Good interview with top oncologist on cancer: myths and reality — “Cancer is a verb, not a noun — our bodies are always cancering”

SS: Okay, cool. So I have the statistic from the World Health Organisation, the latest one. And it says that actually [cancer] cases and the deaths are rising. And I’m thinking, we have so many new technologies, so much research has been done… Are we still losing the battle?

DA: No question about it. We’re losing the battle for two big reasons. One is we’re continuing to smoke. So tobacco is still the leading cause of cancer death worldwide. And we’re doing it. More women are smoking than ever. And while some rates are going down, in many parts of the world they’re going up. Second is all the new treatments that we have, which are really amazing — we could turn off on-switches in cancer, we can have your own immune system attack the cancer—  but that just delays things. It doesn’t cure. It buys time, and it’s quality time. So I’m optimistic that we can control it, but we’re not going to be able to cure it. And in the end, people will still die of this horrible disease. We have our ways to go.

SS: So you’re saying cancer is incurable?

DA: I’m saying cancer is not curable, it’s controllable. If I told you you had diabetes, you don’t jump off a bridge, you go, “I’ll manage it.” Cancer is going to be the same way. To me, cancer is a verb and not a noun. You’re cancering. It’s something the body does, not something the body gets. So my job as a cancer doctor is to change you from a cancer state to a health state. That’s radically different from the old way of targeting the cell and blowing it up. I want to change you.

SS: It is a very interesting verb, cancer. Why does your body start to behave like that?

DA: Well, that’s a million-dollar or a billion-dollar question. The answer is we don’t know. We know inflammation, for example. It’s a state that’s associated with cancer. If you have inflammation in a lung from smoking, if you have inflammation anywhere in the body, that raises significantly your risk of cancer. So one of the best preventive things we have is blocking inflammation. There is a pill that, if you take it every day, reduces not the incidence, but the death rate of cancer by 30 per cent. It’s called Baby Aspirin. So an aspirin a day reduces inflammation and dramatically lowers the death rate of cancer.

SS: Are there any side effects? If you take one aspirin a day, would it be bad for something else?

DA: Well, the only thing aspirin does is it can upset the stomach and it slightly prolongs bleeding time. So in most people, that’s not an issue, but it’s something to discuss with your doctor. But in general, it’s remarkably safe. In the United States, if everybody does take a Baby Aspirin or should be doing it, 900000 excess people are alive in 10 years and we save 600 billion dollars in health care costs. The problem is we don’t do prevention. If I told you, Sophie, do something today that’s going to help you 10 or 20 years from now, you’ll roll your eyes on me.

SS: I will do it. What should I do? Take aspirin every day?

DA: Well, take your aspirin. You should think about taking a statin, which is the Lipitor-like drugs. And there are a lot of behavioural things.

SS: I don’t smoke. But what about secondhand smoking? Because I still get a lot of people around me who smoke.

DA: No question about it. I mean, we’re in a city now, in Russia, where people still smoke. And like it or not, you’re gonna get secondhand smoke here. There’s air pollution here. And, you know, so we are all at risk for cancer. I mean, cancer is still the number one or number two killer, no matter what country in the world you’re in.

SS: There’s this notion I’ve heard, which I thought was really interesting, that cancer is sort of like a living creature that fights for survival. What do you think of that?

DA: It’s an amazing thing if you think about it. This creature is out there trying to take all your nutrients. And in the end, the paradox is, if it kills you, it dies. But we can learn a lot from evolution on cancer. And that’s where we have to start to think. There are creative new ways that actually try to take advantage of that. You know, we can block new blood supply. That’s a way we treat cancer now. So we’re not targeting the cancer. We’re actually changing that. In breast cancer, one of the greatest advances in treatment isn’t a drug that targets the cancer, it’s a drug that changes the bone. It was meant for osteoporosis because breast cancer goes to bone. And if you change the soil, the seed doesn’t grow. Changing the soil stops it from growing. So we give a drug for osteoporosis. We dramatically prolong breast cancer. It’s an amazing finding.

SS: Also, like, logically, if you think about it, from what I understand, cancer cells are those that don’t die, and eventually that’s why people die.

DA: Right.

SS: But then a healthy person —he or she dies because their cells die out eventually when they get old. So if you study cancer, could we maybe find a key to immortality?

