Respectful Insolence

Be afraid. Be very, very afraid. After a prolonged wait, it’s finally here:

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Yes, my promotional copy of Suzanne Somers new book Knockout: Interviews with Doctors Who Are Curing Cancer–And How to Prevent Getting It in the First Place. (The Dalek was included because, well, I was just feeling perverse when I took this picture.)

I can only say that, after having perused the next couple of chapters after Chapter 1, I can already feel my brain melting and oozing out through my ears, screaming as the neuron-necrosing stupidity liquifies it. I’ve also noticed that, by and large, this book is written in grade school level language with short chapters. This observation has led me to change my original plan, which was to blog this book chapter by chapter as I read it. Instead, I think I’ll probably break the book up into chunks of 2-3 chapters at a time, with the exception of certain quacks whom she interviews, at least a couple of whom will deserve their own taste of not-so-Respectful Insolence. In the meantime, while my brain is recovering from the first onslaught, it occurs to me in retrospect that my first couple of posts on this book were rather haphazard because I didn’t immediately realize that I could read the whole first chapter on the Random House website. Later, I found other aspects of Somers’ story of her “whole body cancer” misdiagnosis. So I decided that I would take the first three posts I did, cobble them together, Frankenstein monster-style, add some more commentary, and make this post the “official” first installment of my project of blogging Somers’ Knockout. I apologize if you’re annoyed because you’ve seen parts of this before, both here and elsewhere, but I think it’s important to start this project in a more informed, coherent fashion that I did. I also hope that there are enough changes and rearrangements that you will find this worth reading. Later this week will come the next installment, which will be all new; that is, if my brain survives.

If there’s one thing I’ve become utterly disgusted with in the time since I first became interested in science-based medicine as a concept, its promotion, and the refutation of quackery and medical pseudoscience, it’s empty-brained celebrities with an agenda. Be it from imbibing the atmosphere within the bubble of woo-friendly southern California or taking a crash course at the University of Google and, through the arrogance of ignorance, concluding that they know more than scientists who have devoted their lives to studying a problem, celebrities believing in and credulously promoting pseudoscience present a special problem because of the oversized soapboxes they command. Examples abound. There’s Bill Maher promoting anti-vaccine pseudoscience, germ theory denialism, and cancer quackery on his show Real Time with Bill Maher and getting the Richard Dawkins Award from the Atheist Alliance International in spite of his antiscience stances on vaccines and what he sneeringly calls “Western medicine.” Then there are, of course, the current public faces of the anti-vaccine movement, Jenny McCarthy and her boyfriend Jim Carrey, the former of whom thinks it’s just hunky dory (or at least doesn’t appear to be the least bit troubled) that her efforts are contributing to the return of vaccine-preventable infectious diseases because she apparently thinks that’s what it will take to make the pharmaceutical companies change their “shit” product (her words), and the latter of whom spreads conspiracy theories about vaccines and contempt on people suffering from restless leg syndrome. Finally, there’s the grand macher of celebrity woo promotion, Oprah Winfrey, who routinely promotes all manner of medical pseudoscience, be it “bioidentical” hormones, the myth that vaccines cause autism (even hiring Jenny McCarthy to do a blog and develop a talk show for her company Harpo Productions), or other nonsense, such as Christiane Northrup urging Oprah viewers to focus their qi to their vaginas for better sex.

Unfortunately, last week the latest celebrity know-nothing to promote health misinformation released a brand new book and has been all over the airwaves, including The Today Show, Larry King Live, and elsewhere promoting it. Yes, I’m talking about Suzanne Somers, formerly known for her testimonial of having “rejected chemotherapy and tamoxifen” for her breast cancer, as well as her promotion of “bioidentical hormones,” various exercise devices such as the Thighmaster and all manner of supplements. Her book is entitled Knockout: Interviews with Doctors Who Are Curing Cancer–And How to Prevent Getting It in the First Place. It is described on the Random House website thusly:

In Knockout, Suzanne Somers interviews doctors who are successfully using the most innovative cancer treatments–treatments that build up the body rather than tear it down. Somers herself has stared cancer in the face, and a decade later she has conquered her fear and has emerged confident with the path she’s chosen.

Now she shares her personal choices and outlines an array of options from doctors across the country:

EFFECTIVE ALTERNATIVE TREATMENTS

  • without chemotherapy
  • without radiation
  • sometimes, even without surgery

INTEGRATIVE PROTOCOLS

  • combining standard treatments with therapies that build up the immune system

METHODS FOR MANAGING CANCER

  • outlining ways to truly live with the diease

Since prevention is the best course, Somers’ experts provide nutrition, lifestyle, and dietary supplementation options to help protect you from getting the disease in the first place. Whichever path you choose, Knockout is a must-have resource to navigate the life-and-death world of cancer and increase your odds of survival. After reading stunning testimonials from inspirational survivors using alternative treatments, you’ll be left with a feeling of empowerment and something every person who is touched by this disease needs…HOPE.

I first found out about Somers’ book about a month and a half ago and was fortunate enough (I think) that one of my readers who had a review copy of the book sent me a chapter list. The reason I wanted a chapter list was because I was really curious just who these doctors were whom Somers had interviewed. In particular, back then I predicted (and hoped) that one of the doctors would be one whom we’ve met before. It was. Can you guess which one? Think about it. What major study did I blog about in the middle of September? I’ll tell you:

Dr. Nicholas Gonzalez. He’s the second featured doctor who is “curing cancer,” right there in Somers’ book in Chapter 6!

That’s right, one of these doctors who are “curing cancer” is a quack (in my opinion, of course) whose “protocol,” which includes 150 supplement pills a day topped off by a couple of coffee enemas per day, was recently shown to be worse than useless for pancreatic cancer and, indeed, based on a recent study, far worse than conventional treatment.

From my perspective, it was incredibly bad timing and bad luck on Somers’s part to have one of the subjects she lionized in your book to have his protocol shown to be not just worthless, but likely actively harmful, a mere two months before the release of her book. In case there are any journalists who might be interviewing Somers and are interested in more than a puff piece that lets her promote her book, I list a whole bunch of posts that have discussed the rank pseudoscience that is the Gonzalez protocol because, as many of you have figured out, I’m never satisfied with a hammer to smack down a form of woo when going nuclear is so much more fun:

Sadly, this bad timing appears to have had no effect whatsoever on the publicity blitz of an actress who every day tries to live down to the character she played on Three’s Company back in the 1970s or on the questions asked of her by interviewers. Somers has been all over the media this week, and I’ve seen nary a challenging question stronger than pointing out that some of the doctors featured in Somers’ book have gotten in trouble with their state medical boards, much less a much deserved question about Nicholas Gonzalez. Instead we’ve thus far been treated to cliched, credulous headlines like Suzanne Somers questions chemo in new book, Somers’ New Target: Conventional Cancer Treatment, or Suzanne Somers works to ‘Knockout’ cancer. The article circulating about her book on the AP wire begins:

Less than a year after the former sitcom actress frustrated mainstream doctors (and cheered some fans) by touting bioidentical hormones on “The Oprah Winfrey Show,” she’s back with a new book. This one’s on an even more emotional topic: Cancer treatment. Specifically, she argues against what she sees as the vast and often pointless use of chemotherapy.

Somers, who has rejected chemo herself, seems to relish the fight.

Let’s get one thing straight here. It is most definitely not, as implied by various articles about Somers, in any way amazing that Somers is still alive after having “rejected chemotherapy.” As I explained at the dawn of this blog, Somers had an early stage, estrogen receptor-positive [ER(+)] tumor with a favorable prognosis. If Somers is going to play the gambit of repeating, “I rejected chemotherapy and tamoxifen and I’m still alive” and attributing her survival to the alternative medicine woo she chose instead, perhaps now is the time to go into more detail than I’ve ever gone into before about her case. Well, not quite. I did go into quite a bit of detail in my talk at the Science-Based Medicine Conference at TAM7 in July. After all, I did the research; so I might as well get some more use out of it and spread it beyond the 150 or so people who heard my talk.

Prelude by flashback: Suzanne Somers’ breast cancer

In preparation for my talk at TAM7, I searched for all the information I could find that was publicly available about Suzanne Somers’ diagnosis of breast cancer back in 2000. For your edification, I’ve also uploaded the slides from my presentation relevant to Suzanne Somers’ breast cancer diagnosis as a PDF file. Suffice it to say, there is a great deal of misunderstanding of breast cancer in Somers’ testimonial. In this case, I don’t actually blame Somers all that much for her misunderstanding, because it is a very common misunderstanding that clearly derives from a misunderstanding of the difference between using chemotherapy for primary treatment of cancer versus adjuvant treatment of cancer. In early stage breast cancer, which can be surgically removed for cure, chemotherapy and radiation therapy are in general used as additional therapies that decrease the risk of recurrence of the cancer after surgery. That’s what adjuvant therapy is, extra therapy that improves a patient’s odds of surviving after a primary treatment. In the case of early stage breast cancer, the primary treatment is surgery.

