an antidepressant, combats stress and nervous disorders.
The source of this information is fascinating: it comes from one of the largest drug manufacturers in the world, says that after more than 20 laboratory tests since 1970, the extracts revealed that:
It destroys the malignant cells in 12 cancers, including colon, breast, prostate, lung and pancreas … The compounds of this tree showed 10,000 times better than the product Adriamycin, a drug normally used chemotherapeutic in the world, slowing the growth of cancer cells. And what is even more astonishing: this type of therapy with lemon extract only destroys malignant cancer cells and it does not affect healthy cells.
Institute of Health Sciences, 819 N. L.L.C. Cause Street, Baltimore, MD1201
SEND TO EVERYONE … ! ! ! ! !

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No, I haven’t turned to the dark side, yet. The above was sent to me by a workmate and I have reproduced it here, complete with eye catching colours. Searching the intertubes reveals that many people have perfected the art of the uncritical copy and paste[1]. Not everyone has “drunk the kool-aid” though[2].

Lets deconstruct shall we? This is going to be fun.

Initial reading of this “article” throws up numerous red flags that the claim is either wholly made up or exaggerated. First is the allusion to conspiracy, while drug companies can certainly act in nefarious ways[3] this article implies that scientists in general would close ranks and perpetuate the conspiracy. Otherwise why haven’t government funded scientists or otherwise drug company independent scientists picked this up?
Another is the fact that several authoritative sounding statements are made but there is no detail to back them up

1. lemons kill cancer: Well what part of the lemon? where is it most concentrated? what variety is best? how should it be prepared for maximum benefit? what dose?
2. A laboratory has tested it: Well who? Where? what papers were published? what was the experimental set up? was it in vitro or in vivo? what were the results exactly?
3. Lemons are 10,000 times better than chemotherapy. Really? not 8,000 or 12,000 but exactly 10,000? In all situations?

Many fruits and vegetables have potentially therapeutically beneficial compounds, there are promising anticancer compounds in broccoli[4]. But the levels found in the foods are often too low and too variable to be of therapeutic use. But that’s negative thinking, what matters is that the compounds are there and it’s all natural, practicalities are a downer.

This lack of interest in dose response permeates the altmed/pseudoscientific crowd, both in the positive and negative sense. There is no safe dose of toxic compounds[5] and no lower threshold of benefit for “good” compounds[6]. So questions such as “how many lemons would you have to eat to cure your cancer?” become in this context almost nonsensical. While we in the evidence based camp might ask whether it should be 10 or 100 or 1000 lemons, and is that per day? And for how long? Further, how does the concentration of the anticancer component vary with the nutrition of the plant from year to year, or even within a season? How about between plants? Is the component present in the flesh or the skin? Those in the vague, feel good altmed camp are content with the message “Eat Lemons”.

In a laboratory and medical setting active ingredients aren’t extracted from plants and purified or synthesised solely to generate profits for drug companies (though that’s a motivation don’t get me wrong) but to make it easier to work with and quantify the correct therapeutic doses and optimal delivery methods.

Additionally, labs have to get consent for testing drugs on humans so it’s likely that the tests alluded to, if they occurred at all, were on cell cultures. This method can indicate interesting directions for research but does not guarantee that it will turn into a useful therapy. The body is very complex and things that work in a petri dish do not necessarily work in the body. It could break down too fast, or not reach the right tissues effectively, or be modified by metabolic processes or excreted too efficiently or any number of other things. Basic science research is good at generating these sorts of leads but the journey from bench top to consumer is one fraught with pitfalls.  Few drugs that appear promising at the outset make it to market[7].

Another red flag is the number of other conditions it treats. Each of the ailments listed have different causes and treatments, it is highly unlikely that the same thing will combat both high blood pressure and parasites when these have absolutely nothing in common[8].
Also, much of the text is similar to an article about another “miraculous” fruit, Guyabano, fruit of the Graviola tree[9].

Points of similarity:
1. We don’t know about it because the drug companies are trying to make a synthetic version to patent.
2. You can help a friend by telling him to drink the juice, the taste is not bad and has no side effects.
3. A large drug company has conducted 20 tests on it since the 1970s.
3. Kills 12 types of cancer.
4. “The tree compounds proved to be up to 10,000 times stronger in slowing the growth of cancer cells than Adriamycin, a commonly used chemotherapeutic drug!”
5. Only kills cancer cells.