DA: Damn straight. I mean, that’s what we’re looking for and we’re learning. This is old adage: in order to understand peace, you have to go to war. And going to war with cancer has taught me a tremendous amount about other diseases and the human body and longevity. And it’s powerful. You know, there’s an amazing finding where if I walked through the streets of Moscow now and drew blood on a hundred people I would find eight of them would have the changes of leukaemia in the blood, yet they don’t have leukaemia. Because in order for them to have leukaemia, they need the DNA changes, but they also need an environment that’s receptive. And one of the biggest areas of growth in medicine in the future is to be targeting the environment, changing you so that cancer doesn’t want to happen.

SS: So has cancer itself always been around, and we just didn’t know what it was, or is it something that has appeared over the past century, two or three ago? Does it come with pollution? What everyone’s saying right now, “It’s all because we’re so polluted and we’re eating all those GMO’s, and that’s why we’re getting cancer,” apart from smoking and other reasons.

DA: If you look at the Egyptian mummies, most of them died of cancer. So cancer has always been there.

SS: How do you know?

DA: These mummies actually were preserved and we can see the cancer in their bodies. So we see they had breast cancer. They had lung cancer. They had prostate cancer. We have cases that are three, four thousand years old.

We look in nature at other animals and animals that live in the wild, many of them are dying from cancer also. So cancer’s there. What’s interesting is that cancer was made to knock us off.

Through evolution, we had our children by age 30 or 35. And cancer actually knocks us off and gives more resources to the next generation. So cancer is part of us. It was meant to happen.

*** JdN – I have to sort of agree

And you and I have this crazy inflammatory system because we also died of infectious disease. Well, now we have antibiotics and antivirals and vaccines so we can tamper down that inflammation and live much longer and delay cancer significantly.

SS: So can you live with cancer, like you said in the beginning, in foreseeable future, like people live with diabetes now or with HIV? 20 years ago, if you had HIV, you thought you were going to die for sure. Now people live with this virus and they live normal lives. They’re active. They’re going to work. They have families. Can you do that with cancer, like live a long life?

DA: Four years ago, President Jimmy Carter in our country announced that he had melanoma, skin cancer that went to the brain.

(Talking about Trump voiding the 1980s Russian nuclear-arms deal)

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That’s a death sentence. He was put on a drug to block the “don’t-eat-me” signal on his cancer, allowing his own immune system to attack it. Now he’s still out preaching in church, educating children, building houses for the poor because his cancer is under control. And I think that’s an achievable goal.

You know, my life changed in the late 90s. I was a doctor at Sloan Kettering and I was with the head of the hospital, one of the great doctors, and I was his trainee. And into the room walked a twenty-five year old with germ cell tumor in the brain, the lung and the liver. And this kid, the doctor told him, “Hey, listen, you have months to live. I want you to spend your last couple of months with your mother, because you’re the son of a single mother and chemotherapy is only going to make you sick.”

This kid went and he did research (this was before Google) and he found out a doctor did an experiment where he put two platinum electrodes and put it in a gel and sent it to cancerous cells like electricity. But they didn’t care about electricity, but some of the platinum, the same thing in my wedding band, leeched off and killed some of the cells. So he said, “I want platinum.” So we gave him intravenous platinum. A year and a half later, he won his first of seven Tours de France. That was Lance Armstrong.

So, you know, Lance was given a death sentence and he’s alive today. Why? I’m not sure how platinum work, but it changed his body so the cancer didn’t want to grow. So yes, I think we can live long, healthy lives with cancer, not die from it right away.

SS: There are still so many ways I think that we still don’t know. Like you said about platinum. Who would have thought?

DA: It’s a complex system, you know. Anybody who tells you, “I can predict the weather and I know exactly what’s going to happen,” you know, they’re crazy. Well, the same is true in medicine. And so the great climate modellers look at the shape of the cloud, and from that, they can infer what’s going to happen. They don’t go up and measure 50 thousand variables. I think doctors are going to be more like climate modellers going forward than biologists. They’re going to look at these trends. You know, when you were a child, your mother would go like this and she would know if you were sick. She didn’t draw your blood and look at your lymphocytes and your cytokine levels and all of those. She just went like this. We have to get more ways like that. And I think in a sense, by looking at it as a system is how we’re gonna change things.

SS: You’ve mentioned President Carter and his immune system. I don’t know if it’s a myth or not, but I’ve been told by various doctors and patients that it is possible to cure and kill cancer itself. But the fact is that with many alternative ways of treatment, you have to put one’s immune system to almost zero in order to actually try that treatment on a person so that the person’s organism doesn’t resist whatever treatment they are getting. And then the cancer dies but the person’s immune system is so destroyed that that’s why they don’t survive and die. Is it true?