From what I can find from publicly available information on the Internet (I’ve never read one of Suzanne Somers’ books), at age 54 Somers was diagnosed with a breast cancer that was treated by lumpectomy (excision of the “lump” or tumor) and a sentinel lymph node (SLN) biopsy, the latter of which was negative for tumor cells in the SLN, plus radiation therapy. For those not familiar with the SLN procedure, it is a procedure that developed in the 1990s to determine whether a woman’s breast cancer has spread to the axillary lymph nodes (the lymph nodes under the arm) without actually removing all of the axillary lymph nodes. Before the advent of SLN biopsy, the standard of care was to do an axillary dissection (removal of all the lymph nodes under the arm) on the side of the tumor in order to determine if and how many of the lymph nodes are positive for cancer. This is critical information, because the single most powerful prognostic indicator for potentially curable breast cancer (i.e., breast cancer that has not spread beyond the axillary lymph nodes to the rest of the body, such as bone, liver, or lung) is the presence of metastases in the axillary lymph nodes and, if they are present, how many. Unfortunately, as less invasive means of treating breast cancer were developed, such as lumpectomy, the part of the operation that carried the most morbidity was the axillary dissection. Consequently, as science-based physicians are wont to do, during the 1990s surgeons tried to find a way to get the same information (are the lymph nodes positive or negative) with a less morbid procedure and thus reserve axillary dissection only for patients who do have lymph nodes with breast cancer metastases in them.

Thus, the SLN biopsy was developed as a strategy to decrease the possibility of the most feared complication of axillary dissection, lymphedema, and still get the necessary information regarding lymph node positivity or negativity. Basically, an SLN biopsy is preformed by injecting both a radioactive dye and a blue dye (usually Lymphazurin Blue) into the breast. The dyes are then taken up in the lymphatics and head towards the axilla, where they lodge in one or more lymph nodes. This is (these are) the sentinel lymph node(s). The concept behind the procedure is that the sentinel node is the first lymph node a tumor cell that broke off from the tumor and got into the lymphatics will “see” and lodge in. In other words, the dye mimics the pathway that tumor cells take to metastasize to the axillary lymph nodes. If the sentinel node is negative, it’s an accurate indication that the rest of the lymph nodes are negative, and in general no further surgery is needed. Women are identified as node negative without removing all the axillary lymph nodes. Best of all, the risk of lymphedema from the procedure very, very small, far smaller than it is for axillary dissection (removing all the lymph nodes). Since the purpose of axillary dissection was far more diagnostic (to find out if the lymph nodes are contain tumor and, if so, how many), this is a good thing. On the other hand, if the SLN contains tumor, then axillary dissection is needed. In fact, far fewer women now undergo the procedure than in the past, and it is even coming under question whether a woman with a positive SLN truly needs a full axillary dissection.

Why do I mention this? Because I want readers to understand that Somers underwent, as far as I can tell, standard surgery for a favorable, estrogen receptor-positive stage I cancer. She also underwent radiation, although she has stated in the past and now states in Knockout that, if she had it all to do over again, she would not have opted for radiation. Be that as it may, she has been trumpeting proudly for a number of years that she rejected chemotherapy and tamoxifen and has done quite well. This claim, although true, says nothing about whether he decision to eschew those adjuvant therapies was a good one and even less about whether the woo she pursued after that had anything to do with her survival. As I described so long ago, however, surgical excision is curative for most small breast cancers. Radiation therapy reduces the risk of local recurrences (recurrences in the breast), and chemotherapy and antiestrogen therapy (like Tamoxifen) reduce the risk of systemic recurrences (recurrences elsewhere in the body). In other words, chemotherapy and radiation are “icing on the cake” after surgery. Indeed, there is a website known as AdjuvantOnline.com that allows physicians to calculate the estimated risk of recurrence and the estimated benefit of chemotherapy and, if appropriate, antiestrogen therapy. Given when Somers had her cancer diagnosed (2000) and because I know that she had a stage I tumor, i entered data for her assuming a tumor between 1-2 cm in size, mainly because most tumors under 1 cm would not warrant adjuvant chemotherapy. Here is a blowup of the key slide from my talk where I showed the results I got when I entered the known information about Suzanne Somers’ tumor into AdjuvantOnline:

Somers2a

(Click for a larger image.)

As you can see, based on what I know from publicly available sources (please correct me if there is information that I have missed about Somers’ stage at diagnosis), Somers had an 88.6% chance of living 10 years without any chemotherapy or Tamoxifen. Chemotherapy provides a survival advantage of 2.5%; tamoxifen, 2.5%; and combination therapy, 4.1%. In other words, eschewing chemotherapy and tamoxifen increased Suzanne Somers’ odds of dying of her cancer within 10 years by around 4%, not a huge number. As I’ve explained before, although the benefit of chemotherapy and tamoxifen for early stage breast cancer is around 30% on a relative basis, but it’s only around 4% or 5% on an absolute basis. You may think that’s not very much, but, I assure you, the vast majority of women are willing to undergo chemotherapy and hormonal therapy for that extra insurance. Indeed, I would point out that surveys I have seen have revealed that a majority of women would still opt for chemotherapy even if it provided only a 1% absolute survival benefit. Moreover, for more advanced tumors, that relative benefit generally stays around 30% or so, meaning that, as the risk of dying from cancer goes up, the absolute benefit of adjuvant chemotherapy goes up as well. Be that as it may, I’ve laid out this information to point out that testimonials like Somers’ are not particularly impressive if you know something about breast cancer. I also mention it to point out that, even though it’s a bad idea for Somers to be pumping herself full of “bioidentical hormones,” the favorable nature of her tumor means that she can get away with it. Even if it increased her risk of recurrence by 10 or 20%, the odds of survival would still be overwhelmingly in her favor, adjuvant chemotherapy and tamoxifen or not, thanks to her friendly neighborhood surgeon. So when you see a passage like this about Somers, remember what I’ve just told you:

Diagnosed with breast cancer a decade ago, she had a lumpectomy and radiation, but declined chemotherapy, as she did more recently when briefly misdiagnosed with pervasive cancer.

As I said before, Somers’ misunderstanding of the role of adjuvant therapy in breast cancer is somewhat understandable. It is a concept that can be difficult to communicate this to patients under the best of circumstances, and the absolute benefit of chemotherapy in treating a stage I ER(+) cancer is relatively small. Moreover, treatment paradigms change with new scientific evidence. Most women these days with a stage I ER(+) tumor would undergo Oncotype DX® testing, and the results of that testing would guide the decision of whether chemotherapy is recommended or not. Oncotype DX did not exist in 2000, and adjuvant chemotherapy was recommended for the vast majority of women with a stage I breast cancer with a tumor greater than 1 cm in diameter.

Somers’ second testimonial, however, is not as forgivable as the first, which is actually only somewhat forgivable, given how aggressively Somers has used her own testimonial to promote “alternative” medical treatments such as mistletoe extract (which may have some anti-tumor activity but the evidence is very weak–more on that perhaps in a future installment). It reveals such a profound ignorance of what she herself is recommending to women for their “health” that, as a breast cancer surgeon dedicated to providing only the best science-based surgical and medical care to my patients, I must call her out for it.

Knockout: Suzanne Somers’ “whole body cancer” scare

I do not yet have my promotional copy of Knockout, although, I’m assured, it’s on the way. I had debated whether to wait until I had read it to write about the book, but then last week I saw this interview with Ann Curry:

Visit msnbc.com for Breaking News, World News, and News about the Economy

It was also pointed out to me that Chapter 1 of Knockout is available online at the Random House website. It’s entitled A Cancer Story–Mine. I read it and was appalled at the degree of misinformation being discussed right there in the very first chapter of the book, so much so that I started to doubt whether it was such a good idea of me to get a copy of the whole book and do a review on it. Still, I’m made of fairly stern stuff, and Somers is out there promoting the hell out of this book; so I feel that it’s my duty to look critically at the story she begins her book with. Suffice it to say, after I read Chapter 1, I was left shaking my head that anyone would listen to Suzanne Somers about cancer or any other health issue, so deep is the ignorance and so strong the distrust of “Western medicine.” Somers starts out her book by describing a cancer scare. Specifically, she describes an incident in which she was brought to the hospital with what sounds like an anaphylactic reaction of some sort and was misdiagnosed with what she calls “full body cancer.”

Before I go on, let me say right here that I do not mean to denigrate or otherwise downplay the seriousness of what happened to Somers, nor do I mean to cast doubt on the veracity of her story. At the very least, Somers appears to believe what she is saying, and it is quite possible that she was misdiagnosed with widespread metastasis from her breast cancer. I also don’t want to under estimate how much it probably scared her. Imagine yourself having survived breast cancer and then, eight years later, being admitted to a hospital for something else and being told that you had widespread metastases. It’s a horrible thing, if it really happened the way Somers said it happened, and it’s the sort of experience that would terrify anyone.

Color me somewhat skeptical, however.

Certain elements of Somers’ story sound a bit fishy. First off, Somers declines to identify the hospital. Right at the outset, I wondered why that is and can guess at a couple of likely reasons. First, perhaps she’s worried about being sued. Of course, if you’re a celebrity and the truth is on your side you probably don’t have much worry about being sued. In such a case, it’s far more likely that the entity suing would get the worst of it, at least as far as negative publicity. More likely, Somers knows that, whatever hospital she had been admitted to and whatever doctors had cared for her, patient confidentiality and HIPAA law prevent the hospital and doctors from discussing her case–or even admitting that Somers was ever a patient. Indeed, neither the hospital nor any of the health care professionals involved with Somers care can discuss her case without her explicit permission. Their hands are completely tied, and Somers can write and say whatever she wants without fear that anyone will contradict her. That’s why it disturbs me that no one who has interviewed Somers yet has asked her a handful of very obvious–and inconvenient–questions based on the anecdote in Chapter 1, namely:

  • At what hospital were you hospitalized and when?
  • Who were your doctors?
  • Will you release some of your medical records and allow your doctors to speak about your hospitalization?
  • If not, why not?

