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Cancer Ireland: Everything you need to know about overcoming cancer.

Treatment of Cancer (Advertisements) Bill 2018

Here is the email I sent to all TDs and Senators asking for their support to defeat proposed new legislation targeting advertisements of certain cancer treatments.

I believe the Bill (which passed the second stage in Dáil Eireann in April) is a deliberate attempt to close down all sources of information about “alternative” cancer treatments and those who offer them to patients.

There are other worrying aspects to the Bill that are not dealt with in my email because I didn’t want to risk losing people’s interest by writing a long email. These can be dealt with later on in the debate if necessary.

I would very much welcome your feedback.

Re: Treatment of Cancer (Advertisements) Bill 2018.

Dear Oireachtas member,
I appeal to you in the strongest possible terms to oppose the Treatment of Cancer (Advertisements) Bill 2018 at every stage of its passage through the Oireachtas. The sponsor of the Bill, Deputy Kate O’Connell – a pharmacist – claims the aim of the Bill is to protect vulnerable cancer patients from advertisers peddling ineffective treatments.

However, I believe the Bill is aimed at suppressing legitimate criticism of the dangerous cancer drugs and treatments that are used routinely in our hospitals, rather than a genuine attempt to protect the public from false advertising.

While I agree that the law should protect vulnerable cancer patients from false advertising, it is obvious that this Bill goes far beyond that. As the owner of a not-for-profit website that provides cancer information in Ireland, I find its proposal to severely penalise anybody who provides “any advice in connection with the treatment of cancer” particularly disturbing.

While my website doesn’t provide medical advice to cancer patients, it does provide general advice to patients – for example, it encourages patients to question the safety and efficacy of any treatments proposed by their medical team. It also advises patients about a whole range of strategies and treatments that neither oncologists nor the Irish Cancer Society informs them about.

If this Bill is passed into law, I believe I will be forced to take my website offline, depriving patients and their families of valuable information.

But the Bill is much more dangerous than that. It is a direct assault on the democratic right of journalists and others to challenge the vested interests of the medical-industrial complex. In fact, if the legislation proposed in this Bill had been in force in the UK in the 1960s it would have been a crime for the Sunday Times to have challenged the drug company assertion that Thalidomide “can be given with complete safety to pregnant women without adverse effect on mother and child”. This Bill would prevent Thalidomide victims and others from publicly questioning the efficacy of the drug. Cui bono?

Speaking in the Dáil, the sponsor of the Bill said:
“This short Bill is about being able to prosecute people who are making large sums of money by peddling treatments or cures that, at best, have no proven effect whatsoever and, at worst, increase suffering, cause even greater pain and often hasten death”. Ironically, this perfectly describes pharmaceutical companies and the dangerous cancer drugs they peddle. For example, The Lancet medical journal published a 2016 study carried out by Public Health England and Cancer Research UK that looked at more than 29,112 patients with breast cancer and 15,545 patients with lung cancer who underwent chemotherapy in 2014. Of those treated, 1,974 died within 30 days. Why doesn’t the Bill target the pharmaceutical companies that peddle these “treatments” in order to protect cancer patients?

Furthermore, no evidence was produced by Deputy O’Connell to support the claims that patients in Ireland are being targeted by false advertisements. Speaking in the Dáil, she praised the Primetime show broadcast last year showing the plight of terminally ill cancer patients going to foreign clinics for treatment. However, the programme did not show gullible victims lured overseas by targeted advertisements. Rather, it showed people fighting for their lives who researched treatment centres outside Ireland and subsequently made contact with them – it wasn’t the other way round.

Finally, patients wouldn’t be looking outside Ireland for other kinds of treatment if they could access them at home. So, rather than penalising those of us who provide educational information about such treatments, legislators should be focusing on removing outdated laws that deny patients access to their treatments of choice in the first place.

Please, for all our sake, kill the Bill.

Yours sincerely,
Tommy Roche
email: [email protected]

It’s time to decriminalise medicinal cannabis use

By Tommy Roche
Cancer Ireland
October 2018

It’s time for a public dabate on decriminalising medicinal cannabis use.

cannabis leafMedicinal cannabis is scientifically proven to be effective in the treatment of cancer, chronic pain, epilepsy, and a number of other illnesses. For far too long, patients have been denied access to this amazing gift of Mother Nature.

