Besonders die Bilder oben zeigen den Unterschied von damals und später deutlich, links übergewichtig, rechts ausgemergelt.
[*quote*]
Steve Jobs Treated His Cancer At Veggie Restaurant?By Leander Kahney (10:12 pm, Sep. 07, 2008)
[...]
Earlier this year, Fortune magazine revealed that after Steve Jobs discovered he had pancreatic cancer in October 2003, he tried to treat it by undergoing a special diet. But after nine months, when this failed to be a cure, he underwent surgery in July 2004. Four years later, he appears to be cancer free.
It now appears that Jobs’ special diet was conducted in part at Greens, a popular vegetarian restaurant in San Francisco, and he was often accompanied by Dr. Dean Ornish, the bestselling author of “Eat more, Weigh Less” and a clinical professor of medicine at University of California, San Francisco.
According to two staff who worked at Greens, and who asked to remain anonymous, Jobs regularly met Dr. Ornish at Greens about four years ago. Both staffers said they got the impression Jobs was trying to treat his cancer with meals eaten at Greens
[...]
[*/quote*]
more:
http://www.cultofmac.com/2709/steve-jobs-treated-his-cancer-at-veggie-restaurant/Orac, neben PZ Myers einer der großartigsten und energischsten Blogger bei scienceblogs.com, hat den folgenden Beitrag im März 2009 geschrieben. Ich wette, er hat nicht gewußt, daß Ornish für das Schicksal von Steve Jobs verantwortlich war, sonst hätte er seine weißdarwin nicht gerade zurückhaltenden Worte in einen Feuersturm verwandelt und Ornish darin verdampft.
Wegen der Wichtigkeit (sorry, Dave, this is neccessary) der gesamte Artikel, damit ihn vor allem die Apple-Fans in seiner ganzen Breite und Intensität sehen.
http://scienceblogs.com/insolence/2009/03/dr_dean_ornish_turn_away_from_the_dark_s.php[*quote*]
Dr. Dean Ornish: Turn away from the Dark Side! It's not too late! Category: Alternative medicine • Cancer • Medicine • Politics • Quackery
Posted on: March 5, 2009 9:30 AM, by Orac
I realize I've said it before, but I still can't believe as many people
read what I like to lay down on a daily basis right here on this blog.
Believe me, it has nothing to do with an sort of false sense of modesty.
After four years at this, I know I'm good at blogging. Real good. But good
isn't always enough to make much of a difference or even to garner an
audience. Whether I've done the first, I don't know. I like to think that
I have. As for the second, I've done pretty well for myself. Indeed, after
a year of stagnant traffic, January and February were the best months,
traffic-wise, in the history of this blog. What that means, I guess, is
that sometimes people whom I would never have expected to give a rodent's
posterior about what a nobody like me writes actually sometimes take note.
Sometimes famous people, certainly far more famous and renowned than your
humble pseudonymous blogger, are moved to leave a comment. Not
surprisingly, these responses, on the fairly uncommon occasions when they
appear, are usually provoked by something I've written that has--shall we
say?--displeased the target of my insolence, be it of the respectful or
not-so-respectful variety.
Such was the case late Tuesday night, when one of the Four Horsemen of the
Woo-pocalypse himself, upon whom I had laid a bit of a smackdown in the
course of lambasting Senator Tom Harkin (D-IA) for his plan to piggyback
the legitimization of quackery onto any health care reform legislation
that President Obama might try to get through the Congress. Because Harkin
is a very senior and very powerful Senator, one who nearly single-handedly
birthed the legislation that produced the Office of Alternative Medicine
in the NIH, which later begot the monstrosity that has become the National
Center for Complementary and Alternative Medicine (NCCAM), his intentions
are very important, as he very well might succeed if President Obama is
insufficiently serious about the promise he made in his Inaugural Address
to restore science to "its rightful place." A few of you know of whom I
speak, as you took up the slack when I couldn't respond right away due to
yesterday being a travel day to the SSO Meeting in Phoenix. I'm referring,
of course, to Dr. Dean Ornish, the Founder and President of the
Preventative Medicine Research Institute, who left a comment that, because
it got held up for moderation (I know not why), I did not see until very
late. Suffice it to say, he is not particularly happy with me.
