Respectful Insolence

A couple of weeks ago, as Breast Cancer Awareness Week was approaching, I was highly disturbed to see everybody’s favorite wretched hive of scum and quackery (The Huffington Post, in case you didn’t know) promoting a dubious breast cancer testimonial for quackery. This testimonial, contained in a book entitled You Did What? Saying “No” to Conventional Cancer Treatment and promoted in a HuffPo post by an acupuncturist named One Woman’s Story: Saying No to Conventional Cancer Treatment, on the surface sounded as though a woman named Hollie Quinn had eschewed all conventional therapy after being diagnosed with breast cancer during pregnancy. As I pointed out at the time, in fact Ms. Quinn had had conventional therapy. Specifically, she had undergone a lumpectomy and sentinel lymph node biopsy. A lot of other people pointed this very fact out in the comments of “Dr.” Chilkov’s HuffPo excretion.

Apparently, this criticism has been noticed. Noted and responded to. I missed it when it first appeared, but last week the Quinns (Hollie and her husband Patrick) responded to the criticism in a post entitled Criticism: Surgery Alone Cured Hollie. The arguments used in this post are of about the same caliber as the arguments used in the Quinn’s book. Yes, they’re just that bad–again. On the one hand, once again I wish Hollie no ill will and hope that she continues to do as well as she’s been doing. On the other hand, her promotion of quackery irritates the crap out of me, particularly during Breast Cancer Awareness Month, and I feel obligated to respond again. Here’s how the Quinns see the criticism–completely justified, to me–that came their way:

A common criticism that we’ve gotten in response to our book is that Hollie’s lumpectomy and lymph node removal were alone enough to cure her cancer. This view is a good example of why we say we need to improve the logic in our thinking about cancer. This criticism takes exactly half of the big picture into account, and when you’re dealing with cancer, it’s essential for you to be able to see the entire truth.


“Exactly” half of the big picture? Not 49%? Or 51%? That’s a mighty precise estimate of what part of the “big picture” the Quinns think their critics are getting wrong, isn’t it? Actually, it’s nothing more than a little rhetorical fluorish that sounds good but means exactly nothing. And I do mean exactly. Leaving that aside, however, I find it rather amusing that the Quinns paint themselves as being the ones who can see the “entire” truth whereas presumably by implication their critics, including cancer surgeons like myself, who, presumably only understand “half” of the pig picture. Of course, the Quinns have never treated a breast cancer patient, never deeply studied breast cancer biology, and their statements in their book, in previous comments on HuffPo, and on other blogs reveal that they have grossly overestimated their level of understanding of cancer therapy. In fact, I think their true understanding is exactly 0.0001% of the big picture. How did I come up with that number? Who cares? If the Quinns can play that game, so can I, and that number is certainly in the ballpark.

Let’s get to the meat of the Quinns’ defense against the criticism that surgery alone cured her:

First and foremost, this argument is revisionist history. Hollie’s doctors weren’t saying anything close to “Eh, you’ll probably be fine after just the surgery.” Their advice was exactly the opposite, and we quote it directly in the book: “Hollie, you need chemotherapy.” They strenuously recommended chemotherapy, radiation and five years of hormone therapy. One surgeon recommended extensive additional surgery following the lumpectomy. We rejected the additional surgery, along with all of the other conventional therapies being recommended to us. These are the harmful treatments being doled out indiscriminately, and especially to women with breast cancer, and with little to no scientific support for their effectiveness. In our view, in the future it will be common for women to reject these conventional treatments. But it is not common to do so today, and it certainly wasn’t in 2002.

As I pointed out before, it is, quite simply, incorrect that there is “little to no scientific support” for the effectiveness of adjuvant therapies after breast cancer. In fact, few cancers have been studied as intensely as breast cancer. Indeed, it was for breast cancer that pioneering clinical trials performed by the National Surgical Breast and Bowel Project (NSABP) that determined that mastectomy or lumpectomy and radiation therapy produce equal survival rates in breast cancer, the usefulness of hormonal therapy for increasing survival, and many other important clinical trials that helped define modern breast cancer treatment. To dismiss all this work with an arrogantly ignorant wave of their hands is the height of irresponsibility. Then to combine that dismissal of scientific data with the promotion of pure quackery? Well, patient or not, Hollie Quinn needs to be called out for that.

But what about Hollie’s claim that physicians “strenuously recommended” chemotherapy, radiation, and five years of hormone therapy? In 2002, that was the standard of care for someone with an estrogen receptor-positive [ER(+)] breast cancer. Similarly, in 2002, the standard of care for micrometastases in sentinel lymph nodes was to do a completion axillary dissection; i.e., to remove the rest of the lymph nodes under the arm. Today, these paradigms are not as clear as they were before. For example, as I described in detail, the most recent data is calling into question whether a completion axillary dissection is necessary after a micrometastasis if found in a sentinel node. In fact, I predict that we won’t be doing this operation for micrometastases much longer; we’ve already stopped doing it after finding in a sentinel lymph node isolated nests of tumor cells that don’t rise to the level of micrometastases. Similarly, we are coming to an appreciation that ER(+) tumors tend to be less sensitive to chemotherapy than ER(-) tumors. Moreover, we now have diagnostic tests (for instance, the Oncotype DX) that can measure the expression of many genes in the cancer and estimate whether the tumor is at a high or low risk of recurrence. ER(+) tumors at low risk of recurrence can safely be treated with hormonal therapy alone. The point, which the Quinns are completely missing, is that these options didn’t exist in 2002.

In essence, by eschewing chemotherapy, Quinn gambled on one or both of two things: (1) that she had a cancer with a low likelihood of recurrence and (2) that she would be one of the women who didn’t have a recurrence without any additional therapy. She had no way of knowing whether she would fall into a low risk category or whether she would be one of the women who would not recur after surgery alone. The odds were in her favor, admittedly. However, just because Hollie Quinn was lucky does not justify going on about how in the future more women will “reject these therapies.” If such a situation comes to pass, it will be on the basis of science and clinical trials, not on the basis of highly skewed testimonials like that of Hollie Quinn. Particularly dangerous is the Quinns’ recommendation to forego radiation therapy after a lumpectomy. Local recurrence rates without radiation can be as high as 40%, and evolving evidence supports the contention that radiation therapy increases a woman’s odds of survival by around 5%. While the odds were in Hollie’s favor as far as getting away with refusing chemotherapy, they aren’t nearly so much in her favor after refusing radiation. There, she really did get lucky and is generalizing her experience to other women. The result, if lots of women refused radiation after a lumpectomy, would be lots more women undergoing more surgery, including mastectomies, to treat local recurrences in the breast and more women dying of breast cancer.

The sad thing about Hollie’s arguments is that, like many dubious arguments, Hollie’s does have a grain of truth at its core, a grain of truth that it completely twists into an unrecognizable mass of woo. That grain of truth is that adjuvant chemotherapy (chemotherapy given after primary surgical treatment to reduce the risk of recurrence) in women with early stage breast cancer only slightly increases survival, in some cases as little as 1% in absolute numbers, and this very modest increase comes at a cost, including losing one’s hair, depression of the immune system, and cardiac damage if Adriamycin is used. It is not unreasonable to ask if chemotherapy is appropriate for all women, particularly women with stage I disease, even more so for women with ER(+) disease. However, the Quinns generalize this case to “all chemotherapy is bad” and “chemotherapy doesn’t work.” Worse, and potentially more harmful, they make the same bogus argument about radiation therapy, which has the potential to do a lot of harm in the form of more local recurrences, more mastectomies, and more deaths from breast cancer.

Personally, I think the entire point of the Quinns’ book and the core of their defense against criticism is embodied in this paragraph:

Fast forward eight years to the present–we were right, and they were wrong. Hollie is the picture of health, and she didn’t have to get sicker first (via conventional treatments) in order to get healthy. The most advanced testing available shows that she remains 100% cancer-free, not to mention healthier in a wide variety of other ways (no more migraines, gastrointestinal problems, painful cysts, low energy, thyroid troubles, etc.).

That’s really what it’s all about to the Quinns. It’s about putting their thumbs in their ears, waving their fingertips, and shouting “Nyah, nyah!” They know what’s best and just so happened to get away with refusing “conventional” therapy. By comparison, everyone else is a sucker victimized by the “breast cancer industry” who needs someone smart like the Quinns to enlighten them.

Still, the arrogance of ignorance excuded by the Quinns is nothing compared to this:

Another problem with this argument is that it obscures the fact that cancer statistics are not individualized. Take the 70% cure stat presented by those who offer this criticism. Sure, surgery would “cure” about 70% of women with breast cancer. But, that didn’t mean it would cure Hollie. Hollie may have had a zero percent chance of being cured by surgery, especially given her numerous negative prognostic indicators. Conventional wisdom said that this number could be improved to perhaps 80% via chemotherapy, radiation and hormone therapy. That made no sense to us at all, especially given all of the collateral damage caused by conventional treatments in order to achieve that so-called reduced risk. In our view, using the very best botanical and nutritional science available was a much safer, smarter approach. Via the herbal medicine protocol she followed, along with changing her diet dramatically, Hollie has made her body bio-chemically inhospitable to cancer. That’s a true cancer cure.

