I hate The Huffington Post. I really do.
Why, you ask, do I hate HuffPo so? I hate HuffPo so because of its history from the very beginning of its existence of promoting the vilest forms of anti-vaccine quackery and pseudoscience. It’s because, over the last couple of years, not content with being the one-stop-shop for all things antivax on the Internet, right up there with Whale.to, Mercola.com, and NaturalNews.com, HuffPo branched out very early into quantum quackery, courtesy of Deepak Chopra. Just search for “Huffington Post” and “Deepak Chopra” on this blog and you’ll discover how many times I’ve blogged about this over the last five years. Search all of ScienceBlogs using the same search terms, and you’ll see that I’m not alone in having castigated HuffPo for giving voice to Choprawoo and its assault on medicine, neuroscience, physics, astronomy, molecular biology, and evolution. I hate HuffPo so because over the last five years, it has continually sought out and explored new forms of woo, in particular, virtually every major form of quackery in existence. Examples include homeopathy, the Beck Protocol (which is a trifecta plus one of pure quackery including blood electrification, colloidal silver, magnetic pulsing, and ozonated water). I hate HuffPo so because, not content with its war on medical science and with trying to rival NaturalNews.com and Mercola.com, being the “mainstream” voice of the anti-vaccine movement, and promoting New Age pseudoscience and mumbo-jumbo as personified by Deepak Chopra, HuffPo started into other areas of pseudoscience, including Robert Lanza’s biocentrism and even intelligent design creationism, the latter example proving that even a liberal rag like HuffPo can’t resist pseudoscience, no matter how much associated with the religious right. Crank magnetism in action, indeed.
I especially hate HuffPo so for publishing posts like this one over the weekend, entitled One Woman’s Story: Saying No to Conventional Cancer Treatment. I hate it so because I view this to be exactly the sort of deceptive post that can lead a woman to forego effective therapy for breast cancer and die. Yes, HuffPo continues to be a potential killer with its promotion of quackery. When you, my readers, started sending me the link to this story on Sunday, it outraged me enough that I nearly put aside the grant I was working on in order to have a post ready by Monday. I even did a few searches and found out some things that were to form the basis of this post. Fortunately for my sanity (and the completion of a draft of my grant), I decided to wait a day before writing this.
Let’s take a look at HuffPo’s latest atrocity against medical science, shall we?
The post begins:
What would you do if you were diagnosed with breast cancer during your first pregnancy at the age of 27?
A few months ago I received a book in the mail with the inscription “This all began with you…”
“YOU DID WHAT?: Saying No to Conventional Cancer Treatment” is a book written by Hollie and Patrick Quinn about navigating through the shock and the fear of a breast cancer diagnosis at a very young age and during her pregnancy with their first child. It is the story of the many courageous and intelligent choices they made along the way. They said no to chemotherapy, radiation and hormones, the standard care of the day in the best oncology centers nationwide. They said YES to an evidence based Integrative Alternative Cancer Care model and are living well to tell their tale with two healthy children in tow!
Do you recognize this particular variety of “alt-med” cancer cure testimonial? This sort of thing goes way, way, back to the very beginning of this blog, where in one of my first posts ever (back in December 2004!) I took on a very similar form of cancer cure testimonial, using Suzanne Somers and Lorraine Day as examples. Since then, I’ve periodically revisited just this type of “testimonial” for “alternative” cancer cures, be it from Suzanne Somers or women like Kim Tinkham, although Hollie Quinn’s story is most like Suzanne Somers, as you will see.
