13 Jun 2008
This week’s pharmaceutical fiasco? Federal regulators are investigating whether a group of best-selling arthritis drugs made by Abbott Laboratories, Schering-Plough Corp. and other companies heighten the risk of cancer in youngsters.
The drugs under review are called tumor necrosis factor blockers (TNF-alpha blockers) and include Enbrel, Humira, and Remicade. The current uproar over the medications began after the Food and Drug Administration received 30 reports of children and young adults developing cancer while taking the drugs over the last 10 years. Roughly half the cases were lymphomas, a type of immune system cancer. Others reported were leukemia, melanoma and cancers of various organs. The fact that a possible association between TNF-alpha blockers and some cancers has been recognized for years in adults has only heightened the FDA’s concern.
Since increased cancer risk marks just one of the many side effects associated with TNF-alpha blocking drugs, why are children and teenagers taking them in the first place? Sadly, TNF-alpha blockers are currently considered to be the most popular class of medications used to treat children with rheumatoid arthritis, Crohn’s disease, and other autoimmune conditions.
The link between TNF-alpha blockers and cancer has everything to do with the fact that inflammatory diseases such as rheumatoid arthritis and Crohn’s are actually caused by a chronic intraphagocytic microbiota of pathogens. The immune system constantly releases cytokines – proteins that cause pain and fatigue – in response to these pathogens, and TNF-alpha is one of the main cytokines released as part of the response. But since mainstream medicine still incorrectly considers arthritis, Crohn’s and other inflammatory diseases to be “autoimmune” in nature, most researchers have naturally concluded that TNF-alpha medications provide an optimal way in which to palliate what they incorrectly consider to be an over-active immune system response.
In reality, blocking the production of TNF-alpha requires slowing many components of innate immunity, meaning that the drugs are actually just another class of immunosuppressants. Armed with the understanding that “autoimmune diseases” are are actually caused by bacteria, it’s easy to see that while palliative over the short-term, TNF-alpha blocking drugs allow disease-causing pathogens to spread more easily over the long-run.
“Blocking TNF-alpha allows the bacteria to proliferate and produce lots of capnine-like stuff which blocks the Vitamin D Receptor [the receptor that controls innate immune function] and allows cancers to form and metastasize”, explains Marshall.
Consider the fact that cancers including lymphomas are also, almost certainly, the result of infection with a large microbiota of bacteria. It suddenly becomes clear that the increased rate of cancer seen among youngsters or adults taking TNF-alpha blocking drugs is not due to mysterious side effects of the medications, but rather the fact that any person taking a TNF-alpha blocking medication suffers from a decrease in immune function that allows cancer-causing bacteria to spread with greater ease.
In fact, the deleterious effects of TNF-alpha blockers on the innate immune response mean that the latest findings showing increased cancer rates among youngsters taking the drugs are far from the first reports of “side effects” associated with the class of medications. In 2005 Marcel Flendrie and colleagues, from Radboud University Nijmegen Medical Centre in the Netherlands, followed a population of 289 patients who had been undergoing treatment for rheumatoid arthritis with TNF-alpha blocking drugs for a period of one to ten years. The drugs the patients had been taking included two anti-TNF-alpha antibodies, infliximab and adalimumab, and the TNF-alpha receptors etanercept and lenercept.
The results of the study show that 25% of patients on the therapy suffered from a dermatological condition that led them to visit a skin specialist. In a control group of patients who were not undergoing TNF-alpha blocking therapy and had less severe disease only 13% visited a dermatologist during the same period of time.
The most frequent conditions that patients on therapy suffered from were: skin infections – 33 infections were recorded; eczema, which was diagnosed 20 times; and drug eruptions, which occurred mainly at the beginning of the treatment and were important enough for 7 patients to stop therapy. In addition, 12 patients were diagnosed with skin tumour and 9 with an ulcer. In total, 26% of the patients who developed a dermatological condition ceased their treatment due to the condition.
“Dermatological conditions are a significant and clinically important problem in rheumatoid arthritis patients on TNF-alpha blocking therapy” conclude the authors.
This is not to mention the fact that as noted on the CDC website, the FDA has determined that tuberculosis (TB) is a “potential adverse reaction” from treatment with TNF-alpha blockers. The association makes it abundantly clear that TNF-alpha blockers foster the spread of bacteria.