Well, now. Isn’t that interesting? After spending so much time representing chemotherapy and other adjuvant therapies as worthless, here the Quinns admit that conventional adjuvant therapy could have improved her odds of survival after surgery from 70% to 80%. Most women would jump at that–and, by the way, that’s why physicians so “strenuously” recommended adjuvant chemotherapy, radiation, and hormonal therapy. That’s 30% decrease in the chance of dying! Or, to look at it differently, it’s a 14% increase in the chance of surviving. Personally, I think that’s pretty damned good. The Quinns, apparently, do not. That, of course, is their right if they go in eyes wide open and understand that refusing adjuvant therapy after breast cancer surgery will increase the chance of local recurrence and metastasis. Refusing adjuvant therapy will increase the risk of dying from breast cancer. If Hollie Quinn wants to take that chance, she’s an adult and that’s her right. Given that in doing so Quinn was, now by her own admission, increasing by 30% (10% in absolute numbers) her risk of leaving her newborn baby daughter motherless, I consider her choice irresponsible in the extreme, but it was her choice to make.

Particularly ignorant is the claim that “Hollie may have had a zero percent chance of being cured by surgery.” No, that’s not true at all. Even highly aggressive stage III cancers can sometimes be cured with surgery alone. In fact, probably around 30% of such advanced, nasty cancers can be cured by surgery alone. These are tumors far nastier than what Hollie had. Even using the most pessimistic estimates, Hollie had a reasonable chance of being cured by surgery alone. My guess is that what we’re seeing here is binary thinking. In any case, the Quinns’ invocation of “individualized” therapy is nothing more than a post hoc rationalization of her choice to refuse adjuvant therapy. She had no way of knowing at the time whether her tumor would be one that would be curable with surgery alone or not, but the odds were in her favor that it was.

So, let’s see. Hollie’s railed against conventional medicine, poo-pooed criticisms that she was cured by surgery alone, and invoked “individualization” of therapy in alt-med. What’s next? Oh, yes. The fallacy of “alt-med treats the ’cause’ of disease”:

While surgery is by far the most effective (and least harmful) conventional treatment, it still does nothing to address the underlying reasons why cancer developed in the first place. We believe that surgery (and sometimes chemotherapy) can definitely help to achieve a cancer cure. But they must be used as part of a comprehensive treatment plan that addresses and fixes the imbalances of each unique patient. Because of the uniqueness of each cancer and each person’s body, there is no magic bullet cure (drug, surgery, etc.). That frustrates many people, but it’s the reality of cancer.

And, of course, the “cut,” “burn,” and “poison” trope:

Conventional treatments, including surgery, don’t cure cancer, in the strict sense. They remove it, or burn it to death, or poison it, and in the process they cause a tremendous amount of damage to the body in wide variety of ways. Does that approach “work” in some cases? Sure, and we will never once fail to celebrate someone living after cancer, regardless of what treatments were used.

Well, isn’t that broad-minded of the Quinns? They’ll celebrate your surviving cancer even if you were deluded enough not to have chosen their woo to treat your cancer. Very nice.

As I have pointed out before, among quacks, “individualization” simply means “making it up as I go along.” As I’ve also pointed out before, “individualization” is a bit of a joke when you think about how many “alt med” cancer protocols involve assigning a single cause to all cancer and therefore a single treatment. Think Hulda Clark and her “zapper” or Nicholas Gonzalez and his protocol of fruit juices, special diets, dozens of supplements a day, and coffee enemas. “Individualization” of therapies is the excuse homeopaths use when their woo fails clinical trials. Basically, it means doing whatever you feel like, with no science, no standards, and no objective measures of efficacy. In the eight years since Hollie Quinn had her cancer, treatment has already become more individualized. However, unlike the case with the quacks, we try to make sure that our individualization is based on science, not on fantasy. We measure gene signatures. We validate them. We test different therapies in different situations. That‘s individualization, not the made-up gmish of pseudoscience that alt-med “practitioners” promote.

I doubt that the Quinns would irritate me as much were it not for the fact that they are trying to lure other marks women with breast cancer into following their bad choices. Now they’re “addressing criticisms” on their blog, promising that this is the first in a series, which means it looks as though I’ll have more blogging material soon. Of course, the Quinns will simply view it as “vitriol.” I don’t think it is, but even if it were vitriol, vitriol does not equal wrong. Even if this were vitriol, in this case it is justified, given that the Quinns conclude their post with this:

But here are some hard questions that we need to start asking ourselves. Is there a better way? Are there safer, smarter ways to deal with cancer? Are there ways to heal your body from cancer even without surgery?

The answer to all of these questions is “Yes!” Hollie rejected chemotherapy, radiation and hormone therapy, and lived well to tell about it. And you can, too.

No doubt, but if you’re a woman with breast cancer your chances of “living well” to tell about it decreases if you reject chemotherapy, radiation, and hormonal therapy. That’s the hard truth, and “vitriol” is a justifiable reaction to the promotion of pseudoscience that could result in the deaths of women who don’t have to die.

Comments

  1. #1 Vicki
    October 14, 2010

    I assume when you wrote “the usefulness of hormonal therapy for decreasing survival,” you meant “increasing” survival. (I don’t normally worry about typos or such in other people’s posts, but that one seems ripe for quote-mining.)

  2. #2 Oracle
    October 14, 2010

    Does this also “irritate the crap out of me”, Orac?

    World Health Organization: “Corruption in the pharmaceutical sector occurs throughout all stages of the medicines chain, from research and development to dispensing and promotion. Unethical practices along the chain can take many forms such as falsification of evidence, mismanagement of conflict of interest, or bribery.” http://www.who.int/mediacentre/factsheets/fs335/en/index.html

  3. #3 Chris
    October 14, 2010

    Off topic troll is off topic.

  4. #4 Calli Arcale
    October 14, 2010

    But here are some hard questions that we need to start asking ourselves. Is there a better way? Are there safer, smarter ways to deal with cancer?

    The answer to both of those is probably “yes”, but we’re never going to find those ways by just gambling and then assuming the winners know something special rather than merely being lucky. (Do I take my financial advice from someone who just won the lottery? Do I take my medical advice from someone who ignored her doctors’ recommendations and was lucky?) The people who will answer those hard questions are researchers like Orac. Not people who would rather spend their effort justifying their conclusions than studying something outside of their direct personal experience.

    For yes, breast cancer is largely outside of Hollie Quinn’s experience. She knows what it is like to have the particular tumor that she had; she has made no effort that I can see to learn anything about the tumors that other people have. Breast cancer, like most cancers, is extremely variable. Her experience tells her nothing about a person with an aggressive tumor that has grown into the chest wall. She presents it as if it does, as if her experience and her body is all that matters. If you have cancer, it MUST be just like hers. I don’t think this is out of arrogance or pride; it’s simply out of ignorance. But it’s an ignorance that could kill someone.

  5. #5 Chris
    October 14, 2010

    I’m an ostrich…I’m going to bury my head in the sand and ignore anything bad said about conventional medicine.

  6. #6 Calli Arcale
    October 14, 2010

    Oracle — it irritates the crap out of me, that’s for sure. Pharmaceutical companies serve two masters: medical ethics and the quarterly report. This is a major problem, but not one which is easily solved. But let’s deal with one unscientific irritation at a time, ‘kay?

  7. #7 Denice Walter
    October 14, 2010

    I too, find the alt med invocation of “individualization” a hilarious malapropism : first, they usually reduce *most* illnesses/ conditions _across the board_ to the same cause ( “toxity” or “inflammation”- possibly believing that “toxity” causes “inflamation”); then, they assign the same treatment ( diet- be it vegan, organic, or blood-type specific-, supplements, and other woo-begone non-SBM treatments) to patients indiscriminately and dismiss *all* pharmaceutical intervention. It’s entirely concievable that a pre-schooler with asthma might be given the same “treatment” recommendations as an 80+ year old with CV issues **( “improved” diet, more exercise, no meds, no vaccines).** I’ve actually heard/ read such ideas.

  8. #8 Todd W.
    October 14, 2010

    Wow. The Quinns’ understanding of statistics and risk sound a lot like augie’s grasp of stats. Not to mention their poor understanding of how medicine advances.

  9. #9 Chris
    October 14, 2010

    The issue is not that Ms. Quinn did not take the chemo, it is that she is downplaying the role of surgery in her recovery.

    But then, some people don’t understand simple things, so they turn vile:

    The man who owns this site has a son who was diagnosed with cancer. The son had surgery for one tumour and radiation and chemotherapy for another and now appears to be cured. His parents are suing the doctors who saved his life.

  10. #10 Forbidden Snowflake
    October 14, 2010

    Worse, and potentially more harmful, they do the same thing with radiation therapy, which has the potential to do a lot of harm.

    What can do a lot of harm? Foregoing radiation or radiation itself? Ambivalent phrasing is ambivalent.

    However, unlike the case with the individualization is based on science, not on fantasy.

    Missed a couple of words there.

    This is a good, important post, except for a couple of mangled sentences which Orac will surely fix when less in a hurry.

