Want to know why we are losing the war on obesity, type 2 diabetes and cancer? We don’t admit to the biggest problems causing these wars. And the first step to solving any problem is to admit that one exists, says Canadian nephrologist Dr Jason Fung.
Fung has a special interest in weight management and diabetes. He says that there’s a terminal malaise affecting all of public health. It’s that the “experts” don’t welcome dissenting opinions. Rather than acknowledge the truth, they pretend that everything is just fine, thank you.
That’s despite obesity and type 2 diabetes epidemics that dwarf anything the world has ever seen. And rising cancer death rates. Here’s what Fung believes doctors and researchers should do – starting with changing dietary advice. – Marika Sboros
By Jason Fung*
In the “war on obesity”, it’s obvious that things are not going well. You can take any statistic about global obesity and it will be bad. For example, the CDC recently released obesity statistics for the US.
No state in the Union had a prevalence of obesity under 20%. Only three states fell below 25%. Yikes. Tragically, in 1985, there was not a single state above 10%. Now, even the best state is double that.
Logically then, whatever obesity advice we are doling out to the public is not effective. This is the calorie-centric view of obesity as an energy balance problem. It’s as if the experts believe that the human body is some kind of bomb calorimeter with better hair and makeup.
Perhaps the low-fat diet is making it worse. That’s debatable but it sure ain’t making it better. If it’s not working, then we should change it. That’s logic but that also means we would have to admit there is a problem.
So, looking on the CDC website, what advice are the experts giving? “To lose weight, you must use up more calories than you take in. Since one pound equals 3,500 calories, you need to reduce your caloric intake by 500–1000 calories per day to lose about 1 to 2 pounds per week.” Funny, that sounds like the same, old, tired advice that I heard, growing up in the 1970s.
Tired weight loss advice
Let’s look at it logically. Here’s what we know:
- We are giving the same weight loss advice for the last 50 years
- Obesity is getting worse, very quickly
So, all the obesity specialists in all the universities conclude that we should… keep giving the same caloric restriction advice? WTF? Are these people insane?
The first step to solving a problem is to admit that one exists.
The problem is that our advice is not useful or effective. Instead, there are legions of “professionals” and “academics” who keep screaming that “It’s all about calories”. We’ve focused obsessively on calories (the body, of course, has no actual way of measuring calories) and it’s gotten us exactly nowhere.
Click here to read: A ‘cure’ for type 2 diabetes – 2 easy steps
In type 2 diabetes, we see the same horrifying epidemic. However, in our treatment, we pretended that if only we could give enough medications to normalize the blood glucose, everything would be just fine. And thank you very much. So, we did studies to prove our point. The ACCORD, ADVANCE, VADT, TECOS and other studies all proved the same point.
Drugs don’t always save lives
Yes, you could use medications to lower blood glucose but no, people were not healthier for it. They died at the same rate. They got heart disease and kidney disease at the same rate. Taking the insulin and other medications were also pointless. Sure, the drug companies made lots of money and the doctors got to feel good about themselves.
But in terms of making patients healthier, no, sorry about it.
Ditto for drugs for diabetics
Let’s look at it logically.
- Using medications to lower blood sugar has minimal benefits
- The recommended approach is to give medications to lower blood sugar
WTF? This is the same tired advice that I gave to diabetics in the 1990s. Twenty-five years later, we haven’t advanced a single bit.
The first step to solving a problem is to admit that one exists.
We’ve focused obsessively upon correcting the blood sugar even as this approach has been proven to fail. Time to man up, and face it. But that would mean we are deviating from the pre-specified narrative. And that our researchers and doctors are making brave progress against a terrible disease. Admit a problem? No can do.
The ‘war on cancer’ has gone similarly poorly. The late John Bailar III knew about cancer. He worked in the National Cancer Institute (NCI), was editor of the Journal of the NCI, statistical consultant to the New England Journal of Medicine and a lecturer at Harvard’s School of Public Health.
He started wondering about the effectiveness of the entire cancer research program in the 1970s and left the NCI in 1980. Bailar wrote a piece in the New England Journal of Medicine in 1986 entitled Progress Against Cancer?
From 1950 to 1982, there was not a single shred of evidence that medical advances had slowed down rates of cancer or deaths from cancer. If anything, the situation was worse.
In 1997, he published a follow-up paper, Cancer Undefeated in the same journal. He made the same points as 11 years earlier: cancer as a disease wasn’t getting any better despite the billions of dollars poured into research.
Stark response
As an insider on the cancer wars, published in the most prominent journal in the world, Bailar was somebody who yelled out “The emperor has no clothes”. The response was stark. Experts within the cancer research community almost universally reviled him. They questioned his motives and his intelligence.
