No imputation was implied - I was critically appraising the claims - as I always do here - being made, not those posting the claims, and certainly not anyone just reporting what others are claiming, such as Calico and yourself, Dr. Markham or anyone else. My apologies if any implication of my recent postings in this connection appeared accusatory; that was certainly not my intent.
My point re berry consumption was to counter any false concern raised by a warrantless, evidence-free statement made by the radiation oncologist Calico happen to cite in passing. And my point re omega-3 supplementation was to demonstrate that the widely-reported and repeated claim that the cited studied demonstrates that such supplementation adversely interacts with platinum-based chemotherapy is:
- fallacious, founded on limited and questionable preclinical data, and against the aggregated human clinical evidence to date;
- is further contradicted by epidemiological evidence;
- that the study promoting the claim is significantly methodologically compromised to such degree as to be insufficiently powered to draw that, or any, conclusion re platinum agent to omega-3 supplementation adverse pharmacokinetics;
- that from a methodologically compromised study inconsistent with both human clinical and observational data, no conclusion of any clinical relevance can be derived.
From these collectively, therefore, we have no reason to doubt the pharmacokinetic safety of omega-3 and chemotherapy co-consumption, and no valid safety signal has been raised to advise any special caution, let alone contraindication.
The Deeper Problem: Bias in Pharmacokinetic Reporting of Drug-Drug Interactions
I note that ondansetron (Zofran) a widely used agent for controlling chemotherapy-induced nausea and vomiting (CINV), cimetidine (Tagamet) a common antiacid, and phenytoin (Dilantin) a common anti-seizure agent, have all been documented to interfere with platinum agents used in oncology, and these plus diuretics like hydrochlorothiazide, anticonvulsants / neuroleptics for seizure disorders, ACE inhibitors and antihypertensives, benzodiazepines for anxiety and sleep disorders, antidepressants, anticoagulants like warfarin, among dozens of other categories of traditional drugs all have known potential for adverse drug-drug interactions (DDIs) when concurrent with a wide variety of oncology agents. And it is not only that traditional DDI's (drug-drug interactions across conventional medicines) can compromise the efficacy of oncology drugs, but they can even lead to significant numbers of deaths: a large retrospective study analyzed all deaths that occurred in a Norwegian hospital during 2 years in order to evaluate how often deaths resulted from adverse drug reactions. They found that about 29 of the cancer-related deaths were likely to involve a severe DDI .
With fully one-third of cancer outpatients at risk of significant adverse drug-drug interactions (DDIs) , I never cease to be amazed at the asymmetric nature of drug interaction warnings: I know dozens of patients who have already (in just days) been told to avoid omega-3 intake during active chemotherapy despite the lack of any supporting high methodology data and despite the fact of clear human clinical and observational data to the contrary, but I ask you, when was the last time any oncologist asked a cancer patient about whether they were taking any of the above classes of agents, let alone issued a contraindicative warning against any such agent, despite hundreds of studies documenting the significant potential for harm and compromise? The warnings are invariably reserved for natural agents .
What they fail to do is not objective science.
So I will continue to expose the flaws in reported medical studies and their conclusions as a public service to the patient community here and elsewhere, and in that vein I will shortly be taking up the recent -and falsely reasoned - injunctions against using calcium supplements to reduce the risk of fractures, and their (falsely) claimed cardiovascular harms.
What I do is objective science.
And thanks Gina and Calico, two extraordinary souls and fellow warriors, for your kind appreciation and confidence.
1. Buajordet I, Ebbesen J, Erikssen J, et al. Fatal adverse drug events: the paradox of drug treatment. J Intern Med 2001;250:327-341.
2. Riechelmann RP, Del Giglio A. Drug interactions in oncology: how common are they? Ann Oncol 2009; 20: 1907–1912.
3. Kaniklidis C. Drug Interactions in Oncology. [pending publication; available in pre-pub form under "Contributions" at the ResearchGate profile: https://www.researchgate.net/profile/Constantine_Kaniklidis].