  11. #11 Katen Moore
    October 14, 2010

    I agree with you 100%! I don’t understand this need to convince other people you were right in your decision? Who cares? Good for you (the quinns). But also, breast cancer has a nasty way of recurring YEARS later, I have frequently seen women with recurrences in my years of practice 20 years since their original diagnoses. There really is no such term as “cure” until the autopsy when it can be proven. Otherwise, it is just “no evidence of disease”. And do we truly know what Ms. Quinn’s pathological diagnosis was anyway? We used to make recommendations for DCIS which are now reasonably called into question by research. That’s the beauty of science — we keep learning.

    Besides, most women die of heart disease! A health outcome that we KNOW has many causes that can be PREVENTED. That is far more than we really understand about breast cancer, yet women continue to freak out about a disease that most likely won’t be in their future.

    Ugh.

  12. #12 viggen
    October 14, 2010

    The even handedness of the Quinns’ argument is further revealed in this statement:

    The most advanced testing available shows that she remains 100% cancer-free, not to mention healthier in a wide variety of other ways

    Do they not realize that the “most advanced testing available” originate from the same science that the therapies do? Why should they trust “the most advanced testing available” if they are unwilling to trust the other parts of the process? This reveals a nasty case of confirmation bias: the science which supports our case is okay, but the science that contradicts it is unacceptable.

  13. #13 Amy
    October 14, 2010

    Mom never put me in a car seat, fast forward 28 years later and she was right and they were wrong! I’m the picture of perfect health!

  14. #14 Amy
    October 14, 2010

    Viggen: I agree! Why did they even believe she had cancer in the first place? They don’t trust or understand science, so why even believe the science used to detect and diagnose as acceptable?

  15. #15 Dangerous Bacon
    October 14, 2010

    “Hollie has made her body bio-chemically inhospitable to cancer.”

    Learning and using critical thinking skills will make your brain “bio-chemically inhospitable” to woo.

  16. #16 rob
    October 14, 2010

    i think pushing all the chemo and radiation is getting out of hand.

    why, just today at the drive thru window i was asked if i would like fries, chemo or radiation with my order!

  17. #17 cervantes
    October 14, 2010

    Maybe should take on Christian faith healing some time, or is that a taboo topic?

    “The Department of Human Services on Tuesday won custody of a child who faced blindness in one eye after her parents treated her with prayer instead of seeking medical care.

    The girl’s parents, Timothy and Rebecca Wyland, face criminal charges for failing to provide adequate care. . . .

    John Neidig, an attorney representing Rebecca Wyland, accused DHS of persecuting the Wylands and “trampling” on their religious rights. “If these people had been Jewish, Catholic … even Muslim, DHS would have treated them in a different fashion.”

    Van Dyk said there was no evidence that DHS discriminated against the Wylands .

    “It is unhelpful to this case to point fingers,” Van Dyk said. “It is not a church [The Followers of Christ] that is before this court. It is the Wylands.”

  18. #18 Jarred C
    October 14, 2010

    Chris said,

    The issue is not that Ms. Quinn did not take the chemo, it is that she is downplaying the role of surgery in her recovery.

    This reminds me of my brother’s wife’s mother (mother of my sister-in-law?). She had breast cancer about 30 years ago, and it was removed by surgery. Shortly after the surgery, she started the macrobiotic diet. Now she preaches to everyone how the macrobiotic diet cured her of cancer (while conveniently not mentioning any surgery unless specifically asked about it).

    I get tired of constantly correcting my own parents and siblings that no, her diet did not cure her of cancer; the surgery did.

  19. #20 Composer99
    October 14, 2010

    Via the herbal medicine protocol she followed, along with changing her diet dramatically, Hollie has made her body bio-chemically inhospitable to cancer.

    Since cancer cells in humans are derived from normal cells in humans, making a body ‘bio-chemically inhospitable to cancer’ implies that one is simultaneously making it inhospitable to normal cells.

    Since Hollie Quinn is still alive, I daresay she has not managed to make her body ‘bio-chemically inhospitable’ to cancer cells.

  20. #21 Scott
    October 14, 2010

    @ Composer99:

    That’s rather overstated. If you think about it, that’s not an unreasonable description of what standard chemotherapy does. The result is a body that’s less “hospitable” to cancer cells than normal cells. In principle it’s even possible that her “herbal medicine protocol” contained ingredients which would make good chemotheraputic medicines. (Taxol, anyone?)

    There’s no actual EVIDENCE that it did anything of the sort, but it could have. So one can’t reject that particular claim for that particular reason.

  21. #22 Calli Arcale
    October 14, 2010

    cervantes — no, it’s not a taboo topic here. Orac has covered other instances of religious objections to medical treatment with dire outcomes. Some of them really make my blood boil. It’s one thing to deny oneself adequate care because one believes one is being “tested”. But a child? I know it’s hard to beat one’s convictions, but there are some lines that we cannot cross in the name of religious freedom, and just about the clearest is harming or neglecting children. Some go really tragically far before someone intervenes, and that depresses me.

    But I won’t start ranting on that here; it’d definitely derail the tread. Try searching for things like “faith healing” on this site, or “prayer”. You should be able to find some of the articles.

  22. #23 https://me.yahoo.com/a/Z5ZA2tlvketPsnG3G8EVJbgYwGEUHH4E#13219
    October 14, 2010

    “The answer to all of these questions is “Yes!” Hollie rejected chemotherapy, radiation and hormone therapy, and lived well to tell about it. And you can, too.”
    I read about a woman who fell thirty thousand feet out of an airplane and survived. And you can, too.
    There are people who have gone one-on-one with Great White sharks or grizzly bears who have survived. And you can, too.
    Carl Akely killed an 85-pound leopard with his bare hands. And you can, too.
    Sure, you can try those things and get out alive, maybe even unscathed. I’m just not sure I’d recommend it as a health regimen.

  23. #24 Dan J
    October 14, 2010

    I get “individualized” treatment every time I go to chemotherapy. The dosage of certain drugs is adjusted according to my weight on that day. Woomeisters piss me off.

  24. #25 C.S
    October 14, 2010

    Could you tackle this Orac? These folks seem to think Cancer never existed before the Twentieth Century…

    http://www.manchester.ac.uk/aboutus/news/display/?id=6243

  25. #26 Oracle
    October 14, 2010

    Dan J,

    You’ve got anger issues…and you’re ignorant. Individualized means drug is individualized to you, not the dosage…dummy.

  26. #27 Gray Falcon
    October 14, 2010

    You’ve got anger issues…and you’re ignorant. Individualized means drug is individualized to you, not the dosage…dummy.

    Modern oncologists are learning to do that, while many alternative practitioners will diagnose everyone that comes in with the exact same condition and the exact same treatment.

    I won’t bother with any insults other than to point out that in general, it’s a bad idea to ignore anything personally inconvenient.

  27. #28 Chris
    October 14, 2010

    C.S.:

    These folks seem to think Cancer never existed before the Twentieth Century…

    Here is some reading for you:
    http://www.cancer.org/Cancer/CancerBasics/TheHistoryofCancer/index

    A quote that might interest you:

    There were great surgeons before the discovery of anesthesia. John Hunter, Astley Cooper, and John Warren achieved lasting acclaim for their swift and precise surgery.

  28. #29 Oracle
    October 14, 2010

    “many alternative practitioners will diagnose everyone that comes in with the exact same condition and the exact same treatment”

    lol.

  29. #30 Gray Falcon
    October 14, 2010

    Let me try again, in even simpler terms. Dismissing all of mainstream medicine based on the actions of a few corrupt manufacturers, who only represent one of several factions within the medical community, is the same as dismissing all fire departments based on one corrupt department.

  30. #31 Gray Falcon
    October 14, 2010

    Sorry, that was for a different thread. My response to “Oracle”: lol? That’s not a response. If you want proof, see here and the attached articles: http://www.quackwatch.com/01QuackeryRelatedTopics/mercury.html

  31. #32 Oracle
    October 14, 2010

    let me try again…

    yes, there are some legit pharma folks out there, but how do you know how prevalent that # is when you don’t have access to that information and esp. when corruption is prevalent THROUGH THE WHOLE PHARMACEUTICAL MEDICAL CHAIN, as documented by the World Health Organization in a fact sheet (http://www.who.int/mediacentre/factsheets/fs335/en/index.html)

    and convenient diagram that shows where the unethical practices are in every step of the chain starting from drug manufacturing to dispensing. (http://www.who.int/mediacentre/factsheets/images/medicines_20091209.gif)

    based on the fact that you are a pharma insider and not privy to all pharma info and decisions, i.e., you don’t own or run a pharma company, you realistically are not able to estimate who are the “few corrupt manufacturers” and thus wouldn’t be able to say that they “only represent one of several factions within the medical community.”

    it’s all conjecture and speculation on your part…

  32. #33 Oracl
    October 14, 2010

    sorry, “based on the fact that you are NOT a pharma insider…”

  33. #34 Dan J
    October 14, 2010

    You’ve got anger issues…and you’re ignorant. Individualized means drug is individualized to you, not the dosage…dummy.

    Anger issues? So now you’re a remote psychotherapist as well as a fortune-teller?

    I’m ignorant as well, eh? How many chemotherapy treatments have you experienced directly, eh? How is your lymphoma?