NCI director Vincent DeVita Jr called Bailar’s first paper reprehensible, irresponsible and misleading. He also implied that Bailar himself had departed with reality.
Yet while the personal attacks were plentiful, there was no denying the statistics. In the past four decades, the crude death rate other than cancer dropped by 24%. Cancer, though, has increased 14%. Cancer was indeed getting worse. But nobody wanted to admit it.
The first step to solving a problem is to admit that one exists.
In cancer, the past 50 years have focused obsessively upon the genetic mutations as a cause of the problem. There have been some major advances in some relatively minor diseases (CML and Gleevec). However, in general, doctors have no more defeated cancer than they were able to 50 years ago. This approach has gotten us a single step in a 1000-mile journey.
Click here to read: Cancer is NOT just genetic!
Part of the problem lies in how the regulatory bodies approve cancer drugs. The US Food and Drug Administration (FDA) approves drugs based on their side effects (toxicity) compared to their efficacy — which can be defined many ways.
Drug endpoints
If drugs help cancer patients live longer then there’s a good chance the FDA will approve it. This is probably the most important hard endpoint for drugs. Unfortunately, from 1990–2002, 75% of approvals the FDA gave were for reasons other than making patients live longer.
The biggest reason for approval to market a medication was the ‘partial tumor response rate’. This means that the primary tumour shrank in volume by over 50%. This sounds pretty good – except that it’s completely useless. Cancer kills because of metastasis. Once cancer spreads, it’s far more deadly. Therefore, you need to kill just about 100% of the cancer for patients to survive longer.
That’s the reason that surgery and radiation are ineffective once cancer has metastasized. Imagine that you have a surgical procedure to remove half of the cancer. It would be pretty useless.
Every surgeon in the world would refuse to operate because it’s just stupid. And they would be correct. Getting half the cancer is no better than getting none of it. That’s why surgeons always tell patients optimistically, after surgery that ‘we got it all’. Surgeons will cut huge swaths of normal tissues out of cancer patients in their efforts to ‘get it all’.
Click here to read: Cancer therapy of the future? It’s already here!
More quality years?
Getting half the cancer is just pissing in the ocean. It makes not even a little difference to the overall outcome. Yet, authorities have approved over 50% of the new drugs available for cancer on this completely useless efficacy measure. Based on this hurdle, the FDA made 71 approvals. However, some medications are approved for multiple cancers, each requiring its own approval, so 71 approvals only translated into 45 drugs.
If you look at the more rigorous measure of actually helping save lives, only 12 medications managed to clear this bar in the 12 years from 1990–2002. The duration of life extension is generally only a few weeks or months in the majority of cases. In that same time, the phrase ‘cancer breakthrough’ appeared in 691 published articles. The strange math, according to the terrific, eye-opening book ‘The Truth in Small Doses’ goes like this.
691 breakthroughs = 71 cancer drug approvals = 45 drugs = 12 drugs that barely extended patients’ lives
No – the wars are not going well. Our puny efforts have not defeated or even bothered cancer.
The emperor has no clothes. Therefore, we do need a new approach. Can we just face the fact that the calorie approach is doomed to failure? The ‘blood glucose’ approach is doomed to failure and the ‘cancer is a genetic disease’ approach is doomed to failure.
We’ve tried them all over 50 years and all failed miserably. Let’s admit the problem so that we can move towards a solution. Time to cut bait.
- Dr Jason Fung has founded and runs the Intensive Dietary Management for personalised counselling to achieve weight loss and reversal of type 2 diabetes.
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Anecdotal, yes sure, but I know/knew several people with both diabetes and leukemia whose leukemia went into remission and stayed in remission when they learned to control their diabetes through low carb diets.
One of them subsequently went on to develop two other cancers, none diet-related, and outlived his doctors’ best estimates by a few years.
Now if I know that many people, how the hell many are there in the population of people I DON’T know? And why are doctors and dieticians so incurious that they continue championing diets that patently do not work and condemning all alternatives?
My generation is the last to have personal knowledge that there was ever a time when obesity and diabetes were not “epidemics” and other metabolic diseases, and cancer, were far less prevalent. I also include Alzheimers as something once rare that has only become commonplace since low fat diets were invented. Increasingly, doctors and especially dieticians have no knowledge that such times ever existed.
Signed, just another crank on the internet.
A great article by Dr Fung. I doubt he’s very popular with the medical establishment – and I don’t think he cares very much. Thank goodness for doctors like him.
Great insights!
Ah, another WAR to be valiantly Fought… yet Success is only guaranteed for the Bankers financing both sides, suppliers and support folk providing the tools .
And Conflicts of Interests – Employment in endless, fruitless but heroic Research, Sales/Profits and Power – will tempt those to stretch out the battle.
Cynical – Moi ???
:))