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From the publisher.

The New Trade in Fentanyl Precursors

The musician Prince's death has been attributed to an overdose of the drug fentanyl. One may assume that Prince's doctors were prescribing fentanyl and that his prescriptions were legitimately manufactured and distributed through pharmaceutical middlemen and pharmacies. Unfortunately, that information cannot be verified. And that is the point: how does one know that an authorized drug manufacturer is making any prescription of fentanyl? Even scarier: how does one know if fentanyl or an analogue is hidden in a legally purchased prescription of hydrocodone, oxycodone, or even alprazolam? Lots of folks are getting into the business of peddling fentanyl; it's a very lucrative trade, difficult for customs agents to oversee, with very little downside. Chinese chemists are cleverly synthesizing acetylfentanyl and butyrylfentanyl, analogs that are easily transformed to their parent drug. (1) A downstream precursor such as the chemical NPP has no custom barriers in China, although our DEA has recently placed it in its prohibitive List I class. Pill presses are also in high demand, and not a few of these along with fentanyl chemicals make their way to labs in Mexico, many near the Pacific coast. Since the drug cartels already have distribution systems well established in the US, the black market for fentanyl or drugs tainted with fentanyl has exploded over the past year.

Individuals who are addicted to opioids are facing enormous difficulties obtaining them from physicians. New York State recently legislated that a patient may only be prescribed a seven-day supply; similar legislation is under consideration in many other states. Heroin has been the cheap replacement for legally prescribed opioids--oxycodone is much more expensive to purchase on the street. Now fentanyl can be used to adulterate all these street drugs, making them cheaper and extremely addictive.

The TV series Breaking Bad, as entertaining as it was (and it was a fun show to watch), made it clear that the drug trade brings in all elements of society, even a high-school chemistry teacher with cancer. Addiction may start with pain or a desire for a thrill ride, but opioid addiction is a terrible habit to break, one that is always demanding satisfaction for the addict. We all loved Sherlock Holmes, and yet when the case was solved, he flooded his addled brain with opium. What are we to do with this rattlesnake of an opioid, fentanyl? As the Chinese authorities put it, we cannot expect that the entire responsibility lays with the supplier--the consumer must be expected to take his share. Do we begin to talk about drugs in elementary school and have required courses in junior high? Should urine drug testing become a routine part of the medical checkup? Clearly the "don't ask, don't tell" approach to opioid use is part of the problem. We can no longer afford for an individual to opt to become an opioid addict.

Plutonium Exposure and Cancer

On a winter night in January 1966, a B-52 bomber carrying nuclear bombs was refueling over southern Spain when it collided in mid-air with an Air Force tanker. Both planes crashed and only several crew members of the B-52 survived, while four hydrogen bombs fell but did not detonate. Two of the bombs exploded without triggering a nuclear explosion, yielding a crater-sized depression and aerosolizing a cloud of plutonium dust. Nowadays we would characterize this as a dirty-bomb explosion. Local ripe tomato crops were covered with plutonium. The Air Force quickly marshalled military troops to the area to proceed with a rapid cleanup. Individuals were sent into the fields to shovel up acres of debris, dirt, and tomatoes covered with plutonium; over 53,000 barrels of plutonium-coated dirt were shipped back to South Carolina for burial. The men doing the cleanup were given no protective gear and were exposed directly to the radioactive dust. Worse, the Air Force command stated that the tomatoes were without hazard if consumed, and many of the men ate tomatoes three times per day. Medical teams faked Geiger counter testing reports indicating that there was no radioactivity after initial testing found very high levels. When the men were given urine tests to quantify plutonium exposure, high concentrations were detected; subsequently lab personnel were directed to destroy the abnormal results and new tests were done "demonstrating" no plutonium contamination. These fraudulent tests were maintained by the Air Force to substantiate a cover-up policy that the crews and local population were not exposed to excess plutonium. (2)

The Air Force was so intent upon denying plutonium exposure that a commission to study medical aftereffects was deemed unnecessary after 2 years. Despite the fact that there was an increase in local Spanish children developing leukemia as well as military members acquiring cancer, the Air Force vigorously denied any causal relationships. No formalized registry was organized to follow the medical status of military personnel involved with the plutonium cleanup. Fifty years later, many surviving military members involved in the Palomares, Spain, operation have a high incidence of cancer. Yet the VA denies claims based on the bogus testing that the Air Force maintains is the only authenticated medical study. Many of these individuals have had to deal with repeated bouts of cancer over the years.

