Cancer Decisions - Free Newsletter -May 22, 2004

THE MOSS REPORTS

Science should by definition be open-minded. As the celebrated eighteenth century German poet and philosopher Goethe said, "As soon as anyone belongs to a narrow creed in science, every unprejudiced and true perception is gone." This week I begin a two-part series on an important event that has recently been in the news: the firing of a Boston University professor who has written a book that puts forward ideas that run counter to current medical doctrine.

The very fact that doctrine and dogma exist in the world of medicine is cause for concern. Science-based medicine should be founded on rationality and open-mindedness, not on ideology.

Unfortunately, the tendency for ideology to supplant open-mindedness has become pervasive in medicine. For the past thirty years I have studied the world of cancer and its treatment and have written extensively on the many potentially useful treatments that have been dismissed out of hand simply because they challenged the prevailing medical dogma.

The Moss Reports is a series of more than two hundred detailed reports on different types of cancer. If you or someone you love has cancer, a Moss Report can offer not just an in-depth analysis of the conventional treatment of that type of cancer, but also a thorough examination of the available alternative and complementary treatments. You can order a Moss Report through our website: www.cancerdecisions.com or by calling Diane at 1-800-980-1234 (814-238-3367 from outside the US).

VITAMIN D AND CANCER: A DERMATOLOGIST'S DILEMMA

Note: When you finish reading this article you may be moved to take action. At the end of the article I therefore suggest something you can do.

A Boston professor of dermatology has been asked to resign because he advocates moderate exposure to sunlight. Michael F. Holick, MD, PhD, a professor at Boston University, was asked to resign in April from BU's Department of Dermatology because of a book he wrote, in which he describes the importance of sunlight in boosting vitamin D levels. He was also severely criticized for his ties to the indoor tanning industry.

Department chair Barbara Gilchrest, MD, told the Boston Globe that the book "is an embarrassment for this institution and an embarrassment for him." As demanded, Holick resigned his post, but continues to teach and to direct the medical center's Vitamin D, Skin, and Bone Research Laboratory, without a cut in pay.

Holick is a talented, experienced and highly respected researcher. He is a professor of medicine and physiology, and formerly of dermatology, at Boston University School of Medicine, and (until 2000) chief of endocrinology, metabolism and nutrition. Since 1987 he has also been the program director of the University's General Clinical Research Center.

Department chair Gilchrest's disapproval of Holick stems from the fact that his statements, superficially at least, seem to be at odds with the medical profession's consensus on the damaging effects of sunlight. Dermatologists have been warning the public for years that sunlight, and specifically ultraviolet A (UVA) and ultraviolet B (UVB), is implicated in the causation of melanoma, as well as other less deadly forms of skin cancer.

But the causes of melanoma are still far from established, and there remain many unanswered questions about the exact relationship of sunlight exposure to the development of skin cancers. Exactly how much ultraviolet light constitutes a safe level of exposure is a legitimate topic for scientific debate. For example, according to the American Cancer Society, "We do not yet know exactly what causes melanoma …but we do know that certain risk factors are linked to the disease….Some risk factors, such as smoking, can be controlled. Others, like a person's age or family history, can't be changed. But having a risk factor, or even several, doesn't mean that a person will get the disease" (ACS 2004).

As to sunlight, the ACS says this: "The best way to lower the risk of melanoma is to avoid too much exposure to the sun and other sources of UV light…. Avoid being outdoors in sunlight too long, especially in the middle of the day when UV light is most intense…."

But this view is not universally held. William B. Grant, Ph.D., who heads the Sunlight, Nutrition and Health Research Center (SUNARC) in San Francisco strongly disputes it. "This is not particularly good advice," he told this newsletter. "There are several papers indicating that occupational exposure to sunlight reduces the risk of melanoma (Kennedy 2003). "It is having fair skin, a high-fat, low fruit and vegetable diet, sunburning, etc., that are more linked to melanoma than total UV exposure."

Reasonable people can certainly differ over this complex question. Such vague terms as "too long" or "too much exposure" leave much room for disagreement. In science, intellectual rigidity is never warranted, especially when it rests on fundamental confusion about the actual causes of a potentially fatal human disease.

Despite scientific uncertainty, the attack on Dr. Holick has taken on a quasi-moralistic tone. Some dermatologists, possibly frustrated at the failure of most of their treatments to reverse advanced melanoma, now regard sun exposure without sunblock as analogous to promiscuous sex without condoms. But ultraviolet sunlight (particularly UVB) is not always and absolutely bad for our health. It has essential functions, too. In particular, it enables our skin to manufacture vitamin D: without sufficient exposure to sunlight we run the risk of developing the deficiency disease rickets.

Vitamin D and Internal Cancers

The benefits of sunlight and vitamin D for the development of healthy bones have long been known: a Nobel Prize was awarded for discoveries relating to the importance of vitamin D as early as 1928.

But what has only fairly recently been discovered is that, in addition to its role in bone metabolism, vitamin D may also help prevent a variety of cancers. I wrote about this in my book Cancer Therapy I quoted the work of San Diego scientists Drs. Cedric and Frank Garland, who argued that colon cancer could be prevented by sunlight. The Garlands went further, however, showing that "brief, regular exposure to sunlight was probably beneficial in preventing melanoma, while either too little or too much exposure was potentially harmful" (Moss 1992, citing Garland 1990).