In fact, according to About.com, it turns out that patients taking TNF-alpha blockers are also at greater risk for developing MS and increasingly prone to develop congestive heart failure, as well as “autoimmune and lupus-like problems.” The drugs have been linked to blood problems like pancytopenia (a decrease in production of all blood cell types) and aplastic anemia (complete loss of production of red blood cells). Again, one must wonder: do TNF-alpha blockers mysteriously cause these other diseases, or do they simply facilitate the spread of the bacteria that drive their progression?
While it’s abundantly clear to those who understand the Marshall Pathogenesis – which implicates bacteria in inflammatory disease – that TNF-alpha blockers elicit “side effects” by nothing more than facilitating the spread of bacteria, the FDA is far from grasping this reality.
Instead, the government body plans to spend our tax dollars on several long-term studies to definitively assess the drugs’ potential to cause cancerous “side effects”, particularly in children. The agency has asked drug makers to provide all information about children who developed cancer while taking the medications, and regulators will report the findings of their review by November. The product of such time consuming and costly investigations will result in the following – a potential label on TNF-alpha medications saying the drugs may increase the risk of cancer. A true step forward for the medical community? Sadly not.
Meanwhile, the TNF-alpha blockers continue to generate large profits for the companies that make and market them. Considering that Abbott’s Humira was the company’s best-selling product last year with over $3 billion in sales, and Remicade also topped Schering-Plough’s portfolio with sales of $1.65 billion, there is little hope that such companies will be willing to embrace a true understanding of how their drugs foster the development of chronic disease.
Note: While Olmesartan reduces levels of TNF-alpha, it does so by blocking the generation of the substance in the first place rather than blocking its release after it has been produced. So Olmesartan is effective at palliating immunopathology, but does not cause the immunosuppression generated by TNF-alpha blockers.
14 Responses for "Bacteria likely the missing link between TNF-alpha blocking medications and cancer"
Hi,
I really admire Dr. Marshall and I’m considering giving the MP a shot. However, allow me to play devil’s advocate for a moment. How can we be certain that the inherent anti-inflammatory properties of Benicar and the tetracyclic antibiotics aren’t responsible for putting people into remission? Why is blocking the release of TNF-alpha immunosuppressive, but blocking it’s generation (as you state to be the case with Benicar) not immunosuppressive?
I am concerned about this. I was on the tricyclic antidepressant amitriptyline for four years to help with chronic pain. While it did help with symptom control, my health really deteriorated while I was on it. I believe this is because amitriptyline, like many so-called “psychotropic” medications, has rather profound immunosuppressive properties. Like the medications mentioned in this article, it suppresses TNF-alpha release, albeit most certainly to a lesser degree. Nevertheless, I did develop a couple of internal cysts while on it and also had some skin issues.
Thanks,
Paul
Hi Paul,
I am glad you are researching the Marshall Protocol. I am extremely confident that Benicar and the antibiotics are not putting people into remission. That’s because during the vast majority of the time that MP patients are take the antibiotics and Benicar they feel worse, often much worse.
If Benicar works as an immunusuppressant, and the antibiotics work in the palliative manner – as they do when taken in high, multi-daily doses – then at atmosphere of relief would be created during the MP. The patient would feel better.
Instead, people on the MP face years of difficult immunopathology before reaching a state of remission. The anti-inflammatory properties of Benicar only help patients manage the bacterial die-off reaction to a certain degree. Instead, Benicar’s primary job is to serve as a VDR-agonist (a drug that strongly activates the Vitamin D Receptor). So it’s main action is stimulating the immune response and facilitating bacterial death.
Immunopathology is very difficult for MP patients. Antibiotics must be ramped over the course of years, often up to five or six years in cases of severe illness so that the patient can manage the die-off. Believe me, there is no palliation going on during the MP.
Furthermore, the MP antibiotics were specifically chosen via molecular modeling data from the Max Plank Institute in Germany so as to be administered at concentrations that essentially null the immunosuppressive effects they possess at high doses. For example, one of the phase II antibiotics is only taken every 10-14 days. That’s very low dosing with little possibility for immunosuppression. This article describes how the MP antibiotics were chosen in greater detail and would be a good read:
http://bacteriality.com/2007/10/11/antibiotics/
Finally, there is absolutely a difference between blocking a substance after it has already been created and blocking the creation of a substance in the first place. Once TNF-alpha has been created and released, blocking it’s actions unfortunately require blocking many other components of innate immunity. Hence the immunosuppression.