Although I can totally understand why Dr. Ornish might not appreciate my
criticism, he should actually know that, of the Four Horsemen of the
Woo-pocalypse, I consider him (probably) the least objectionable.
Certainly he would not be Death (that would be Andrew Weil). Smart-ass
that I am, maybe I'll consider Dr. Ornish to be Famine, given that his
claim to fame is the use of very low fat diets, along with major lifestyle
alterations, to effect changes in health. The reason that I find Dr.
Ornish perhaps the least objectionable is that at least he tries to do
science. It's preliminary science, and usually the controls aren't the
greatest, but it is for the most part science. My main beef with him is
how he represents that science to the public. For his claims for dietary
treatment of prostate cancer at least he tends to take preliminary studies
of highly select patients and make way too much of them. Indeed, he often
says one thing in his papers, where peer-reviewers force him to remain
tentative and keep him from going too far off into the deep end with his
claims, but quite another thing to virtually everyone else, including the
aforementioned Senator Harkin and, even worse, to the recent Institute of
Medicine/Bravewell Collaborative conference on alternative--excuse me
"integrative" medicine--from which he hopped over to the Senate to do a
two-fer of woo promotion in our nation's capital.
My post about him and his fellow horsemen led him to respond in the
comment section thusly (comment reproduced in its entirety), after which I
will provide my response:
For someone who prides himself on attention to detail, it's surprising
that you haven't done your homework. My testimony that comprehensive
lifestyle changes may affect the progression of early-stage prostate
cancer was not based solely on the paper that my colleagues and I
published in the Proceedings of the National Academy of Sciences last year
(Proc Nat Acad Sci USA 2008; 105: 8369-8374. Ornish D, Magbanua MJM,
Weidner G, et al. Changes in prostate gene expression in men undergoing an
intensive nutrition and lifestyle intervention. Proc Nat Acad Sci USA
2008; 105: 8369-8374).
It was based on a randomized controlled trial that I directed in
collaboration with Peter Carroll, M.D. (Professor & Chair of Urology,
School of Medicine, University of California, San Francisco) and the late
William Fair, M.D. (Chief, Urologic Surgery and Chair, Urologic Oncology,
Memorial Sloan-Kettering Cancer Center) which was published in one of the
leading peer-reviewed urology journals (Ornish DM, Weidner G, Fair WR, et
al. Intensive lifestyle changes may affect the progression of prostate
cancer. Journal of Urology. 2005;174:1065-1070). Other subsequent studies
have shown similar findings.
In September, we published a pilot study in The Lancet Oncology in
collaboration with Dr. Elizabeth Blackburn, who was awarded a Lasker prize
for discovering telomerase, showing that these comprehensive lifestyle
changes increased telomerase by almost 30%. This is the first study
showing that any intervention may increase telomerase.
Our earlier studies showing that comprehensive lifestyle changes may stop
or reverse the progression of coronary heart disease were published in
several peer-reviewed journals, including:
• Ornish D, Scherwitz L, Doody R, et al. Effects of stress management
training and dietary changes in treating ischemic heart disease. JAMA.
1983;249:54-59
• Ornish D, Brown SE, Scherwitz L, et al. Can lifestyle changes reverse
coronary atherosclerosis? The Lifestyle Heart Trial. The Lancet. 1990;
336:129-133.
• Gould KL, Ornish D, Scherwitz L, et al. Changes in myocardial perfusion
abnormalities by positron emission tomography after long-term, intense
risk factor modification. JAMA. 1995;274:894-901.
• Ornish D, Scherwitz L, Billings J, et al. Intensive lifestyle changes
for reversal of coronary heart disease Five-year follow-up of the
Lifestyle Heart Trial. JAMA. 1998;280:2001-2007.
You can do a medline for more references.
Although you dismiss this statement as "nonsense," we are, in fact, more
than just genes and germs, microbes and molecules. You might begin by
reading some of Leroy Hood's work (no slouch as a scientist) who described
systems biology and the concept of synergy. I cited his work in my keynote
talk at the recent Institute of Medicine's "Summit on Integrative
Medicine" at the National Academy of Sciences that will be posted later
this week (
http://www.iom.edu/integrativemedicinere) in which I describe
the studies of those such as Sheldon Cohen in JAMA showing that not
everyone who is infected with rhinovirus develops the signs and symptoms
of a cold, and found a direct relationship between the degree of social
support and immune function.