    For someone who professes such brilliance, you certainly failed to see the hint of sarcasm in my original post. Perhaps I should include a tag next time so you don’t miss it.

  34. #35 Medicien Man
    October 14, 2010

    Besides being Breast Cancer “Awareness” month, it is also Vaccine Injury Awareness month. take note.

    Again, there is no way in Hell I will be taking the deadly flu vaccine this year. I have never taken one and I don;t plan to start now.

    I asked my grandfather to not take it, but he went against my will and took it anyway becuase some dummy doctor at the VA (a government hospital) suggested he do so. He has been in pain and feverish for days. Screw that. I’ll not be taking any vaccine of any kind. Thank you kindly sir, but throw your shot in the garbage.

  35. #36 JohnV
    October 14, 2010

    medicine man, I know this is wasted effort, but how many people died as a result of the flu vaccine compared to how many died of the flu?

    in related news, if you were bitten by a rabid animal would you eschew the rabies treatment? what if you had a wound infected with C. tetani?

  36. #37 Medicien man
    October 14, 2010

    Rabies and tetnus vaccines have been proven to be safe. The flu vaccines keeps chnaging from year to year. Remember when in 2005 we find out it was being made from aborted fetal cell lines to save time and money? Someone should have goen to prison over that fiasco. Especially in Alabama. Of all people, they should have known better. I think the south is going downhill fast.

  37. #38 Pablo
    October 14, 2010

    In essence, by eschewing chemotherapy, Quinn gambled on one or both of two things: (1) that she had a cancer with a low likelihood of recurrence and (2) that she would be one of the women who didn’t have a recurrence without any additional therapy. She had no way of knowing whether she would fall into a low risk category or whether she would be one of the women who would not recur after surgery alone. The odds were in her favor, admittedly. However, just because Hollie Quinn was lucky does not justify going on about how in the future more women will “reject these therapies.”

    There’s another important thing to remember, and this is particularly true when it comes to anecdotes like these: Of course Hollie Quinn had a good outcome in the end, for whatever the reason. The reason it is obvious is because she is writing a book about it.

    Amazingly, women who get surgery, eschew radiation, and subsequently have reoccurance of their cancers don’t write books about how they made a bad choice. So it’s really hard to judge the significance of this outcome in isolation. All her story tells us is that it is POSSIBLE to have surgery to get rid of the cancer, and then not have it come back without doing chemo or radiation.

    Then again, it’s not a big story. Orac notes above that the recurrence rate without radiation is high, something like 40%. That’s a lot. But it also means that 60% of the people who don’t have radiation WON’T have their cancers reoccur!!!! Jesus, where is the miracle here?

    A cancer surgeon has told us that she had a better than 50/50 chance of survival given her treatment. She lived. Good for her. But come on, if I flip a coin (once), should I be shocked if it comes up heads? Because in fact, the chance that a coin will come up heads is actually less than the chance for her outcome.

    The deceit in this story is huge. If the point is that it is possible to survive without chemo/radiation after surgery, then there is nothing new. Any doctor can tell you that it is possible that you can do this without, and the odds are actually better than 50/50. However, do you really want to play 50/50 odds (or 60/40)? Especially when you can get an 80% chance?

    And I really have to say, someone who takes that risks and comes through coming back and writing a book afterward is pretty darn galling. Who is writing the books for those women who took those risks and failed? As they say, dead men tell no tales.

    This case here is like someone who won the lottery writing a book and telling people that playing the lottery is a good way to make money. See, all you have to do is look at me! I played the lottery, and I am rich! Don’t listen to those people who tell you that the lottery is a waste of money. They are just jealous.

  38. #39 Paul
    October 14, 2010

    Off topic, but FYI. There’s an ad being served to your blog that plays loud music upon loading. It’s the one that says, “win $500 for a Halloween party.”

  39. #40 JohnV
    October 14, 2010

    Interesting that the same person can say “I’ll not be taking any vaccine of any kind.” and then “Rabies and tetnus vaccines have been proven to be safe” when questioned about vaccine usage.

  40. #41 Composer99
    October 14, 2010

    Scott, I will concede your point that what Hollie claims her alt-med treatments do is what, more or less, chemo does.

    However, I will also note that one of the reasons – if not the principal or even only reason – Hollie decided to forego adjuvant therapy was because of the side-effects she anticipated undergoing.

    If her régime of herbs, diet & such actually affected her to such a degree as to make her body biochemically inhospitable to cancer[s], one would expect (a) that this treatment would have actual pharmacological effects and (b) that among these effects one would find side effects not unlike those seen in chemotherapy.

  41. #42 Calli Arcale
    October 14, 2010

    Well, that same person also can’t tell that the thread is about breast cancer, so go figure.

    Oracle — you are quite right that we can’t tell who is corrupt. Can you? You seem fairly convinced that it’s a substantial majority. How? Are you privy to some information we are not?

    You don’t have to just give up on making medical decisions just because there is corruption in medicine (as there is in all things run by humans, especially when money is involved). Just like you don’t have to give up on putting your money in an investment porfolio just because of the recent financial meltdown. There are other options than surrender to a state of ignorance. You can educate yourself.

    I’m not talking about going around and reading blogs like this one. Sure, you can do that too, but mostly there you’ll be getting people’s opinions. That can be helpful, but opinions are, well, opinions. They’re not facts. For those, turn to the scientific literature. PubMed is one of the greatest things the Internet has brought us, because it gives free access to a great many scientific publications on medical research.

    By the way, cancer treatment really is individualized — to the point where the drugs often have to be administered in a hospital setting because of the high degree of precision required. There isn’t a pill labeled “for breast cancer”, for instance. Instead, tests are run, biopsies are sampled, and the oncologists devise a treatment plan which will best reduce the risk of a recurrence. It’s complicated stuff, and it’s not unusual to put a patient on several drugs to attack different aspects of the tumor growth process. The idea there is usually to avoid applying selective pressure on the tumor — evolution applies at the cellular level too, and some tumor cells may be more vulnerable to certain chemotherapeutic agents than others. Use of chemo can basically do the same thing that antibiotics can — breed a strain which is resistant to the drugs. And then there’s that new “cancer vaccine” (though it’s not a vaccine in the traditional sense) for prostate cancer. It’s hideously expensive, so it’s likely it’s being given to the wrong people at present — it may be better to give it to people who are less sick and more likely to survive than people already terminal. (But that’s what you do with a new drug; the first recipients are the terminally ill.) It’s as individualized as it is actually possible to be — the vaccine is manufactured using the patient’s own biopsied tumor. (That’s *why* it’s so expensive.)

    A case can certainly be made that bone marrow transplant is also highly individualized, and it’s not just the dose. The recipient must be carefully matched to the donor to avoid rejection. And then there are the surgical and radiation treatments. These are unique every time. No two surgeries are exactly the same; they are individual by nature, because they are *dealing* with an individual.

    Some alternative therapies do attempt to individualize in this way, though as they are generally not well studied, it’s hard to see how they could be terribly effective at it. They individualize according to how they understand things. In this, they are not much different from an oncologist devising a chemotherapeutic regimen for his/her patient. But they are different in the standards they use for deciding what to do. The alt med practitioners base their decisions on intuition, past experience, and/or various spiritual frameworks. They could base them on science, but none of these modalities have been studied well enough for that. (Which is unsurprising; if they had, they’d be adopted into mainstream medicine.) So while it’s true that a traditional chinese medicine practitioner will individualize the treatment, offering a particular combination of remedies in order to correct the patient’s imbalanced spiritual flow according to the principles of feng shui or whatever, I’m not convinced this individualization is particularly meaningful.

  42. #43 Drivebyposter
    October 14, 2010

    There are corrupt fake med. people out there, so it looks like everyone goes without any treatment, woo or otherwise right oracle?

  43. #44 realinterrobang
    October 15, 2010

    Remember when in 2005 we find out it was being made from aborted fetal cell lines to save time and money? Someone should have goen to prison over that fiasco.

    Um, not that I believe this actually happened or anything, because it didn’t, but why would aborted fetal cell lines (ie. things that were derived at several removed from something that was someone’s terminated pregnancy once some time ago) even bother you in the first place, and why in hell would someone need to go to jail for doing it?

    A vast amount of medical and scientific research is done using cell lines derived from a piece of cervical cancer taken from a woman without her consent, sixty ears ago or so. If that doesn’t even impinge on your consciousness at all, why would this hypothetical other thing?

  44. #45 Chris
    October 15, 2010

    JohnV, further evidence that one should never take medical advice from stranger on the internet. Especially from an electronics technician who cannot spell, and thinks the problem with engineers is that they “think too much.”