But Benicar has a subtle effect that causes less TNF-alpha to be created in the first place. If TNF-alpha is never produced, it never has to be blocked, and the innate immune response never has to be blocked. TNF-alpha is a potent inflammatory cytokine so having a little less of it around thanks to Benicar allows the patient to tolerate their immunopathology a little bit more easily, yet the strength of the rest of their immune response stays the same.
Hope this helps!
Best,
Amy
Hi Amy,
Thanks for the detailed response. It does help assuage some of the fears I have about being on medication again. Do you know if any patterns have emerged that might help predict how much immunopathology one might expect to face while on the MP. For instance, is length of illness or severity of debility more likely to impact one’s immunopathology?
Thanks,
Paul
Hi Paul,
Sorry for the delayed response. Yes, there are patterns that can predict the severity of immunopathology to a certain degree. The first thing to keep in mind is that bacterial load very often correlates with how long a person has been ill. Generally patients that have been sick for decades have accumulated larger bacterial loads, whereas those who start the MP closer to their time of diagnosis often have lower bacterial loads and thus deal with lower levels of IP.
Patients who have taken large amounts of immunosuppressive medications or steroid medications such as prednisone generally also have bacterial loads that have spread to a greater extent. So such patients usually experience stronger immunopathology. Of course, since dietary vitamin D is a secosteroid in its own right, anyone who has a long history of supplementing with vitamin D can generally also expect to have a higher bacterial load and thus stronger immunopathology when they begin the MP.
Many patient say that the level of their immunopathology doesn’t become too much worse than their disease symptoms in the first place, although there are definitely exceptions. To be more specific, I mean that most people find that if they can work before the MP they can generally still pull off working while on the treatment.
So there are a few clues that might allow you to predict what your immunopathology may be like. However, it’s often very hard for people to estimate bacterial load before the MP. Patients are often surprised that they get immunopathology in areas they didn’t even realize were infected.
So it’s really only after you start Benicar and minocycline that you will be able to get the most accurate impression of the immunopathology and light sensitivity that you will be dealing with.
So I hope you can start the MP soon!
Best,
Amy
Dear Amy,
My daughter’s dx is idiopathic uveitis and negative for both ankylising spondilytis (sorry for the spelling errors) and JRA.
This News Flash came out at just the time I needed it. At our June08 appointment with a rheumatologist, he advised my (then)17 yo to try remicade or humira, after ill-health prevented full compliance with methotrexate.
Prior to that (in March08), our visit to an eye specialist in Boston proved to be most disappointing; however, since we had discovered the MP in January (two months earlier), we were not without hope, even though we thought we might have to search a long time for an MP supportive physician.
What did seem hopeless, though, was the sight of the young mothers and teens we saw hooked up to IV’s (presumably remicade).
BTW, in contrast to her declining health on steroid eye drops and MTX, she has experienced the biggest improvement in her health since starting the MP in Aug08. She’s had hypothyroidism since age 11 and can never really remember the feeling of good health until now, thanks to the MP!!!!
Finally, Amy, where can I find the results of the FDA’s findings to this review last June through November?
A happy mom, Carol
Hi Carol,
Amy and I are so glad to hear of your daughter’s improvement and that you were able to learn about the MP in time for it to count.
I believe the report your looking for is linked to here, on the Knowledge Base article on anti-TNF drugs:
http://mpkb.org/doku.php/home:othertreatments:antitnf
Hope this helps.
Best,
Paul
Hi Carol,
What good news! I hope your daughter continues to make more and more progress!
Yes, the image of so many young women hooked up to IVs of what are likely only immunosuppressant drugs makes me cringe too. I remember what it was like to live from relapse to relapse with no hope of real improvement and I expect their health follows a similar trend.
Take care,
Amy
I found it!! The grim report of this review is just being reported today 04Aug09 by AP here:
http://news.yahoo.com/s/ap/20090804/ap_on_bi_ge/us_arthritis_drugs_fda_warning
Where are the doctors who are willing to offer this life-giving protocol to these little ones who are suffering needlessly!!!!
Hi Carol,
Thanks for the article. So now the the makers of TNF alpha blockers have to put a warning on the bottle saying the drugs may cause cancer.
I’m not sure if this does anything for children or adults suffering from autoimmune conditions in which their doctors think that TNF-alpha drugs are still “beneficial” because they can suppress the immune response.
I’m sure doctors will continue to prescribe these drugs despite these new warnings because they are unaware that they have other treatment options.
So it’s very important that the scientific community starts to really appreciate that bacteria and other pathogens are causing the inflammation they incorrectly attribute to an “autoimmune state.”