The best scientists are open to new ideas, not glibly dismissing them just
because they don't agree with their preconceptions.
Dean Ornish, M.D.
Founder and President, Preventive Medicine Research Institute
Clinical Professor of Medicine, University of California, San Francisco
Ow. That's gonna leave a mark.
Well, not really. In fact, I'm rather disappointed that Dr. Ornish played
the "close-minded" gambit so vociferously. Whether consciously or not, Dr.
Ornish appears to have missed the broader point I was making about how
pseudoscience had coopted what should be the very science-based
interventions of diet and exercise as a "wedge strategy" designed to open
the way for the entry of all manner of quackery in order to focus like a
laser on the much narrower point of my criticism of his work. When I first
saw Dr. Ornish's response, I was half-tempted to ignore his complaints
about my criticism of him, because even if each and every point he makes
about his diet and lifestyle interventions were 100% perfect science with
overwhelming support and I really were a close-minded, lousy scientist, it
wouldn't change one whit my annoyance with him for allying himself with
supporters of pseudoscience to support Senator Harkin (the broader point
of my broadside against Weil, Hyman, Oz, and him), as I'll explain a
little later. However, when someone throws down the gauntlet like Dr
Ornish, I have a tendency to pick it up and slap him across the face with
it, accepting the challenge. Even if I end up losing badly, better to go
down honorably than to slink away. So let me deal with a handful of the
specifics of Dr. Ornish's complaints before I move on to finish this post
addressing the broader point of why Dr. Ornish drives me crazy.
First off, Dr. Ornish is mistaken to assume that I have not read or was
not aware of his other papers testing his diet against prostate cancer.
I've read them all, although I've done a detailed deconstruction of only
the microarray paper that I mentioned. I've even obliqulely alluded to his
telomerase paper before, and I've read several of his others.
Consequently, it's probably my fault that he got the impression that the
microarray paper was the sole basis of my criticism. However, my post was
long and a detailed discussion of all of Dr. Ornish's work in prostate
cancer was beyond the scope of the post; so I picked one example that I
had already discussed, which you can read again right here if you so
desire. In the meantime, let's look at a couple of the other papers Dr.
Ornish cites as evidence that I am a close-minded, careless dolt, as well
as a brief look at the microarray paper again.
The telomerase study, which did indeed appear in The Lancet Oncology in
September, was entitled Increased telomerase activity and comprehensive
lifestyle changes: a pilot study, is very interesting in that Dr. Ornish
reported telomerase activity results on the same patients upon whom he did
his microarray experiments. This is what Dr. Ornish said about this
problem in the discussion section of the PNAS microarray paper:
...our analysis was limited to normal prostate tissue because tumor tissue
was present on the biopsy specimens of only a minority of patients. Thus,
the implications of this study are not limited to men with prostate
cancer. Because of the microfocal nature of low-risk prostate tumors and
the limitations of ultrasound biopsy guidance, we were unable to precisely
match pre- and postintervention tumor samples for individuals in our
cohort...Because only one-third of patient biopsies in our study included
tumor tissue, we were limited to examining the response of the normal
prostate tissue (stroma and epithelium) to the intervention. It will be
very important for future work to examine tissue molecular responses to
determine whether the normal stroma, tumor stroma, normal epithelium,
tumor epithelium, or a combination of these tissues respond to diet and
lifestyle changes.
I will admit that it is fair enough to point out that, if the results are
validated, that the changes in gene expression occurred in normal prostate
cells does imply that his diet might be useful for prevention. However,
given that he missed cancer epithelium 2/3 of the time, it's really
difficult for him to conclude anything whatsoever about his microarray
experiment. In fact, what I'd be interested in is a comparison of the
array results of tissue samples with no tumor tissue versus those with
tumor tissue. All it would take is a couple of patients whose pre-diet
biopsy had tumor tissue but whose post-diet biopsy did not to
significantly affect the results. That was the main basis of my skepticism
over whether the PNAS paper meant much of anything.
Moving on, I have to admit that the telomerase paper led me to scratch my
head. In cancer, telomerase is generally a bad thing. To put it simply,
telomeres are repetitive DNA sequences at the end of chromosomes. They
serve to keep chromosomes from degradation. The reason chromosomes degrade
during replication is that the enzymes that replicate the chromosome
cannot replicate the DNA all the way to the end of the strand.