The Air Force's denial was given the apt operational name of "sleeping dog." Even to this day, the Air Force refuses any scientific inquiry into what occurred, dismissing the possibility of latent cancer developing as a result of exposure and ingestion of plutonium dust. It appears that agrochemistry, Big Pharma, and the petroleum industry have all taken their cue from the Air Force--liking to deny the possibility that chemical exposure leads to hypersensitivity, allergy, and disease. Given that cancer diagnostics are revealing an increasing association of epigenetic abnormalities and cancer, it behooves us to connect the dots and show how chemical exposures are playing an important role in cancer epidemiology.

Now the Good News: Coffee Protects Against Certain Cancers

Conventional wisdom has always acknowledged that a prudent diet emphasizing fruits and vegetables, cutting down on sugar and fat, eating less nitrates and preservative-laden foods, consuming less alcohol, and decreasing animal proteins generally is helpful in improving cardiovascular health. Similar recommendations are advised in helping to prevent cancer and chronic degenerative diseases. In the 1990s coffee was thought to be a risk factor that increased one's chances for developing cancer, particularly pancreatic and bladder cancer. (3) However, subsequent research has pointed in a different direction, suggesting that coffee drinking may help stave off heart disease, diabetes, CNS disorders, and some cancers.

A report released by the World Health Organization on June 15 concluded that coffee drinking would help in preventing several types of cancer. The expert panel thought that coffee was particularly protective for liver and uterine cancer. In addition its review of more than 1000 studies suggested that coffee did not increase one's cancer risk. The panel found that both caffeinated and decaffeinated coffee demonstrated similar preventive effects; hence caffeine was not thought to be the key protective factor. While coffee is known to have abundant antioxidants, it is not clear whether they are pivotal for cancer prevention.

Breast Cancer Smoothies

One of the conundrums for cancer patients and doctors alike is the patient with advanced cancer who is losing weight. Significant weight loss is an ominous development nearly as worrisome as progressive anemia, leukopenia or thrombocytopenia, tumor growth, bleeding, and cachexia. Doctors frequently tell patients to try to "pack in" the calories, eat more desserts and fat, especially ice cream and milk shakes. Not only do these efforts go largely without benefit, especially if the patient is experiencing nausea, vomiting, and anorexia, but the patient will be prone to problems with food allergy, digestive intolerances, and leaky gut. Furthermore, the high-calorie sugar intake will undoubtedly fuel additional cancer cell growth, defeating any value to ingesting huge food quantities. One needs an alternative approach to augmenting nutrition during the cancer process.

Daniella Chace, MS, CN, is the author of 10 books on nutrition, most of which use nutritional smoothies to support anticancer and anti-inflammatory activity. Her current book, Breast Cancer Smoothies, offers 100 delicious, easy-to-prepare, research-based recipes for prevention and recovery. (4) Chace is a dedicated journal researcher; her smoothies use fruits, vegetables, and herbs that have evidence-based phytochemicals acknowledged to have activity preventing or reversing cancer. However, unlike some nutrition books in which the recipes are philosophically based on eating more fruits and vegetables and avoiding gluten, dairy, and sugar, Chace provides a succinct synopsis of the reasoning and literature reference for using the food directly with each recipe. That is a terrific learning process for patient and doctor --the option to direct one's diet on a specific aspect of the cancer process.

Daniella is enthusiastic about using smoothies as food, medicine, and a gourmet process. These recipes have distinct tastes and flavors, and she has engineered them to stimulate gustatory appreciation. Chace describes the smoothies in terms that would warm the heart of any sommelier: "lightly sweet and creamy," "aromatic deep blueberry flavors with a hint of spice," or "sorbet-like, thick and frosty with a bit of citrus." One should try out these smoothie recipes if for no other reason than to experience their taste sensations. Being a nutritionist, Daniella provides perfect proportions for each serving--most recipes are for two, but some are for four. The serving is generally 120 to 150 calories, and carbs, fat, and protein quantities are generally about 5 to 10 grams per serving. The specificity permits doctor and patient to have a very good idea of what sort of nutrition the patient will be getting, as well as what quantities should be imbibed. The smoothies are not meant to replace meals, although they could be used in that manner to "starve" the cancer. Daniella offers all the tips needed to prepare the smoothie recipes efficiently and with cost consciousness.