These are questions that need be asked in addition to questions about Somers’ support for Nicholas Gonzalez, whose pancreatic cancer “protocol” was recently shown to be worse than useless, but I have yet to see anyone ask her these questions.

Now, on to Chapter 1:

I wake up. I can’t breathe. I am choking, being strangled to death; it feels like there are two hands around my neck squeezing tighter and tighter. My body is covered head to toe with welts and a horrible rash: the itching and burning is unbearable.

The rash is in my ears, in my nose, in my vagina, on the bottoms of my feet, everywhere — under my arms, my scalp, the back of my neck. Every single inch of my body is covered with welts except my face. I don’t know why. I struggle to the telephone and call one of the doctors I trust. I start to tell him what is happening, and he stops me: “You are in danger. Go to the hospital right now.” I knew it. I could feel that my breath was running out.

Right off the bat, to me Somers’ symptoms sound like an allergic reaction to something or an anaphylactic reaction. It could be something else (more later), but the first thing that comes to mind is an allergic reaction. Indeed, upon hearing this story, I couldn’t help but wonder if one of the many supplements that Somers takes on a routine basis was the cause. Did she start any new supplements recently? Certainly I’d wonder about that. (Again, more on that later; my speculation may well have been correct, just not in the way I thought at first.) Regardless of the initial cause, it certainly sounded as though the E.R. docs at whatever hospital Somers was brought to thought she was having some sort of allergic reaction. Based on that, they treated her appropriately with Benadryl, Albuterol, and steroids. Even someone as medically ignorant as Somers realized the most likely diagnosis:

I say to the doctor, “It seems to me that I’ve either been poisoned or am having some kind of serious allergic reaction to something. I mean, doesn’t that make sense? The rash, the strangling, the asphyxiation. Sounds classic, doesn’t it?”

“We don’t know. A CAT scan will tell us. I really recommend you do this,” the doctor says. “Next time you might not be so lucky — you might not get here in time. You were almost out.”

As I read this part of the story, I was puzzled, and certainly Somers didn’t initially give enough information for me to hazard a particularly educated guess about why her doctor ordered a CT scan. After all, a CT scan is not generally the test of choice for diagnosing the cause of anaphylaxis or respiratory distress, which is what it sure sounds as though Somers was being treated for. On the other hand, maybe doctors saw a mass on chest X-ray (quite likely, as we will soon see). They may also have suspected a pulmonary embolus (PE), for which chest CT has supplanted the older test previously to detect PE, namely the V-Q scan. There may have been other findings on physical examination that suggested that a CT scan might be indicated. (There almost certainly were.) Again, initially, at least, Somers doesn’t give us enough information to judge. She does, however, engage in typical pseudoscientific thinking. While acknowledging that those evil pharmaceuticals had saved her life, still she can’t help but attack them:

I am now dressed in a blue hospital gown, and so far I’ve been reinforced by three rounds of oxygen and albuterol. I’m starting to feel normal again. Drugs have been my lifesaver this time. This is what they are for. Knowing the toxicity of all chemical drugs, I’ve already started thinking about the supplement regime and detox treatments I’ll have when I get out of here, to get all the residue of pharmaceuticals out of me. I’m hopeful this will be the one and only time I have to resort to Western drugs.

Remember, whenever you hear an alt-med maven say “Western medicine” (shades of Bill Maher!), what that alt-med maven is really referring to is science-based medicine. As for supplements, if they have anything in them that does anything physiological, they contain “chemical drugs.” There is no difference between “chemical drugs” found in pharmaceuticals and “chemical drugs” found in supplements, other than that the drugs found in supplements are adulterated with all sorts of stuff. There is no magical difference between the two. They both contain chemicals, and the body responds to chemicals through its biochemistry. Nothing makes supplements magically immune to the laws of physics and chemistry. Moreover, “detox” treatments are completely unnecessary quackery. Somers apparently doesn’t realize it, but her body is more than capable of “detoxing” away those evil “Western” pharmaceuticals through its own amazing abilities. Somers appears to think that “Western” pharmaceuticals somehow leave their taint behind. Maybe she thinks the cells in her body have a “memory” in the same way that homeopaths claim that water has “memory” and that the taint has to be somehow purged, just as a Catholic believes that confession purges sins or certain Muslim sects think that self-flagellation will purge them of their sins. It really is religious thinking more than anything else for Somers to think that she was somehow “contaminated” by “Western” pharmaceuticals and needed to have that “contamination” purged.

But I digress. So what did the CT scan find? This, apparently:

We have very bad news,” he continued. My heart started pounding, like it was jumping out of my chest. “You have a mass in your lung; it looks like the cancer has metastasized to your liver. We don’t know what is wrong with your liver, but it is so enlarged that it is filling your entire abdomen. You have so many tumors in your chest we can’t count them, and they all have masses in them, and you have a blood clot, and you have pneumonia. So we are going to check you into the hospital and start treating the blood clot because that will kill you first.”

We already know that Somers did not, in fact, have cancer. (Otherwise, it would not have been a misdiagnosis.) So what she did have, I’ll get to shortly. In the meantime, let’s take a look at what Somers says about her oncologist:

The oncologist comes into my room. He has the bedside manner of a moose: no compassion, no tenderness, no cautious approach. He sits in the chair with his arms folded defensively.

“You’ve got cancer. I just looked at your CAT scan and it’s everywhere,” he says matter-of-factly.

“Everywhere?” I ask, stunned. “Everywhere?”

“Everywhere,” he states, like he’s telling me he got tickets to the Lakers game. “Your lungs, your liver, tumors around your heart … I’ve never seen so much cancer.”

So the oncologist who saw Somers first was a world-class jerk. It’s quite possible. Not every doctor has a good bedside manner, and some have a horrendous bedside manner. Sadly, some of them are oncologists, even though, if there’s a specialty that really demands a good bedside manner, it’s that of medical oncologist. On the other hand, as physicians we have to remind ourselves all the time that what we think we have said to the patient is not always how the patient has heard it and how we come across to the patient is not always how we have, in fact, come across to the patient. Maybe the oncologist was that uncaring, maybe not. We have no way of knowing because all we have is Suzanne Somers’ report. Maybe it’s also true that the other oncologist who saw her was somewhat less of a jerk but just as quick to jump to a conclusion prematurely:

Then the lung cancer doctor enters the room. Maybe he has better news. But no–he says, “I just looked at your CAT scan, and you have lung cancer that has metastasized.” He is nicer, more thoughtful. “I mean, I’m going to think about this,” he says. “Maybe it’s something else, but this sure doesn’t look good. I’ll be back tomorrow.” Leslie takes out pen and paper and is making notes. She will continue to do this the entire week, writing down everything everyone is saying. Thank God, because when you are stunned and on medication, things get foggy.

Day one is almost over. The most shocking, devastating day of my life, our life! I know the facts: when you have lung cancer and it has metastasized to your liver, heart, abdomen, and all over your body, you have at most two months–maybe only two weeks or less.

As a possible bit of perspective, I’ll point out that not too long ago I had to relearn the lesson of how my perception of what I say to a patient may not always jibe with the patient’s perception of what I said. A while back, I saw a patient with breast cancer in her hospital room, a woman I had operated on the day before. I thought I had calmly laid out the situation, reassured her that her tumor was treatable, and told her that she might not need chemotherapy. About an hour later I got a frantic page from the floor. The patient was in tears, and the family was in an uproar. I don’t know how I had done it, but I had somehow given this patient the impression that her situation was hopeless and that she was going to die. When her family arrived to take her home she was crying. Apparently she had interpreted my telling her that she might not need chemotherapy (mainly because of her age and tumor characteristics) as telling her that it was pointless to treat her more. I relearned a valuable lesson that day, one I (and, I daresay, most doctors, no matter how experienced) need to relearn periodically, namely that patients don’t always interpret what I tell them the way I think they will and that sometimes how I view a conversation with a patient may be very different than how the patient viewed the conversation. Fortunately, I was able to reassure everyone and correct the misconceptions that had been left, but I did not feel too good about my bedside manner that day. In fact, the rest of that day I felt like the most insensitive, idiotic doctor in the world.

Or maybe Suzanne Somers’ oncologist was indeed a flaming jerk. That would be the worst case for “Western medicine” in this story, and it is not nearly as uncommon as I’d like to admit for a physician to have the personality of a paper cup or the bedside manner of bully. Besides, it’s easier to assume that that is how the oncologist in question treated Somers. Even so, in that case, I’d say, “So what?” I’m sorry that Somers’ oncologist treated her badly. There’s no excuse for that. I’d also tell her simply to go and get another oncologist or go back to her regular oncologist, which she ultimately did. One nasty doctor does not invalidate “Western medicine,” nor does the occurrence of a misdiagnosis, even one apparently this spectacular. In any case, it’s quite possible that there was a bit of Somers hearing things one way when her doctors weren’t telling it the way she interpreted them as telling her. The reason I say that is because Somers goes on and on, mainly in interviews but also in the book, about how, over six days, doctors told her she needed chemotherapy. As someone who has dealt with medical oncologists every day for over 10 years, that part of her story just didn’t seem very likely to me. The reason is that, in general, oncologists are very reluctant to administer chemotherapy to a patient in the absence of a definite tissue diagnosis proving that they have cancer, be it metastatic cancer or any cancer.