DA: No. You know, chemotherapy came about because in WWI they used nitrogen for the bombs, and the people who were actually handling those bombs, their white count went to zero. They said, “Oh, my gosh, let’s use those same chemicals to treat leukaemia.” And they did. And that was the first chemotherapy.

So the old generation of chemotherapy, the 1950s, 60s and 70s, basically hit the cancer and any rapidly dividing cell — the cancer cells and the immune cells. The newer forms of therapy are targeted. They hit an on-switch within the cancer and they don’t suppress the immune system. So we’re in a new era where we can actually power the immune system, like with Jimmy Carter, or we can target the on-switches, which are very tolerable and which buy many years of quality life.

SS: I wonder also what does it depend on when someone gets cancer or not? Well, obviously, the pollution, right? What about when you’re saying that plastic pollution really causes cancer or 5G [wireless] will cause cancer? Do you believe in that?

DA: There certainly are associations between certain things and cancer. So certain types of plastic, if you drink from them every day, they can disrupt your endocrine system and raise your risk of certain cancers. If you look at the biggest causes of cancers today, no, it’s not necessarily from our environment. You know, people said cell phones cause cancer. They cause brain cancer because you’ve talked on your phone while the incidence of brain cancer from 1970 till today hasn’t changed at all. So if cell phones were causing brain cancer, it should go up and they’re not. So if you look at the trends in cancer, the only real trend we see that’s different over the last two decades is colon cancer in young people is going up. That’s because there’s more obesity. And colon cancer is associated with obesity.

So in general, while environment is a contributor, unfortunately, cancer just happens. It’s part of us. So our job is to prevent it, which a lot of which we can do. And if it’s identified early, so it’s curative at that point. And that’s where we have to focus on in the medical community and for the average patient.

SS: Does cancer somehow depend on where you come from geographically? I mean, a race or ethnicity? I don’t know if it’s crazy to ask things like that, but I’ve read somewhere that, for instance, Ashkenazi women are prone to get 10 per cent more breast cancer than other nationalities and ethnicities.

DA: It’s interesting. There’s certainly a gene for breast cancer called BRCA. That’s very common for Ashkenazi Jewish women.

Benjamin Netanyahu, wife and sons. all Ashkenazim

And so that gives them a higher risk. In general though, most cancer is not genetic. In fact, Google bought the ancestry.com dataset and they tried to find the genes for longevity. What they found is only 6 per cent of longevity is genetic, 94 per cent is behaviour. It’s what you do.

So while there are some associations between genes and cancer, it’s rather rare. Most cancers just happen. And so we can do whatever we can to prevent. You could be active all day. You could be lean body mass, which works, do the preventive anti-inflammatory things. All of those work. But in general, you know, you’re not going to get it from what’s going on in your environment for most people.

SS: So when someone tells you, “You have breast cancer in your family or any cancer in your family, so, therefore, you must do regular checkups,” I shouldn’t listen to them?

DA: No, you should listen to them. So certainly, you know, first of all, behaviour travels in families. Your behaviour is similar to your mother’s and your grandmother’s ones. So many times those risk factors are behavioural.

And the other is, I mean, there certainly is some genetic component to it. Certain families have a gene where if you have a BRCA mutation like Angelina Jolie did, you almost have a 90 per cent chance of breast cancer in your lifetime. Breast cancer is one of those diseases that are very common in women. I mean, one in six women will get this cancer. So it is very common. So we have to practice prevention no matter who you are, no matter what your family history, getting a mammogram, doing a self-exam. They work. They identify early and make it much more curative.

SS: And once again going back to President Carter’s example, tailor-made medicine, is it something that is the future now? What do you think of that?

DA: I don’t think it’s the future. I think it’s the present. I think we’re there. So I think now any patient with cancer, we now can look at genes. There are now over a dozen molecularly targeted drugs on the market that can control lung cancer. So this is a pill a day that can put the cancer asleep. We can unblock the immune system, block that “don’t-eat-me” signal in kidney cancer, in skin cancer, in lung cancer… Dramatic results we’re seeing in patients that were deadly and now people live with the disease. So we’re in a new era. We’re not curing this disease, people are still dying, but there’s a lot more hope and optimism.