For those who already are smoothie drinkers, Chace's book offers the opportunity to experience another smoothie connoisseur's experience, wisdom, and passion.

More Insights on Vitamin C and Cancer

Ever since Ewan Cameron, MD, and Linus Pauling, PhD, reported their successful treatment of cancer patients using intravenous ascorbic acid, vitamin C has played a prominent role in the integrative approach to cancer. (5,6) Despite the fact that Moertel at the Mayo Clinic reported no benefit of ascorbic acid in his trials, Pauling repudiated Moertel's conclusions, finding that his data, did, in fact, demonstrate ascorbic acid's efficacy. (7,8) Twenty years ago Hugh Riordan, MD, outlined the first of many protocols for using intravenous ascorbic acid in cancer patients. (9) Recently Jeanne Drisko, MD, at the University of Kansas Medical School found that not only was intravenous ascorbic acid effective in supporting cancer, but it augmented the effect of concurrently administered chemotherapy. (10) Additionally Drisko's work has concluded that it is the prooxidant effect of high-dose intravenous ascorbic acid that confers the cancer-controlling effect, not the antioxidant effect of oral low-dose ascorbic acid. Still the routine use of ascorbic acid in the treatment and support of cancer remains controversial and thereby is not covered by insurance plans; hence the treatment is underutilized. Furthermore, numerous proprietary cancer treatment protocols call for the avoidance of concurrent use of intravenous ascorbic acid. In most circumstances vitamin C's contraindication has not been established by study, but is the opinion of the proprietary treatment's originator.

In 2014 Michael Gonzalez and Jorge Miranda-Massari, respectively professors at the University of Puerto Rico School of Public Health and School of Pharmacy, published New Insights on Vitamin C and Cancer. (11) Gonzalez and Miranda-Massari's brief book offers a well-referenced introduction to the use of ascorbic acid in treating cancer. Their work provides a solid discussion of the putative mechanisms of action for vitamin C. It also details the results of the studies and trials in humans, animals, and in vitro experiments of ascorbic acid used alone or in combination with another anticancer treatment. In general ascorbic acid potentiates the effect of the chemotherapy agent. However, one study revealed that ascorbic acid negated the benefit of bortezomib, a proteasome inhibitor anticancer drug, which is effective in multiple myeloma and mantle cell leukemia. (12) Given the fact that numerous cancer biologic modifier drugs, such as bortezomib, are now in use and others are being developed, it is important to study whether more of these drugs are inactivated by vitamin C. Moreover, Drisko has observed that when ascorbic acid is administered intravenously as an anticancer treatment, it should not be mixed with antioxidants such as glutathione or other vitamins, such as B complex.

Ralph Moss on Prostate Cancer

Readers of the Townsend Letter are familiar with Ralph Moss, who has penned his column, War on Cancer. Moss began his career working at the Memorial Sloan Kettering Cancer Institute in New York involved with conventional medical therapies. When Moss took an interest there in some innovative, "alternative" approaches (laetrile), the powers that be looked at him askance. After departing, Moss became seriously involved in studying and examining alternative cancer diagnostics and treatments. His review brought him in touch with physicians and clinics involved in unconventional therapies in the US and abroad. Moss also played careful attention to the physicians involved in using conventional therapies in unconventional ways. His expertise led to his appointment to the US Congress 1986-1989 study of unconventional cancer treatments. Moss eventually wrote a number of texts that reviewed these alternatives' pros and cons (I still refer to his 1992 Cancer Therapy: The Independent Consumer's Guide to Safe Non-Toxic Treatment and Prevention book). He is best known for his ongoing cancer information service, cancerdecisions.com, where he provides a comprehensive report for patients and doctors on the best treatment options based on the individual's cancer pathology.