This would be doubly true in a case like what Somers describes in her book, particularly given that she had one oncologist thinking that she had lung cancer, not a recurrence of her breast cancer. In any case, widespread cancer could be a recurrence of her breast cancer (especially given Somers’ proclivity to pump herself full of “bioidentical hormones” after having been treated for an estrogen receptor-positive cancer), but in a 63-year-old woman, there are lots of other possible malignancies. Chemotherapy would be used for breast cancer might not work very well against, say, colon cancer or ovarian cancer, both of which are other likely possibilities in a woman of Somers’ age. Another reason I seriously question whether doctors were pushing hard for chemotherapy in a mere six days is because, if they truly thought she had such a massively widespread recurrence of her breast cancer, particularly an estrogen receptor-positive breast cancer, all treatment would be palliative. We can’t cure most metastatic solid tumors, and the first rule in treating stage IV disease is usually the classic “First, do no harm.” Thus, oncologists usually tend to do the minimum possible that it takes to relieve symptoms and (hopefully) slow the progression of the tumor. Most likely, if this was indeed metastatic breast cancer, an oncologist would have chosen to treat Somers first with an anti-estrogen drug, probably an aromatase inhibitor (no tamoxifen if she had blood clots causing that much trouble!) and then seen how she did. In the case of a woman who has ER(+) cancer recur as stage IV disease, that is almost always the first option. In such cases, chemotherapy is usually reserved for the case when antiestrogen therapy fails. Indeed, if the cancer was truly as widespread as Somers reports, chemotherapy might not even be used at all if the likelihood of success is tiny; in such cases, hospice would be recommended.

Be that as it may, the very first thing that any competent oncologist would demand before initiating chemotherapy is a tissue diagnosis, either from a needle biopsy or other tissue, to prove that there was cancer and to identify the type of cancer, so that the correct chemotherapy could chosen. Cancer chemotherapy is not like antibiotic therapy. In the case of infectious diseases, it is not uncommon to begin an antibiotic empirically based on the most likely organisms to be causing the infection and then to tailor the therapy to whatever organism(s) can be identified by cultures. Oncologists, on the other hand, are incredibly reluctant to treat metastatic cancer empirically, particularly cancer that appears to have recurred eight years after the original diagnosis of a stage I tumor. Such cancer might very well be a different cancer from a different organ, and the chance of doing harm with chemotherapy for no benefit is too great.

That’s why I thought right away that there’s something very fishy about Somers’ story. It just doesn’t add up very well. What I suspect to have happened is that perhaps the oncologist did have a conversation about a probable need for chemotherapy, and, like my conversation with my postoperative patient, Somers saw the conversation differently from how her doctors did. She probably viewed various “what if” scenarios or “if this is recurrent breast cancer, then you will need this” conversations as “pressuring” her to take chemotherapy. If her oncologist wasn’t particularly warm and fuzzy or patient, she might have been even more likely to interpret his recommendations that way. Or perhaps her oncologists were incompetent enough to pressure her to take chemotherapy without a diagnosis of biopsy-proven cancer. Who knows? Even if the latter is true, it still doesn’t excuse Somers’ horrible ignorance that becomes manifest later in the chapter.

Ultimately, Somers did get a biopsy. She describes it in her interview above, “They cut into my neck and went in and took a piece of my lung, a piece of one of the so-called tumors around my heart turned out it was not cancer at all.”

So what was it?

I’ll admit that my first guess, sarcoidosis, was dead wrong. Given the symptoms of skin lesions, shortness of breath, and, apparently, “tumors around the heart” (which could indicate either pericardial involvement, or, more likely enlargement of the paratracheal nodes), I didn’t think it too unreasonable a first guess. (Besides, in the cases in House, MD, sarcoidosis almost always appears on the differential diagnosis list.) However, never having lived in the southwest, having forgotten my medical school learning about common fungal infections, and being what I self-deprecatingly like to call a dumb surgeon, I didn’t consider what turned out to be the real diagnosis right away, namely valley fever, or, as it’s known by its official name, coccidioidomycosis. Indeed, the description of the most severe disseminated form of coccidioidomycosis matches Somers’ presentation quite well:

The most serious form of the disease, disseminated coccidioidomycosis occurs when the infection spreads (disseminates) beyond the lungs to other parts of the body. Most often these parts include the skin, bones, liver, brain, heart, and the membranes that protect the brain and spinal cord (meninges).

The signs and symptoms of disseminated disease depend on which parts of your body are affected and may include:

  • Nodules, ulcers and skin lesions that are more serious than the rash that sometimes occurs with other forms of the disease
  • Painful lesions in the skull, spine or other bones
  • Painful, swollen joints, especially in the knees or ankles
  • Meningitis — an infection of the membranes and fluid surrounding the brain and spinal cord and the most deadly complication of valley fever

Now here’s the kicker. Take a look at these two (out of several) risk factors for the most severe form of coccidioidomycosis:

  • Weakened immune system. Anyone with a weakened immune system is at increased risk of serious complications, including disseminated disease. This includes people living with AIDS or those being treated with steroids, chemotherapy or anti-rejection drugs after transplant surgery. People with cancer and Hodgkin’s disease also have an increased risk.
  • Age. Older adults are more likely to develop valley fever than younger people are. This may be because their immune systems are less robust or because they have other medical conditions that affect their overall health.

These are risk factors for the serious disseminated coccidioidomycosis. Most people who contract coccidioidomycosis are either asymptomatic or exhibit relatively mild symptoms. Indeed, valley fever often presents as a flu-like illness from which people recover rapidly. Many people, in fact, are unaware that they’ve ever had coccidioidomycosis until there’s either an abnormality on chest X-ray done for another reason or they have a positive skin or blood test. It’s very much like histoplasmosis right here in the Midwest. So why did Somers get such a serious case? It’s a legitimate question, given how she represents her regimen of supplements, bioidentical hormones, and various other woo as a highly effective path to rejuvenation and health that she recommends to her readers. Let’s see. Somers is 63, but apparently in good health. She also takes all sorts of supplements which, or so she claims, “strengthen the immune system.” But her immune system was obviously not strong enough to prevent her from getting disseminated coccidioidomycosis. Why didn’t all those supplements ward off the fungus? For someone who takes handfuls of supplement pills every day and makes millions of dollars selling woo to “boost the immune system,” Somers sure doesn’t appear to have a particularly strong immune system, as it failed miserably to protect her from a severe infection due to an endemic fungus that usually causes only mild disease or any symptoms at all but almost killed her.

Another possibility presents itself. As we know from her previous books and appearances on The Oprah Winfrey Show, Somers takes boatloads of “bioidentical” hormones. She promotes them as a fountain of youth for women. One wonders if any of her various supplements or bioidentical hormones were somehow adulterated with corticosteroids, which suppressed her immune system, one does. Or at least I do.

One need wonder no more. Right there, in Chapter 1 of her book, is a highly plausible, highly likely explanation for why Somers became as ill as she did from coccidioidomycosis:

Day 5. Dr. Oncologist comes into my room. Now, you would think he’d say, “Well, sometimes it’s good to be wrong.” Or “Isn’t it great that you don’t have cancer?” But no. He walks in, doesn’t sit down, just looks at me and says angrily, “Well, you should have told me you were on steroids.”

I am flabbergasted. I don’t know what to say to him; I am so stunned by his lack of compassion that I just stare at him. I am not on steroids. I would never take steroids. But because he is stuck in old thinking and so out of touch with new medicine, he has no clue and doesn’t understand cortisol replacement as part of the menopausal experience.

I don’t know where to begin with him. He’s too arrogant to listen to a “stupid actress,” anyway. So much of his attitude with me has been the unsaid but definite “So you think all your ‘alternatives’ are going to help you now, missy?”

Why steroids would have anything to do with being misdiagnosed with full-body cancer, I can’t guess. But we still don’t know what has gone wrong in my body. We still have to find out what caused me to end up in the ER.

(Emphasis mine.)

It’s incredibly hard at this point not to go even beyond Mark Crislip-grade acid sarcasm at the arrogance of ignorance on display. Here we have a woman who is apparently taking cortisol as part of her “bioidentical hormone” cocktail, and this woman does not know that each and every one of those estrogens she is taking is a steroid hormone. More importantly, Somers apparently does not know that cortisol is a corticosteroid (“cortico,” get it?), the very same kind of steroid that is routinely used by us evil reductionist practitioners of “Western medicine” as an anti-inflammatory and immunsuppressant. When used that way by us evil pharma shills, cortisol is known as hydrocortisone, which is–gasp!–a pharmaceutical concoction! It’s also “bioidentical,” too, proving once more that “bioidentical” does not mean “risk-free.” Indeed, hydrocortisone is often included as one of the drugs in immunusuppressive protocols used to prevent the rejection of organ transplants. Given that Somers has said that she takes enough “bioidentical” estrogens to recreate the hormonal milieu of a woman in her 20s (in other words, far more estrogens than a 63 year old woman would ever have or need), it’s not beyond the pale to wonder whether she similarly takes a significant dose of hydrocortisone (sorry, cortisol) as part of her brew of “bioidenticals,” particularly in light of her having fallen seriously ill due to an organism that usually causes mild disease in immunocompetent hosts. Yes, valley fever can sometimes be a bad disease in immunocompetent hosts, but being immunocompromised for whatever reason is still a significant risk factor for disseminated disease or the reactivation of quiescent disease.