  45. #46 Coco
    October 15, 2010

    As a woman with breast cancer who had a wide local excision [WLE] and sentinel node biopsy with no adjuvant therapy – no chemo, no hormones and no radiation, I can see both sides of this debate. There were sound reasons for me taking the treatment path I did, and that relates solely to my peculiar statistics arising from my histopathology report. I am in the odd situation of chemo/hormones only giving me a 30% boost against recurrence BUT its 30% of 1 % ie., 0.33% versus a huge percentage risk of morbidity and mortality associated with chemo. My risk of breast cancer recurrence is only 1%. Even my Oncologist said he could not justify overtreating me. Radiation Oncologist stuck to the standard recommendation – full 6 weeks plus boost RT. When I probed he finally admitted RT could only give me a 3% boost against local recurrence. My stat was no recurrence rate of 95% but with RT it would be 98%. I was not given any RT options other than the scortched earth wide beam RT by him. Because of other health and skin issues, I felt the 3% benefit was not enough to justify RT IN MY INDIVIDUAL CASE. That being said, I would never advocate to other women to avoid standard treatment as I am only too well aware how unique my situation is [ki 67 of less than 1% so its as slow growing as is possible to measure, cribifiorm and tubular etc so my survival stats as close to someone without BC as you can get!]. I think the lesson is not to relfexibly rebel against standard BC treatment regime or stick your head in the sand like an ostrich and to whatever the experts tell you – its to know your histopathology report and stats inside out, so when you make decisions about your body, you do so based on the best evidence and information. I also happen to reject the parternship decision making paradigm between me and medical professionals – I pay them [at times more than one when I want more input] for their expertise to give me information and recommendations – then I decide what I do with my body. After I also do exhaustive research and check every fact myself.

  46. #47 Oracle
    October 15, 2010

    calli, you ask, “You seem fairly convinced that it’s a substantial majority. How? Are you privy to some information we are not?”

    No, there’s actually a lot online. Something pops up all the time…here’s a one for you from the NY Times, Oct. 2, 2010:

    “The new generation of antipsychotics has also become the single biggest target of the False Claims Act, a federal law once largely aimed at fraud among military contractors. Every major company selling the drugs — Bristol-Myers Squibb, Eli Lilly, Pfizer, AstraZeneca and Johnson & Johnson — has either settled recent government cases for hundreds of millions of dollars or is currently under investigation for possible health care fraud”

    http://www.nytimes.com/2010/10/03/business/03psych.html?adxnnl=1&pagewanted=2&adxnnlx=1287122401-KugyMRr7RcB5rtGEsBvJjQ

  47. #48 T. Bruce McNeely
    October 15, 2010

    I asked my grandfather to not take it, but he went against my will and took it anyway becuase some dummy doctor at the VA (a government hospital) suggested he do so. He has been in pain and feverish for days.

    I don’t believe you.

  48. #49 Drivebyposter
    October 15, 2010

    Oracle,
    For one, you seem to have missed my question about whether or not we should reject woo crap since there are woo frauds.

    Also, many is not a majority
    Finding many screw ups (or however you’d phrase it) isn’t hard. No one really writes reports about all of the times the companies don’t mess up in some way.

    People die falling down stairs a lot… and if you judge the safety of stairs in the same way you judge medical companies…you would probably find that stairs kill a majority of people.

    But that’s just you not having any idea what makes a majority.

  49. #50 Arlene
    October 15, 2010

    Dear Dr.

    Boy, you use the words “Crap” and Quack” and quite an array of majorly anger-packed words throughout your blog. I’d be pretty uncomfortable about having you approach me with a knife. Also, I think it’s unfortunate that you would try to lead readers to think they can’t affect their outcomes through diet and well forumulated supplements, especially for people like myself with cancers where treatments nor outcomes have improved in nearly 20 years. And especially when there are so many evidence-based studies from NCI-affiliated research institutions that would all have to be bogus if diet and supplements are “quackery.” I, too, question how much of a difference can be made by moderate to extreme diet changes, high concentrations of certain herbs, etc. But there is an abundance of evidence prooving diet with conventional medicine (especially avoiding animal fats,sugars and processed foods) makes a difference. Late phase trials on pomegranate, green tea supplements in combination with certain other herbs ,etc. are all based on this science that you talk about. I think that there’s room for conventional doctors like yourself and those who don’t totally write off integrative approaches to work together.

  50. #51 nybgrus
    October 15, 2010

    @Calli Arcale: Well said. Thank you. You are certainly one of the most intelligent people writing on these blogs, and that includes the bloggers themselves.

    Sadly it won’t shut up these trolls, but I want you to know you have my respect for it.

  51. #52 Lawrence
    October 15, 2010

    I don’t think it has been pointed out thus far that Orac, in his criticism of the Quinn’s book, never said the surgery was 100% the reason behind her remission – he said that she was being evasive (at best) and lying (at worst) by not mentioning the fact she did have the surgery first.

    Instead, it is her that puts forward the claim that her CAM treatments were 100% responsible for her current condition.

    I’m sure we won’t hear too much from her if he cancer returns (and I hope it doesn’t, because regardless of a person’s background or attitude, no one in this world deserves to be on the receiving end of cancer or any other disease).

    And I still don’t understand why those who defend CAM seem to have no problem with the fact that there is no quality control, no testing, and no oversight of any of those treatments (which aren’t being sold for free either) of that entire industry.

    At least we can point a critical eye back on the medical industry and medical professionals (Orac does so fairly regularly here), but if you say something bad about alternative medicine, all the woo-meisters come out in force to defend it – without any consideration that such and such a treatment or supplement, etc could actually be harmful.

  52. #53 Ender
    October 15, 2010

    Yes Arlene, extensive testing has proven that people who use the words ‘crap’ and ‘quack’ are not to be trusted as surgeons.

    It’s just lucky he’s never said ‘fuck’ otherwise it’s almost certain that all of his patients would have died. As it is it’s touch and go for the rest of them.

    For the rest of your post: Diet and well formulated supplements (where actually neccessary) are in fact not quackery when it comes to staying healthy. They are key components to living a healthy life, and recovering from certain nutritional deficiencies.

    What is quackery, is when some people in the alt-med world recommend their ‘diet’ and supplements based on no scientific evidence.
    This can seriously harm people’s health and quality of life, when they either reject useful treatments to try untested and unproven diets, or restrict what they want to eat and spend huge amount on unneccesary supplements, all the while creating more profits for the large companies that produce these supplements!

  53. #54 Orac
    October 15, 2010

    Boy, you use the words “Crap” and Quack” and quite an array of majorly anger-packed words throughout your blog.

    Seeing someone promote misinformation that has the potential to cause suffering and death among breast cancer patients has that effect on me. I get ticked off when I see someone in essence lying by omission and promoting woo to women with cancer. I make no apologies for that reaction, particularly since my mother-in-law died of breast cancer. Don’t like it? Don’t read. The road to hell is paved with good intentions, and Hollie Quinn’s good intentions could well lead to women suffering and dying unnecessarily.

    I’d be pretty uncomfortable about having you approach me with a knife.

    Then don’t use my services if you ever are ever unfortunate enough to need a breast surgeon. Other women appreciate how much I care about these issues.

    Also, I think it’s unfortunate that you would try to lead readers to think they can’t affect their outcomes through diet and well forumulated supplements, especially for people like myself with cancers where treatments nor outcomes have improved in nearly 20 years.

    Which cancer? If you have breast cancer or colon cancer it’s certainly not true that treatments and outcomes haven’t improved in 20 years. In any case, no one is saying that it’s not possible to affect outcomes. What I am saying is that there is no good evidence to support the contention that you can change cancer outcomes using various dietary woo and supplements. Got the evidence? Show it! Diet is pretty useful for decreasing the risk of cancer, but when it comes to actually treating an established cancer, the record is far less impressive.

  54. #55 sophia8
    October 15, 2010

    A couple of years ago, somebody gave me a link to a US alt-med forum that had a sub-forum where breast cancer sufferers could post about their treatment. A number of the posters were, naturally, declaring that they were dropping conventional treatment altogether.
    Appalled, I decided to try a little backwards longitudinal study. Going back two years to the start of the forum, I found five first-time posters with breast cancer who announced that they would be trying the alt-med methods recommended on the site, and I tracked their posts.
    Two of the five made no further posts.
    Two others made a total of three posts between them and dropped off within a year.
    Only one of the five was still posting her progress after two years. She still had cancer, was still trying all kinds of alt treatments and was blaming her lack of success on the stress of a breakup!
    Yes, people who don’t survive cancer generally don’t write about it.

  55. #56 Gray Falcon
    October 15, 2010

    Two of the five made no further posts.

    I don’t know which is worse: Not knowing what happened to them (few things are as horrifying as Nothing)…

    Only one of the five was still posting her progress after two years. She still had cancer, was still trying all kinds of alt treatments and was blaming her lack of success on the stress of a breakup!

    …this rather dramatic version of the sunk costs fallacy (Seriously, you have to know when to fold ‘em)…

    Two others made a total of three posts between them and dropped off within a year.

    …or the fact that even taking into account factors like this, it still constitutes a better study than most done by alternative medicine practitioners and advocates.

  56. #57 Scott
    October 15, 2010

    However, I will also note that one of the reasons – if not the principal or even only reason – Hollie decided to forego adjuvant therapy was because of the side-effects she anticipated undergoing.

    An excellent point, Composer. I hadn’t fully considered that aspect of the hypocrisy.

  57. #58 trrll
    October 15, 2010

    Moreover, Ms. Quinn fails even as a testimonial, because she is not telling other women to do as she did–she is telling them “Do as I say, not as I did.” She is advising them to forego, not merely adjuvant therapy, but surgery, the treatment that clinical studies have shown to have the greatest chance of being curative, and a treatment that she herself received.

