Too much of a good thing

Sometimes it is better to leave things alone if they are working well.

Trying to refine things does not always make it lot better.

A case in point is the Troponin blood test used for diagnosis of heart attacks.

The conventional troponin blood test used to work reasonably well. I suppose it is human nature to try and make existing things better.

The high sensitivity troponin tests were developed to diagnose more heart attacks.

Yes, it is a good thing to diagnose more heart attacks quicker.

But the problem is these new blood tests can also generate false positives. It’s like a super sensitive fire alarm which is triggered by impurities rather than by fire. It’s not only annoying, but affects people’s response to alarms.

The high sensitivity troponin test can sound the false alarm for heart attack in lot of hospital patients admitted for something else.

Just because a test is highly sensitive doesn’t make it super useful!

But it looks like the genie is out of the bottle and the high sensitivity troponin tests are here to stay ….

Share your thoughts at the BMJ website through the rapid response option.


1. High sensitivity troponin assays: too much of a good thing.

Toll-free link:

2. True 99th centile of high sensitivity cardiac troponin for hospital patients: prospective, observational cohort study.

BMJ 2019; 364 doi: (Published 13 March 2019)

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Taking up Exercise in middle age: is it worthwhile?

You could have been a ‘couch potato‘ all your life.

Is it worthwhile starting exercise now?

Yes, says the paper published in British Medical Journal.

The study involving nearly 15,000 people found that irrespective of your past, taking up physical activity in middle and old age is beneficial.

The study concludes “Middle aged and older adults, including those with cardiovascular disease and cancer, can gain substantial longevity benefits by becoming more physically active, irrespective of past physical activity levels and established risk factors.”

So get going !!!!!


Physical activity trajectories and mortality: population based cohort study. BMJ 2019; 365 doi: (Published 26 June 2019)

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Can some advanced cancer kidney cancer patients be safely watched closely (without going for chemotherapy treatment straightaway).

A Canadian team presented data on this topic at the American Society of Clinical Oncology meeting at Chicago.

The team says it can be safely done in select group of patients without compromising the survival.

Delayed treatment without putting patients through nasty side effects is certainly a welcome option for some patients.


1. ASCO 2019: Abstract number 4516.

Session: Genitourinary (Nonprostate) Cancer. Type: Poster Discussion Session

Time: Monday June 3, 4:30 PM to 6:00 PM

Location: Hall D2

Active surveillance in metastatic renal cell carcinoma (mRCC): Results from the Canadian Kidney Cancer information system (CKCis). 2019 ASCO Annual Meeting J Clin Oncol 37, 2019 (suppl; abstr 4516)

Robotic or Laparoscopic versus Open surgery for Cancer of Cervix

For early cervical cancer, surgical removal of the uterus is the primary treatment which provides a very good chance of cure.

Open Surgery can cause complications and so surgeons set about using the latest Robotic Surgery or Laparoscopic surgery to perform minimally invasive surgery.

Unfortunately, newer techniques led to more recurrences of cancer.

A Swedish study abstract published at the American Society of Clinical Oncology meeting at Chicago confirms the findings from a previous study which was widely reported in mass media including in New York Times


1. NEJM paper. Minimally Invasive versus Abdominal Radical Hysterectomy for Cervical Cancer.

2. NEJM paper. Survival after Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer

3. European Society of Gynaecological Oncology – statement

4. Sweden Study: Recurrence rates in cervical cancer patients treated with abdominal versus minimally invasive radical hysterectomy: A multi-institutional analysis of 700 cases.

5. British Gynaecological Cancer Society (BGCS) statement.

6. New York Times. Studies Warn Against Minimally Invasive Surgery for Cervical Cancer.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Can Vitamin D make cancer patients live longer ?

Taking high doses of multi-vitamins is usually not a good idea for someone having a well balanced diet and hence multivitamins are not medically advocated.

Vitamin D is often an exception. Lot of prostate and breast cancer patients are often advised to make sure they have adequate vitamin D ( sunlight exposure , but D rich diet or Vit D supplements) for preservation bone health.

An intriguing study presented at the American Society of Clinical Oncology annual meeting on June 3, 2019 suggests Vitamin D supplements can help cancer patients live longer.