After reading Somers’ story in Chapter 1, I shook my head in disbelief that Random House apparently didn’t have better editors who could have told Somers that she had just written something incredibly contradictory and just plain dumb when she wrote that didn’t take steroids in the context of writing how she castigated her oncologist for “not understanding” the role of cortisol in her menopause treatments. Also, based on Somers’ (or her ghostwriters’) own words in Chapter 1 of her book, I think I have discovered the most likely explanation for Somers’ contracting disseminated coccidioidomycosis. True, it could be that she was just unlucky and getting old, given that age is indeed a risk factor for disseminated disease, but one can’t ignore all the supplements she was taking. One can’t ignore that Somers was apparently taking cortisol as part of the cocktail of “bioidentical hormones” to recapture her youth. It is thus very reasonable to wonder whether the reason that Somers became so ill last year was because she had been chronically dosing herself with cortisol and suppressing her very own immune system. Worse, Somers doesn’t even understand that cortisol is a steroid and an immunosuppressant and therefore can’t accept or admit that this is a possibility. Indeed, that misunderstanding is leading her to view her misdiagnosis as clear evidence supporting her worldview that “Western medicine” is hopelessly flawed, chemotherapy rarely works, and the “alternative” medicine doctors whom she interviews can actually cure cancers that “Western” medicine cannot. Even worse still, Somers is successful enough to be able to parlay her suspicion into a highly lucrative career, and her promotion of dubious, unproven, and even ineffective medical treatments for cancer may well result in cancer patients who might be saved eschewing science-based medicine and endangering their lives. At least, that is what I fear.

A panoply of unproven treatments and what’s to come

As I said before, I plan on looking at Knockout and writing a more formal review once I get my copy to read. That’s why this post is labeled “Part 1.” However, so incensed was I at the rank pseudoscience and dangerous misinformation being promoted relentlessly over the past week by a woman who is apparently utterly ignorant of what a steroid hormone is or that steroids are immunusuppressive that I decided to do this post now, while Somers’ media blitz is still at its height. I concluded that an antidote to Somers’ promotion of nonsense such as the Gonzalez protocol needed to be provided in clear, concrete, unequivocal terms was needed now, that someone needed to express his opinion now that pseudoscience such as the Gonzalez protocol is quackery, particularly given the limp, woo-friendly response of Dr. Otis Brawley, chief medical officer for the American Cancer Society. His article, Somers’ cancer advice is risky, appeared on CNN.com. In it Dr. Brawley practically bent over backwards to be conciliatory, calling Somers a “wonderful actress” (she’s not and never has been), writing that he is “not critical of the concept of alternative and complementary medicine” (I am) and that “open-mindedness to other ideas is how we advance conventional medicine” (apparently his mind is so open that his brains threaten to fall out), even going so far as to invoke the hoary old alt-med examples of aspirin being derived from tree bark or vincristine being derived from a plant as though pharmacognosy were the same thing as herbalism. It’s not. Moreover, I wanted to provide a handy-dandy resource for journalists who may be interviewing Somers or people who may be seeing her at book signings or promotional events, hoping against hope that skeptics will ask her why she doesn’t think a steroid like cortisol wouldn’t predisopose her to disseminated coccidioidomycosis or why she thinks that Dr. Gonzalez is “curing cancer” when a clinical trial was published a mere two months before her book was released that showing clearly that his protocol is worse than useless and that pancreatic cancer patients undergoing conventional therapy live three times longer than those undergoing the Gonzalez protocol.

A guy can hope, can’t he?

In the meantime, here’s a chapter list, which will give you an idea of what you have to look forward to when I get around to reading the book:

The Doctors Who Are Curing Cancer
Chapter 5: Stanislaw Burzynski, MD
Chapter 6: Nicholas Gonzalez, MD
Chapter 7: Burton Goldberg
Chapter 8: Julie Taguchi, MD
Chapter 9: James Forsythe, MD

Preventing Cancer Before it Starts
Chapter 10: Russell Blaylock, MD
Chapter 11: Steve Haltiwanger, MD
Chapter 12: David Schmidt
Chapter 13: Jonathan Wright, M.D.
Chapter 14: Steven Sinatra, M.D., F.A.C.C., F.A.C.N.
Chapter 15: Michael Galitzer
Chapter 16: Cristiana Paul, M.S.

Most names I actually don’t know, but some names stand out, such as Dr. Burzynski, whom we haven’t yet discussed much on this blog but should (reviewing this book will give me just that opportunity), and Dr. Blaylock, who is best known for videos like this about H1N1:

I’ll spare you parts 2 and 3 of Dr Blaylock’s video. You get the idea, and if you are masochistic enough top want to view them, you can easily find them on YouTube. Suffice it to say, showing up on Alex Jones’ Prison Planet TV is not exactly a way to burnish one’s scientific credentials. Jones’ websites, Infowars and Prison Planet, are repositories of conspiracy craziness on par with David Icke’s lizard people, including 9/11 Truthers, “New World Order” conspiracy theorists (including, of course, the Illuminati and the Rothschilds), and a heaping helping of anti-vaccine and alt-med conspiracy mongering. In fact, Dr. Blaylock isn’t too far from David Icke’s rant about how the swine flu vaccine is a plot by the Illuminati.

Such are Suzanne Somers’ “doctors who are curing cancer.”

The bottom line is that, whatever her intentions, whether they be to help people or make money or both, Somers is unwittingly promoting dangerous cancer “cures” that are anything but cures. They are treatments that are anything but science-based, as well. Just as Jenny McCarthy, Jim Carrey, and Bill Maher are promoting anti-vaccine pseudoscience to the nation and Oprah Winfrey is providing an unmatchable soapbox for all manner of promoters of woo, Somers is taking advantage of her position to bash conventional medicine and promote non-science-based medicine, most likely raking in the cash hand over fist.

People may well die as a result.

NOTE: Part 2 will arrive sometime this week. Be afraid. Be very, very afraid.

Comments

  1. #1 DLC
    November 3, 2009

    Yes, Cancer is a tool of (ominous music) The Man!
    And these Brave Maverick Doctors™ are the only ones fighting The Man, and his Evil Western Medicine.
    I dunno, I always thought of Western Medicine as being
    what the character “Doc” Adams performed on TV’s “Gunsmoke.”

  2. #2 tam
    November 3, 2009

    Holy cow, huge post, even by your standards! I can’t wait for the chapter by chapter analysis. I rather like the feeling of being gobsmacked in the morning!

  3. #3 TGAP Dad
    November 3, 2009

    Judging by her appearance (a Joan Rivers trajectory), she’s a regular at the plastic surgeon’s office. I’m guessing she uses a *real* surgeon, not a psychic, ayurvedic, maori, herbalist, homeopath, or chiropractor.

    I LOVE the Dalek perched on top of the book, though.

  4. #4 SteveF
    November 3, 2009

    Thanks for your efforts Orac.

  5. #5 JohnV
    November 3, 2009

    How on earth did you manage to get a promotional copy? :P

  6. #6 DrWonderful
    November 3, 2009

    Is it true that 2,000 i.u.’s of Vit D per day provide as much protection against the flu as the vaccine?

  7. #7 Mike Barnes
    November 3, 2009

    Hey, for those after harder stuff than even Somers’ book, I just followed your link to David Icke’s site (near the bottom of Orac’s great post).

    I don’t think I’ve EVER read anything so mad. Ever. Ever.

  8. #8 Adam_Y
    November 3, 2009

    Give Otis Brawley some slack. He actually slammed Sommers with this sledge hammer of a quote:

    “I am very afraid that people are going to listen to her message and follow what she says and be harmed by it,” says Dr. Otis Brawley, the organization’s chief medical officer. “We use current treatments because they’ve been proven to prolong life. They’ve gone through a logical, scientific method of evaluation. I don’t know if Suzanne Somers even knows there IS a logical, scientific method.”

    I wonder why is is capitalized.
    http://www.google.com/hostednews/ap/article/ALeqM5hA60E_ueyggHVwotNK3YsFCyUIyQD9BEFOO00

  9. #9 Chris
    November 3, 2009

    “Dr”Wonderful:

    Is it true that 2,000 i.u.’s of Vit D per day provide as much protection against the flu as the vaccine?

    No!

  10. #10 James Sweet
    November 3, 2009

    Hearing your analysis about the relative benefit of chemo and tamoxifen in case like (your estimate of) Somers’, I think there is yet another tragedy about this whole mess: Somers could have used her first account to spark a discussion about the limitations of what SBM can tell you, and about the importance of a public understanding of SBM.

    SBM can tell us with great precision how your odds change when exploring various treatment options, but SBM can’t possibly tell a person whether a 4% improvement in survival rate is “worth it” in comparison to aggressive adjuvant treatment.

    In this case, 4% is actually a pretty big number when you are talking about LIFE or DEATH, but I think there are other cases that are much murkier, and I rarely get the feeling that the doctors I have encountered are that interested in presenting the full costs and benefits to patients — nor do I get the feeling most patients would understand what the hell the doc was talking about.

    As a personal example… a few months ago, I asked my doctor to up the dosage on a medication I was on. I had already looked into it a bit (the University of Google is not entirely useless!) and was aware of what the maximum recommended was, and, more relevant to this story, I also knew that moving from the standard dose to the maximum recommended dose increased the probability of a seizure side-effect manifesting itself to about 0.25% (I can’t recall what the relative increase in risk was).