This is causing unnecessary suffering among hundreds of thousands of patients who are being let down by the system.

Under current law, patients who use medicinal cannabis are classified as criminals. Medicinal cannabis use needs to be decriminalised.
But, it is now obvious that only sustained public pressure will make that happen.

Within the last two years, two opportunities to give all patients unrestricted access to medicinal cannabis were deliberately sabotaged.

Firstly, the Cannabis for Medicinal Use Regulation Bill 2016 aimed at legailising medical cannabis was killed by the Joint Oireachtas Health Committee.

Secondly, when asked by the Minister for Health to provide expert scientific advice in relation to the merits of medicinal cannabis, the Health Products Regulatory Authority (HPRA) rejected any notion of making medicinal cannabis available to the vast majority of patients that need it.

It advised that only synthetic (pharmaceutical) cannabis products be made available to select patients with multiple sclerosis, epilepsy, and intractable nausea and vomiting caused by chemotherapy. Even then, each patient will need a ministerial licence to be able to access the products. This comes nowhere near what is required; namely, unrestricted access to full extract cannabis for all patients.

In reality, both the politicians and the HPRA put political and pharmaceutical industry interests ahead of the rights and wellbeing of patients. Let’s take a closer look at how both bodies failed patients.

Hypocritical politicians and medicinal cannabis:
the kettle calling the pot black!

Oireachtas members – especially those on the Joint Health Commmittee – who opposed the introduction of medicinal cannabis say one reason they did so was because of a desire to protect the public. But how do they reconsile keeping medicinal cannabis, which is a proven treatment for chronic pain and a number of serious illnesses including cancer, illegal, while:

Approximately 6,000 deaths annually are attributable to smoking and exposure to second-hand smoke. (Report: The State of Tobacco Control in Ireland 2018). Yet, tobacco is not illegal?

Over 1,000 deaths per year are directly attributable to alcohol (around 500 of these from alcohol related cancers).
(Health Research Board). Yet, alcohol is not illegal?

161 deaths were among the 3,264 reported cases of new adverse reactions associated with the use of prescription medications in Ireland in 2016. Yet, prescription medications are not illegal.?

This is gross hypocracy.

It would be wrong, in a free country, to deprive adults of their right to consume alcohol or tobacco, even though they pose health risks. Isn’t it equally wrong to deprive them of their right to consume a medicine that is relatively risk free and improves health?

Aren’t legislators supposed to enact (and support) laws that benefit the population as a whole? Why then, are large numbers of citizens who use medicinal cannabis treated as criminals under the law?

I believe our Bill has been completely sabotaged. I was rather shocked by the shambolic nature of the pre-legislative scrutiny. I believe it was politically motivated in some ways. It was rigged… I believe the Committee on Health looked for every excuse to stymie progress of our Bill. It is as simple as that. Gino Kenny TD

“It is legal to kill a man to save your own life.
It is illegal to use a plant to do the same.”
Author unknown

Health Products Regulatory Authority:
whose interests does it really serve?

The Health Products Regulatory Authority (HPRA) 2017 report Cannabis for Medical Use A ScientificReview effectively gave the two fingers to vast numbers of patients by denying them access to medicinal cannabis. In particular:

* The 40,000 people who are diagnosed with cancer every year; many of whom would benefit from the addition of medical cannabis in their treatment. There is a substantial body of scientific evidence, along with countless patient testimonies supporting the benefits of cannabis in treating cancer.

* The 800,000 people who suffer from chronic pain, of whom 40% do not get relief from existing authorised pain killers.

Unreliable and biased.
In a response published in Gino Kenny TD( sponsor of the Cannabis for Medicinal Use Regulation Bill 2016 and Dr Peadar O’Grady said: “the HPRA guidance is unreliable and biased because it did not use any expert advisors with practical experience of cannabis for medicinal use and because the reasons given by the HPRA for restricting access are not applied consistently to other drugs, and do not take into account the serious risk of death and dependency caused by the existing authorised drugs such as opioids and benzodiazepines.”

We shouldn’t be surprised. According to Richard Boyd Barrett TD, the HPRA is 77% funded by the pharmaceutical industry. The recommendations in its report clearly show whose interests it serves.

Health Products Regulatory Authority
recommendations in relation to cancer.