  58. #59 DaNiao
    October 15, 2010

    Well stap me.
    If this benighted harlequin (Holly Quin? Pah) does suffer a recurrence of her cancer, which I hope she doesn’t, and suffers the likely consequences of it developing (which I hope it doesn’t) and at the same time decides to continue with the woo, then should she die an agonising and messy death I wouldn’t shed a hint of a trace of a scintilla of a tear since she would have deserved all that subsequently came to her.
    Of course, given the dishonesty of the woman I would expect her to opt for surgery & then lie about it in order to hush up that she did so.
    Bad cess to the black-hearted lying get.

  59. #60 AB
    October 15, 2010

    I don’t think I would trust my care to anyone who writes a blog like this. The lack of insight is astounding and the need to be so defensive is scary. The word “woo” is thrown around as if it actually means something and that it came out of your mouth makes is powerful and meaningful. It isn’t and it doesn’t. Individualization is the single most important thing anyone can understand in medicine and you only have to understand just a wee bit of statistics to know this. If you don’t, I suggest visiting Stanford professor Stephen Schneider’s video on decision analysis and seeing why knowing statistics and the power of the individual response not the clinical trial results changed his drug protocol during his cancer and saved his life (he later died of another unrelated cause). Eventually, his Stanford oncologists understood statistics also. He treats them with deep respect but the bottom line is, they were wrong and he was right and everyone knew it. He wasn’t a MacArthur genius grant recipient because he was stupid.

    You need to grow up and ditch the rants and learn there is more to heaven and earth than you know. (not a religious statement, btw, hope you get the reference).

  60. #61 Scott
    October 15, 2010

    @ AB:

    How about some actual facts, data, or evidence to support your claims? (Hint: one individual’s experience means nothing, regardless of their profession.) PubMed citations preferred.

  61. #62 Fuzzzone
    October 15, 2010

    @AB: Yeah, we got it, we’ve all read Shakespeare, and it’s not like you’re quoting from one of his little-known plays. You’re most erudite.

    As to your initial commentary, I couldn’t disagree with you more. I’d gladly trust someone with my health who took a rational, evidence-based approach to medicine and who, from time to time, gets ticked about people delivering falsehoods and half-truths. I guess you’re welcome to use whatever variety of stick-shaking witch doctor you’d prefer though.

  62. #63 Arlene
    October 15, 2010

    Ender,
    I didn’t say there were scientific studies linking cussing to medical outcomes. I personally, like the ladies I’ve met in my support groups, just happen to prefer docs who aren’t hostile. Though I can appreciate that Dr. is passionate.

    Dr, There are far too many studies for me to list more than a handful that strongly suggest we should consider the power of diet and supplements (the properly studied ones without toxins and unnecessary fills and that have been processed in a way to retain their antioxidant/nutritional value) along with conventional medicine. Here are just a handful of links to recent studies on supplements from leading institutions:

    Pomegranate and Prostate Cancer Research:
    http://mensnewsdaily.com/2008/10/12/pomegranate-juice-prostate-cancer/
    http://www.webmd.com/prostate-cancer/news/20090426/pomegranate-juice-may-slow-prostate-cancer http://clincancerres.aacrjournals.org/content/12/13/4018.abstract

    Green Tea and Prostate Cancer:
    http://www.sciencedaily.com/releases/2009/06/090619112329.htm

    Green Tea and Breast Cancer:
    http://www.green-tea-health-news.com/breast-cancer-survival-rate.html
    http://www.green-tea-health-news.com/breast-cancer-recurrence.html

    Vitamin D Supplementation and Breast Cancer Recurrence:
    http://doctorwascher.com/Archives/8-9-09.htm

    Vitamin C metabolism and resistance to malignancy
    http://www.sciencedaily.com/releases/2009/06/090619112329.htm

    More on Vitamin C and Cancer
    http://profiles.nlm.nih.gov/MM/B/B/K/Z/_/mmbbkz.pdf
    http://www.cmaj.ca/cgi/content/full/174/7/937

    There’s a book, “Life Over Cancer” by a medical doc who treats cancer patients with what he calls integrative cancer care – chemotherapy, diet, exercise, supplements, he suggets mind-body, etc. He references hundreds of medical journal articles with similar findings.

    Also, as for my individual case, I am Triple Negative – though I was in an MD Anderson clinical trial, what I got was the standard protocol. 50 plus-year old chemo and Taxol which as you know is about 15 years old or so. The new study drug (used nearly 4 years in late stage Triple Negative) is not showing promise as far as extended survival and it’s yet to be seen what if anything it will do to prevent recurrence in early stage. And I was correct in saying survival rates for Triple Negative have not improved in close to 20 years;no one even recognized the disease then. I did surgery, chemo, radiation, which brought my chance for survival to 70 percent – (but that was before I learned I had a severe Vitamin D deficiency and before I had to stop chemo because it made me develop grade 4 neutropenia, so who knows what my prognosis is). I’m not going to just call anyone a quack who can recommend complimentary things like mega volumes of vitamin d (just wish the deficiency was caught earlier). I would not tell anyone – certainly not someone with limited options – to poo the repeated studies on green tea, especially in combination with other herbs, that are showing promise in slowing growth or reducing chance for recurrence. I also don’t think survivors should be encouraged to poo poo the studies showing that some cancers are sugar guzzlers and how animal fats change the environment of the cells to make them more acidic and thus more hospitable to cancer. I was grateful for what options my doctors could give me – but I don’t think eating healthy, exercising and popping a few supplements that I researched through Consumer Reports is going to hurt me. It just may help. I tell other survivors not to be blind sighted by naturalists offering a cure, but not to close the door on supplemental or complimentary ideas – to do the research and complimentary and conventional together is not a bad idea – especially if your options are limited.

  63. #64 Just Sayin'
    October 15, 2010

    how do you know how prevalent that # is when you don’t have access to that information and esp. when corruption is prevalent THROUGH THE WHOLE PHARMACEUTICAL MEDICAL CHAIN

    Or when corruption is prevalent THROUGH THE WHOLE HOMO SAPIENS SAPIENS SPECIES?

    I suggest that we no longer rely upon treatments developed by humans, since they cannot be trusted. We must import Vulcans, or maybe even Romulans, since they have not been affected by human corruption, to do all medical research and treatment! Anyone who says otherwise is a RACIST!!!!11ONE!!

  64. #65 Jarred C
    October 15, 2010

    Arlene said,

    More on Vitamin C and Cancer
    http://profiles.nlm.nih.gov/MM/B/B/K/Z/_/mmbbkz.pdf

    Now I’m sure others will dissect the rest of your post, but I just had to comment on this one bit.

    Did you just seriously quote Linus Pauling as an expert on Vitamin C? Seriously? Wow. That’s beyond ignorant.

    Apparently you don’t realize that Linus Pauling’s opinions on Vitamin C are considered his “dark days.” It the time in his life where everyone competent asks, “What happened? He was so great.”

    Freaking Linus Pauling. Wow.

  65. #66 Todd W.
    October 15, 2010

    @Arlene

    I took a quick look at the first of your green tea links. A couple problems jumped out at me right off the bat. First, the study they mention as showing that green tea improves breast cancer survival rates was done in rats. While the results are certainly interesting (if true…more on this later), the findings may not translate to humans.

    The second problem was that they did not mention the title of the study. This makes it extremely difficult to find the actual study to see if its results are being reported accurately or to examine the quality of the study. The best we have to go on is “Hirose 1994″. Some poking around on Google scholar helped me find what I think is the study here.

    As your link states, this is a preliminary study (as well as a really old study – 1994!). While I would say that it probably wouldn’t hurt for a breast cancer patient to consume green tea in addition to normal treatment, the site you linked to seems to exaggerate green tea’s effects:

    Green tea tripled the breast cancer survival rate*

    *One dramatic study showed that green tea tripled the breast cancer survival rate.

    People reading that site are probably going to remember that and ignore, forget or rationalize away the fact that the results were limited to rats and that this is only one study. I haven’t searched yet to see if it was replicated or if there were any follow-up studies.

    But all this, I think, kinda misses the point of Orac’s post. He is angry because Hollie Quinn is not only promoting supposed treatments that often have dubious support, but that she is actively encouraging women to forego any conventional treatment, including surgery.

    Diet and exercise are important and are part of science-based medical care. Exaggerated claims about them or supplements should be viewed with care and a grain of salt. Certainly, if a patient wants to try adding them to their normal care (in consultation with their physician to avoid possible contraindications), more power to them. But diet, exercise, supplements and so forth, in and of themselves, are not a viable treatment for cancer.

  66. #67 MI Dawn
    October 15, 2010

    @Arlene: no one here would diss someone trying other treatments along with conventional treatment ,provided they had a logical, researched rationale for their decision. The problem is that most of us have dealt with too many people who claim that (name your favorite item) CURED their cancer without admitting they also had XX type of conventional treatment.

    You, from all your informtion, have tried conventional treatment with one of the most difficult types of breast cancer to treat. Orac, in previous posts, discussed breast cancer types and treatment successes and failures. He acknowledges that conventional treatment isn’t perfect. And I don’t think he would ever argue with a patient trying a specific diet/exercise/massage as long as it didn’t interfere with treatment. However, he would argue against treatments that studies have shown to have little/no/negative effects (laetrile, Hulda Clark’s zapper, etc).