SS: What about all those vitamins? Is this a big myth? Because like 10 years ago, everyone was saying, “Oh, you’ve got to drink Omega; it’s going to support your body; it’s going to prevent cancer.” And then right now, people are saying it really doesn’t help, it doesn’t do anything. And we used to be, like, if our immune system is down, OK, let’s take this vitamin every morning and we’re going to get better. Is this true or it has nothing to do?

DA: No. It has nothing to do with it. First of all, you know, a vitamin is something the body can’t synthesize enough of. Period. That’s all it is. So taking a large amount of it, there’s no benefit. In fact, if a man takes vitamin E, he increases the risk of prostate cancer by 17 per cent. Women who take multivitamins have higher cancer rate than women that don’t. The problem is your body makes free radicals to get rid of bad damaged cells. If you take high-dose antioxidants and these vitamins, you actually block your natural processes and many times you enable cancer to happen. So there’s yet to be a positive study in the history of man- or womankind showing a benefit to a vitamin or supplement. It’s amazing. Multi-billion dollar business, yet no benefit. I’m going to save you some money.

SS: So there’s no benefit at all for taking — what am I taking? I’m taking vitamin D because there’s no sun in Russia. Should I stop that?

DA: Women who take vitamin D have an increased rate of bone fracture than women who don’t. You know the human body has a way so we don’t get too much vitamin D at once, it’s called tanning. The reason we tan is to block vitamin D. When you take so much vitamin D in a pill, you actually down-regulate the sensor and you screw up signalling. You don’t have rickets, which is clinical lack of vitamin D; we haven’t seen it for a long time in this country. And so there’s no question that supplemental vitamins and supplements have no benefit right now for the average individual.

SS: What about all these new technologies? For instance, the nanorobots? They blow my mind — this little thing that you let into your blood and that sort of cleans your organism of any virus — can that help with cancer?

DA: There’s a lot of potential for technology. Two years ago, October 1st, I’m sure you remember, was one exciting day of the year. You know, it’s when they announced “Molecule of the Year.” It’s kind of our Academy Awards. And that year, it was CRISPR. This is an enzyme that can change one letter of the three billion letters of the DNA code.

So we have the ability of editing things, to couple that with a nanorobot that can actually go places and change things. There’s crazy potential. You know, a scientist in China changed embryos and three children were born through this technology. And unfortunately, he didn’t do it right. He didn’t do it with ethics, and these children are going to have issues as they get older.

But now under the right science, the right governance and the right ethics, I think the potential is there to really have an enormous impact on human health. I could change your own immune cells to attack your cancer and they only attack your cancer.

SS: Does it have to happen once someone’s an embryo — changing the genes while…?

DA: These for the cancer? No. We can take your immune cells out now and do it. In fact, there’s an FDA-approved technology now. It’s approved in the United States. If there’s a child with leukaemia who has failed everything, they take their white cells out, they ship them to New Jersey, which is where the plant is, and they put in a gene that enables those white cells to target the child’s leukaemia. And 85 per cent of those children who literally have two to three weeks to live go into full-time remission. This is a remarkable nutricell therapy called CAR-T.

This therapy is curing kids of leukaemia that were literally dying. So it’s a new era and it’s a very exciting era. Still, it’s a lot easier to prevent a disease than it is to treat it. And so I still focus on the prevention. And by the way, we’re getting better at things. So the longer you delay or prevent, the better these technologies will treat everything from cancer to Alzheimer’s to heart disease.

SS: But just one more question about the gene-editing. For instance, if you detect cancer cell in an embryo and you take that out and you replace it with a healthy cell, does it mean that if that becomes a widespread practice, then we’re going to have just a healthy population with no cancer at all in the future?

DA: Well, you can either be born with a defective gene that can lead to cancer or it could just happen during your lifetime. Whether you’re exposed to sunlight which can cause cancer in the skin or smoking, or it just happens. So those cancers will still happen.

But we can get rid of the sickle-cell anaemia [which affects blacks], of Tay–Sachs disease [which affects Jews], of inborn DNA errors that can lead to cancer like that BRCA, the Angelina Jolie gene. Yes, we can eliminate them.

SS: You know, there is this new method when you starve your body basically, and then somehow that makes your cells get rid of all the toxins and unnecessary things and you become healthy and look young. Is this something that could also help, you know, battling, if that’s the right word, cancer? Maybe you can also attack the cancer cells that are right in your body or maybe prevent cancer?