Curiously similar given it is a completely different plant being talked about.

Searching the “Health Sciences Institute” (not the Institute of Health Sciences) I couldn’t find anything about Lemon and cancer but a Graviola and cancer search turned up a similar looking article (requires a subscription[10] to read but I suspect it may well be the source of the information for the one at the address above)

So it looks like this is actually a mash up of at least two different claims. I think we are witnessing the birth of a new altmed mythology, right here.

None of this means that Lemons cannot be used as a basis for anti-cancer drugs, in fact I did actually find that there are at least a couple of citrus derived compounds being investigated for anticancer activity[11&12]. Even so, the likelihood that simply eating lemons will cure you of cancer seems quite low, for all the reasons given above.

Multiple lines of evidence appear to be converging on this being if not a scam then at least a confabulation. Well meaning people will forward items like this to friends and relatives without much thought. I consider this to be irresponsible behaviour. As I have pointed out before in the context of chain emails, if we truly want to help our loved ones it behoves us to investigate these claims before passing them on. Whom do we help by perpetuating falsehoods?


Footnotes:

1. Here, here, here, here, here, here, here, here, here, here, here- and about a thousand others. I’m so depressed right now.

2. While searching out instances of this rot I found a breast cancer forum that had posted it, as a joke to be ridiculed. Read it now, it shows how these ridiculous items are actually insulting to those affected by cancer.

3. Like ghost-writing research and review articles in their favour. Yes they are profit driven entities, and yes they can go too far to ensure those profits but they do crucial research and development and we need them.

4. Yanyan Li et al (2010), Sulforaphane, a Dietary Component of Broccoli/Broccoli Sprouts, Inhibits Breast Cancer Stem Cells
Clinical Cancer Research May 1, 2010 16; 2580

http://clincancerres.aacrjournals.org/content/16/9/2580.abstract

5. For example in the anti-vax movement.

6. Like homeopathy, even ZERO isn’t a small enough amount for there to be no benefit.

7. Shoot, I’ve been archiving wecite versions of pages I link to to make sure the don’t vanish without a trace but was too late for this one. http://brneurosci.org/drug-failures.html
8. Not withstanding that everything in the altmed world is linked, it’s all toxins or vibrations or pH or quantum or something.

9. http://guyabano.com/   [webcite]  – with another version containing even closer wording here: http://mybongabon.com/samut-sari/the-sour-sop-miraculous-natural-cancer-cell-killer-by-arlyn-roa/ [webcite].

10. 1-year risk-free membership, Brand-New Encyclopedia of HSI’s 100 Greatest Cures and FREE bonus reports :No More Sick Days: The Immune Discovery of the Decade” and “How to Survive the FDA’s 10 Deadliest Hush-ups” for just US$67. [webcite]. You can’t get more credible than that. [article webcite]

11. Chidambara Murthy K.N., et al(2011), Citrus Limonin and Its Glucoside Inhibit Colon Adenocarcinoma Cell Proliferation through Apoptosis.
Journal of Agricultural and Food Chemistry

http://www.ncbi.nlm.nih.gov/pubmed/21338095

12. Cazal, C.M., et al(2010), Evaluation of effect of triterpenes and limonoids on cell growth, cell cycle and apoptosis in human tumor cell line.
Anti-Cancer Agents in Medicinal Chemistry, 10(10):769-76.

http://www.ncbi.nlm.nih.gov/pubmed/21269253

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October is Beast Cancer Awareness Month, or as The New Zealand Breast Cancer Foundation is re-branding it “Action Month“.

Because of this my post last week regarding the screening technology Thermography has been picked up and included in a blogging carnival. If you are not yet aware of blogging carnivals they are collections of blog posts from across the web highlighting single issues or interests, usually they are hosted on a regular schedule and pass from blog to blog.

Pick a topic you’re interested in and there’s likely a carnival out there dedicated to it. Anyway, Highlight Health is hosting this month’s edition of the Cancer Research Blog Carnival (#38). Go over and check it out, there looks to be a large selection of high quality writing gathered in one place and I’m honoured to have been selected to be included with the likes of Science-Based Medicine and The Scientist.

