Book review: Tripping over the Truth: the Return of the Metabolic Theory of Cancer Illuminates a New and Hopeful Path to a Cure, by Travis Christofferson.
This book is mostly a history of cancer research, focusing on competing grand theories, and the treatments suggested by the author’s preferred theory. That’s a simple theory where the prime cause of cancer is a switch to fermentation (known as the metabolic theory, or the Warburg hypothesis).
He describes in detail two promising treatments that were inspired by this theory: a drug based on 3-bromopyruvate (3BP), and a ketogenic diet.
Most of the book implies that the Warburg effect is a universal rule. Yet close reading shows two places that seem to admit that only 95% of cancers work that way. It’s not hard to find different estimates elsewhere. E.g. this NewsWeek article says “Up to 80 percent of cancers display the Warburg effect.”
Or David Gorski, who sounds like he’s optimizing for low risk of malpractice suits, and not someone I’d turn to if I was dying of cancer, in this diatribe against the book’s ideas:
Indeed, only approximately 60-90% of cancers demonstrate the Warburg effect.
I don’t know whether that’s enough to discredit the Warburg hypothesis, but it’s at least a big red flag, which Christofferson doesn’t adequately address.
Christofferson points out some real problems with mainstream approaches to cancer. Everyone seems to agree that the Warburg effect is real. But Christofferson’s stronger claims look suspicious. I’m still confused about whether cancer has a “prime cause”.
Christofferson repeatedly characterizes researchers who focus on the metabolic theory as heroes, who are fighting a medical establishment that has been tranquilized by the somatic mutation theory of cancer. Once again, reality is much messier than this story.
A large number of researchers have dedicated and are dedicating their efforts to the study of the Warburg effect that is intimately associated with the Warburg hypothesis.
Here’s Gorski’s reaction to one of Christofferson’s heroes:
If you do a Pubmed search on “targeting cancer metabolism,” which is what Dr. Seyfried is talking about, you’ll find over 22,000 articles, with over 3,000 in 2013 alone, with a sharply increasing curve since 2000 that only now appears to be leveling off. … From my perspective, Dr. Seyfried is exaggerating how hostile the cancer research community is towards metabolism as an important, possibly critical, driver of cancer
Christofferson touts 3BP as a general-purpose cancer cure, and complains about the delays in developing into an FDA-approved drug. Christofferson doesn’t provide a particularly clear explanation of the obstacles to progress with 3BP. I’m inclined to guess that they’re all too typical of the molasses that pervades attempts to commercialize drugs that were patented by academics.
Christofferson’s second general-purpose cancer cure is a ketogenic diet. This time there’s somewhat more reason to suspect that the medical establishment is reluctant to adopt a promising treatment that doesn’t fit their worldview.
Christofferson complains [quoting someone else about obstacles to treating epilepsy]:
The biggest problem today is trying to figure out how hospitals can reimburse trained ketogenic diet dietitians for their time.
I expect that’s half right.
It’s hard to patent effective advice to eat little sugar and lots of fat, and that’s a serious obstacle to building support for it within the medical establishment.
It takes special skill and/or training to tell patients to consume less sugar, at least if you want to do it effectively (do dietitians have that skill and/or training? your guess is likely as good as mine).
Most doctors probably want to avoid thinking about what would happen if they tried to persuade their patients to follow a ketogenic diet. Many patients would falsely imagine that they’re following the diet. Many others would get upset at the doctor for making them depressed (Christofferson is a bit cryptic when referring to the psychological costs of the transition to ketosis; I’ve tried to adopt a ketogenic diet, and decided it wasn’t worth the effort, given that I haven’t had a specific problem that it’s expected to fix). The doctors would likely be reluctant to admit that they don’t have the skill to convince people to eat less sugar.
A treatment doesn’t have to be especially safe or effective to be better than standard cancer treatments. If I’m dying of cancer, I expect I’ll try at least one of the treatments that Christofferson advocates.
Christofferson presents plenty of reasons to think there are problems with most cancer research. They seem broader than just a reluctance to pursue one theory or to pursue treatments that are hard to charge for.
Christofferson tells one story in which research on one drug was canceled because its anti-cancer effect in mice seemed to come from calorie restriction. Christofferson seems only interested in that in so far as it’s relevant to which grand theory is true. He ignores an obvious question: why wasn’t the drug company interested in charging money for the equivalent of eating less? That seems weird, in a way that doesn’t fit Christofferson’s good versus evil-or-confused-or-something narrative.
The obstacles to human use of ketogenic diets don’t seem to explain why it hasn’t caught on for pets. Cancer is a big problem for dogs, so why doesn’t Christofferson point to success there?
A quick search turned up many claims that a ketogenic diet is good for dogs (even a book on the subject), with occasional reports of results that sound promising. But if it were a miracle cure, I’d expect enthusiasm to spread more rapidly among dog owners than what I see.
Christofferson seems to have gotten nutritional advice from a good source, and only garbled it a little. E.g. he says walnuts have “fewer omega-6’s than most nuts”, when they have nearly twice as much per ounce, or per calorie, as the second highest nut of those that he lists. I’m guessing he means fewer omega-6’s per omega-3, and it might be wise to focus on that. But the omega-6 per calorie likely matters, and readers are likely to be misled by his wording.
Much of the book is written for a rather unsophisticated audience, yet parts of it are heavy with biochemistry. It takes some effort to remember what all the acronyms mean. He used the acronym CMT in three places while discussing CML patients, and I was only able to figure out that those were typos by using Amazon’s search inside the book function to determine that they’d been fixed since my copy was printed (I tried looking in the book’s index … and found the book has no index).
What does the book’s title mean? I’m tempted to interpret it as saying that the author keeps wanting a simple answer to cancer, but occasionally trips over facts which don’t fit that dream. Yet he still ends the book by directing readers to SingleCauseSingleCure.org (which appears to have been taken over by someone touting miracle cures that are unrelated to cancer. The site Christofferson intended seems to now be at foundationformetaboliccancertherapies.com).
I’m currently reading a book by Valter Longo that overlaps somewhat with this book (Christofferson has a favorable summary of Longo’s work; I had not been aware of this overlap when I made plans to read them back-to-back). Longo is clearly a more trustworthy source of information.
Cancer still looks much messier than Christofferson wants us to believe. Yet his solutions seem at least as promising as the alternatives.
I’m dissatisfied with the progress being made against cancer, but my main advice is to focus a bit more on the more radical ideas proposed by Aubrey de Grey.