1. Cancer treatment
The HPRA says
“There is currently no evidence for a benefit in the treatment of cancer, despite anecdotal reports to the contrary”. This claim is absolutely bizarre. It is blown out of the water by both the number of scientific studies and the numerous testimonies of real people showing the benefits of cannabis.

Scientific studies
There are hundreds of studies showing that cannabinoids are effective against many cancers, as well as reducing the side-effects of conventional cancer treatments like chemotherapy and radiation.

For example, A study published in the US National Library of Medicine outlined multiple studies proving the effectiveness of cannabis on prostate cancer.

A study published in the US National Library of Medicine, conducted by the California Pacific Medical Centre determined that cannabidiol (CBD) inhibits human breast cancer cell proliferation and invasion. They also demonstrated that CBD significantly reduces tumour mass.

Even the US National Cancer Institute says:
+ Cannabinoids may cause antitumor effects by various mechanisms, including induction of cell death, inhibition of cell growth, and inhibition of tumor angiogenesis invasion and metastasis.
+ Cannabinoids appear to kill tumor cells but do not affect their nontransformed counterparts and may even protect them from cell death.

Here are links to over 100 studies

Anecdotal evidence
There are thousands of patient testimonials to the life-saving benefits of cannabis oil. Landon RiddleThese include Landon Riddle who was diagnosed with leukemia and given mere days to live by doctors when he was just 3 years old. He is now a healthy 7 year-old
thanks to cannabis oil treatment. Full story

mykayla7-year-old Mykayla Comstock was diagnosed with intermediate risk T-Cell acute lymphoblastic leukemia in the summer of 2012.

Just one week after beginning cannabis oil therapy, scans of Mykayla’s bone marrow and blood showed no signs of leukemia. She was in remission! Mykayla is now a healthy 13-year-old. Mykayla’s website

Here’s a link to more testimonials.

How can so much anecdotal evidence be dismissed out of hand?

A cautionary tale.

Cashy Cash Hyde was first diagnosed with cancer at 20 months. Along with chemotherapy and radiation – as well as brain surgery when he was 2 years old – cannabis was a key component of his cancer treatment: the medical marijuana helped him sleep and helped him eat.

Cancer-free, Cash began to get sick again and was found to have a stage IV growth. This time, the tumor progressed really fast, but a change in Montana State law led to the family being without a source of medical marijuana for 73 days.

He had beaten cancer twice, but its third appearance was too much. He died in his father’s arms at the family home in Missoula, Mont.

He was 4 years old.

The Family Says Medical Marijuana Extended His Life

The hope is that Cash’s suffering and passing will highlight the medical benefits of marijuana, and the absurdity of creating barriers to its access, a family friend said.
After all, the plant brought relief to a young child whose only memories were of being terminally ill – what, exactly, is the harm?

2. Chronic Pain
In its report, the HPRA says “The HPRA considers that current evidence does not support the use of cannabis in the treatment of chronic pain.

Chronic pain is an important issue for cancer patients. There is a lot of evidence to support the use of cannabis in the treatment of chronic pain.

The evidence is strongest for the efficacy of medicinal cannabis in the area of pain according to Professor Mike Barnes consultant neurologist, professor of neurological rehabilitation and author of the authoritative report on medicinal cannabis for the UK Parliament, and Professor David Finn, who has spent 16 years researching the area of medicinal cannabis.

Last year, a large review from the National Academies of Sciences, Engineering, and Medicine assessed more than 10,000 scientific studies on the medical benefits and adverse effects of marijuana.

One area that the report looked closely at was the use of medical marijuana to treat chronic pain. The review concluded:
There is substantial evidence that cannabis is an effective treatment for chronic pain in adults.

The HPRA report also says “ The HPRA does not consider that there is an unmet medical need as a large number of authorised medicines, and other treatments are available to treat the many factors involved in chronic pain.”

However, Professor David Finn, President of the Irish Pain Society said ” There are many other analgesic drugs for and non-pharmacological approaches to the treatment of pain, but we cannot ignore the fact that one in five people in Europe suffer from chronic pain. In Ireland, the figure is approximately the same…This is the case despite the availability of other treatments. The largest study ever carried out on this matter in Europe involved 46,000 patients. The study: Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment, by H. Breivik et al, showed that 40% of chronic pain patients said that their pain was inadequately managed by current treatments. This illustrates that there is a massive unmet clinical need here. Existing drugs are working well for some patients but they are not working well for all. That may be because of lack of efficacy or unacceptably high levels of side effects.”