Reading this article only makes me want to work harder! There are a lot of researchers besides those of us at ARF who recognize bacteria in autoimmune disease. Hopefully our research will continue to spread as fast as possible so that children are offered the chance to recover from their autoimmune condition rather than being forced to take such terrible drugs.
Best,
Amy
Hi Amy,
I’m an admirer of your work. I am on the MP and in stage 3. I am having a difficult time of it, as I still have a huge amount of fatigue, although the pain has decreased a lot. I have seen the MP work for people with sarcoidosis when they have gone onto it immediately. This didn’t happen for me. I was on no treatment after diagnosis for two years. Then I was put on immunosuppressives. I guess I was on them for about 5 years before I heard about the MP. I researched the MP, but, but that time, I was too ill to work, and therefore too poor to afford to import Olmesartan. I had to wait a further three years for it to become available in Australia, and then become affordable on the PBS list before I was able to attempt the MP. I hate the idea of immunosuppressives. I wouldn’t like lymphoma, I watched my dad die of it. I know of a lady who recently died of melanoma who also had RA. So the MP was for me. However, my progress is slow compared to others, though still apparent. When we are going through the bad stuff, it is easy to start having doubts. How do we know the pain, fatigue and blood test alterations are due to immunopathology and not just due to a combination of all the drugs. Do you know what would happen to a healthy person if they took the same drugs? Would there be some reaction? I guess everyone has some microbiota. Is the pulsing of antibiotics part of the cause? If a person with sarcoid took the antibiotics on a daily basis would it totally halt immunopathology and hence, pain, weakness fatigue etc? I guess I am becoming a bit skeptical, as I don’t know what would happen in the case of a person who was basically healthy.
Denise
Hi Denise,
Considering the fact that it took what sounds like ten years to begin the MP, your bacterial load is almost certainly higher than that of many other people with sarcoidosis who are currently on the MP. As long as your body is continuing to fight bacteria, you are going to fight fatigue as it is taxing your body to continue fighting these microbes.
When you ask if any of the fatigue could be due to any of the side effects of the medicines, I’m not really sure what you mean. The safety profiles of Benicar and the antibiotics are actually quite good. Here’s a few pages on the safety of the MP antibiotics:
http://mpkb.org/doku.php/home:protocol:olmesartan:safety
http://mpkb.org/doku.php/home:protocol:mp_antibiotics:antibiotics_concerns
To answer your main question, no, a healthy person would not react to minocycline and Benicar the way that you are.
Both my sister and my Mom started the MP and they were essentially healthy. They could both tolerate the highest doses of the MP antibiotics in a matter of days and reported very little immunopathology. If anything, my sister felt a bit tired after doing two hours of exercise, and my mother tends to feel okay unless she gets way too much sun. So, their reactions to the MP are so mild that most of the time, you wouldn’t know what they’re on. I’m almost confident that your symptoms are a result of your body trying to wear down your bacterial load.
I recommend hanging in there and lowering your antibiotics if your find your symptoms too deblitating.
Best,
Amy
Dear Amy,
Thank-you. It is a comfort to know I am not going through this for nothing. It is also a comfort to know that your healthy mom and sis tried the MP and were able to tolerate the antibiotics. That is also a great comfort to me, i.e. that is not some trick of the combination of drugs which is causing the IP. I will continue to ‘hang in’ there.
Denise
Hello Amy, I was reading up on MP treatment options as my 13 yr old daughter has Crohn’s Disease (but we are not sure if it’s actually active at this point) and they are starting up Cimzia trials in Canada and just the thought of any risk of cancer puts us on edge we are not happy and the treatment options are limited at this point as she has already gone through the cortisteroids immune suppressants (Imuran) without success.
I tried to click on the link that you had regarding printing out packet to present to doctor and this link is broken, can you find another link for me that I can further study and print out for the doctor?
Thanks Kindly.
Jackie Young
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Actually, one MP member has put together a packet of information that people can use to present to their doctor. It’s very good and comprehensive. You can either print out the document, or if you ask, she will send it to you in paper format. Here’s the link to the manual and how to order it:
http://www.ginariggio.com/MPP1PACKET/infopacket.html
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(broken link not working)
Hi Jackie,
Here is the up-to-date link for the information packet.
http://mp.ginariggio.com/downloads/PHYSICIANSGUIDE2009.pdf
For a first step, we usually recommend giving your doctor some of our peer-reviewed published papers, the full text of which is linked to here:
http://mpkb.org/doku.php/home:publications
Best,
Paul