Vitamin D was associated with significant reduction of cancer-related deaths in patients who have been diagnosed with cancer in the past.

On the other hand , in healthy people with no prior history of cancer, Vitamin D did not have any cancer prevention properties.


ASCO. 2019. Annual Meeting abstracts. Role of vitamin D supplementation for primary prevention of cancer: Meta-analysis of randomized controlled trials.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Darolutamide : a new prostate cancer drug

Darolutamide is a new drug developed to treat prostate cancer that has come back after failure of hormone injections .

Dr Fizazi from France presented the study at the American Society of Clinical Oncology meeting at Chicago.

The drug was found to be highly effective at controlling the cancer and had a significant impact on the ability of prostate cancer to spread.


Impact of darolutamide (DARO) on pain and quality of life (QoL) in patients (Pts) with nonmetastatic castrate-resistant prostate cancer (nmCRPC).

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Apalutamide : Another new drug for Advanced prostate cancer

Apalutamide, a new hormonal tablet, has been found to improve survival of patients with metastatic, castration-sensitive prostate cancer .

The study was presented at the ASCO (American Society of Clinical Oncology) meeting at Chicago .

It is wonderful to have so many treatment options to treat advanced prostate cancer.


Apalutamide for Metastatic, Castration-Sensitive Prostate Cancer

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Enzalutamide versus Docetaxel in advanced prostate cancers ( tablets vs injections )

Data presented just now at the American Society of Clinical Oncology meeting at Chicago shows that the Enzalutamide ( Xtandi) tablets improve survival in advanced prostate cancer patients.

So in addition to starting hormone injections to suppress production of testosterone hormones , additional treatment with Enzalutamide ( Xtandi) helps in controlling cancer much more longer.

What’s the downside: The tablets do have physical side effects such as fatigue and it needs to be taken continuously. Since it is a oral medication, in some countries patients do end up paying a lot ( co-pays).

Furthermore, the benefits of Enzalutamide ( Xtandi) is limited to patients who didn’t receive intravenous docetaxel chemotherapy.

Having six doses of chemotherapy over 18 weeks seems to provide the same benefits as 36+ months of Enzalutamide ( Xtandi) .

Other agents are also available in this setting.

So patients need a detailed discussion with their oncologists !!!


Enzalutamide with Standard First-Line Therapy in Metastatic Prostate Cancer.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Thank you for reading my blogs!

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Perceptions matter

People’s perception and expectations do affect their health care.

Palliative care physicians, at least in UK, are mainly based or linked to hospices.

In UK , hospices often provide terminal care to cancer patients. The hospice team provide a invaluable service in terms of minimising the patient’s suffering as the cancer takes its toll.

Palliative care physicians are an integral part of terminal care team. But they are often able to offer more than terminal care. Their significant expertise can be of immense help to patients in “early” part of cancer journey.

But the perception that a referral to palliative care team at hospice is bad news hinders some patients….

One option to overcome the stigma would be relocation of palliative care departments to cancer centres at hospitals so that the referral to palliative care team doesn’t have a negative connotation .

Please provide your thoughts at the BMJ site through rapid response link.


“Palliative care: relocation rather than rebranding is needed” published online by BMJ.

Access the article at:

Toll-free link:

Can dietary supplements make you live longer?

A recent study published in Annals in Internal Medicine looked at the effects of dietary supplements on overall mortality risk.

“Use of dietary supplements was NOT associated with mortality benefits among U.S. adults.”

In fact, there was a suggestion of increased risk of cancer deaths from calcium supplements.

Reference: Association Among Dietary Supplement Use, Nutrient Intake, and Mortality Among U.S. Adults: A Cohort Study. Ann Intern Med. [Epub ahead of print 9 April 2019] doi: 10.7326/M18-2478.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

What’s in a name?

awareness cancer design pink Photo by Miguel on

The word cancer is a dreaded one. Not without a good reason. Cancer is the number one killer. Even when someone has a good outcome, the cancer journey is torture. Emotional turmoil is immeasurably horrendous.

But many people would be surprised to hear that there exists a category of low risk cancers. “Low-risk Cancers are cancers which usually don’t kill; These Cancers are found either incidentally on scans performed for some other reasons or found as part of routine cancer screening.”