Consequently, during each round of cell division and chromosome
replication, some DNA sequence is lost. With telomeres at the end, what is
lost is noncoding repetitive DNA, and no important DNA sequences that code
genes or regulatory regions are lost. In most eukaryotic organisms, an
enzyme known as telomerase adds these DNA sequences to the end of the
chromosomes. However, in the adult telomerase is generally active only in
cells that need to divide a lot, such as stem cells and immune cells but
only expressed little, if at all, in most normal cells. In immune cells,
which is where Dr. Ornish looked, decreased telomerase activity has been
associated with an increased risk of atheroclerosis, although, as he
himself points out in the paper, telomerase length is not.
In any case, I went back and looked at the telomerase paper again. To boil
it down, what Dr. Ornish found was that his diet is associated with an
increase of about 25% in telomerase activity in peripheral blood monocytes
(PBMC). The standard deviations are quite large and overlapping, and the
statistical significance is there, but not impressive. I looked at the
table that showed all the telomerase activity values "before and after"
(statistical significance tested, appropriately, with Student's paired
t-test) and saw huge variability, with telomerase activities actually
decreasing slightly in some patients. This leads me to concede that there
is probably a difference in telomerase activity, but to wonder whether the
difference is clinically relevant. Moreover, that increased telomerase
activity appears to be associated with Dr. Ornish's diet in PBMCs makes me
wonder something. If his diet does definitely increase telomerase activity
in PBMCs (something that remains to be demonstrated), then could it be
possible that it does the same thing in cancer cells? Remember, many
cancers have high telomerase activity, and telomerase inhibitors are being
developed for various cancers. Just a random thought. I went back to look
at the microarray paper to see if telomerase gene expression levels
increased or decreased in prostate tissue as a result of the Ornish diet,
but couldn't find anything.
Finally, there are the two papers, one in Urology and one in the Journal
of Urology, reporting that the Ornish diet is associated with slower
progression of early stage prostate cancer in men who choose watchful
waiting for their tumors, and a longer time to progression, all of which
is very interesting, although pretty preliminary given the few numbers of
men. In addition, I won't go into the cardiovascular papers (much),
because (1) I'm a cancer surgeon and (2) no one is arguing, least of all
me, that diet and exercise don't play a very important role in
contributing to (and potentially preventing) cardiovascular disease. I'm
not even that skeptical that diet and exercise might be preventative for
prostate cancer and other cancers--or even mildly therapeutic. It's a
straw man to say otherwise. My sole purpose in mentioning some of the
papers that Dr. Ornish cited is to emphasize that they are all pilot
studies and that their results are tentative at best. Moreover, what I
have been arguing is that Dr. Ornish has willingly and enthusiastically
allied himself with the "alternative" medicine movement, many of whose
leaders are boosters of pseudoscience, when the use of diet and exercise,
the very health interventions he champions, are not and should not be in
any way considered "alternative." Worse, Dr. Ornish is overselling his
results to Congress, the medical profession, and the public in order to
champion them as "alternative."
Which brings me back to my main complaint about him, the complaint that he
completely ignored, which is why I'm going to e-mail him and make sure he
sees this response, given that he was kind enough to comment.
As an example, let's go back to his article in the Washington Post in
January, in which in addition to Dr. Weil, Dr. Ornish teamed up with, of
all people, Deepak Chopra and Rustum Roy. Let's get one thing straight.
Deepak Chopra is a booster of pseudoscience. There's no other
scientifically accurate way to describe him. Indeed, he is so full of
pseudoscience that I can take credit for coining a term that has spread
through the blogosphere for the nonsense that he regularly that he
regularly lays down: Choprawoo. I and others have deconstructed the
nonsense about medicine, evolution, and other "quantum" nonsense. His
contortions of science are legion (and legendary). The same is true of
Rustum Roy, who has become known above all else for his support for the
quackery that is homeopathy.