3. Anti-emetic medicine
The HPRA approved access to cannabis products (but not full extract cannabis) for patients who have “Intractable nausea and vomiting associated with chemotherapy, despite the use of standard anti-emetic regimes whilst under expert medical supervision”

Why not allow natural full extract cannabis?

This study, published in Current Oncology in 2016 states:
For the cancer patient, cannabis has a number of potential benefits, especially in the management of symptoms. Cannabis is useful in combatting anorexia, chemotherapy-induced nausea and vomiting, pain, insomnia, and depression. Cannabis might be less potent than other available antiemetics, but for some patients, it is the only agent that works, and it is the only antiemetic that also increases appetite.

Cannabis proven safer than prescription medications
During 2016, the HPRA received a total of 3,264 reports of new adverse reaction associated with the use of medicines (that have HPRA approval). Of these, 161 patients were reported to have died while on treatment. Ironically, the highest number (45) involved cancer drugs.
The HPRA says that in many of these cases, significant underlying illness, disease progression and other factors contributed to the deaths.

The HPRA ignores the fact that there is no evidence that the side effects of medicinal cannabis are anywhere as serious as the effects of drugs that are toxic, that kill people and that are already authorised and sold in chemists countrywide. Professors Mike Barnes and David Finn say the side effects of medicinal cannabis products – and they acknowledge there were some – were moderate.

In terms of its adverse effects, it is worth starting with the major benefit of cannabis. Unusually for a medicine, there is no fatal toxic dose. It has never killed anyone. That is true of very few medications, particularly alternative medications for one of the biggest areas of use of cannabis medicinally, which is for pain. Opioids, benzodiazepines and valium-type drugs are commonly used and these are major causes of death. Cannabis does not cause death, which is the first important aspect to understand about it. Dr. Peadar O’Grady

In the US, where cannabis is allowed for medicinal use, the sale and use of opiate painkillers reduces as does the number of people who die from overdoses every year. That amounts to tens of thousands of people. If those figures are extrapolated for Ireland – we have asked the HSE for accurate figures but it does not seem to have them – we reckon hundreds die of opiate overdoses annually, many of whom are at the top end of the dose trying to relieve their pain, in particular. Unfortunately, as they increase the dose to try to get more pain relief, they exceed the toxic level and they die. Nobody has ever died from cannabis use. One of the answers as to who would benefit is people who are near the maximum of their pain medication and who are thinking of increasing it, thereby putting themselves at risk of overdosing. Hundreds of people probably die that way every year and, therefore, making an alternative available to reduce the toxic dose will save lives. Professor David Finn

The HPRA ignores the views of doctors and patients

About 60% of GPs, the people who do not regulate and do not sell medicine but who actually prescribe it and are medical professionals, favour the legalisation of cannabis for medicinal use. A 2018 study published in the Irish Journal of Medical Science showed that 88.54% of patients also agree that cannabis should be legalised for chronic pain medicinal purposes and that they view it as a reasonable pain management option.

Meanwhile…at least 17 countries permit the medicinal use of cannabis, while others plan to do so, soon. Here are a few:

In December 2013, Uruguay made history when it became the first country to legalise cannabis

Doctors will be able to prescribe medicinal cannabis by the autumn of 2018 according to the British Home Office.

Cannabis will be legal as of October 17, 2018. The Cannabis Act creates a strict legal framework for controlling the production, distribution, sale and possession of cannabis across Canada. The Act aims to accomplish 3 goals:

  • keep cannabis out of the hands of youth
  • keep profits out of the hands of criminals
  • protect public health and safety by allowing adults access to safe, legal cannabis

On March 29 2017, the Argentine senate approved the use of Cannabidiol for medical reasons.


The Australian government legalised growing cannabis for medical and scientific reasons on 24 February 2016. Medical cannabis can now be prescribed in all Australian states.

As of January 1, 2018, GPs in Denmark have been able to prescribe medical cannabis to certain patients as part of a four-year trial.

The country decriminalised cannabis in 1953, and has famously allowed the sale of the plant for recreational uses in so-called “coffee shops” since 1976.

In 2016, the country legalised cannabis for medical uses.