    Orac is a physician who really cares about his patients as people and, like most good physicians, hates to see someone die when they should have lived. That’s why he fights against treatments that have not been proven to HELP people.

    One problem with various supplements is that there is little or no oversight to make sure that you get what you pay for. (Gary Null being poisoned by Vitamen D overdoses due to a manufacturing error is an example of this).

    I wish you the best with your continuing treatment and hopeful return to health.

  67. #68 Arlene
    October 15, 2010

    Yes, I agree Todd. That was the point I was trying to make; supplemental/complimentary is worth trying with other methods. And there are actually multiple studies on green tea – Hopkins, and other NCI-affilated leaders are saying we should look at it and it definitely has been studied in humans. I know of at least one s study showing a 30 percent decrease in PSA and other tumor markers for prostate cancer in human men with prostate cancer who did a certain amount of green tea for a specified time (I thought I included that study? Not sure I did; there are many) Then of course there were all the other links referencing study source for other supplement types. When the source isn’t there, you can be resourceful as you were, and google.

    I did not miss Orac’s point; I was just concerned by his wording he was doing the same thing as Quinn: misleading people by implying it’s quackery to suggest we could have any control over our immune system once we’ve had cancer with diet and supplements. You should pick up Dr. Block’s book. Tons of well documented stuff that will lead you to the journals and studies. I, like my father who has mets prostate cancer (the smallest amount of chemo damaged his liver in 3 months) have no options in conventional medicine right now and for this moment I am cancer-free.

    So I say, practitioners on EITHER SIDE, be careful about how you tout what you have – I know there’s overselling going on on both sides. And make sure you’re objective when you argue against the other side if you do not believe that working together may be a progressive idea.

  68. #69 trrll
    October 15, 2010

    AB writes
    Individualization is the single most important thing anyone can understand in medicine and you only have to understand just a wee bit of statistics to know this.

    I must say that this is a remarkably stupid thing to pontificate about to a breast cancer specialist who has written extensively about matching the therapy to the type of cancer. Have you ever heard the saying, “Don’t teach your grandmother to suck eggs”?

    On the other hand, “individualization” is commonly used as a sort of magic incantation to excuse doing whatever “feels right” and calling it “therapy.” True individualized therapy is based upon diagnostic methods and treatments that have been validated in controlled clinical trials. When it is just hand-waving to cover up a wild guess, then it truly deserves to be “woo.” But if you don’t like the informality of the slang term “woo,” feel free to substitute “quackery,” “malpractice,” or “fraud.”

  69. #70 Orac
    October 15, 2010

    @Arlene

    Regarding the studies. The pomegranate juice studies, while mildly intriguing, consist of a study in cultured cells and a small clinical study with no real control group, where five of the six researchers disclosed ties to POM Wonderful, which makes the pomegranate juice used in the study.

    In other words, not very convincing but maybe worth more study.

    The green tea/prostate study is similar. It’s an open label phase II single arm study that looked at biomarkers. That means no controls and no survival data. The green tea/breast cancer study was in rats and was aimed at preventing, not treating, breast cancer.

    Not very convincing, either.

    Regarding vitamin D, lots of researchers are studying vitamin D to prevent cancer, but there is a paucity of evidence that it can treat already established cancers.

    As for the Linus Pauling study, I’ve written about that:

    http://scienceblogs.com/insolence/2006/04/by_seed_prodded_or_theres_les_1.php
    http://scienceblogs.com/insolence/2009/02/vitamin_c_and_cancer_has_linus_pauling_b.php

    Regarding your cancer, I could comment more intelligently if I knew what stage you were at and what specific treatments you underwent. I wish you nothing but the best in terms of beating your cancer and am happy that you still remain cancer-free, as far as your doctors can tell. However, you did undergo conventional therapy.

  70. #71 Dianne
    October 15, 2010

    While we’re discussing green tea, this study suggests that green tea may inhibit the efficacy of bortezomib on myeloma. This is an in vitro study with the usual caveats. I actually think it’s kind of hopeful for green tea as a drug: it shows that there is something biologically active in green tea…and reemphasizes that the activity of biologically active plants is not always what we want. If green tea can inhibit cancer then it can almost certainly also cause problems including bad drug-drug interactions and end organ damage.

  71. #72 Arlene
    October 15, 2010

    Of course any powerful medicinal can have adverse affects. Very high doses of green tea are contraindicated for someone on anticoagulants. But there are also new studies indicating green tea helps the body absorb chemo (opposite of what we’ve been hearing) And lots of other promising studies on it– certainly enough to consider. But like my gynecologist said, you can make numbers look almost however you want in a study– that goes for alternative and conventional medicine.

    Yes, I’d said I’d done conventional. I’m praying that (though I had to stop early because of severe side effects) with the diet, supplements and exercise, it will be enough. I also, as I’d said, I had a severe vit D deficiency which fortunately my gynecologist found. Unfortunately, he found a year after my diagnosis; again, nutrition was so critical. I don’t have the education or experience you do, of course. But I’m still holding out hope that supplements, diet and exercise combined with the limited options conventional had for me will be enough. It’s all there is so I have to be optimistic. There are plenty of talented researchers at top notch cancer institutes who feel some of the supplements warrant further serious study – certainly worth considering for me as well as for my father (stage 4 prostate cancer can’t tolerate chemo, hormone therapy-resistant, though he did get several years from conventional.) Thank you for your kind wishes. I’m stage 2B TNBC. Worried about missing chemos and the vit d thing. Do you think crossing my fingers and toes might help?

  72. #73 Dangerous Bacon
    October 15, 2010

    Best wishes to Arlene.

    Getting back to the Quinn testimonial, I’ve been involved in two cases in the past week where I doubt that the patients who completely rejected post-surgical mainstream therapy for cancer will be writing books like the Quinns did.

    The first case involves a woman who I diagnosed with a diffuse large B-cell lymphoma (DLBCL) early this year. DLBCL is one of the more treatable cancers, with cures via chemo commonly occurring. This patient opted instead for homeopathy. Her malignancy has spread and she now has extensive ascites (tumor-laden fluid in her peritoneal cavity).

    The second case is that of a woman who had a breast lumpectomy for cancer (she is vague about the details). She declined chemo and radiation. She has been losing substantial weight in the last year or so, developed abdominal pain and has been found to have small bowel obstruction secondary to widespread involvement by tumor consistent with metastatic breast cancer.
    It’s true that metastasis might have occurred even with recommended therapy. But this case is not exactly a good testimonial for stopping at surgery only.
    The alties would probably explain that she didn’t eat the right foods to make her body “biochemically inhospitable to cancer”, that the surgery caused her cancer to spread, or that she didn’t think positive enough thoughts.

  73. #74 Antaeus Feldspar
    October 15, 2010

    Besides being Breast Cancer “Awareness” month, it is also Vaccine Injury Awareness month. take note.

    According to whom? Any random paranoid can declare any month “My Personal Hobbyhorse Awareness Month” and it doesn’t mean much. A Google search for “Vaccine Injury Awareness Month” shows that no one much is paying any attention to it except those who are already obsessed with vaccine injury and hallucinate it everywhere they look.

  74. #75 LH
    October 15, 2010

    Orac,

    I’m a long-time reader, have always appreciated your clear arguments.

    This topic struck a personal note with me: I’m a medical student, my mother was just diagnosed with Stage IB ER+ breast cancer. She was recommended chemo in addition to radiation and AIs (the latter two I expected, the former I did not, and was somewhat shocked).

    Your comment on chemo’s effectiveness for ER+ thus has me thinking; my mother will take the rads and the AI but is very much against the chemo. Oncologist says it will take recurrence (post-rads, post-tamoxifen) down from 7% to about half that. I’m not asking for medical advice, but can you (or anyone else) point me in the direction of some journal articles I can read? I have full access through my school. UpToDate is about as helpful as always.

  75. #76 Orac
    October 15, 2010

    I can’t give medical advice, but I can speak in generalities. In the case of an ER(+) node-negaytive tumor that is also HER2(-), in general these days we send the tumor for Oncotype DX testing. The Oncotype test comes up with a recurrence score. If it’s high; then chemotherapy is still indicated. If it’s low, then chemotherapy is not indicated. If it’s intermediate, well, then it’s a bit of a judgment call on the part of the oncologist. In essence, these days, the Oncotype has allowed us a bit of true “individualization” of therapy when it comes to recommending chemotherapy.

    If the tumor is ER(+) and HER2(+), then in general chemotherapy is still recommended, followed by Herceptin and either an AI or Tamoxifen.

  76. #77 nybgrus
    October 16, 2010

    @Arlene: I believe you are getting some static here because you have missed a very key point. You state:

    “So I say, practitioners on EITHER SIDE, be careful about how you tout what you have – I know there’s overselling going on on both sides. And make sure you’re objective when you argue against the other side if you do not believe that working together may be a progressive idea.”