This leads me to ask: Does Dr. Ornish think there is anything at all to
homeopathy or the "memory" attributed to water by homeopaths? If so, he
has left the path of science, as homeopathy is quackery. Period. If not,
then why on earth did he associate himself so publically with a booster of
such quackery? Rustum Roy is one of the most famous current supporters of
homeopathy. Talk about shooting oneself in the foot, scientifically
speaking! Let's put it this way: Palling around with Deepak Chopra and
Rustum Roy--and even going so far as to write an article on alternative
medicine with them to be published in the Washington Post--do not exactly
constitute a sound strategy to enhance one's scientific credibility, if
you know what I mean. An analogy would be hanging out with Bernie Madoff
as a strategy to enhance one's cred as an honest investment guru.
Given Dr. Ornish's obvious distress at my criticism, though, I had
considered apologizing for having gone a bit far and getting a bit too
testy (although I take back absolutely nothing that I said about Senator
Harkin and the rest). Truly, sometimes I do get a bit carried away when
I'm on a roll, particularly after coming up with a pithy phrase like "the
Four Horsemen of the Woo-pocalypse," which, if I do say so myself, is one
of my better ones. Then I saw Dr. Ornish's slide set from his presentation
to the Institute of Medicine/Bravewell Collaborative woo-fest last week,
which, not-so-coincidentally, overlapped Senator Harkin's woo-fest.
Now I'm half-tempted to conclude that I may not have been hard enough on him.
The first thing that bugs me is that Dr. Ornish invoked Leroy Hood. Since
he told me in his comment, in essence, to "go read some Leroy Hood," I
can't resist pointing out that I have, in fact, "read some Leroy Hood" and
that I have, in fact, attended talks by Leroy Hood. It can even be said
that I rather admire Leroy Hood. In fact, I have even blogged about Leroy
Hood and exactly why I like his systems biology approach. I am even
currently striking up a collaboration with a systems biologist at my own
institution who's very big on network analysis. Nonetheless, I still have
a great many reservations about whether the hype over systems biology as
epitomized by Leroy Hood is an accurate reflection of its ability to
deliver truly "personalized medicine" (very much like the dubious
"individualization" of medicine claimed by CAM advocates, which is, in
most cases, a synonym for "making it up as I go along). I won't rehash my
comments here, but rather refer readers to my post on the issue. I will,
however, reply to Dr. Ornish by saying, "You, sir, are no Leroy Hood." Nor
is Dr. Hyman, Dr. Oz, Dr. Chopra, Dr. Roy, or Dr. Weil, for that matter.
The reason is that Leroy Hood, for whatever faults he may have in perhaps
overselling his work a bit, does not represent his approach as
"alternative," nor does his approach embrace pseudoscience along with his
science, as apologists for "alternative" and "integrative" medicine all
too frequently do. Invoking Leroy Hood as a supporter of the kind of
arguments that Dr. Ornish made at the IOM is akin to Deepak Chopra's
invoking Einstein, the only exception is that it is not clear that Hood
will have anywhere near the effect on medicine that Einstein had on
physics.
Next, Dr. Ornish invokes Dr. Hyman's functional medicine, which is, in
fact, nothing more than a mish-mash of a lot of old woo about "balance"
(just leaving out the yin/yang or qi) given a fresh "science-y" gloss, as
longtime skeptic Wally Sampson has described. Dr. Ornish also cites
approvingly a paper that claims that "mindfulness meditation" improves the
antibody titer response to the influenza vaccine. I went and looked up
that paper to read while I was on the plane to Phoenix. I have to say, I
was underwhelmed; indeed, it reminded me of a similar study of Tai Chi
that I blogged about in that there was no attempt at blinding, but, even
worse, the measures used to control for confounding factors were truly
inadequate.
But Dr. Ornish hit the jackpot in provoking my annoyance when cited an
acupuncture study thusly:
In patients with low back pain, response rate was 47.6% in the acupuncture
group, 44.2% in the sham acupuncture group, and 27.4% in the conventional
therapy group.
The medical blogosphere extensively covered this study, as did I. Suffice
it to say, the study fell far short of how it was represented. Morever,
the most obvious conclusions about acupuncture from the study are that:
(1) it's a placebo effect and (2) acupuncture meridians are bunk, given
that there was no difference between the sham acupuncture and "real"
acupuncture group. In all fairness, I don't know what Dr. Ornish said
about the slide, because the video of the conference hasn't been posted
yet, but his slide sure does lead me to suspect that, when it comes to
science-based medicine, he just doesn't get it, as does his comment to me
remonstrating with me for taking him to task for saying that we are "more
than just genes and germs, microbes and molecules." Indeed, if he thinks
that Leroy Hood's work indicates that to be true, he is more misguided
than I thought. Nothing in Leroy Hood's work indicates that we are "more"
than these things, only that how these things work in human physiology and
disease is likely to be far more complicated than we had previously
thought. It does not imply any sort of dualism, which is what Dr. Ornish
seems to think that it does. He can correct me if I'm wrong.