So get over there and educate yourself, learn about breast cancer screening effectiveness, possible new treatments, scams perpetrated on breast cancer sufferers, underlying causes and other fascinating topics.

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Breast cancer screening is in the news once again. Late last year controversy flared around new recommendations in the frequency of screening. (A review of this change can be found Here.) Now it seems that even the type of screening available is generating controversy.

Current breast screening technology in the form of mammograms is a mature approach, the advantages and drawbacks have been extensively studied and are now quite well understood (though more is still being discovered, see the related article at the bottom of this post). As such we can use the mass of accumulated data to create guidelines that attempt to optimise how screening should be done. A balance must be struck between the benefits gained by accurate detection of cancer and the costs, both psychological and financial, of false positives generated by the screening process.

These are the points that must be kept in mind when evaluating new approaches for appropriateness in the consumer screening market. Recently the media has highlighted a minor battle between private medical industry, in the form of breast screening clinic Clinical Thermography, and professional medical organisations and cancer research and advocacy groups. Yesterday the NZ Herald ran a story about the clash, and you can see TV3 coverage Here*.

At issue is the offering of a breast cancer screening service using thermal imaging to detect incipient or established tumours in the breast. The operating principle behind this technique is the requirement of tumours to generate access to their own blood supply early in the process of formation in order to secure the nutrients required for the unrestrained cell growth that is typically associated with cancer.

This process is called angiogenesis and entails the formation of new blood vessels in and around the tumour. This brings a larger amount of blood to the area than would be seen normally and this blood would bring extra body heat with it. Given this information it is not unreasonable to attempt to use this physiological change to attempt to detect cancer. By using high resolution thermal imaging the surface temperature of the breast can be measured and used to infer the presence of “hot spots” that may indicate tumours.

Thermography is not a new technology, developed in the 1960s it was largely abandoned in the early 1980s after an influential trial found the false positive rate and sensitivity unsatisfactory. As such, while the approach is not novel there is a distinct lack of large scale trials from which we can determine the appropriate sensitivity and specificity to apply to the technique and thereby judge it’s efficacy in the screening market, especially using current technology. In particular the technique has been emphasised in the existing literature to have the most impact when used in conjunction with more understood approaches such as mammography.

The current halabaloo seems to centre around concerns by the medical community that the appropriate caveats will not be adequately conveyed to the public and thereby may lead to either unwarranted panic in individuals receiving false positive results or complacency in those that may receive false negative tests. In particular position paper put out by the Cancer Society et al. attempts to raise awareness that the thermography screening process does not have the data to allow the decisions regarding balance between benefit and harm mention above to be made effectively (a position echoed by the UK organisation CancerHelp UK).

In investigating this issue I visited the Clinical thermography website to see what they had to say about the relative effectiveness of Thermography and mommography. I found it revealing that on the FAQ page there were two questions addressing accuracy for Thermography and mammograms. The Thermography entry was essentially an apologetic giving reasons why thermography may give a false negative result, no numbers regarding sensitivity or specificity were included in this.Conversely the mammography entry was a condemnatory piece giving percentages of false negative for the two age groups of particular interest, without any further explanation.

The ommision of hard data in the Thermography portion of the FAQ may reflect the dearth of adequate information as decried by the position statement above or may simply be standard marketing tactics. Either way Clinical Thermography aren’t doing themselves any favours with this evasive approach. Now this is not to say that Clinical Thermography is wholly against mammography, they accurately state earlier in the FAQ that Thermography is not a replacement for mammograms and that the technique should be used in conjunction with other screening methods.

Interestingly an American site for Breast Thermography is careful to include a disclaimer on the front page of the website stating:

“Breast thermography offers women information that no other procedure can provide. However, breast thermography is not a replacement for or alternative to mammography or any other form of breast imaging. Breast thermography is meant to be used in addition to mammography and other tests or procedures. Breast thermography and mammography are complementary procedures, one test does not replace the other….”

This is a straight forward upfront statement that Clinical Thermography would do well to emulate on the front page of it’s own site.

Finally, I’d like to point out that the position I have taken in this post is not contested even by those who would be proponents of this screening method. A commentary piece, published in Minnesota Medicine last December, entitled “Emerging Controversies in Breast Imaging: Is There a Place for Thermography?” was essentially pro-thermography at least in terms of investigating the technique further in order to address the questions raised regarding it’s efficacy.