    Since in this case the possible side-effect was unlikely to be fatal (unless I was driving at the time!) I decided that it was worth the small risk in order to try the increased dosage. I of course discussed it with my wife first, and we agreed it was worth it, because we thought increasing the dosage could have a significant effect on both my quality of life and, indirectly, hers. For a different person, with different symptoms and different reactions to the standard dosage, though, it very well might not have been worth the increased risk of seizure.

    When I asked my doctor, he just looked up on his computer and saw what the max recommended dosage was and said okay, let’s try it. When I mentioned the increase risk of seizures, he had not heard of that. I can’t really blame him that much (who can be up to date on the obscure side effects of every single medication?) but I think it illustrates what I’m getting at here:

    In a perfect world, patients would be presented with full information on the risks and benefits of their various treatment options, allowing each person to make a judgment call based on how they personally value those risks and benefits — something which legitimately varies from person to person.

    There are all sorts of practical barriers to making this a reality… but if Somers was a completely different person, she could have used her celebrity to start a conversation about this. She could have started to teach people that treatment options are not always cut-and-dry. She could have used her account to help teach people about SBM, and its capabilities and limitations.

    It’s not just that she is doing a bad thing; she missed an opportunity to do a good thing. Shame on her.

  11. #11 attack_laurel
    November 3, 2009

    Awwww, little Dalek! Awesome!

    Excellent synopsis. I really can only think at this stage that Somers is wilfully ignorant of the “bio-identical” hormones she’s taking. As long as it’s touted as “natural”, she closes her mind and stomps her foot and insists it’s not anything like that nasty (effective) “Western Medicine. Her altie “specialists” must be making a fortune off her.

    This also makes me think that if I take Ibuprofen and repackage it as a “natural headache cure!” I can make a fortune at the Farmer’s Market. Sure, it’s illegal, but at least it’ll work.

    I think that’s enough scare quotes for one comment.

  12. #12 Militant Agnostic
    November 3, 2009

    Thanks to the David Icke link, I now know why the American H1N1 vaccine is different from the Canadian H1N1 vaccine – It is all part of our secret plot to depopulate and invade the US under the auspices of the UN. Bow down before your future overloads Eh.

  13. #13 marcia
    November 3, 2009

    “Speaking of cancer treatments, is your oncologist concerned that you take estrogen after having been diagnosed with breast cancer?

    He told me I could die, but here I am eight years later doing just fine. I declined chemotherapy and the drug tamoxifen, which cuts off estrogen, and am sticking with bioidentical hormones. [Somers says that she did recently have a hysterectomy after experiencing uterine bleeding and severe hyperplasia.] Obviously, every woman has to make her own individual choices when it comes to breast cancer treatments, and I just felt that my choices were the best shot I had at survival.”

    http://www.baltimoresun.com/health/women/sns-health-suzanne-somers-hormones,0,6985339.story

    Severe hyperplasia, Suz? Do you really know what that means? All that estrogen gives you the best shot at survival?

    So she believes in ‘natural’ treatments:

    -Menopause is unnatural – false
    -Adding estrogen (a growth factor)to an older body, a body, more likely to grow cancers than a younger body is natural – false

    She’s got it completely backwards.

    This actress, this, this poet, yes poet, needs to be mocked and ridiculed so her 20 year-old mind inside her hormone-overdosed 60 year old body can’t do too much more damage.

    Kick it, Kristen:
    http://www.youtube.com/watch?v=unD2bzhDkLk

  14. #14 Phoenix Woman
    November 3, 2009

    So, a synopsis that was as short as possible while still remaining medically accurate might look like this:

    “Suzanne Somers was diagnosed with Stage 1 breast cancer in 2000; publicly-released data indicates her tumor was in all likelihood smaller than 2 cm. The primary treatment for Stage 1 breast cancer, in 2000 and now, is surgery, with chemo and other treatments recommended but not considered essential; the ten-year survival rate for purely surgical treatment is 88%. Somers chooses instead to credit her long-term survival to woo, and in the course of doing so is doing a dangerous disservice to other breast cancer patients.”

  15. #15 Uncle Dave
    November 3, 2009

    Such an extenisive review leaves me wondering if I should just read the book (likely only a few words less reading). However, that would mean contributing to the Suzanne Somers Self absorbed Celebrity Sleezbag Fund. This is along the lines of driving by an automobile accident and telling yourself not to look but you look anyway. I refuse to look in this instance.

    Sorry for the aside, but Dr. Russell Blaylock is not related to deceased Dr. Alfred Blaylock the heart surgeon is he? There appears to be some sites that spell Blaylock with a Y rather then Blalock.

    Forgive me if this was addressed already somewhere else.

  16. #16 JohnV
    November 3, 2009

    @militant agnostic

    Sorry to spoil your nefarious plans, but I just watched the entire V miniseries on syfy this weekend. I am now well versed in biological warfare against reptile overlords. Of course, where I’m going to find giant worm-like E. coli to infect you with, I don’t know. But I’ll figure something out.

  17. #17 Todd W.
    November 3, 2009

    @JohnV

    Sorry to spoil your nefarious plans, but I just watched the entire V miniseries on syfy this weekend. I am now well versed in biological warfare against reptile overlords. Of course, where I’m going to find giant worm-like E. coli to infect you with, I don’t know. But I’ll figure something out.

    Ah, but have you seen the updated version, based on the latest science that is to begin tonight at 8pm/7 central on CBS? In the couple decades since the original miniseries, I expect more information has come out about how to deal with invading lizard people, and giant, worm-like E. coli may not be effective, after all. We will see…

  18. #18 Bronze Dog
    November 3, 2009

    Slightly off-topic, but still in the cancer ballpark.

    There’s a post I’ve been meaning to type up for a while. It’s mostly going to be sort of ranty opinion, but I’m sure all my friends here could provide handy links to shore up the concept.

    “Cancer Quackery and Fear”: The idea I’d like to express is that cancer quackery lives on because the quacks have kept alive the idea that “cancer is incurable” aided by the somewhat understandable (but still bad) media non-response to actual advancements in cancer treatment: It’s my perception that real doctors have been slowly pushing up the survival rates, but not in massive master strokes that make for an exciting news article. In the absence of these master strokes, quacks fill the silence with promises of magical breakthroughs.

  19. #19 D. C. Sessions
    November 3, 2009

    In a perfect world, patients would be presented with full information on the risks and benefits of their various treatment options, allowing each person to make a judgment call based on how they personally value those risks and benefits — something which legitimately varies from person to person.

    And in the imperfect world we live in, it’s a great idea to get to know your organic mechanics well enough that they can point you to information with some expectation that you’ll make good use of it — and are willing to discuss it with you at the level you’ve shown you can handle.

    Then there’s Ms. Somers. I don’t know of any pre-K books or websites on the subject of estrogen-sensitive tumors, corticosteroids, immunosuppression, etc.

    Although — I wonder whether she was having her daily hormonal cocktails smuggled into the hospital or whether she went through cortisone withdrawal while there. That last can be nasty (speaking as the parent of a child who spent too much time on Prednisone as a kid.)

  20. #20 sharky
    November 3, 2009

    Orac:

    This year, for probably the second time in my life, I got the flu shot. My getting it inspired another person I know to get it. We’ll be getting the swine flu vaccine when we can.

    I was never an antivaxer and come from a long line of people with common sense. But I wouldn’t have gotten it if I didn’t read this blog so often, just saved the money and taken my chances.

    I know you’re trying to reach people who might be threatened by cancer and finished off by bad advice, not healthy people who don’t have the flu shot. But your voice is heard and if you’ve motivated me, you’ve made a difference for others.

    I hope that thought took a little pressure off you as you argue the book. Can’t do a thing for the stupid you have to wade through, sorry.

  21. #21 #1 Dinosaur
    November 3, 2009

    Great post, as always. I’ve taken the liberty of condensing the part about the “total body cancer” into a post less than one-tenth the length HERE, although I do link back here liberally. Here’s my bottom line summary of Suzanne Somers, though:

    Dumbass.

  22. #22 antipodean
    November 3, 2009

    Orac.

    It’s clearly all part of the Dalek’s master plan to “EXTERMINATE!” us with alternative medicine pushing plastic surgery addicts.

    Turns out they were really pissed at us when we invented stairs and totally fucked up their invasion plans.

  23. #23 LovleAnjel
    November 3, 2009

    @militant agnostic and JohnV

    Don’t you know, biological warfare will not work? It is nothing without precocious two-year hybrids and prete-nama!

  24. #24 LovleAnjel
    November 3, 2009

    @antipodean

    Stairs no longer foil the Daleks, for they can “ELEVATE!”.

  25. #25 Rae
    November 3, 2009

    “It’s clearly all part of the Dalek’s master plan to “EXTERMINATE!” us with alternative medicine pushing plastic surgery addicts.

    Turns out they were really pissed at us when we invented stairs and totally fucked up their invasion plans.”

    Dude- don’t you watch the new Who series? Daleks can fly now!

  26. #26 Angie
    November 3, 2009

    I’m just snickering at the doctor in the second video clip who keeps talking about “floor-eye-ded” (flouridated) water. It’s almost as painful as a president going on about “nuke-you-lar” weapons.

  27. #27 Dan Weber
    November 3, 2009

    If you put Suzanne Somers’ book in a bomb, and threw it at your neighbor’s house for letting his dog poop on your lawn, it would explode and release energy.

  28. #28 T. Bruce McNeely
    November 3, 2009

    He walks in, doesn’t sit down, just looks at me and says angrily, “Well, you should have told me you were on steroids.”