Now, you may think I’m an utter cad for criticizing a woman with breast cancer, my being a breast cancer surgeon and all. A fair enough criticism–to a point. The reason such “testimonials” irritate me so is that I spend my clinical time trying to save women from death from breast cancer and my research time trying to think up better ways to prevent women from dying from breast cancer. Anything that interferes with that calling does not meet with a favorable response from me. So, while I can feel a lot of sympathy for what Ms. Quinn must have gone through being diagnosed with breast cancer at age 27 while pregnant with her first child (I’ve taken care of a few patients just like that, one of whom was actually a 26 year old and an illegal immigrant), while I can comprehend how she could misunderstand breast cancer biology so profoundly leading her to write the sorts of claims summarized in the HuffPo post by Dr. Chilkov and expounded upon in Quinn’s book, I can’t let them go unanswered, particularly Dr. Chilkov, who is a practitioner of traditional Chinese medicine:
Patrick and Hollie are two highly intelligent and well-educated people. Upon hearing the devastating diagnosis and the recommended toxic chemotherapy treatment, they decided to take a few months to systematically learn and understand the molecular biology of breast cancer and the cancer treatments recommended to them. They also researched alternative and natural cancer treatments thoroughly and rationally. I know. I watched them do it.
Hollie and Patrick decided to embark on an unconventional and alternative path. They chose to radically change their diet and lifestyle and to use botanical medicines and nutritional supplements and Chinese medicine (herbal medicine and acupuncture) in a very systematic and thoroughly researched manner. They sought the care and guidance of health care professionals experienced in this approach. They did not do this on their own. They were incredibly organized and disciplined. They fully understood the risks and benefits of their choices. Their eyes were wide open.
Needless to say, this took an enormous amount of courage, self-discipline and self-trust. This was not a New Age fantasy with rose-colored glasses or magical thinking. They took a very pragmatic approach. These two young parents with a newborn in their arms, made a very serious science-based study of ALL of their choices.
Actually, what the Quinns did was to make a choice that increased the odds of their new child becoming motherless. Yes, the choice was that stark, that misguided, and that potentially disastrous. That Ms. Quinn was fortunate not to suffer the consequences of her choice with it does not make it a good choice any more than surviving a car crash in which you didn’t wear your seatbelt made not wearing your seatbelt a good choice. It was a monumentally poor choice that Ms. Quinn has until now been fortunate enough not to pay for with her life. Dont’ get me wrong, though. I sincerely hope that Ms. Quinn never pays for her choice with her life. Her child deserves no less. Unfortunately, Ms. Quinn seems utterly oblivious to the fact that, even eight years later, she is not out of the woods yet. Breast cancer recurrences can occur as late as 10, 15, 20 years later or more, particularly for estrogen-responsive tumors such as the one hers appears to have been. That being said, even though I wish no evil on Hollie and hope that she lives a long and happy life to see her daughters grow up and possibly even produce grandchildren for her, I also can’t abide seeing videos promoting her book without investigating:
Whenever I see a video or testimonial like this, I ask: What is the history? So I did something very simple. I went to Amazon.com and looked at the book page for You Did What? Saying ‘No’ To Conventional Cancer Treatment. I then used Amazon’s “Search Inside This Book” feature and looked for terms like “surgery,” “lumpectomy,” and “lymph nodes.” Guess what I found out? Ms. Quinn had definitive curative surgery for her tumor! She underwent a partial mastectomy and sentinel lymph node biopsy. On p.25, it reads:
Less than two weeks later, Hollie had a lumpectomy, along with a sentinel lymph node biopsy, in order to start to gauge the spread of the cancer through her lymphatic system. It was the last conventional medicine we accepted, and, despite the relative success in “curing” cancer, even this intervention is one that Hollie now says she wouldn’t do if she had a chance to do it all over again.
In a comment on HuffPo, Hollie states:
I was diagnosed with a very aggressive Stage 2 breast cancer, which had begun to spread to my lymph nodes. I did undergo a lumpectomy and sentinel node biopsy before rejecting the rest of conventional treatments (chemo, radiation, and hormone therapy).
And, on p. 32 of her book:
For her part, Hollie now says that if she could do it all over again she wouldn’t have had her tumors removed surgically–the only conventional treatment she had–but would have enjoyed the empowering experience of watching traditional medical wisdom melt the lumps away.
And if Hollie had done that there would be a good chance that, eight years later, her daughter would be motherless, having not enjoyed the very un-empowering experience of the decline of her bodily functions. It’s also funny that Ms. Quinn’s surgery was mentioned neither in her promotional video nor by Dr. Chilkov in her HuffPo post.