The research on the subject of vitamin D and cancer is now voluminous, with over 3,500 PubMed articles on the topic. The US National Institutes of Health has stated that "laboratory, animal, and epidemiologic evidence suggest that vitamin D may be protective against some cancers. Some dietary surveys have associated increased intake of dairy foods with decreased incidence of colon cancer. Another dietary survey associated a higher calcium and vitamin D intake with a lower incidence of colon cancer" (NIH 2004). One randomized trial, published last December, showed that people who had high vitamin D levels benefitted from calcium supplementation: the incidence of premalignant adenomas of the colon was reduced by 29 percent in those who had optimal amounts of both nutrients (Grau 2003).

Vitamin D (and indirectly, therefore, sunlight) might also convey protection against prostate cancer. It is certainly true that more full-scale clinical trials need to be done to test this hypothesis. (PubMed lists 29 such trial articles.) But people are exposed to sunlight every time they step outdoors; the public needs and deserves preliminary recommendations from those with the greatest knowledge.

Dr. Holick's "crime" is that he has provided an answer that is at variance with the positions of the professional dermatology associations. Yet he is well positioned to offer an opinion, as he himself is in the forefront of this research. He is the author of over 200 PubMed articles on the topic of vitamin D, the first of which appeared in 1970. The latest, published this March, suggests the scope and importance of his research: "Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis" (Holick 2004). By contrast, Dr. Gilchrest, although herself well published in dermatology, has only authored two PubMed papers on vitamin D, one of which she co-authored with Dr. Holick.

It is hard to believe that a policy dispute of this sort would warrant such a gross violation of academic freedom and intellectual rights. We do indeed live in parlous times when doctors are removed from high positions for offering carefully reasoned and well intended advice to the general public on preventing cancer!

Mysteries of Sunlight

There is much about sunlight's biological effects that is not known and no one would argue that the case for increasing ultraviolet exposure has yet been conclusively proved. But neither is it firmly established that blocking sunlight is entirely beneficial. In fact, the value of physical or chemical sunscreens is itself in dispute.

In February 1998, an epidemiologist at Memorial Sloan-Kettering Cancer Center in New York, Dr. Marianne Berwick, presented a careful analysis of sunscreen use and skin cancer at the annual meeting of the American Association for the Advancement of Science (AAAS). She concluded that sunscreens may not actually protect against skin cancers such as melanoma. In her own words: "We don't really know whether sunscreens prevent skin cancer." Berwick first looked at four studies of squamous cell cancer, a skin cancer that is destructive but not frequently lethal. Two of the studies concluded that sunscreen protected against a precancerous skin condition while two others reported that sunscreen did not shield people from this condition.

She then analyzed two studies of basal cell carcinoma, another generally non-lethal skin cancer. Those two studies found that people who used sunscreen were actually more likely to develop basal cell cancer than people who did not.

Berwick then analyzed ten studies of melanoma, the most deadly form of skin cancer. Melanoma often starts in or near moles on the skin. In five of the ten melanoma studies, people who used sunscreen were also more likely than nonusers to develop melanoma. In three of the studies, there was no association between sunscreen use and melanoma. In the final two studies, people who used sunscreen seemed to be protected (Berwick 1998).

More recently, L.K. Dennis of the University of Iowa reviewed the topic in the Annals of Internal Medicine. Again, he found that sunblocks offered no protection "No association was seen between melanoma and sunscreen use," he and his colleagues wrote (Dennis 2003).

Dr. Berwick's was a factual presentation. But the dermatology profession's response to her analysis was as unmeasured as its response to Dr. Holick. The American Academy of Dermatology promptly denounced the Memorial Sloan-Kettering researcher's conclusions. In March 1998 the Academy issued a press release calling her message "misleading and confusing."

Roger Ceilley, MD, a Des Moines dermatologist and a past president of the Academy, called Berwick "a numbers cruncher," not a doctor, according to an article in Science News. Incidentally, Dr. Ceilley has only one PubMed article on the topic of melanoma, dating from 1980 (Elmerts 1980). Dr. Berwick—the Sloan-Kettering "numbers cruncher"—has 81 such publications.

"We're going to have millions more cases of skin cancer in the next decade" if people forgo sunscreen, Dr. Ceilley proclaimed (Fackelmann 1998).

TO BE CONTINUED, WITH REFERENCES, NEXT WEEK

ACTION ALERT

The Dermatology Department at Boston University invites the public to send comments, suggestions and concerns. Those wishing to comment on the case of Dr. Holick should click or go to:

http://www.bumc.bu.edu/Departments/FeedbackMain.asp?DepartmentID=57&Script=%2FDepartments%2FPageMain%2Easp&Arguments=Page%3D5951%26DepartmentID%3D57

I would appreciate receiving a copy of any of your comments and letters and with your permission may print some of them in a future issue.

--Ralph W. Moss, Ph.D.

**NOTE** To view this page in a more printable format, please CLICK HERE.

IMPORTANT DISCLAIMER

The news and other items in this newsletter are intended for informational purposes only. Nothing in this newsletter is intended to be a substitute for professional medical advice.