Finally, Dr. Ornish truly buried himself when he finished up with a series
of slides that concluded:
"Integrative Medicine" = transformation
With all due respect, I ask: Transformation into what? One does not have
to embrace pseudoscience to "transform" healthcare. Indeed, the best
transformation of health care would be to make it more science-based. If
science shows that lifestyle alterations are the best treatment for some
conditions, bring it on! I'll be all for 'em, as they say. If science
bears out Dr. Ornish's results, I would happily recommend his diet to men
with early stage prostate cancer. To me, there is no such thing as
"alternative" or "integrative" medicine. There is medicine that has been
validated by science as effective and safe, and there is medicine that has
not. In fact, I would happily recommend even something that I now think as
ridiculous as homeopathy if science could show that (1) it works
significantly better than a placebo and (2) provide an reasonable
scientific mechanism by which it could work. Indeed, I'd even scratch #2
if someone could show me that homeopathy could cure an incurable disease
like pancreatic cancer.
In the end, the problem is that Dr. Ornish has yoked his science to
advocates of pseudoscience, such as Deepak Chopra and Rustum Roy. Why he's
done this, I don't know. The reason could be common philosophy. It could
be expedience. It could be any number of things. By doing so, however, Dr.
Ornish has made a Faustian deal with the devil that may give him
short-term notoriety now but virtually guarantees serious problems with
his ultimately being taken seriously scientifically, as he is tainted by
this association. Let me yet again reemphasize that this relabeling of
diet, exercise, and lifestyle as somehow being "alternative" is nothing
more than a Trojan Horse. Inside the horse is a whole lot of woo,
pseudoscience and quackery such as homepathy, reiki, Hoxsey therapy,
acid-base pseudoscience, Hulda Clark's "zapper," and many others, all
contradictory, virtually all pseudoscientific, but all intentionally
hidden within the Trojan horse of diet and exercise. Once the horse is
within the fortress of scientific medicine, the quackery will leap out and
take over. Thus, as far as I'm concerned, the answer is not to blindly
accept diet and exercise as "alternative," but rather to smoke out the
quackery from within the Trojan horse constructed by CAM advocates and
then return diet, exercise, and lifestyle interventions to where they were
before they became "alternative" and to where they should be: In the realm
of scientific medicine. Dr. Ornish could be a huge help in accomplishing
this. Indeed, one of my commenters put it very well:
You're doing science-based preventive medicine. Prevention and health care
maintenance have always been core concerns of medical science. Nothing
"alternative" about it.
So what do you need CAM for?
Why sit with that army of anti-science quacks on their side of the table
when you could be over here with us? (Srsly. Take a look at Weil. Dude
knows his way 'round a bong and a sandwich LOL.)
We try not to lie to the people, even though it might be fun. We don't
like to over-state our data, unless we're really drunk. We don't like
getting called on our bullshit, but we accept that this might sometimes be
necessary for the greater good.
We are tough. We are rockin'. Chicks dig us!
So get yer ass over here!
I echo the sentiment, and say to Dr. Ornish: "Get your ass over here, back
on the side of science- and evidence-based medicine." Or, channeling Luke
Skywalker trying to persuade Darth Vader, "I know you can still turn away
from the Dark Side."
What do you need "alternative" medicine for, Dr. Ornish? Really? Think
about it. What has it done for you other than lump you together with the
crystal gazers, shamanic chanters, and purveyors of quackery? I do not say
"unfairly lump you," because you yourself chose this association, and you
yourself can choose to end it.
You have the potential to be a pioneer in showing scientifically just what
dietary and lifestyle interventions can really do, but instead, you're
letting a bunch of opportunistic apologists for quackery coopt you and
your work for their own purposes. They're using you, and your diet is
nothing more than a convenient tool, a "foot in the door," if you will,
behind which quackery will follow.
Stop it. Please.
[*/quote*]