    I’ll stick my neck out and suggest that the reason the doctor spoke “angrily” was that he probably asked her “Are you taking any drugs or supplements or other agents?” when she was admitted, and Somers neglected to tell him about the bioidentical hormones, including cortisone. If this is in fact what happened, that little admission would probably have sent her doctors on a wild goose chase for a few days. I’d be very surprised if she wasn’t asked, because that is a standard question on both medical and nursing admission histories.

    Here’s an idea if you want to check out this book-o’-crap without contributing to Somers’ Mission of Death:
    Go to CostCo or wherever else you see it sold, stand in front of the display, and read it while you rest it on the remaining stack of books. Not only will you get to read it for free, but you will prevent other shoppers from looking at it while you stand there. If you really want to be effective, don’t bathe or wash your clothes for a few days.

  29. #29 Uncle Dave
    November 3, 2009

    This is the same speech general Jack T Ripper gave in his discussion with Major Mandrake (Peter Sellers)in the picture Dr Strangelove.

    http://video.google.com/videosearch?hl=en&source=hp&q=youtube+dr+strangelove&um=1&ie=UTF-8&ei=Sb_wSsnhLM3g8QbwpIz-CA&sa=X&oi=video_result_group&ct=title&resnum=1&ved=0CBAQqwQwAA#

  30. #30 ER Doc
    November 3, 2009

    Out of curiosity, did Somers ever get the Coccidiodomycosis treated?

  31. #31 superdave
    November 3, 2009

    this post was epic, and is worth a long slow careful read

  32. #32 Mike Kocan
    November 4, 2009

    Looking at the picture on the cover I would say it is a fair bet she has had lip enhancement injections. Presumably she does not regard Hyaluronic Acid as one of modern societies toxins.

  33. #33 Mike Kocan
    November 4, 2009

    Oops, that should be “society’s”, sorry

  34. #34 maxh
    November 4, 2009

    Presumably she does not regard Hyaluronic Acid as one of modern societies toxins.

    Well HA is naturally found in joint fluid, and using her twisted logic then as long as it does occur naturally, there is nothing unatural with sticking it into her lips.

    *headdesk*

  35. #35 Rob
    November 4, 2009

    Orac, that’s a long post. Have I got the general sequence of events approximately correct below?
    [1] Suzanne Somers weakened her immune system by taking steroid drugs.
    [2] She then contracted a disease which is dangerous in immunosuppressed people.
    [3] The doctors initially have problems diagnosing the illness, possibly in part because they didn’t realise she was immunosuppressed (“An additional risk is that health care providers who are unfamiliar with it or are unaware that the patient has been exposed to it may misdiagnose it as cancer…”).
    [4] The doctors successfully treat the disease, quite possibly saving her life.
    [5] She says they’re insensitive bastards because they correctly identified that she was taking steroids.

  36. #36 Reader #666
    November 4, 2009

    Let me just say that I am no conspiracy theorist, and I certainly agree that S. Somers is a maladroit. And from what I’ve read of her book and all of these links and fraudulent doctors’ scribblings, I can’t say I disagree with Orac on the stupidity of the whole thing…

    However, I would assume right off the bat that major pharma companies are out for money, not cures. Why not? Why would they want to shut down their main income by eliminating diseases? Why not create more income? I just don’t understand why people seem to think that everyone in the world is a fucking humanitarian! People want money, especially people who run major organizations.

    Isn’t that enough to make you at least consider that there may be other research taking place that doesn’t involve highly toxic chemicals? Do you really think that the AMA would allow that research to become public? Give me a break. That would be similar to McDonald’s releasing a statement that promoted a Mom and Pop burger joint.

  37. #37 Orac
    November 4, 2009

    Isn’t that enough to make you at least consider that there may be other research taking place that doesn’t involve highly toxic chemicals?

    Uh, cancer research “not involving toxic chemicals” is going on at my institution, funded by the NIH, and in my own lab. None of this is anything new. Real scientists have been trying to come up with less toxic treatments for cancer for decades.

    To alt-med mavens like Somers, “no toxic chemicals” is synonymous with woo, and indeed that is very, very true in her book.

    Do you really think that the AMA would allow that research to become public? Give me a break. That would be similar to McDonald’s releasing a statement that promoted a Mom and Pop burger joint.

    Actually, you seem delusional. I say that because you seem to labor under the delusion that the AMA has the power to prevent the results of such research from becoming public. Given the vastly diminished power of the AMA these days (less than 25% of physicians belong), the AMA can’t even keep Congress from cutting Medicare reimbursements reliably. So, yes, I do believe that the AMA would let such research become public, because it would have no choice. There would be nothing it could do about it.

    BTW, I don’t believe you when you say you aren’t a conspiracy theorist. You just spouted a whole heap o’ conspiracy mongering.

  38. #38 Dianne
    November 4, 2009

    I would assume right off the bat that major pharma companies are out for money, not cures. Why not? Why would they want to shut down their main income by eliminating diseases? Why not create more income?

    I agree with you about one thing: the pharma industry is not in it for your health. Pharma corporations, like any large corporation, are in it to make money. However, for the rest, I think one of your basic premises is wrong: you seem to think that there is only one pharma company out there. Or that all pharma companies cooperate. No. Not likely.

    Let’s take a hypothetical cure for a condition. Forget the cure for cancer: cancer isn’t one disease and it won’t have one cure. Let’s make a still overambitious hypothetical drug: a cure for breast cancer. Breast cancer isn’t one disease either, though…maybe, say, all estrogen receptor positive breast cancer. Let’s go further and say that it was a very effective cure which needed to be administered only once and took away the need for any other treatment. So, no need for surgery, chemotherapy, radiation or 5 year long anti-estrogen treatment. Would the pharma conspiracy be out to suppress it? Maybe, but individual pharma companies would be out to get their hands on it first! Sell that pill for $10,000 a dose and it’s still cheaper for the consumer and/or HMO than conventional treatment. They’ll love it, the patients will love it, the pharma company loves it! And the other pharma companies? Their only thought will be how fast they can get out a me-too drug which does the same thing but at a cost of a mere…$9900 a dose! Or with less nausea. Or with a prettier shaped pill. Or whatever advantage they can think up.

    You might argue that this sort of behavior is not in the long term interest of pharma companies and therefore they wouldn’t do it. Why make $10,000 with Hypotheticalene when you can make $50,000 with adriamycin, cytoxan, taxol, and arimidex? Even worse, suppose your drug cures high blood pressure, diabetes, high cholesterol or some other chronic treatable but not curable disease. Doesn’t that impact the long term earnings of the company?

    True, true, all true. Fortunately (in this case), people don’t usually consider the long term. Hypotheticalene would shoot the companies profits into the stratosphere in the next quarter and that’s all the average executive will look at. The long term profits…well, who cares what the company does after they retire, hmm? Consider the example of over fishing. It was completely against the long term interests of professional fishers yet they did it.

    So, no, I’m not in the least bit worried about drug companies suppressing the miracle cure. And the AMA? Yeah, right. They can’t even get health care reform passed, much less enact major conspiracies.

  39. #39 Michael Ralston
    November 4, 2009

    Dianne: One point.
    If some company came up with a pill that cured, diabetes, they would most likely increase their long-term profit by producing the pill! It’d be protected by patent for however many years, which means that for those years everyone with diabetes would buy the pill from that company, as opposed to buying their current treatment options from a whole host of companies.

  40. #40 Dianne
    November 4, 2009

    Michael: That I’m less sure of. Certainly DiabetesBeGone would be under patent, but if we were really that close to a simple cure for DM then most likely everyone would be that close, not just the company that came out with it first. So there’d be the “me too” drugs (think cimetidine, ranitidine, famotidine or all the statins or the ACE inhibitors) that would come out shortly after the first one did. But everyone would be racing to be first, not futzing around with trying to suppress the invention.

  41. #41 Andreas Johansson
    November 5, 2009

    Something I’v been wondering about these massive supplement regimens – why such huge numbers of pills? Why not smaller numbers of stronger pills? Or are these pills already as strong as they can be, meaning people like Somers take truly humongous amounts of vitamins etc?

  42. #42 H
    November 5, 2009

    Andreas: Vitamins and supplement pills are generally not made nearly as large/strong as they could be, for more convenience of incremental dose customization, ease of spreading out the desired quantity into more than one dose per day, and (in some cases) so that they don’t become large enough for some people to be averse to trying to swallow them. And they are often kept to one type of supplement per pill even though multiple ones could be combined into a single pill, to again allow more convenience of customization (you might want twice as much of supplement #1 and half as much of supplement #2, as what a combined pill chose to include).

  43. #43 Dianne
    November 5, 2009

    One final point for 666: There are a number of curable or preventable diseases out there. If pharma companies were so great at suppressing cures in favor of long term treatments, why do antibiotics (lots of them and more in development) exist? Or consider the polio vaccine. Why didn’t the makers of the iron lung suppress this preventative measure that nearly completely destroyed their business?

    There are perverse incentives in the health care business and drug companies do behave badly at times. But not to the extent or in the ways you’re proposing.

  44. #44 Andreas Johansson
    November 5, 2009

    @H: Thank you. Still seems there’d be considerable room for rationalization if one, like Gonzalez, prescribes hundreds of pills per day.

