Chapter 34: Advocating for Chemoprevention, Lifestyle Changes and Cancer Prevention
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Description
Dr. Levin begins by mentioning his support for the work of Dr. Michael Wargovich, PhD.on the chemo preventative effects of natural compounds related to garlic and derivative products. He explains that Dr. Waravick added a facet to the Department of Gastroenterology. He also notes that in animal models the sulfur compounds of the derivatives protect against colon cancer. He then talks about the Division of Cancer Prevention’s focus on lifestyle issues. The Division provided nutrition advice and assessment: he lists the people involved with studies of selenium and vitamin E derivatives. He touches on the importance of tobacco, another “ingested” compound, and the importance of physical activity. He notes the challenges to setting up studies of activity, as people needed to have cardiac monitors while exercising.
Dr. Levin then comments on diet, including his own ethically based choice to be a vegetarian. He states his belief that attempts to isolate chemo-protective elements of diet will be fruitless. He cites the study of carotene, which harmed patients, as an example of how misguided it can be to insert nutrients into a diet. He advocates a moderate diet that can even include moderate amounts of meat and processed food.
Identifier
LevinB_05_20130827_C34
Publication Date
8-27-2013
City
Houston, Texas
Interview Session
Topics Covered
The Interview Subject's Story - The AdministratorThe Researcher The Administrator Overview Definitions, Explanations, Translations Understanding Cancer, the History of Science, Cancer Research The History of Health Care, Patient Care Discovery and Success Healing, Hope, and the Promise of Research MD Anderson Snapshot Building/Transforming the Institution Multi-disciplinary Approaches Education Information for Patients and the Public Definitions, Explanations, Translations The Researcher Character, Values, Beliefs, Talents
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Tacey Ann Rosolowski, PhD:
Right. I wanted to ask you about a few other kind of institutional roles, but before I shift gears, is there anything else you wanted to say about the screening or the public campaigns or the research that you’ve done?
Bernard Levin, MD:
Well, I think we talked previously about chemoprevention, and I think that I explained that it had gone from the familial polyposis work done by Patrick Lynch and Gideon Steinbach and then to work that was done in a multi-institutional setting with Pfizer, which I was the co-principal investigator. I think we covered all that.
Tacey Ann Rosolowski, PhD:
Mm-hmm.
Bernard Levin, MD:
We didn’t talk about work that I wasn’t directly involved in, although supported, which was the work of one of the basic scientists whom I w recruited from the Ludwig Institute in Toronto whose name is Michael Wargovich, W-a-r-g-o-v-i-c-h, and Michael’s interest was something I supported, which lay in natural compounds such as substances from wine and green tea, fruits and vegetables, compounds in herbs and spices, vitamins and minerals, NSAIDS and dietary supplements for chemoprevention. Michael was then involved in a number of studies related to garlic and its derivative compounds, and to a very limited extent, I helped participate in his studies. He developed a productive relationship quite early on with the Wakunaga Company in Hiroshima, Japan, and Michael and I went there to strengthen these links aSubsequently, a scientist from Wakunaga spent time in Michael’s laboratory. So this was another facet of the department’s interest and more general interest in chemoprevention, which was related particularly to garlic but also to other natural compounds. Michael subsequently moved to University of South Carolina, and then to UT San Antonio.[
Tacey Ann Rosolowski, PhD:
And what were some of his findings?
Bernard Levin, MD:
Well, experimentally these compounds, which are sulphur derivatives, giving garlic the characteristic aroma and flavor, that are protective in animal models of colon cancer. They can inhibit the formation of some of the early changes that lead to cancer. So these kinds of natural compounds might have a role in why certain populations develop some cancers and don’t develop others, that there are naturally occurring in our diet compounds that are helpful.
Tacey Ann Rosolowski, PhD:
Mm-hmm. That kind of leads to—I mean, certainly nutrition is an important lifestyle issue that influences cancer prevention. What are some of your observations about lifestyle issues?
Bernard Levin, MD:
Well, they’re very important in the development of our cancer prevention program at MD Anderson. In the Cancer Prevention Center, we place great emphasis on there being availability of nutrition and nutritional advice and nutritional assessment, nutritional advice. There was a full-time nutritionist in the Center.
Tacey Ann Rosolowski, PhD:
Is that still the case?
Bernard Levin, MD:
I think so, yes.
Tacey Ann Rosolowski, PhD:
Mm-hmm. I was just asking because when I interviewed John Stroehlein in the Department of Gastroenterology, he said they actually had to let their nutrition program kind of go dormant.