Because they are not deadly, Should the patients diagnosed with low-risk cancers be spared the dreaded label of cancer?

Should low-risk cancers be labelled something else and the word cancer used only for the “serious” high-risk cancers ?

Personally, I do not agree with renaming of the low risk cancers..Others disagree

Joint the debate at the BMJ.

Submit your views through rapid response

Should we rename low risk cancers? BMJ

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Is it a bad idea to use alternative therapy instead of conventional treatment for Cancer?

bamboo bamboo whisk board bowls

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Generally speaking Yes, it is a very bad idea.

Patients using alternative therapy exclusively  such as mistletoe therapy, vitamin therapy quite often come to harm.

For example, a well known Chinese actress shunned conventional chemotherapy for her lymphoma. Instead, Ms Xu Ting – a previously fit and well 26 year old – opted for traditional Chinese medicine methods for her lymphoma.

She underwent alternative therapies such as cupping, acupuncture, back stretching and a method called gua sha. Unfortunately traditional treatments didn’t help and she died from a potentially curable cancer. (1-3).

The misconceptions are certainly NOT confined to East. One of the prominent examples in the West is the fate of Dutch actress Sylvia Millecam.

She refused conventional treatment for her Breast Cancer and instead tried a wide range of so called alternative treatments – such as faith healing, salt therapy and magnetic field therapy. She unfortunately died of a potentially curable cancer. (4-6).

In addition to these well known anecdotal evidence, Studies have shown that alternative therapies can affect survival. Utilization of alternative therapies for curable cancer without any conventional therapy was associated with greater risk of death. (7-11).

However convincing the material you read on social media and wider internet, do NOT abandon conventional tretments. Always ask professional opinion about various things you have read and if not satisfied, ask second or third opinion.


How else cancer patients use complementary/ alternative therapy?

Although scientifically not universally validated, complementary medicine may help some cancer patients to cope better with their symptoms. Many patients do use acupuncture, hypnotherapy, massage, aromotherapy and group art therapy to deal with physical and psychological symptoms and side effetcs from conventional treatments.

two yellow sunflowers with clear glass bottle with cork lid

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Chinese actress




Dutch actress




Survival Risk

7. Cancer patients who use alternative medicine more than twice as likely to die.The Independent, August 15 2017

8. Cancer patients who rely on herbs, homeopathy or energy crystals over conventional treatment are two-and-a-half times more likely to die within five years of diagnosis.Mail Online, August 15 2017

9. Cancer patients who shun chemo for alternative therapies ‘are TWICE as likely to die’.The Sun, August 15 2017

10. Johnson SB, Park HS, Gross CP, Yu JB. Use of Alternative Medicine for Cancer and Its Impact on Survival.Journal of the National Cancer Institute. Published online August 10 2017



Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Surprising Number of Americans Believe Alternative Therapies Can Cure Cancer

woman holding white laptop between women

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A recent National Cancer Opinion Survey found that a significant Number of Americans Believe Alternative Therapies Can Cure Cancer.

Nearly four in 10 Americans (39%) believe cancer can be cured solely through alternative therapies such as enzyme and oxygen therapy, diet, vitamins, and minerals.

Even many of the respondents with direct cancer experience—people who have or had cancer and family caregivers—believe cancer can be cured solely through alternative medicine.(22% and 38%, respectively).

The American survey also found that younger people are the group most likely to hold these views: 47% of people ages 18 to 37 and 44% of people ages 38 to 53.

It is counterintuitive that the generation with access to vast online information at the swipe of a finger holds such unscientific views. One wonders whether the social media is inadvertently promoting misinformation.


1.American Society of Clinical Oncology : Second National Cancer Opinion Survey.


Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Can Turmeric control cancer ?

Turmeric powder


Turmeric is an orange coloured spice widely used in Indian dishes.

Turmeric has been used in Indian traditional medicine (Siddha and Ayurveda).

Turmeric has anti-inflammatory and anti-Cancer properties when tested in laboratories.

Remember – a potential to be beneficial (based on lab studies) is not the same as being proven to work in humans. Lot of substances which are promising in the laboratory eventually turn out to be useless in humans.

If you search PUBMED database- which is an online database of scientific papers- you will find hundreds of papers pertaining to medicinal use of turmeric and its key ingredients such as curcumin. But unfortunately among the many hundreds of published papers, there are very few human trials which have explored turmeric as a anti-cancer treatment.