  45. #45 Michael Simpson
    November 5, 2009

    @666

    Others have disabused you of your rather amateur strawman arguments. I never get you conspiracy nutjobs. You complain that pharmaceutical companies are out to make money. Yet, if they did have a “cure” for cancer, you think they’re going to suppress, even though, if they did, they would make boatloads more money. So, if you’re going to accuse someone of evil behavior, please be consistent in that accusation.

    If a company is going to be economically evil for a little money, they’re going to be more evil for more money. At least that seems logical to me!

  46. #46 Karen
    December 9, 2009

    Somehow came across your blog – oh yeah, I was looking up the backward walking cheerleader.
    My 80-year-old mom was recently diagnosed with stage 3B colon cancer – had a resection and is starting chemotherapy.
    My sister read Suzanne Somer’s book and thought it had valid points and suggested some things to my mom – all of which the pharmacist and nurses shot down.
    Suzanne Somer’s book ticks me off everytime I see it (and it is everywhere, even in Canada) because I hate celebrity testimonials, especially, as you say, they purport to know things about which they have no idea. I imagine some breast cancer patients would feel a great relief in reading her book thinking they won’t have to have chemo. Sheesh, so dangerous.

  47. #47 Paul
    December 13, 2009

    Orac, fantastic post! Just a few comments from a cancer survivor who HAS undergone chemotherapy and supports it HUGELY. Regarding…

    1) The conspiracy theory raised in the comments (big pharma is suppressing the cure for cancer for financial gain): I love this one. If you believe this, you are both ignorant and incapable of rational thought. First, as already noted by other contributors to this discussion, there are umpteen different forms of cancer. Some – like mine, for instance – are curable or highly treatable. Others, not so much. There will never be, therefore, a one-size fits all solution to cancer that could be theoretically “held back” by the drug companies.

    Second, if there was such a conspiracy, you’d have to recognize just how many people would be complicit in it. Hundreds if not thousands of drug company employees, scientists and doctors (all who have sworn the Hippocratic oath) worldwide would have to make a decision on a daily basis to prolong the suffering of their patients, instead of ending it completely. That’s a bit hard to believe. Especially when you consider that statistics are showing close to 1 in 3 people will have to deal with one form of cancer or another in their lifetimes – this in essence meaning these people will at some point be withholding the treatment from family, friends, and loved ones.

    Riiiiiight.

    2) Somers’ “fishy” misdiagnosis and the prescribed chemotherapy regimen: As already noted, this story is so obviously bogus it stinks. No oncologist is going to prescribe chemotherapy as a treatment regimen before having a biopsy result because chemotherapy is not an effective treatment for certain cancers. And while chemotherapy may have been mentioned as a possible treatment, I would be extremely surprised if the oncologist did not quantify that statement with, “depending what the biopsy shows us.” In fact, I can guarantee the discussion never progressed beyond this stage.

    Listening to Somers, you’d think doctors walked out of a pharmacy with a bolus or a bottle of pills ominously labeled “chemotherapy.” Chemotherapy really means that your doctors will be treating your cancer with chemicals. Had the biopsy been performed and chemotherapy been the preferred mode of treatment, Somers would have been given information on the specific drugs which would be included in her protocol (mine, for instance, where Cisplatin, Etoposide, and Bleomycin). In the cancer center where I was treated, I was told by a pharmacist that no two patients had exactly the same treatment or drugs. Treatment, obviously, is entirely dependent on biopsy results, which once again emphasizes that Somers’ story is either an entire fabrication or a complete misunderstanding of what she was being told.

    At best, she’s a moron, at worst, she’s a real danger to people dealing with a cancer diagnosis.

    Additionally, she fails to recognize what can be accomplished by chemotherapy, and how many people – myself included – are alive because of it. As someone who had two choices – chemotherapy or a slow agonizing death – I find Somers’ heralded rejection of chemotherapy insulting and patronizing.

  48. #48 Paul
    December 13, 2009

    Orac, fantastic post! Just a few comments from a cancer survivor who HAS undergone chemotherapy and supports it HUGELY. Regarding…

    1) The conspiracy theory raised in the comments (big pharma is suppressing the cure for cancer for financial gain): I love this one. If you believe this, you are both ignorant and incapable of rational thought. First, as already noted by other contributors to this discussion, there are umpteen different forms of cancer. Some – like mine, for instance – are curable or highly treatable. Others, not so much. There will never be, therefore, a one-size fits all solution to cancer that could be theoretically “held back” by the drug companies.

    Second, if there was such a conspiracy, you’d have to recognize just how many people would be complicit in it. Hundreds if not thousands of drug company employees, scientists and doctors (all who have sworn the Hippocratic oath) worldwide would have to make a decision on a daily basis to prolong the suffering of their patients, instead of ending it completely. That’s a bit hard to believe. Especially when you consider that statistics are showing close to 1 in 3 people will have to deal with one form of cancer or another in their lifetimes – this in essence meaning these people will at some point be withholding the treatment from family, friends, and loved ones.

    Riiiiiight.

    2) Somers’ “fishy” misdiagnosis and the prescribed chemotherapy regimen: As already noted, this story is so obviously bogus it stinks. No oncologist is going to prescribe chemotherapy as a treatment regimen before having a biopsy result because chemotherapy is not an effective treatment for certain cancers. And while chemotherapy may have been mentioned as a possible treatment, I would be extremely surprised if the oncologist did not quantify that statement with, “depending what the biopsy shows us.” In fact, I can guarantee the discussion never progressed beyond this
    stage.

    Listening to Somers, you’d think doctors walked out of a pharmacy with a bolus or a bottle of pills ominously labeled “chemotherapy.” Chemotherapy really means that your doctors will be treating your cancer with chemicals. Had the biopsy been performed and chemotherapy been the preferred mode of treatment, Somers would have been given information on the specific drugs which would be included in her protocol (mine, for instance, where Cisplatin, Etoposide, and Bleomycin). In the cancer center where I was treated, I was told by a pharmacist that no two patients had exactly the same treatment or drugs. Treatment, obviously, is entirely dependent on biopsy results, which once again emphasizes that Somers’ story is either an entire fabrication or a complete misunderstanding of what she was being told.

    At best, she’s a moron, at worst, she’s a real danger to people dealing with a cancer diagnosis.

    Additionally, she fails to recognize what can be accomplished by chemotherapy, and how many people – myself included – are alive because of it. As someone who had two choices – chemotherapy or a slow agonizing death – I find Somers’ heralded rejection of chemotherapy insulting and patronizing.

  49. #49 Paul
    December 14, 2009

    Orac, fantastic post! Just a few comments from a cancer survivor who HAS undergone chemotherapy and supports it HUGELY. Regarding…

    1) The conspiracy theory raised in the comments (big pharma is suppressing the cure for cancer for financial gain): I love this one. If you believe this, you are both ignorant and incapable of rational thought. First, as already noted by other contributors to this discussion, there are umpteen different forms of cancer. Some – like mine, for instance – are curable or highly treatable. Others, not so much. There will never be, therefore, a one-size fits all solution to cancer that could be theoretically “held back” by the drug companies.

    Second, if there was such a conspiracy, you’d have to recognize just how many people would be complicit in it. Hundreds if not thousands of drug company employees, scientists and doctors (all who have sworn the Hippocratic oath) worldwide would have to make a decision on a daily basis to prolong the suffering of their patients, instead of ending it completely. That’s a bit hard to believe. Especially when you consider that statistics are showing close to 1 in 3 people will have to deal with one form of cancer or another in their lifetimes – this in essence meaning these people will at some point be withholding the treatment from family, friends, and loved ones.

    Riiiiiight.

    2) Somers’ “fishy” misdiagnosis and the prescribed chemotherapy regimen: As already noted, this story is so obviously bogus it stinks. No oncologist is going to prescribe chemotherapy as a treatment regimen before having a biopsy result because chemotherapy is not an effective treatment for certain cancers. And while chemotherapy may have been mentioned as a possible treatment, I would be extremely surprised if the oncologist did not quantify that statement with, “depending what the biopsy shows us.” In fact, I can guarantee the discussion never progressed beyond this
    stage.

    Listening to Somers, you’d think doctors walked out of a pharmacy with a bolus or a bottle of pills ominously labeled “chemotherapy.” Chemotherapy really means that your doctors will be treating your cancer with chemicals. Had the biopsy been performed and chemotherapy been the preferred mode of treatment, Somers would have been given information on the specific drugs which would be included in her protocol (mine, for instance, where Cisplatin, Etoposide, and Bleomycin). In the cancer center where I was treated, I was told by a pharmacist that no two patients had exactly the same treatment or drugs. Treatment, obviously, is entirely dependent on biopsy results, which once again emphasizes that Somers’ story is either an entire fabrication or a complete misunderstanding of what she was being told.

    At best, she’s a moron, at worst, she’s a real danger to people dealing with a cancer diagnosis.

    Additionally, she fails to recognize what can be accomplished by chemotherapy, and how many people – myself included – are alive because of it. As someone who had two choices – chemotherapy or a slow agonizing death – I find Somers’ heralded rejection of chemotherapy insulting (especially considering the severity of her diagnosis) and patronizing.

  50. #50 Susie
    December 31, 2009

    How much is Big Pharma paying you to write this crap?

  51. #51 Scott
    December 31, 2009

    Susie, you might want to take a bit of a look at:

    http://scienceblogs.com/insolence/2006/09/the_pharma_shill_gambit_1.php

  52. #52 Orac
    December 31, 2009

    Hah. I love it when a woo tries the pharma shill gambit on me. Cracks me up, it does!