Conscious Choice: Breast Health Diet Controversy

January 1999

Breast Health Diet Controversy

by Meg McGowan

Much of the current controversy over the impact of diet on breast health centers on a critique of Dr. Bob Arnot’s book The Breast Cancer Prevention Diet: The Powerful Foods, Supplements, and Drugs that Can Save Your Life (Little, Brown), issued by the American Council on Science and Health (ACSH). Entitled "The Breast Cancer Prevention Diet by Dr. Bob Arnot: Unscientific and Deceptive — A Disservice to Women," the ACSH’s position paper was released on November 16, 1998 with a concurrent news release.

A summary of the ACSH’s critique, published at their own website, cites the following points of objection: "it exploits women’s deep-seated fears of breast cancer; it promises more than it can deliver; following the book’s advice could result in substantial disruption of eating patterns, both of women themselves and of their families (for example, Dr. Arnot recommends that women avoid rice, potatoes, and many forms of pasta); not adhering to Dr. Arnot’s dietary program could instill feelings of guilt; it could discourage high-risk women from seeking intensive medical monitoring (frequent mammograms, for example) and from accepting drug regimens (such as the recently approved tamoxifen) that have proven efficacious in reducing the toll of breast cancer in favor of unproven dietary interventions; it betrays the trust women have in physicians."

The ACSH’s denouncement of Arnot for disrupting the eating patterns of women and their families and betraying the trust women have in physicians sounds paternalistic and demeaning. Neither statement springs from an assumption that a woman is a human being capable of analyzing and evaluating information and deciding on an appropriate course of action for herself and those who depend on her. The accusations of exploiting women’s fears of breast cancer and instilling possible feelings of guilt could be applied to the traditional medical community’s mandate that women should submit to a prescribed series of mammograms, a screening technique that is not as universally accepted as the ACSH implies. Samuel Epstein, M.D., and David Steinman, authors of The Breast Cancer Prevention Program, are among those who believe that mammograms are part of the problem, not the solution, for premenopausal women.

The charge that Arnot’s diet could discourage women from taking "the recently approved tamoxifen" may be perceived as a positive rather than a negative effect, based on information presented about the drug by the ACSH in the body of the paper itself. The ACSH points out the drawbacks of tamoxifen in an effort to refute Arnot’s claim that "drugs strongly interfere at one very specific point in the sequence that causes cancer, and can therefore develop prominent side effects. By changing your diet, you can interrupt many places in the sequence without the toxicity of drugs."

According to the ACSH, "Dr. Arnot’s suggestion that these food substances — as contrasted with pharmaceuticals, which are subject to the most stringent government efficacy and safety testing — have the same level of beneficial effects, is misguided."

Yet the paper also concedes that "the pharmaceuticals tamoxifen and raloxifene have anti-estrogen functions similar to those described for phytoestrogens," which are found to occur naturally in foods and herbs. The ACSH paper cites a clinical trial that found "a 49 percent reduction in incidence among women using the medication, when compared to a group receiving placebo." To follow this logic is to substantiate the claims by Arnot (and others) that food substances can provide protections claimed by drugs.

The ACSH position paper goes on, however, to state that "the risk of endometrial cancer was more than doubled among the women receiving tamoxifen, when compared to the women assigned the placebo. Additionally, the incidence of stroke, pulmonary embolism, and deep-vein thrombosis was elevated among women receiving tamoxifen, relative to the same outcomes in the placebo group." Raloxifene is currently being studied to see if it may produce a better risk/benefit ratio. Concluding that "there is a great potential benefit for tamoxifen and raloxifene, but this benefit must be balanced against the increased risk of other serious problems," the ACSH warns that the risk/benefit ratio of naturally occurring phytoestrogens should be similarly evaluated, targeting soy protein as an example. Their position ignores the fact that entire populations have consumed soy protein (and other phytoestrogen-rich foods) as a significant portion of their diet for thousands of years, providing information that is beyond the possible scope of any ballyhooed "scrutiny of analytic study in humans, by means of tests similar to those conducted for tamoxifen." The data we have available on any synthetic substance are insignificant from any historical perspective.

The ACSH claims that Dr. Arnot’s suggestions will deter high-risk women from "accepting drug regimens (such as...tamoxifen) concedes that "tamoxifen and raloxifene have anti-estrogen functions similar to those described for phytoestrogens," even as it cites debilitating and life threatening side effects of tamoxifen. It expresses concern that foods consumed as part of a regular diet by many people throughout history may have "adverse effects resulting from indiscriminate use." Finally, it condemns Dr. Arnot’s "suggestion" that food could have anti-estrogen functions similar to those described by pharmaceuticals.

Examined closely, the ACSH’s condemnation of Arnot’s book refutes itself. While some portion of the criticism may be valid, the apparent intent of the paper is to discredit Arnot, not to encourage public dialogue on the importance of individuals making the best possible decision with the information at hand. The ACSH’s paper is far more insidious than Arnot’s book in its blatant assertions that what has been approved by the government is safe, that scientific method is inherently beyond reproach, and that what has received a nod from the traditional medical community at large constitutes truth. The ACSH alleges that Arnot overstates some of his positions, such as referring to breast cancer as an epidemic. Yet even the format of their position paper, in which the ACSH sets forth a "Claim" by Arnot and then refutes it under the heading "Reality," is an hyperbolic effort to reinforce the organization’s own mythology.

The public is unlikely to read and evaluate the ACSH position paper in its entirety. Most will hear about it in sound bites on the news, a format in which the ACSH has the advantage. Unfortunately, "The American Council on Science and Health" sounds unassailably official, especially when combined with the clout of an acronym. The ACSH is not a government agency. In its own words, it is "an independent, nonprofit, tax-exempt organization... a consumer education consortium concerned with issues related to food, nutrition, chemicals, pharmaceuticals, lifestyle, the environment and health." Part of their funding admittedly comes from food and chemical companies.

Both the ACSH’s paper and its press release issue a call to media action. In their Position Statement ACSH "respectfully requests that the producers of NBC’s Today and other major television programs that have promoted Dr. Arnot’s book offer airtime to scientific and medical authorities who are qualified to critique Dr. Arnot’s unproven recommendations. The organization also calls upon medical and health professionals in the fields of nutrition, cancer treatment and prevention, and public health to join with ACSH in communicating their concerns about Dr. Arnot’s book, by contacting Andrew Lack, President of NBC News, and Little, Brown, and Co., publisher of The Breast Cancer Prevention Diet."

It’s important that those who do not agree with the ACSH’s campaign of criticism and attempted censor should heed the call as well: make your dissenting opinions heard. The measuring rod of scientific method is only a tool — not the only tool by which to measure truth as those who wield it often claim it a priority in their positions. Don’t let ACSH forge that tool into a weapon against the dissemination of significant, useful information.

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