DA: It’s certainly the dream to tell your body, “Let’s do a quick restart.” You know, your computer crashes, you restart it, it works fine. And so the dream is we can be able to do that. You know, autophagy was thought to be that. And there’s been some people talking about that. But that really hasn’t worked in that regard. And so, you know, cancer is within us. It’s part of us. It’s not without us. And so, unfortunately, I don’t know of any data that it could be used to actually fight disease today.

There’s a lot you can find on the Internet. But when it’s been proven in clinical trials, it didn’t work. That being said, you know, time-restricted eating has a benefit. So I’m a believer that you want long periods without eating. So you want to not snack in between dinner and breakfast, breakfast and lunch. In those periods don’t eat so insulin, cortisol, the stress hormones go all the way down. When your body doesn’t know what’s going to happen those hormones stay up and that’s stressful. So just having an apple in between lunch and dinner actually changes your metabolism for two to three days. You gain weight. You don’t think as well and you don’t exercise as well. So we were made to actually have periods without food in between meals. We have to go back to that.

SS: Well, there is this new tendency right now. Everyone’s doing it at least around here where you don’t eat for 16 hours. That’s like an interval that, for instance, you ate last time at 8:00 in the evening and then you don’t eat until like 12:00 or 2:00 in the afternoon. And people usually do that to lose weight. But a lot of doctors also have said that it’s such a good thing for preventing a lot of diseases — not eating for a long period of time.

DA: Right. I think that the data show is that whether that interval is 16 hours or 12 hours, there’s no real difference in the data. But you need to have meals the same time every day and nothing in between meals. I mean, that’s the simplest data and that’s what we were actually made for, right? We would make our kill in the wild, we would have it for dinner, and we have the leftover in the morning. We never had a kitchen cabinet till a hundred years ago. So the notion that food is plentiful is rather a modern invention. And when we eat all the time, basically our stress hormones stay up. So if you eat the same amount of calories, three meals a day versus whenever you want, 81 per cent more diabetes when you eat whenever you want, even though it’s the same amount of calories.

SS: So there is this tendency for people right now to become health freaks. From one extreme to another, we’re not paying attention at all to how we eat, when we eat, what we do with our body, like smoking and drinking a lot of alcohol, or we’re becoming complete freaks. And to be quite honest, I don’t know which one is better, because when you’re such a health freak, I feel like it’s such a stress on your brain that that actually may cause other diseases. What do you think?

DA: I agree with you. I think somewhere in the middle is that you want to pay attention to you. You want to collect your own data, but not in a crazy way. You know, going to your doctor once a year and having him or her check your blood pressure makes no sense. You want to check it multiple times during the day when you relax, when you’re upset after a phone call, and bring that data to your doctor. You want to pay attention to what you eat. You want to take a look at your body and look at the changes. You want to know your data, but not to an extreme. It won’t help. I mean, moderation is the key to almost everything in health. And every extreme has been shown not to work.

SS: Do you believe in psychosomatics? Because 50 per cent of the really great doctors that I’ve spoken to, they’re saying, “No, it’s complete B.S. There’s no such thing.” Others are saying, “You can actually cure diseases if you have this sort of healthy mindset, where you are going to overcome a disease, you’re going to be healthy and you’re gonna live.” Where are you at?

DA: It’s not where we are at, it’s where the data are at. The data show the latter is right. Optimism in a belief system actually has 30 per cent better results across the board in every clinical trial. So the data are there. If you’re optimistic and you have a belief system, you do better. I mean, that’s not what I think. That’s the data.

SS: Can you explain that scientifically as a doctor? How does what you think actually change your body molecules and cells in your body?

DA: Your body talks to itself all the time. You know, in one second you could feel good or you could feel nauseous. Your GI tract, your brain talk to each other. That connection we can’t explain and we can’t model. I don’t know how your brain works. I have no idea. But what I do know is that a belief system works. I see it when you’re optimistic, you do better. Period. And so we have to support each other to have that. And we’re going to do better as a society and as a whole. But no, I can’t explain that. I wish I could. It’s a complex emergent system. I can understand the brain.

SS: David, thank you so much for this insight. Thank you for your work and good luck with all your future endeavours. Have fun in Moscow.

DA: Oh, thank you. It’s a privilege to be here. And I’m so excited to be in the city.

SS: Pleasure talking to you. Thank you.