October 23, 2019
I was in Vancouver last weekend for the annual conference of the British Columbia Naturopathic Association. Three of my colleagues, Tina Kaczor, Lise Alschuler and Gurdev Parmar, along with my help, did a one-day presentation that introduced our colleagues to some of the larger concepts in naturopathic oncology. Drs. Kaczor and Parmar have been working madly on finishing their Textbook of Naturopathic Oncology, a project now in its fifth year. They are almost done with the final chapter and to page through the current draft was quite exciting for all of us, a cause for congratulations.
We did something novel in this one-day workshop. We took what had been hour long lectures, which we had already done in the past, and edited them down to 25-minute rapid presentations. It’s impressive what experienced speakers can do when the pressure is on. Every 90 minutes, that is after three speakers had taken a turn at the mike, all four speakers congregated at a table on stage and entertained questions from the audience and discussed answers among themselves and with the audience. We were able to cover a great deal of information. I spoke about insulin-like growth factor-1 (IGF-1), eliciting spontaneous remissions and repurposed drugs. This short and fast lecture approach was novel and the response was favorable, though we are still awaiting official feedback from the conference organizers. I was quite honored to be invited to present these lectures with this group of eminent practitioners.
I detoured to a local pharmacy on Sunday morning on the way to the airport train with Tina Kaczor, ND to see if I could purchase Dukoral as Tina claimed I could. The rumors Dr. Kaczor had shared with us were true. One can walk right into a Canadian pharmacy and purchase Dukoral without a prescription and even pay cash. They keep it in stock. The price I was quoted was just $105 (CAD). Dukoral is a drinkable vaccine that provides protection against “traveler’s diarrhea” or technically “heat-labile producing enterotoxigenic E. coli ”. A full immunization requires 2 oral doses taken at least 1 week apart, with the last dose taken at least 1 week before travel.[i]
Canadians certainly like to travel. Per capita they spend $1007 per year on international travel while we Americans spend only $266. No one wants to get diarrhea especially far from home so it makes sense that they keep a ready supply of Dukoral at the corner pharmacy and don’t require prescriptions. This vaccine is made from chemically purified Cholera Toxin. It has been licensed in Sweden since 1991. Cholera is caused by Vibrio cholerae, whichproduce an enterotoxin, composed of five receptor binding subunits surrounding a single catalytic subunit. The binding subunits bind to GM1 ganglioside receptors in the small intestine and the catalytic subunit is released into the cell where it activates adenylate cyclase. This activation leads to a massive outpouring of fluid from the small intestine, overcoming the absorptive capacity of the bowels resulting in massive amounts of watery diarrhea. Somehow developing immunity to Cholera also provides protection from other toxins that cause diarrhea including these more common E. colistrains that ruin many a holiday. Full blown Cholera treatment requires rapid rehydration and antibiotics. Timely appropriate treatment can reduce mortality to less than 1% from as high as 50%. [ii] Yet, it wasn’t to prevent diarrhea that we were so interested in this vaccine.
Back in 2017, a paper was published in the journal Gastroenterology that suggested that use of cholera vaccine was associated with a lowered risk of death in patients with colorectal cancer. The researchers identified patients diagnosed with colorectal cancer in Sweden between 2005 and 2012. Sweden has nationalized healthcare and so these patients’ records of drug use could be checked in a national registry. As mentioned, Sweden has used this vaccine longer than all other countries so we can assume it is more commonly used. Using Cox regression analysis, a hazard ration (HR) of death from CRC and overall mortality were each calculated for CRC patients who had used the cholera vaccine against matched controls who had not. A total of 175 CRC patients were identified who had taken the vaccine after diagnosis. Their risk of death from CRC was 47% lower than the matched controls who had not received the vaccine (HR, 0.53; 95% CI, 0.29-0.99). In addition, overall risk of death decreased 41% (HR, 0.59; 95% CI, 0.37-0.94) irrespective of patient age, tumor stage, or sex.[iii]
A few hours after I posted the first version of this newsletter, Steven Nemeroff ND, a colleague of ours, forwarded along a second study that I hadn’t been aware of, by the same authors that was published in 2018. In this second study the researchers looked at cholera vaccine and risk of death in prostate cancer patients.
Again using data gathered in Sweden, in this case from 841 patients diagnosed with prostate cancer and who had used this cholera vaccine, the authors concluded that those who used the vaccine had a 43% lower risk of death from their cancer (HR, 0.57; 95% CI, 0.40-0.82) compared to patients who had not used it.
In addition, patients using vaccine had a 47% decreased risk of death overall (HR, 0.53; 95% CI, 0.41-0.69). Again, the decreased mortality rate was consistent, irrespective of patients’ age or tumor stage at diagnosis. [iv]
I am tempted to calculate what it will cost to fly from Denver to Calgary, and spend a night there in order to purchase oneself a treatment or two using this vaccine. It seems like whatever it adds up to be, the cost would be a small price to pay to achieve the degree of prognostic improvement that these studies suggest.
[ii] Lopez AL, et al. Killed oral cholera vaccines: history, development and implementation challenges. Ther Adv Vaccines. 2014 Sep; 2(5): 123–136.
[iii]Ji J, Sundquist J, Sundquist K. Cholera Vaccine Use Is Associated with a Reduced Risk of Death in Patients with Colorectal Cancer: A Population-based Study. Gastroenterology. 2017;0(0).
[iv]Ji J, Sundquist J, Sundquist K. Association between post-diagnostic use of choleravaccine and risk of death in prostate cancer patients. Nat Commun. 2018 Jun 18;9(1):2367. Free pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6006429/pdf/41467_2018_Article_4814.pdf