What this means is that Hollie underwent the first part of conventional therapy for breast cancer, making the title of her book inherently deceptive. She did not “say no to conventional therapy.” She said no to chemotherapy and radiation therapy. There’s a huge difference. As I have explained time and time again, surgery is the primary curative modality for breast cancer that has not metastasized beyond the lymph nodes under the arm. Chemotherapy and radiation add to surgery by decreasing the risk of recurrence. Chemotherapy decreases the risk of systemic recurrence (i.e., in the rest of the body), while radiation therapy decreases the risk of local recurrence (i.e., in the breast). If Hollie had said no to surgery, as she says she would now do if faced with the same decision, it is highly unlikely that she would currently be doing as well as she is now. In fact, it is quite likely that she would either have died of metastastic disease or developed cuirasse disease, which is in many ways a fate worse than death. That’s how women died of breast cancer before we had effective therapies.
So, from what we can find out, Hollie had a stage II tumor. That means it was either large enough to have reached the threshold to be considered stage II (2 cm in diameter) and/or there was involvement of the axillary lymph nodes (the lymph nodes under her arm). I tried but couldn’t find a description of the size of the tumor by searching the book; but I did find this passage in her book (p. 34):
In her lymph nodes, Hollie had what is called a micrometastasis. This means that there were microscopic cells that had begun to spread to the lymph nodes. According to all the doctors, the mere presence of any cancer cells in lymph nodes meant that the cancer was now in the circulatory system and could spread anywhere (i.e., metastasize to other parts of the body). And we agree with this point.
Here’s something you need to know about this story to have this story make sense. It was 2002 when Hollie was diagnosed and underwent her therapy for breast cancer. In 2002, the sentinel lymph node (SLN) biopsy in breast cancer was still a relatively new procedure. Accrual to the NSABP-B32 trial of sentinel lymph node surgery had just wrapped up, but, because of the decreased morbidity of SLN compared to the old procedure (axillary dissection, which involved removing all the lymph nodes under the arm), SLN had already taken over as the standard of care before all the evidence was in that it was as effective and that it didn’t result in harm due to an increased risk of dying or having a recurrence in the axilla. Because the single or handful of lymph nodes harvested during SLN biopsy are subjected to much greater scrutiny by pathologists than the 10-35 lymph nodes typically removed in an axillary dissection were, more and more pathologists found, rather than larger metastases, microscopic tumor deposits in SLNs. In 2002, breast cancer surgeons and oncologists honestly didn’t know what the significance of micrometastatic disease to the lymph nodes was. Based on our previous paradigm, we assumed it had to be bad, and based on our past experience we chose the most conservative course, namely recommending removal of the rest of the lymph nodes for micrometastatic disease and treating them as enough to bump a patient from stage I to stage II if there wasn’t any other feature of the primary tumor do justify doing so. This may very well have resulted in stage migration, or, as it’s commonly known, the Will Rogers phenomenon.
By the time I had to give a talk regarding the management of the axilla in the era of SLN biopsy, I reviewed the literature regarding SLN biopsy. Then, in June I attended the ASCO Meeting in Chicago, where results of the NSABP-B32 and ACOSOG Z0011 trials of SLN biopsy were reported. Basically, what they showed is that SLN was effective and accurate and, more importantly, that in the case of micrometastases, there appears to be no survival advantage to going back and taking all the lymph nodes out. In other words, micrometastases, although they do portend a somewhat worse prognosis, are not as serious as macrometases. We know that now based on having had eight years for the data to mature and provide us with survival data. We now know that about 60% of women with micrometastases have no other lymph node metastases and that the local recurrence rate in the axilla with SLN biopsy alone is around 3%. True, the major writers of cancer care guidelines, such as the NCCN, have not yet updated their recommendations to take ACOSOG Z0011 into account. It is, after all, only one trial. However, it is likely to be the last trial that ever randomizes patients to SLN alone or full axillary dissection; so we are going to have to look at the accumulated evidence regarding the necessity for full axillary dissection after an SLN positive for micrometastatic disease and come to a consenus. My suspicion is that that consensus will be that full axillary dissection will be considered unnecessary for such patients.