Inspite of the positive anectodal reports on various internet sites, the available scientific evidence for use of turmeric as an anti-cancer treatment is very spare. ( references below).

Hence it is not worthwhile using turmeric as a cancer treatment.

If you do like Indian dishes, use turmeric as a spice in your normal diet.

But do stay away from the supplements which are sold with health claims.


ginger and turmeric powder

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The EssentialMedicinal Chemistry of Curcumin.Nelson KM, Dahlin JL, Bisson J, Graham J, Pauli GF, Walters MA. J Med Chem. 2017 Mar 9;60(5):1620-1637.

Phase I clinical trial of oralcurcumin: biomarkers of systemic activity and compliance.Sharma RA, Euden SA, Platton SL, Cooke DN, Shafayat A, Hewitt HR, Marczylo TH, Morgan B, Hemingway D, Plummer SM, Pirmohamed M, Gescher AJ, Steward WP. Clin Cancer Res. 2004 Oct 15;10(20):6847-54.

A Placebo-Controlled Double-Blinded Randomized Pilot Study of Combination Phytotherapy in Biochemically Recurrent Prostate Cancer.van Die MD, Williams SG, Emery J, Bone KM, Taylor JM, Lusk E, Pirotta MV. Prostate. 2017 May;77(7):765-775.

Efficacy and Safety of Curcumin in Treatment of Intestinal Adenomas in Patients With Familial Adenomatous Polyposis.Cruz-Correa M, Hylind LM, Marrero JH, Zahurak ML, Murray-Stewart T, Casero RA Jr, Montgomery EA, Iacobuzio-Donahue C, Brosens LA, Offerhaus GJ, Umar A, Rodriguez LM, Giardiello FM. Gastroenterology. 2018 Sep;155(3):668-673.

Effect on prostatic specific antigen by a short time treatment with a Curcuma extract: A real life experience and implications for prostate biopsy.Fabiani A, Morosetti C, Filosa A, Principi E, Lepri L, Maurelli V, Fioretti F, Servi L. Arch Ital Urol Androl. 2018 Jun 30;90(2):107-111.

Pharmacodynamic and pharmacokinetic study of oral Curcuma extract in patients with colorectal cancer.Sharma RA, McLelland HR, Hill KA, Ireson CR, Euden SA, Manson MM, Pirmohamed M, Marnett LJ, Gescher AJ, Steward WP. Clin Cancer Res. 2001 Jul;7(7):1894.

Consumption of the putative chemopreventive agent curcumin by cancer patients: assessment of curcumin levels in the colorectum and their pharmacodynamic consequences.Garcea G, Berry DP, Jones DJ, Singh R, Dennison AR, Farmer PB, Sharma RA, Steward WP, Gescher AJ. Cancer Epidemiol Biomarkers Prev. 2005 Jan;14(1):120-5.

A double-blind, placebo-controlled randomised trial evaluating the effect of a polyphenol-rich whole food supplement on PSA progression in men with prostate cancer–the U.K. NCRN Pomi-T study.Thomas R, Williams M, Sharma H, Chaudry A, Bellamy P. Prostate Cancer Prostatic Dis. 2014 Jun;17(2):180-6

Consumption of the putative chemopreventive agent curcumin by cancer patients: assessment of curcumin levels in the colorectum and their pharmacodynamic consequences.Garcea G, Berry DP, Jones DJ, Singh R, Dennison AR, Farmer PB, Sharma RA, Steward WP, Gescher AJ. Cancer Epidemiol Biomarkers Prev. 2005 Jan;14(1):120-5.

A phase I/II study of gemcitabine-based chemotherapy plus curcumin for patients with gemcitabine-resistant pancreatic cancer.Kanai M, Yoshimura K, Asada M, Imaizumi A, Suzuki C, Matsumoto S, Nishimura T, Mori Y, Masui T, Kawaguchi Y, Yanagihara K, Yazumi S, Chiba T, Guha S, Aggarwal BB. Cancer Chemother Pharmacol. 2011 Jul;68(1):157.

