The adage “you can’t judge a book by its cover,” is true, but authors still need to be aware of the importance of first impressions. The title of science writer Travis Christofferson’s book Tripping Over the Truth: The Return of the Metabolic Theory of Cancer Illuminates a New and Hopeful Path to Cure says to a book browser that, for some reason, the science and oncology community has clumsily missed a golden opportunity in cancer research and treatment, and Tripping Over the Truth offers the “theory” that should have be pursued. One glaring problem with the title is that truth is absolute, whereas theory is subjective.

The title’s oxymoronic edginess should attract hard-core readers steeped in alternative and complementary medicine. However, that crowd might be disappointed if they expect a polemic against mainstream oncology, conspiracy theories, and a roadmap to the exotica of cancer cures and holistic remedies. Instead, the book opens by taking the reader on an exciting 100-year scientific journey, which, in the end, boldly challenges our current understanding and treatment of cancer. And although this book is written in a punchy, lay person–friendly format, it is a well-researched book with enough fact-based science and theoretical explorations to make it a worthwhile read for open-minded oncologists willing to give a pass to the book’s shortcomings.

For instance, in the introduction, Mr. Christofferson tells readers that his book is the result of his journey to discover why cures for cancer have remained so elusive. “There is no shortage of ideas…. Some suggest that because of the collective failure of academia, government, and industry, a culture has developed that discourages risk taking and encourages narrow thinking,” writes the author. “I’ve tried to look for the answer to this question in a place others haven’t—one protected by an invisible dome of dogma, large-scale group think, and institutional inertia.”

Of course, this collective blame game is nothing new, and, in part, there’s merit to ponder why we have made such sluggish progress in the fight against cancer. But the sector most frustrated by the clinical realities of cancer is the oncology community, probably the most introspective of all medical specialties.

Showcasing Giants in the Field

In chapter one, the author presents a clear-headed history of cancer research and treatment, beginning with Rudolf Virchow, MD, considered the father of modern pathology, and moving elegantly into a discussion of the fascinating origin of chemotherapy. Readers of The ASCO Post will be familiar with the names and deeds of the oncologists showcased in the succeeding chapters: Drs. Farber, DeVita, Frei, Freireich, Holland, and so on—all giants in the field.

To his credit, Mr. Christofferson does a nice job weaving history, science, and the human experience into a compelling read. However, although these chapters will certainly entertain and enlighten science-eager lay readers, most will be old hat for The ASCO Post readership.

Worthy Sections

The author’s thesis is based largely on the work of Nobel Laureate Otto Heinrich Warburg, who examined the practical consequences of the anaerobiosis of cancer cells, resulting in the Warburg Theory of Cancer. Dr. Warburg’s central postulate is that the driver of tumorigenesis is an insufficient cellular respiration caused by an insult to the mitochondria. Once the author sinks his teeth into this area of inquiry, the book begins to take shape, giving the reader a thought-provoking ride for about 60 pages, before bogging down in unnecessary polemics about diet and cancer. Sure, diet is a vital component of prevention, but it comes across as filler, especially when he strays into highly speculative territory.

Dr. Warburg’s theory is worth the read. We know the relationship of oxygen and tumor tissue. Human solid tumors are invariably less well oxygenated than the normal tissues from which they arose, and this so-called hypoxia leads to resistance to radiotherapy and chemotherapy as well as predisposition for increased metastases.

Tripping Over the Truth has flaws, but the sections about the Warburg Theory and mitochondria as well as the scientists behind those postulates make up for other shortcomings.

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And the author’s segue into mitochondria is riveting, given his talent for taking a complex subject, breaking down its constituent parts, and then rebuilding those parts back into a whole. In this section, he also delves into Herceptin (trastuzumab) and Gleevec (imatinib), two of cancer's major drug advances. The inspirational imatinib saga, although well chronicled, is also worth a read; the author brings the drama to life.

From Dr. Watson to Dr. Vogelstein

What would a book about cancer and scientific figures be without a mention of James Watson, PhD? According to the author, Dr. Watson was an early believer in the Warburg Theory of metabolism. In a correspondence, Dr. Watson wrote: “While targeted combination chemotherapies would be a big step forward, I fear we still do not yet have in hand the ‘miracle drugs’ that acting alone would stop most metastatic cancer cells in their tracks…. We may have to turn our main focus away from decoding genetic instructions behind cancer and toward understanding the chemical reaction (metabolism) with cancer cells.”

From Dr. Watson, the author moves into Dr. Bert Vogelstein’s laboratory at Johns Hopkins. Dr. Vogelstein argues that most recurrent drivers in most major cancer types have now been discovered. The parts list is more or less complete, and the opportunity for discovering major new cancer genes is ‘plateauing.’ We therefore need to move onto new opportunities, including more detailed cancer pathway analysis, earlier diagnostics, and better cancer prevention.

Culling the Content for Gems

When Mr. Christofferson takes off his muckraker’s hat, his book gains momentum and value. Tripping Over the Truth has flaws, but the sections about the Warburg Theory and mitochondria as well as the scientists behind those postulates make up for other shortcomings. This book is suggested for The ASCO Post readers who have the patience to cull the content, picking out the gems. ■