There’s also another confounding factor. From Ms. Quinn’s description, I can’t tell if she had a true micrometastasis or simply had some isolated tumor cells. There’s a difference. The definition of a micrometastasis, which wasn’t firmed up in 2002, is a tumor in the lymph node measuring between 0.2 and 2 mm. Anything under that is now defined as isolatd tumor cells. These days, we now treat isolated tumor cells the same as negative lymph nodes because that’s what the developing evidence over the last several years tells us. In other words, it’s quite possible that Ms. Quinn would be considered stage I under today’s staging system if her primary tumor was under 2 cm. In other words, with surgery alone, Ms. Quinn appears to have had an excellent chance of survival. Again, chemotherapy and radiation therapy simply decrease the risk of recurrence.
Perusing what Amazon let me peruse in the book, I found a number of statements and discussions that demonstrate, more than anything else, the arrogance of ignorance and the truth of the old saying that a little knowledge is a dangerous thing. In other words, the understanding of cancer demonstrated in Ms. Quinn’s book is quite superficial but that she is able to cite references in a “science-y” way to add apparent credibility to her claims. For example, there were passages about hormonal therapy in which Ms. Quinn seemed to confuse resistance to Tamoxifen, which is indeed associated with HER2-positive tumors with Tamoxifen actually decreasing the likelihood of survival. She notes that adjuvant chemotherapy doesn’t work for most women, which is something I’ve discussed before, but fails to understand that the relative benefit of chemotherapy increases as the tumor is more advanced, up to stage III and that it is the only modality that can improve survival in triple negative breast cancer. She also writes this about radiation:
In short, the research was very clear that while there sometimes was a reduction in local recurrence with radiation there was no difference in survival. In other words, one was just as likely to be alive in five years if you did radiation, as compared to if you did not undergo radiation.
Well, yes, but the difference is that the woman gets to keep her breast! Moreover, without radiation the risk of local recurrence after lumpectomy is on the order of 1 in 3, and most of these recurrences require mastectomy to treat. Moreover, in node-positive cancer, there is an emerging body of evidence that radiation therapy to the axilla does indeed very likely improve 15-year survival in breast cancer by an average of 5.4%. There might have been an excuse for making such a misstatement in 2002 and it may well have been what her doctors told her then. In 2010, there is no excuse.
The rest of the passages I examined were full of the standard “alt-med” tropes: chemotherapy doesn’t work and it’s “poison”; surgery spreads the tumor (it doesn’t); and that her unfeeling doctors tried to badger her into accepting chemotherapy (that may well be true). Fortunately for Ms. Quinn, it is not so surprising that she is still alive. Without further chemotherapy and radiation, she probably had roughly a 2 in 3 chance of surviving this long from surgery alone, which would have improved if she accepted chemotherapy and radiation therapy. In other words, the odds were still in her favor with surgery alone, which probably cured her, just not as much in her favor as they would have been if she hadn’t “said no” to chemotherapy and radiation. Unfortunately, Ms. Quinn extrapolates that result to conclude that she would have done just as well or even better than she is doing now if she hadn’t undergone surgery, that her tumors would have “melted away” from the various “alternative cures” to which she subjected herself:
For the record, I did not treat my cancer simply by changing my diet (although this is a critical element to healing). I chose an aggressive herbal oncology protocol, under the guidance of experienced practitioners. I encourage you to take a look at the book, which provides all the details about my case, but more importantly, speaks to the broader topic of the ongoing ineffectiveness and harmfulness of conventional cancer treatment today, citing extensive research.