Phytosome complex of curcumin as complementary therapy of advanced pancreatic cancer improves safety and efficacy of gemcitabine: Results of a prospective phase II trial.Pastorelli D, Fabricio ASC, Giovanis P, D’Ippolito S, Fiduccia P, Soldà C, Buda A, Sperti C, Bardini R, Da Dalt G, Rainato G, Gion M, Ursini F. Pharmacol Res. 2018 Jun;132:72-79.

Monoclonal gammopathy of undetermined significance, smoldering multiple myeloma, and curcumin: a randomized, double-blind placebo-controlled cross-over 4g study and an open-label 8g extension study.Golombick T, Diamond TH, Manoharan A, Ramakrishna R. Am J Hematol. 2012 May;87(5):455-60.


Image credit: Simon A. Eugster. Turmeric (Curcuma longa):fresh rhizome and powder.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Does Cranberry juice relieve bladder symptoms due to radiation cystitis?

bowl of red round fruits

Many people do look for natural remedies to help with their symptoms.

Anectodally, many patients undergoing radiotherapy have reported that Cranberry Juice has eased their radiation cystitis symptoms.

What is the scientific evidence behind it ?

Should all patients having cystitis symptoms during radiotherapy take cranberry juice?

There is certainly scientific basis to expect benefit from Cranberry Juice.(1).

A lab study and a volunteer study (with volunteers from Japan, Hungary, Spain and France) has shown that certain chemicals in Cranberry can make bacteria ‘less sticky‘ to urinary tract walls and hence potentially reduces virulence of the bacteria.(1). But subsequent large studies have NOT confirmed any large benefit from Cranberry in terms of treating or preventing urinary tract infections. (2)(3).

But Radiation Cystitis is not due to bacterial infections although infections can co-exist sometimes. Hence the use of Cranberry has been studied separately in patients undergoing radiation therapy.

A New Zealand study involved 41 men undergoing radiotherapy for prostate cancer. Taking Cranberry (one capsule a day at breakfast) was found to reduce symptoms of pain and burning. (4).

On the other hand, in a study from Canada involving 112 patients , consumption of Cranberry juice compared with apple juice had no effect on radiation cystitis symptoms. (5).

Another study from United Kingdom was inconclusive because of poor patient recruitment and poor compliance. (6).

So the scientific evidence is inconclusive at present.(7).

Practically, if someone is keen to try it – the best course of action – ( for someone not intolerant of cranberry juice) – is to try it and see whether it offers any symptomatic benefit .

Disclaimer: Please note- This is NOT medical advice. This blog is purely for information only. See your own doctor to discuss options.

There are prescription medications available to help with radiation cystitis symptoms.


1.Dosage effect on uropathogenic Escherichia coli anti-adhesion activity in urine following consumption of cranberry powder standardized for proanthocyanidin content: a multicentric randomized double blind study. BMC Infect Dis. 2010 Apr 14;10:94.

2. BBC News. Does Cranberry juice stop cystitis. By Claudia Hammond. (Accessed 1st Jan 2019).

3. BBC News. Ditch cranberry juice for urine infection . (Accessed 1st Jan 2019).

4.Standardized cranberry capsules for radiation cystitis in prostate cancer patients in New Zealand: a randomized double blinded, placebo controlled pilot study. Support Care Cancer (2015) 23: 95.

5. A Randomised Trial of Cranberry Versus Apple Juice in the Management of Urinary Symptoms During External Beam Radiation Therapy for Prostate Cancer. G.Campbell et al. Clin Oncol (R Coll Radiol). 2003 Sep;15(6):322-8.

6. A Randomised Double-blind Placebo-controlled Trial to Determine the Effect of Cranberry Juice on Decreasing the Incidence of Urinary Symptoms and Urinary Tract Infections in Patients Undergoing Radiotherapy for Cancer of the Bladder or Cervix. Cowan CC, et al. Clin Oncol (R Coll Radiol). 2012.

7.Chemical- and radiation-induced haemorrhagic cystitis: current treatments and challenges. BJU Int. 2013 Nov;112(7):885-97.

Image credit: Photo by Jessica Lewis on

Low carbohydrate diet

The advocates of low-carb diet received a scientific boost recently.

An American trial, published recently in the British Medical Journal, compared the effects of low-carb-high-fat diet with high-carb-low-fat while keeping total calories and protein intake constant.