Portugal’s parliament overwhelmingly approved a bill in 2018 to legalize marijuana-based medicines

Marijuana is legal for medical purposes in 30 states

Thailand’s Governmental Pharmaceuticall Organisation (GPO) has begun researching how to develop medicines from marijuana in acknowledgement of evidence that the outlawed substance has health-enhancing properties, according to a September, 2018 report in The Nation (Thailand). It is also seeking to initiate a legal amendment that would permit cannabis for medicinal use, possibly by May next year.

It’s the responsibility of legislators to enact laws that benefit society as a whole. It’s time they did just that for the hundreds of thousands of people who need medicinal cannabis to treat illness or relieve pain. Patients are suffering enough without being treated like criminals.
It’s time to decriminalise medicinal cannabis use.

For more information please see Cannabinoids page on this site.

Sources include:
– Cannabis: The Evidence for Medical Use (Prof. Michael Barnes)
Report on Scrutiny of the Cannabis for Medicinal Use Regulation Bill 2016
Health Research Board
Cannabis for Medical Use – A Scientific Review (Health Products regulatory Authority)
Attitudes of Irish patients with chronic pain towards medicinal cannabis.
Rochford, Ciaran and Edgeworth, Deidre and Hashim, Mohammad and Harmon, Dominic (2018) Attitudes of Irish patients with chronic pain towards medicinal cannabis. Irish Journal of Medical Science , Early online .

Proton Beam Therapy in Ireland

Proton Beam Therapy in Ireland

CANCER sufferers will be given greater access to a pioneering treatment as a leading centre looks to expand in Ireland. 

Proton beam therapy, which uses positively-charged particles to destroy cancerous cells, is not currently available in the country. 

But specialists from the Proton Therapy Center in Prague, Czech Republic say they hope to “bridge the gap” in cancer care by setting up a new network of proton therapy pioneers.

Medical director Dr Jiri Kubes says specialists will be looking to share their experiences of proton therapy with local professionals and make access to the technology smoother. 

At the moment, cancer patients looking to explore their proton therapy options face travelling to Europe or the US. 

Dr Kubes said: “The general public is becoming increasingly aware of the benefits of proton therapy, and we are seeing a growing number of patients from Ireland enquiring about what proton therapy can do for them. 

“Most of the enquiries are from patients with prostate cancer who are looking for treatments which preserve bowel and sexual functions.”

Traditional treatment options for prostate cancer – the most common male cancer in Irish men – can often lead to erectile dysfunction and urinary incontinence. 

Unlike traditional radiotherapy using X-rays, proton therapy can pin-point the precise area to target, preserving healthy tissue surrounding the tumour while reducing toxicities and minimising harmful side-effects. 

Dr Kubes added: “In the last four years, since the centre opened, we have achieved excellent results and are excited to be able to share our knowledge so that patients in Ireland can directly benefit and proton therapy will become more readily accessible.”

John O’Kelly, 68, from Limerick, was diagnosed with prostate cancer two years ago after experiencing a sudden and frequent need to visit the bathroom. 

John was advised to ‘watch and wait’ to see how his cancer progressed. 

But frustrated with advice and determined to carry on living life to the full, John travelled to the Proton Therapy Center for treatment.

John said: “I wasn’t happy. I just thought ‘This isn’t me’, I’m not used to sitting and doing nothing.

“I thought it was only going to go one way, and by then I might have no option but to have fairly aggressive treatments, which I did not want to do.

“I had already read about how surgery could leave you with incontinence.”

John was treated with five hyper fractions over a two-week period, going in for treatment every other day.

He said: “They were reassuring and very professional and put me at ease from the word go.”

John says he’s now cancer-free and has no regrets about seeking healthcare elsewhere. 

For further info please visit Proton Therapy Ireland

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New Study Delivers Another Black Eye for Chemotherapy.

New Study Delivers Another Black Eye for Chemotherapy
Article Source:
Saturday, July 8th 2017 at 3:45 pm

Written By:Jefferey Jaxen

chemotherapy spreads cancer







What if chemotherapy actually helped to spread cancer? Many within the medical and research communities are becoming emboldened to speak out against outdated and failed healing modalities still in use today.