Bernard Levin, MD:
Hmm. Well, for a while, they had the title—they changed the title to Gastroenterology, Hepatology, Nutrition. I always wondered what that component was. I didn’t know. But certainly in cancer prevention, the emphasis was on providing for the individual patient who came to Cancer Prevention Center. On a research basis, the idea that nutrition played a role was also strongly expressed in the work that Scott Lippman, who was chair of the Department of Clinical Cancer Prevention, was involved in, and he now is the director of the Cancer Center at UC San Diego. He was recruited from cancer prevention to Cancer Medicine at MD Anderson, where he became Chair of thoracic, head, and neck medical oncology for a number of years, maybe a decade. Anyway, he was very involved in studies of selenium as a cancer protective agent in the multi-center national study called SELECT [phonetic]. He was one of the lead investigators of the SELECT trial of prostate, and subsequently it was shown that selenium supplementation didn’t actually play any positive role. We also in that department also had an individual who was interested in vitamin E derivatives (Tocopherol), various forms of the Tocopherol family, and also there was some other studies on Tocopherol. I’m trying to think if there were any other good examples of nutrition. Well, of course, tobacco as an inhaled substance, although not customarily thought of as being in the diet, but very much something you ingest and swallow, there was a great deal of work in both the behavioral science and epidemiology on tobacco as an ingested substance. Now, also in terms of lifestyle, colleagues in the Department of Behavioral Science became very interested in research studies of physical activity,. We set up an exercise room in the Cancer Prevention Center with a treadmill, and individuals there did research on physical activity. One of the earliest studies was done on weight gain by women with had breast cancer who had undergone chemotherapy, trying to understand the factors involved in that. It was a bit of a challenge to set these studies up because there was need for cardiac monitoring of people using a treadmill, and there was a tremendous amount of discussion of how that could be done. Eventually it got sorted out, but at the time seemed to pose significant logistic issues.
Tacey Ann Rosolowski, PhD:
Hmm. Were there any significant results from those studies?
Bernard Levin, MD:
You know, they were still in progress when I left.
Tacey Ann Rosolowski, PhD:
Mm-hmm. Okay.
Bernard Levin, MD:
Relatively recent. I’m sure there were, but I don’t know them.
Tacey Ann Rosolowski, PhD:
Mm-hmm. I’ve been, you know, kind of like perusing of Health News and all of that. It’s been interesting that in the past six months or so there’ve been a number of studies that have come out that have shown that a lot of vitamin supplements don’t have as much of an effect as a whole diet that includes all of those same things but in their natural form, in food. And I know that you’ve had—I mean, I’m wondering about your observations about that. And I know from discussions and reading about profiles of you that you have chosen to be a vegetarian, so you’ve been aware of diet for a long time. So what’s your comment about, you know, overall diet and your own choice to be a vegetarian vis-à-vis cancer?
Bernard Levin, MD:
All right. Well, my choice to be a vegetarian wasn’t really related to cancer. It was more a moral, ethical, in quotation marks, viewpoint, I suppose related to a liking for mammals. The health benefits were secondary in my mind, but I’m glad, if there are any, to have them. I believe strongly that trying to isolate individual components of a diet is probably a fruitless exercise, and there’s no better example of that in the so-called CARET study, C-A-R-E-T. Individuals who ingested beta carotene, a precursor for one of the forms of vitamin A, actually, and who were smokers fared worse in terms of getting lung cancer than the controls. So not only was this form of vitamin A not protective, it was actually harmful. So that’s a good example of how you could be misguided about selecting a component of a complex foodstuff and thinking that you might know how to modulate that in the diet or insert that into the diet and produce a favorable outcome. So, I mean, it’s a longwinded answer to your question. I just don’t believe that’s a good idea, and I think all things in the diet are reasonable in moderation. I happen to think that the American diet is too high in red meat and processed meat, and I think the absence of any of those would be okay, too, but even having said that, I think eating modest amounts of those compounds probably is okay for most people from a health point of view.
Tacey Ann Rosolowski, PhD:
You mean I can still have a Twinkie?
Bernard Levin, MD:
Yeah, probably. (laughter) If you had three Twinkies a day every day for two years, it’s probably not a good idea.
Tacey Ann Rosolowski, PhD:
Probably not. (laughs)
Bernard Levin, MD:
But I think having an occasional Twinkie with an occasional steak, for some people that’s important. I think taking away their enjoyment of food isn’t necessarily a smart idea.
Tacey Ann Rosolowski, PhD:
Well, you know, you could practically hear the cries of joys when there were reports coming out that red wine was actually good for you in moderation.
Bernard Levin, MD:
Yes, I believe that to be true. I think there’s a lot of evidence for suggesting that resveratrol in red wine and other products is probably healthy, but, you know, it’s been hard to prove, and Ithere are a number of companies formed on the basis of resveratrol. As far as I know, they haven’t yet been able to prove the point, at least in a commercial sense.
Recommended Citation
Levin, Bernard MD and Rosolowski, Tacey A. PhD, "Chapter 34: Advocating for Chemoprevention, Lifestyle Changes and Cancer Prevention" (2013). Interview Chapters. 1370.
https://openworks.mdanderson.org/mchv_interviewchapters/1370
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