This elegantly done trial shows that carbohydrates are bad for weight loss. A diet with a combination of low-carb-high-fat content was the winner in this trial and it promoted energy loss and helped maintain weight loss.


Effects of a low carbohydrate diet on energy expenditure during weight loss maintenance: randomized trial.

Are Vitamin and Food supplements safe and helpful?


medical tablets pharmacy cure

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A British man recently ended up needing a liver transplant after taking green tea capsules. (1).(2).

Many people do not realise that supplements can be useless or even harmful. 

Firstly, Dietary supplements may not always be helpful. Even though the Public Health team in England recommend vItamin D supplements, a large study published recently  – found that Vitamin D supplements do NOT prevent fractures or falls in General population. (3) (4).

Secondly, Dietary supplements can be harmful. For example , a cancer prevention trial involving 35,533 North-American men reported that  “Dietary supplementation with vitamin E significantly increased the risk of prostate cancer among healthy men”. (JAMA 2011; 306: 1549).  Another cancer prevention trial in Finland involving 29,133 male smokers unexpectedly found a “higher incidence of lung cancer among the men who received beta carotene dietary supplements”. (NEJM 1994;330:1029 )

On the other hand, Vitamin are essential nutrients. Vitamin deficiency can be severely harmful to health. Vitamin D deficiency is common in colder parts of northern hemisphere. Vitamin D supplements are used in treatment and prevention of osteoporosis (5). Vitamin B12 deficiency is common in Vegans and Vitamin B12 supplements are used. (6).

So there is no clear cut answer ….

Always consider the possibility that “dietary supplements may actually have harmful as well as possible beneficial effects”. 

yellow health medicine wellness

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  1. BBC News – Are supplements safe and do they work?
  1. Daily mail: Green tea supplements may cause liver damage, warns EU watchdog.
  1. Public Health England recommends vitamin D supplements in autumn and winter.  BMJ 354 doi:10.1136/bmj.i4061
  1. Guardian : Vitamin D supplements don’t help bone health, major study concludes.
  1. Vitamin B12 and Health:
  1. National Osteoporosis Guideline Group:

Gout: Should you blame your diet or should you blame your parents and ancestors?


Gout is caused by excess Uric acid in blood. It is known for a long time that certain diets increase Uric acid levels in blood.

For Centuries, the common perception is that Gout is mainly caused by poor diet. But this myth has been busted by a recent study published in British Medical Journal.

The study found that

“Seven foods were associated with RAISED serum urate levels (beer, liquor, wine, potato, poultry, soft drinks, and meat (beef, pork, or lamb) &

Eight foods were associated with REDUCED serum urate levels (eggs, peanuts, cold cereal, skim milk, cheese, brown bread, margarine, and non-citrus fruits)”.

But poor diet was NOT found to be the MOST important cause of raised Uric acid levels in this study.

The “Genes” handed down by parents and other ancestors were found to be responsible for raised Uric acid levels and Gout in a significant number of people.

So it’s not you but your parents at fault if you are unlucky to have Gout !!


Major Tanya J, Topless Ruth K, DalbethNicola, Merriman Tony R. Evaluation of the diet wide contribution to serum urate levels: meta-analysis of population based cohorts BMJ 2018; 363 :k3951

Can Vitamin D control prostate cancer?

Vitamin D is also known as the “sunshine vitamin” because it’s produced in your skin in response to sunlight. Vitamin D is critical for bone health and general health.


Low levels of vitamin D in blood have been linked to cancer and other diseases.

But taking Vitamin D supplements to control an existing prostate cancer is controversial.

vitamin D

In  the lab, Vitamin D can stop prostate cancer cells growing and spreading.

One human trial suggested better outcome when high strength vitamin D is combined with standard chemotherapy.  But a second trial involving prostate cancer patients showed an unexpected and unexplained increase in death rate in patients taking Vitamin D with chemotherapy.

So the answer is “no” – Vitamin D cannot be used to control prostate cancer.

Related Links:

1. Sung V. 1,25-Dihydroxyvitamin D3 decreases human prostate cancer cell adhesion and migration. Mol Cell Endocrinol. 2000;164:133–143.