UK Headlines were made in 2015 when a study in the British Journal of Cancer was published claiming 1 in 2 women and 1 in 3 men will develop cancer at some point in their lives. Two years later on June 20, 2017, a report titled Canadian Cancer Statistics 2017 released by the Canadian Cancer Society stated for males, the lifetime cancer risk is 49% and for females it is 45%.

Another study showing the dangers and ineffectiveness of chemotherapy has just been published and it has gone viral. The study titled Neoadjuvant chemotherapy induces breast cancer metastasis through a TMEM-mediated mechanism was published in the journal Science Translational Medicine describing how chemotherapy could allow cancer to spread, and trigger more aggressive tumors. By studying the process of intravasation, or entry of cells into the vasculature, the study’s authors discovered that chemotherapy, in addition to targeting tumor cells, can also increase intravasation. The authors found that chemotherapy increased groups of cells known as tumor microenvironment of metastasis (TMEM) which collectively usher tumor cells into the body’s vasculature. The study discovered that several types of chemotherapy can increase the amounts of TMEM complexes and circulating tumor cells in the bloodstream. Why is this important? The chances of survival dramatically decrease once cancer begins to metastasize through the bloodstream and effect other organs and systems.

Is the recent study the only one painting chemotherapy as a dangerous treatment option? In 2016 a groundbreaking study was commissioned by Public Health England and published in the journal Lancet Oncology. The study represented the first time that national data has been gathered together and analyzed for 30-day mortality after chemotherapy. It found that a larger proportion of patients are actually dying after chemotherapy than in the clinical trials carried out by the drug companies. The death rate in the clinical trials of drug treatments for lung cancer was 0.8%, but in the present study the reality shows it is actually 3%.

What happens when the extended survival rate of chemotherapy as a cancer treatment is studied beyond 30 days? An Australian study published in the journal Clinical Oncology found the contribution of cytotoxic chemotherapy to 5-year survival in adult malignancies in adults was estimated to be 2.3% in Australia and 2.1% in the US. In fact, the study concluded by stating:

To justify the continued funding and availability of drugs used in cytotoxic chemotherapy, a rigorous evaluation of the cost-effectiveness and impact on quality of life is urgently required.

By now, many are beginning to understand that one of the problems with chemotherapy is that it doesn’t address the underlying cause(s) of cancer. Chemotherapy originated from an idea and consciousness that was far from idealistic. The whole generation of chemotherapeutic drugs that are being used today, and there are over one hundred of them, developed from poisonous nerve gas created for warfare. As reported in 2012 by Green Med Info, cancer is the second leading cause of death in the developed world, and yet much of the medical and research communities are still in the dark ages when it comes to treating and understanding it. However, in the age of information, great strides are being made by doctors and researchers who are going against the grain of the failed convention ‘wisdom’ in cancer treatment. In addition, individuals are beginning to take responsibility by educating themselves. GreenMedInfo has been at the forefront with the world’s most widely referenced, evidence-based natural medical resource database containing over 30,000 abstracts and articles.

© [Article Date] GreenMedInfo LLC. This work is reproduced and distributed with the permission of GreenMedInfo LLC. Want to learn more from GreenMedInfo? Sign up for the newsletter here


Proof that cancer patients’ increases in survival is not ‘because of better drugs’

Proof that cancer patients’ increases in survival is not ‘because of better drugs’

Source: CancerActive

Colorectal cancer patients who improve their diet and lifestyle survive longer with a 42 per cent reduced risk of death than those who do not make the changes.

The results, from an American Cancer Society study(1) presented at the 2017 Annual Meeting of the American Society of Clinical Oncology showed survival extension and ‘cure’ way beyond that provided by chemotherapy and even the new breed of ‘better’ drugs, belittling claims frequently made by Pharmaceutical companies.

The American Cancer Society produced a booklet in 2012 entitled ‘Nutrition and Physical Activity Guidelines for Cancer Survivors’. This research was an attempt to see if the guidelines did actually make a difference!

The study followed almost 1000 former patients for more than 7 years. Those who stuck most closely to the guidelines, had a staggering 31 per cent less recurrence and 42 per cent lowered death rate! 

Realising the enormity of the results, the researchers were quick to point out that ‘This does not mean cancer patients should give up on the drug treatments simply for a healthier life style of exercise and nutrition’’.

Ref (1): Van Blarigan E, Fuchs CS, Niedzwiecki D, et al.