Peto’s Paradox, Blue Whales, and Patient Education

Gene S Lysko, Medical Writer  


Very few people need to know that the evolution of multicellularity requires the suppression of cancer. Yet, that cancer can be suppressed or prevented would certainly interest many.

The basis for the belief that cancer can be prevented is established in a mouse study conducted by Peto et al in 1975, who found a direct, non-age-related correlation between the length of exposure to carcinogens and the risk of cancer (Br J Cancer. 1975;32:411-426). Their findings have yielded what is today known as Peto’s Paradox, which Roche et al describe succinctly as “the absence of a correlation across species between cancer and body size or longevity” (BMC Cancer. 2012;12:387).

So what’s that have to do with patient education?

Peto’s Paradox is a concept that explains the very existence of blue whales. Yup. Blue whales. Read on; there’s a connection.

Cancer occurs as mutations accumulate in somatic cells, which are any of the body’s cells excluding the reproductive or “germ” cells. Because each proliferating cell is at risk for malignant transformation, organisms with many cells (a greater chance of tumor initiation) and/or long lifetimes (a greater chance to accumulate more mutations), should have an unusually high probability of developing cancer.

This is the hypothesis of equivalent carcinogenic risk among mammalian cells. The hypothesis predicts that everything else being equal, blues whales have virtually no chance of living a cancer-free life. But many blue whales appear to do just that. Or, with greater certainty, we can say that cancer hasn’t caused the extinction of the blue whale.

Although no patient needs to understand or even be aware of the concept of Peto’s Paradox to be informed about his or her condition, especially outside of oncology, the ability to make the seemingly incomprehensible understandable (think mitochondrial disease or chromosome translocations) is vitally important. Patients who understand their disease, the impact of their lifestyle, the importance of their treatments, and the role that they play in their own care tend to do well. We know this is especially true when it comes to chronic asymptomatic conditions, hypertension being a good example.

Make the complicated simple

It’s safe to assume that most patients are completely unaware of the most basic anatomical vernacular and even more ignorant of medicine in general and pharmacotherapy, specifically. Patients, more often than not, need a Great Explainer, such as Isaac Asimov (1920-1992).

Asimov is renowned for presenting scientific concepts in an entertaining and enlightening way. He grounded each topic in historical background, distilling questions down to their simplest foundation and defining and explaining terms by revealing their origin, how they may have changed with time, and with pronunciation guides.

Here’s where taking a page from Asimov’s book to popularize science by clearly simplifying complex concepts helps patients. Neither patients nor their caregivers can make informed decisions if they don’t understand their condition or its treatment or how critical their role is in their own care. A key element of patient education is to provide patients with the knowledge that will empower them to participate as an important member of the healthcare team. Patient education can help patients appreciate the importance of following directions, solving problems, and preventing or minimizing avoidable complications, and it can teach them the skills needed to handle these tasks successfully.

Patients need clear, actionable, relevant, and engaging (CARE™*) education to understand the increasing complexities of disease and its treatment. It’s an art form. Artcraft Health can help.

*Learn more about our CARE™ principles at