2. Moffatt KA. Growth inhibitory effects of 1α, 25-dihydroxyvitamin D3 are mediated by increased levels of p21 in the prostatic carcinoma cell line ALVA-31. Cancer Res. 2001;61:7122–7129.

3. Double-blinded randomized study of high-dose calcitriol plus docetaxel compared with placebo plus docetaxel in androgen-independent prostate cancer: a report from the ASCENT Investigators. J Clin Oncol. 2007 Feb 20;25(6):669-74.

4. Another Clinical Trial Failure – Ascent-2

5. Randomized, open-label phase III trial of docetaxel plus high-dose calcitriol versus docetaxel plus prednisone for patients with castration-resistant prostate cancer. J Clin Oncol. 2011 Jun 1;29(16):2191-8.




Can Pomegranate fruit control prostate cancer?


Some lab studies have indicated that pomegranate fruit is active against prostate cancer. Unfortunately, three separate patient studies have shown only minor activity  in the form of “slowing down of PSA rise”

So “Eat fresh fruit or Drink fresh juice” if you relish it like any other fruit or juice. If there is any effect on prostate cancer, it would be unexpected bonus. But don’t compel yourself to eat or drink it for therapeutic benefit !

Bear in mind that the pomegranate juice or fruit can interfere with some other medications. And I will also state the obvious that “pomegranate is not an approved cancer treatment”.

Links for further reading:

1. Daily Mail. Pomegranate juice ‘can help fight prostate cancer’.

2. Guardian: Consider the pomegranate.

3.Phase II study of pomegranate juice for men with rising prostate-specific antigen following surgery or radiation for prostate cancer. Clin Cancer Res. Jul 1 2006;12(13):4018-4026.

4. A randomized phase II study of pomegranate extract for men with rising PSA following initial therapy for localized prostate cancer.Prostate Cancer Prostatic Dis. 2013 Mar;16(1):50-5.

5. A double-blind, placebo-controlled randomised trial evaluating the effect of a polyphenol-rich whole food supplement on PSA progression in men with prostate cancer—the U.K. NCRN Pomi-T study. Prostate Cancer Prostatic Dis. 2014 Jun;17(2):180-6.

6. Is pomegranate juice a potential perpetrator of clinical drug-drug interactions? Review of the in vitro, preclinical and clinical evidence. Eur J Drug Metab Pharmacokinet. 2013 Dec;38(4):223-9. doi: 10.1007/s13318-013-0137-x.



What causes prostate cancer?

The short answer is “bad luck“.


The fact is that we do not know the exact cause of prostate cancer in most patients .

So, at present, we have to say it’s “bad luck” if one develops prostate cancer.

Many things have be shown to be associated with increased risk of prostate cancer.

father son

Sometimes prostate cancer runs in the family and abnormal genes are passed from one generation to other. So it’s “bad luck” if you have inherited the abnormal genes. One cannot change their genes.

Western men are at increased risk compared to the Asians.  Afro-Caribbean men are at much higher risk of developing prostate cancer compared to Caucasians.


Many other factors such as bad diet, obesity, unhealthy life style, smoking, hormones, & inflammation have been suggested as possible risk actors but none of the them have been conclusively proven as the cause of prostate cancer.





How to communicate that the disease is mild even though symptoms are disabling?

women s white long sleeved top

Beth McHugh makes a strong argument for doctors “not to explicitly discuss disease severity scale”.


(1) A valid informed consent would then become difficult

(2) Not discussing severity, is not a practical option for patients with certain illness.

My BMJ eLetter on this topic…

Risk categorisation will continue to be the norm in future as genomic data leads to personalised medicine.

England’s 100 000 Genomes Project

Can milk cause cancer?

blur calcium close up dairy

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A vegan group’s recent advertisement claimed that “cow’s milk contains 35 hormones, including oestrogen … some of these are linked to cancer”.

Advertising Standards Authority (ASA) in U.K banned the vegan group’s advert  as it found the groups claims misleading.

Does the evidence stack up?

First of all, I have to emphasize that “Human Mothers milk” is the best nutrition a new born baby can have…even though it might have various natural hormones.

But “mass produced diary milk” is a different matter.