Given how she “cited extensive research” in the parts of her book I could preview, you’ll excuse me if I don’t have a lot of faith in Ms. Quinn’s ability to interpret the medical literature. Harsh? Yes, but. although she either doesn’t understand it or won’t admit it, she’s promoting therapies that could lead women to decrease their odds of surviving their breast cancer, and I find that appalling. There is no good evidence that any “aggressive herbal oncology” protocol, “integrative oncology,” or “naturopathic oncology” can result in increased survival for cancer patients. But it sure sells a lot of supplements, as the video on Ms. Quinn’s website shows.
Unfortunately, I don’t think that Quinn’s going to “get it” with respect to science-based oncology, at least if her comments on HuffPo and elsewhere are any indication. For example, on the Anaximperator blog, she showed up in response to an equally harsh but less lengthy dissection of her claims than this particular bit of insolence and wrote:
Greetings! Thanks so much for sharing a small piece of the story in our book. As you rightly point out, I did have conventional surgery to remove the tumors in my breast, along with a few lymph nodes as well. For the record, we acknowledge this openly in the book. But there are a couple of important points that I’d like to add to your post here. First, the cancer was aggressive (by several measures, and by the universal agreement of the conventional oncologists), and had begun its march through my lymphatic system. As you probably know, conventional medicine holds that in cases like this, additional aggressive treatments are necessary in order to survive, and I was told repeatedly and strenuously that I would die if I didn’t undergo chemotherapy, radiation, and five years of hormone therapy. I disagreed, having concluded that natural holistic medicine was a much smarter, safer route to take. Secondly, and more to your point, we cite numerous case studies in our book of patients who used the same treatment system I followed to eliminate solid tumors without any surgery. Again, we lay this out very clearly and openly in the book, so that everyone can see exactly how I arrived at my conclusions.
I couldn’t find any of these case studies in the preview of Hollie’s book. Dr. Nalini Chilkov, the author of the execrable HuffPo piece, not surprisingly, finds her story totally convincing and uses it to justify a number of alt-med canards, including co-opting the term “individualized treatment”:
Today, the landscape of cancer treatment and diagnosis is rapidly changing. Many forward thinking Oncologists and Oncology Centers now include Alternative Cancer Care in the treatment plans of their patients. Because our understanding of cancer genetics is advancing, Oncologists are beginning to acknowledge that Cancer Care can now become more individualized and that lifestyle and diet, nutrients and botanicals and acupuncture have a place in a complete treatment approach for cancer patients.
Note that it is scientists and science-based physicians, not promoters of alt-med, who are doing the research to characterize the genetic sequences responsible for increasing cancer risk and individualizing treatment. Moreover, as I have pointed out time and time again, diet, exercise, and lifestyle are science-based interventions. Or at least they should be. Note, however, how Dr. Chilkov yokes woo like acupuncture and “nutrients” (in CAM-speak, supplements by the dozen, as shown on the preview video for Quinn’s book featured on her website.
The bottom line is that we know that HuffPo is a cesspit of pseudoscience and quackery, but this post is bad even by HuffPo standards. It takes a book that is designed, despite the presence of the Quack Miranda Warning on p. vii and the reader’s understandable desire for Ms. Quinn to continue to do well and raise her daughters while remaining happy and healthy, to persuade women with breast cancer that they should forego effective, science-based therapy in favor of ineffective treatments based on magical thinking, and uses it to advocate the same. But it leaves out the fact that the woman who wrote the book actually did undergo science-based “conventional” therapy for her breast cancer. She simply underwent incomplete science-based conventional therapy for her breast cancer and was fortunate enough to survive without the added risk reduction that chemotherapy, anti-estrogen therapy, and radiation therapy provide. It’s such a glaring omission that even Ms. Quinn doesn’t make, but Dr. Chilkov does. One wonders why.
You think I’m being too harsh on both Hollie Quinn and especially Dr. Chilkov? Women could die if they take their advice. After rereading this post, I’m not sure I was harsh enough. Certainly, it is very difficult to be harsh enough on Arianna Huffington and her misbegotten creation for promoting advice that could lead to the death of women with breast cancer who follow it. Those could be my patients. They could be our wives, mothers, daughters, or friends.