One of the inspirations for today’s show was a series of reports in the media about new guidelines for prostate cancer prevention. Issued by the American Society of Clinical Oncology and the American Urological Association, the guidelines recommend that physicians encourage older men to consider what they call chemoprevention. The shocking thing about these recommendations is that they are for older men who are without any overt symptoms, without elevated PSA readings, without prostate enlargement. This is a classic example of turning healthy people into patients. It’s also a classic example of self-enforced ignorance by the media. But most of all, it’s a classic example of medical ideology trumping actual science.
The specific therapy promoted by these so-called experts consists of administering a drug that inhibits 5-α-reductase, an enzyme that converts testosterone into the biologically more potent dihydrotestosterone (frequently referred to as DHT). DHT is responsible for, among other things, male secondary sex characteristics. The 5-α-reductase drugs are one of the standard treatments for prostate cancer based on the theory that out-of-control DHT is its cause. That theory is not, in my opinion, correct—but let’s set that aside for now.
Here we have experts among oncologists and urologists deciding that, in addition to this drug’s role in treating actual medical conditions, it should be used to prevent their occurrence among otherwise healthy men. What is the basis for this belief? Principally, one large-scale study called the Prostate Cancer Prevention Trial. According to the experts, this study showed a 25% reduction is prostate cancer over 7 years for men taking the drug. What the actual statistics boiled down to was that, at these rates, out of 71 men taking the drug over a 7-year period only 1 would avoid a prostate cancer diagnosis. Even some of the researchers in the Prostate Cancer Prevention Trial itself questioned the rosy glow of the study’s conclusions.
What would men risk by taking the drug? Loss of sexual function at a rate similar the risk reduction and a small but statistically significant increase in the risk of high-grade prostate tumors. All for a mere $1,000 per year.
So once again science of questionable validity with unimpressive results based on a false premise is hailed by its promoters as “a milestone in chemoprevention.” The media dutifully reported the expert panel’s findings and framed it so that it would have maximum fright value: “Prostate cancer is the most common cancer in men after skin cancer.”
What’s that supposed to mean? How much of a threat is it compared to the risk of, say, a heart attack? How much suffering is involved? How likely is it to kill you? On these issues the media are utterly uninformative because they are utterly uninformed and completely uncritical. The experts are worried! Oh, no! A scary diagnosis! Go get some of that drug right away!
You will recall that I said that this whole enterprise is based on a false premise: that a metabolite of testosterone, DHT causes prostate cancer. To this day, researchers from the 1940s such Dr. Charles Huggins are cited for observing that prostate cancer was virtually absent from castrated men. The logic seems inescapable: no testes, no testosterone, no prostate cancer. However, as Dr. John Lee points out in demolishing this particular myth, removing a man’s testes not only eliminates the major organ for producing testosterone, it also removes the major organ in men that produces estrogen. The problem, he argued, is not too much DHT or even too much estrogen but too much estrogen in relation to DHT and testosterone.
Outside of the medical establishment and its ideological commitments, the role of estrogen in prostate cancer is recognized very clearly. In a review last year of research on the effect of environmental endocrine disruptors on prostate cancer, a string of research is cited regarding the direct and indirect estrogenic effects of chemical pollutants on the risk of prostate cancer. For example, farmers are at a disproportionately greater risk of prostate cancer. A substantial body of evidence points to pesticide exposures. The biochemical mechanism is not through direct estrogenic effects, since the six pesticides that have so far been implicated do not act directly on estrogen receptors. Instead, these pesticides inhibit the action of enzymes responsible for metabolizing estrogen and testosterone in the liver. In other words, they disrupt hormone balance.
Oddly, the article that reviews the estrogenic effects of pesticides and other substances such as bisphenol A and polychlorinated biphenals (PCBs) opens by citing the 1940s research that John Lee so effectively dismantled. It is a failure by these researchers to see what is before their eyes—a failing common to us all. What fails is the ability to distinguish science from theology. We’re all attached to ideas. It becomes dangerous when we become too attached, when the theology becomes ecclesiastical, as in the case of prostate cancer orthodoxy.
In the early Seventeenth Century, the scientist Galileo Galilei studied the heavens and found evidence for the then-revolutionary idea that the Earth orbits the Sun. This contradicted the theological tenets established by the Church’s ecclesiastical court. And so he was put under house arrest for the rest of his life. In the middle of the Twentieth Century, Bertolt Brecht wrote a play about Galileo in which he stages a scene that has ecclesiastical representatives visit Galileo. Galileo invites them to look through his telescope and see for themselves moons orbiting Jupiter. The ecclesiastics decline. They have no need to look because they already know that such a thing is not possible.
There are two lessons here. First, the health effects of a hormone are not about it alone but about its balance with other hormones, the enzyme systems regulate them, and the environmental assaults that disrupt both. Second, whenever possible, look through the telescope.