A large observational study from ” Central Sweden”  found that “High milk intake was associated with higher risk of death and higher fracture incidence in women”. The paper was published in the prestigious BMJ journal in 2014. I suspect the substances used in mass production of diary milk might be the culprit rather than natural milk itself.

So the jury is out on this question. In the mean time, moderation is the key as Cows’ milk does contain many beneficial substances.  Switching to sugary, fizzy drinks or other artifically produed milk alternatives is not sensible either.

Related Links

Milk intake and risk of mortality and fractures in women and men: cohort studies

BMJ Letter: S Sundar. Milk and mortality: the potential effects of modern milk production

Telegraph: Vegan group’s advert wrongly linking cow’s milk to cancer is banned.

Independent: Vegan group’s advert wrongly linking cow’s milk to cancer gets UK ban

Living with cancer…


A cancer diagnosis turns your life upside down. But “Living with cancer” should not bring your professional life to a cliff edge.

Continuing to offer your professional knowledge and expertise not only helps you financially but also boosts your self esteem. But working full time is not an option nor feasible for many cancer patients.

Asteriid,a unique charity, launched by David Shutts, aims to help millions of people living with cancer.

Read the inspiring story of David Shutts at BBC website.

How do you get work when your cancer won’t go away?“.

BBC TV news also featured the pioneering Charity Astriid on its Morning bulletin on 11th May 2018.

To know more about Astriid, please visit: 

Can alcohol cause cancer?


Can alcohol cause cancer?

Yes,  worldwide, 1 in 20 cancers are attributed to alcohol .

How much drinking causes cancer?

“Even modest use of alcohol may increase cancer risk, but the greatest risks are observed with heavy, long-term use”

“The more that a person drinks, and the longer the period of time, the greater their risk of development of cancer, especially head and neck cancers”

Are light drinkers at risk ?

Risk of cancer is present at  even at low levels of consumption.  Hence, the World Cancer Research Fund/AICR makes the following recommendation: “If alcoholic drinks are consumed, limit consumption to two drinks a day for men and one drink a day for women.” They also recommend that, “for cancer prevention, it’s best not to drink alcohol.”

Is wine less risky than spirits?

No,  the risk is present “regardless of the specific type of alcoholic beverage (ie, beer, wine, or spirits/liquor)”

Which cancers can arise due to alcohol?

Alcohol is causally associated with Mouth, Throat, Gullet, Liver, Breast and Bowel cancers.


  1. Alcohol and Cancer: A Statement of the American Society of Clinical Oncology.
  2. Alcohol is a direct cause of seven ​​forms of cancer, finds study .



New test for Prostate cancer

Research team from Dundee University are developing  a new scan for diagnosis of prostate cancer.  The technique is non-invasive. This novel scan uses an ultrasound process called shear wave elastography (SWE) to detect prostate tumours.

The team’s leader, Professor Ghulam Nabi claims “Our new method is far more accurate and also allows us to identify the difference between cancerous and benign tissue in the prostate without the need for invasive surgery.”

This exciting project was funded by Prostate Cancer UK with support from the Movember Foundation.

The raw data from the paper abstract does call for caution. The test was done in patients who are already known to have prostate cancer. The test was not use to diagnose the cancer. It was a single centre study which usually calls for caution. How well the scan would perform in ” real world” patients who are yet to be diagnosed with prostate cancer remains to be seen.

Early results from about 200 patients are very promising indeed. The test has enormous potential if it is proven to work in a large scale, multi-centre trial.


  1. The Guardian:
  2. Daily Mail:
  3. BBC:
  4. Pubmed:


Image credit: Anon


stetchscope pen laptop


This blog will be a commentary on health related news with particular focus on clinical studies involving the cancers I treat. (my profile: ).

Disclaimers first:

  1. This blog cannot provide personal medical advice. Medicine is incredibly complex and nothing is absolute, and everything depends on individual circumstances. So always consult your own oncologist.
  2. Remember modern medicine is ever changing and the “only thing that is permanent is change itself”. That’s why new evidence sometimes completely contradicts conventional wisdom and practice.  Don’t be surprised if scientific studies contradict each other.
  3. To avoid anyone inadvertently disclosing personal or confidential information, comments will be disabled.
  4. The views expressed here are strictly personal and the views do not in any way whatsoever reflect the views or policies of the many professional organisations I am associated with.