Quoting from the text of this article:

“The biggest question concerns the efficacy of thermography to detect breast cancer. Despite various studies that suggest positive results for thermography, there has never been a major randomized controlled trial to determine baseline measurements of sensitivity and specificity. It is hard to imagine thermography being accepted by the conventional medical establishment without such data or evidence of cost-effectiveness.”

and:

“In lieu of any industry or professional standards for thermography, a variety of practices and protocols have emerged among practitioners and equipment manufacturers. As one practitioner described it, the industry is in its “Wild West” days.”

In addition, a study linked to on a pro-thermography website concluded:

“we currently limit the role of infrared imaging to that of a closely
controlled compliment to clinical exam and high quailty mammography. Our initial data should not be extrapolated to either formal screening or noncontrolled diagnostic environments without appropriate evaluation, preferably in prospective controlled multicenter trials.”

In summary, Thermography is at this stage a screening method of unproven efficacy. This is not to say that it could not become a valuable adjunctive tool in screening for breast cancer but that caution should be exercised by both promoters and customers of the technology not to oversell or over rely on the results obtained using this technique. Further research should be undertaken to determine the answers the the questions raised about the technique, namely accurate estimates of the sensitivity and specificity of the technique and what role in the screening process it is best suited for.

*This link seems to be down currently, but a note with regard to Breast Self-Examination (BSE) as mentioned in the TV3 story. This has also come under scrutiny as a practice that does not lead to improved outcomes. See the review of the new breast cancer screening guidelines linked to above.

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I don’t think the observation that cancer contributes to depression would win any awards for profundity, it’s likely such news would put a crimp in anyone’s day. Indeed, the very fact that the news of cancer itself can influence our emotions  makes it difficult to examine the contributing factors toward depression in those suffering from cancer. Our ability to foresee our own possible demise and react emotionally to it confounds attempts to tease out the strands of cause and effect. Approximately 10% of cancer sufferers are diagnosed with clinical depression and up-to two thirds experience some sort of mood disorder.

In order to separate out the effect of conscious knowledge of the disease from the psychological symptoms researchers have to turn to rats. How do you tell if a rat is depressed? To find out the scientists monitored the rat’s Twitter and Facebook pages for negative statements, no actually the rats are subjected to a swimming test, the longer the rats floated in the water without trying to escape the more depressed the animal is. The researchers found that rats with cancer showed signs of depression but not other behaviours normally associated with sickness, implying the rats were not simply feeling unwell.

Analysis of the rats tumours, blood and brain showed an increase in specific cytokines that have been linked to behavioural changes. In other words the presence of the tumour triggers changes in the brain that influence behaviour. This means that depression could be considered another symptom of cancer and not merely a by-product of knowledge of the cancer. This could have implications for how we treat depression in cancer patients and help them deal with the side-effects, simply knowing that being depressed is not something under their own control might itself be helpful.

Sunscreens can get a bad rap from promoters of alternative medicine, often returning to the well used warnings about the dreaded Toxins. While being aware of what you apply to your skin is a good idea the scaremongering employed by these groups is almost certainly counter productive in terms of reducing cancer risk in those exposed to the harmful effects of the sun. To assert that the application of sunscreen itself actually causes cancer is to both willfully misinterpret the medical literature and engender ill founded paranoia in those that are susceptible to such tactics.

This is not to say that sunscreens are universally good or are a magic bullet for cancer prevention. There have been studies that found a positive correlation of cancer with screen use, however this is likely due to an over-optimistic attitude towards the capabilities of the screens as well as the fact that almost by definition people who use sunscreens tend to spend more time in the sun. Even so, my own opinion that the nuclear furnace that dominates our sky is over rated, is one that even today should probably not be encouraged.

With regards to use of sunscreens as well as outdoor activities in general it should be realised that a responsible attitude towards sun exposure is prudent, cover up and limit sun exposure when able and reapply sunscreen often. It is generally recognized that the light from our closest star is beneficial to our health in many ways but as with anything else moderation is the key and an overdose can have fatal consequences.

Resources

http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1447210

http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1070981

http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1180647

http://www.worldimage.com/blog/archives/000027_sunscreen_dangers.html some sunscreen bashing, luckily they sell their own.

http://www.lyricscrawler.com/song/3953.html -The “Sunscreen song” just because.

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