In this issue Moss provides us with a prostate cancer update. Moss introduces us to Geo Espinosa, ND (cover photo), who has developed the CaPLESS method of active surveillance rather than watchful waiting for prostate cancer. The acronym refers to carcinoma of the prostate (approach) of lifestyle, exercise, stress/sleep, and supplements. Dr. Espinosa's method is explained in his new book, Thrive--Don't Only Survive. Espinosa is a member of the urology cancer team at New York University's Langone Medical Center. The CaPLESS approach provides an effective method to work with less aggressive prostate cancer and is supportive as an adjunct to moderately aggressive cancer.

Jacob Schor on the Pros of Omeprazole

Say what? An ND advocating the use of a drug, much less a PPI? How could that be? We are all aware of the heavy consumption of PPIs by a clueless public who are only interested in calming their heartburn. Not only that, but the side effects of these medications are more than just academic --not only is the risk for developing gastritis increased, but so too are the risks for developing pneumonia, diverticulitis, bone fracture, and kidney function abnormality. Even from a nutritional viewpoint, vitamin B12, calcium, and iron may become depleted. Why would anyone want to use a PPI?

Schor would counter: to increase their chances of surviving cancer! Say what? Yes, PPIs have anticancer activity, and a plethora of recent studies are confirming that property. The reason that PPIs exert an anticancer effect is not based on some obscure mechanism. PPIs, proton pump inhibitors, act by blocking the proton pump of H2+, lessening acidity. It turns out that the external microenvironment of most tumor cells is highly acidic. Tumor cell acid production decreases the effectiveness of immune cell functioning and, more importantly, chemotherapy agents. PPIs decrease localized interstitial acidity, increasing the effectiveness of chemotherapy. It would be one thing if this were purely hypothetical thinking; multiple studies reviewed by Schor in this issue demonstrate PPI anticancer activity.

As Schor editorializes, we have an obligation to tell our patients to take a drug that is usually disdained in naturopathic circles because its use will increase their survival.

Jonathan Collin, MD

Notes

(1.) Whalen J, Spegle B. China's role in U.S. opioid crisis. Wall Street Journal. June 23, 2016.

(2.) Philips D. Decades later, sickness among airmen after a hydrogen bomb accident. New York Times. June 19, 2016.

(3.) O'Connor A. Coffee may protect against cancer, W.H.O. concludes. New York Times. June 15, 2016.

(4.) Chace D. Breast Cancer Smoothies. Nook Press. 2016. E-book.

(5.) Cameron E, Pauling L. Supplemental ascorbate in the supportive treatment of cancer: Prolongation of survival times in terminal human cancer. Proc Natl Acad Sci. 1976;73(10): 3685-3689.

(6.) Cameron E, Pauling L. Supplemental ascorbate in the supportive treatment of cancer: Reevaluation of prolongation of survival times in terminal human cancer. Proc Natl Acad Sci. 1978;75(9):4538-4542.

(7.) Creagan ET, Moertel CG, et al. Failure of high-dose vitamin C (ascorbic acid) therapy to benefit patients with advanced cancer; a controlled trial. N Engl J Med. 1979;301(13):687-690.

(8.) Moertel CG, Fleming TR, et al. High dose vitamin C versus placebo in the treatment of patients with advanced cancer who have had no prior chemotherapy; a randomized double blind comparison. N Engl J Med. 1985;312(3):137-141.

(9.) Riordan N, Jackson J, Riordan HD. Intravenous vitamin C in a terminal cancer patient. J Orthomol Med. 1996;11:80-82.

(10.) Ma Y, Chapman J, Levine M, Polireddy K, Drisko J, Chen Q. High-dose parenteral ascorbate enhanced chemosensitivity of ovarian cancer and reduced toxicity of chemotherapy. Scien Trans Med. 2014;6(222):222ra18.

(11.) Gonzalez M, Miranda-Massari J. New Insights on Vitamin C and Cancer. Springer Briefs in Cancer Research. 2014. E-book.

(12.) Zou W et al. Vitamin C inactivates the proteasome inhibitor PS-341 in human cancer cells. Clin Cancer Res. 2006;12(1): 273-80.
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Title Annotation:distribution of drugs tainted with fentanyl; risk of cancer after exposure to plutonium; and role of coffee in cancer prevention
Author:Collin, Jonathan
Publication:Townsend Letter
Date:Aug 1, 2016
Words:2947
Previous Article:The 'structure-function' dysfunction.
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