    There are no “sides” in this. There is medicine and there is quackery (or woo, or fraud, or whatever you want to call it). Finding studies that show some correlation with health improvements and green tea does not mean that the “other side” has a point and that CAM green tea integrated with “mainstream medicine” is now the best approach. The reality is that green tea DOES have some very interesting benefits. In fact, I did some work with it as a post-grad. But it is not “green tea” that is the medicinal part – it happens to be the epigallocatechin gallate (ECGC) that is showing the actual effects. So the answer is to find how ECGC works and if there are any other synergistic compounds in green tea and then to do studies and find in whom and at what doses it is most effective. Then, it ceases to become CAM or “integrated” – it is just medicine. And that is all there EVER is. In the meantime, since we can say from a scientific basis that moderate amounts of green tea in ADDITION to evidence based treatment likely wont harm anything and could help, there is no reason to say not to drink it. Nobody here, least of all Orac, would ever say there aren’t great benefits to diet and exercise. The issue we have is when those “alternative” treatments replace evidence based treatment and/or when it sets up this false dichotomy you have stated.

    I am a medical student as well, and I can tell you that a huge portion of my training is in fact to individualize treatment modalities and use whatever methods could be most helpful to my (future) patients. Regardless of whether it is recommending a bowl of yogurt to help quiet a stomach with antibiotics (instead of pharmaceutical anti-emetics) or suggesting a plan to help improve exercise and diet while on an anti-hypertensive and statin until the patient can be taken off the drugs. In fact, in a recent exam to receive full points I had to write “… prescribe the minimum dose and number of drugs at all times.”

    The websites that you cited above (and most alt-med, woo, fraud, crank, quacks, etc) are almost always reactionary simply to be against medicine. They take pilot studies, inconclusive data, and old outlier data and quote mine them to make it sound like that is ALL you need. Many (if not most) also overtly advocate stopping “conventional” medical treatments. That is the danger that blogs such as this (and practitioners like Orac and eventually myself) try so hard to fight. And yes, we get pretty worked up about it, because I assure you – I am not spending enough money to buy a nice house and busting my ass over textbooks day in and day out because this is the best way for me to make a buck at the end of the day. Some of my professional friends have been attendings for 8-10 years and STILL have in excess of $100k in loans left (one has been an orthopedic surgeon for 6 years – that’s 4 years undergrad, 4 years of med, 5 years of residency, and 6 years of being an attending – and he still has $200k in loans AND works like a dog). We do this because we care about people and thus when women like Hollie Quinn write a book saying essentially “Screw mainstream med – my diet change is what ACTUALLY saved my life. Never trust these bozos” instead of “Hey – mainstream med can be a bit impersonal and here is my story. Maybe you too can be in the situation to not need adjuvant therapy and here are some tools to help you stand up to an overbearing doctor and see what is really right for you” that pisses us off. Because scared women with breast cancer listen to her and make a BAD decision that costs a life – and a daughter, mother, sister. We find that unacceptable.

    But please recognize – we do not set aside our ways as “right” and alternative as “wrong.” We are happy to accept ANY treatment that helps our patients – as long as it is PROVEN to work and has scientific plausibility. It is the woo-meisters that set up this false dichotomy because they have no evidence to prove their claims and the only way their woo works is by making people reactionary to anything mainstream.

  77. #78 JKW
    October 16, 2010

    I admit that I clicked on the nlm link from Arlene’s spam post. I always read about Pauling falling off the academic horse, but I had never read the actual “work” he was doing toward the end of his days. What a sad way to go out. This was written by the guy who predicted the basic secondary structure of all proteins:

    “Even though no formal process of randomization was carried out in the selection of our two groups, we believe that they come close to representing random subpopulations of the population of terminal cancer patients in Vale of Leven Hospital”

    I want to believe.

  78. #79 Arlene
    October 18, 2010

    Dear NYBGROS,
    Thank you for clarifying several things for the readers: ECGC is the component in green tea (also available in supplement form) Also thank you for making a point that alternative medicine does NOT equal quackery. But, unfortunatley, many of the bloggers at this site do see it as “two sides.” It is clear just in the comment preceding this one I am now leaving. Referring to my “spam post” and the one scientist “falling off the academic horse” and what a shame it is that happened to him. Even Orac shot down every one of the evidence-based studies I sent him and he and the other bloggers have not made the distinction you so objectively did that there is good alternative medicine out there. Rather they have continued to refer only to “quakery” “woo” and “fraud” when ever they make any reference to people who push diet and supplements and doing anything that’s not conventional med to boost the immune system. I can understand you’ve spent a lot of money and time in advancing in your career. And if you feel you need to make that point, fine. But you don’t have to tell me that to convince me you care. But let’s make it clear that there are a lot of people in alternative medicine who genuinely care and have put a lot of time into developing as well. Some actually know what they are doing as you unlike most on this site point out. One of many people I personally know who turned to diet and high concentrations of herbs tailored to treat her Stage 4 Ewings Sarcoma along with chemo saw a minister for the alternative meds. The minister, who treated her own daughter with advanced leukemia (now cancer free for over a decade) gives all the proceeds of her work to her church. She’s one of many, who, like you, are not about the money and who is anything but a quack. Far too many of her patients who conventional had limited to offer to still live long lives to tell about it. Of course some die, too, just as do those who only do conventional. By the way, the young girl I knew who she treated who had advanced Ewings Sacrcoma was given a 10 percent chance of surving a year. She went into complete remission for a year and lived for three years. She outlived every child on her unit at Johns Hopkins, though her cancer was more advanced than all of theirs. Her doctors told her mother to keep doing what she was doing. I suppose they’d seen the two types of regimens work together enough times before. I hope that not too many people come to this site and are scared away from considering both modalities. My mother is afraid to try supplements for my father and he is dying – stage 4 prostate cancer that is hormone-therapy resistant. He can’t do chemo due to his frailty. The weakest drug that was an option for him (casadex) damaged his liver in three months. This website would not help my mother who I am still trying to get to consider to talk to the doc about at last trying high doses of ECGC with chaga mushroom and a couple of other well researched products as a last alternative in his case to hopefully slow the growth which is still only a moderate rate. I will not be returning to this site to pick up the hostile responses I imagine will appear. I’ll go back to visiting the cancer sites that post well-done research worth considering on all sorts of options. With no name calling or bashing. Where consumers are given objective information on two sides and left to decide. I am greatful conventional and supplements have been options for me and have learned to do my research on both.

  79. #80 Chris
    October 18, 2010

    Arlene: visualize paragraphs.

    It is really easy. When you have a natural break in the flow of information, hit the “enter” key a couple of times.

  80. #81 Chris
    October 18, 2010

    Arlene:

    One of many people I personally know who turned to diet and high concentrations of herbs tailored to treat her Stage 4 Ewings Sarcoma along with chemo saw a minister for the alternative meds. The minister, who treated her own daughter with advanced leukemia (now cancer free for over a decade) gives all the proceeds of her work to her church.

    The plural of anecdote is anecdotes, not data. It is important to remember this with cancer, which is in a word: complicated.

  81. #82 AnthonyK
    October 18, 2010

    there is good alternative medicine out there

    Where?

    10 percent chance of surving a year

    At least 10% of people do.

    Tragically, she still died.

    Alternative medicine didn’t work. (Proper medicine didn’t work either, but at least it didn’t claim to work.)

    The thing is, you are free to try anything you can afford, and think is helping, for any condition you are suffering from. But please also be aware that the alt med mavens out there will give you ineffective/untested/toxic (though unlike proper medicine they won’t tell you about the side effects – they don’t know what they are!) and they will make you pay for them, heavily, and without any comeback, legally, if they are frauds.

    Anything useful, testable, and true from “alternative medicine” will be snapped up by the real version. All you’re left with is the chaff.

  82. #83 Calli Arcale
    October 18, 2010

    Where consumers are given objective information on two sides and left to decide.

    That’s great, but please try and remember that “objective” is not a synonym for “uncritical”.

    I’m sorry you feel ill-used here, but you are misunderstanding what this site is about. It is not about being diplomatic about all of the options. It’s about laying the smack down when a practitioner or promoter is being less than honest (with themselves and/or the world) about the thing they are promoting.

  83. #84 drivebyposter
    October 19, 2010

    Wouldn’t it make sense that Dr.s would adopt stuff like homeopathy and acupuncture, since it wouldn’t cure anyone and thered be more illness to “treat” and they are only out for money? Instead of…you know…stuff that’s been shown to work?

  84. #85 nybgrus
    October 19, 2010

    Wow. I realize I pontificated a bit in my post, and certainly brought in personal experience to make the point that the slanderous accusations that doctors are only in it for the money are false, but I would not have thought that Arlene could so masterfully have taken everything I wrote and continue her same party line which is entirely antithetical to my point.

    In re-reading what I wrote I still feel that I clearly stated that there is “no dichotomy” and that any modality that works is “simply medicine.” It never ceases to amaze me how much pseudoscience and CAM breed blind faith.

    If you do read this Arlene, please, re-read my previous post but this time do it knowing that I do NOT agree with what you have said and that the strength of your “evidence-based studies” is either lacking or not saying what you wish them to say. And I will echo a sentiment that is stated so many times here as to have burned a hole into my lateral geniculate nucleus – “The plural of anecdote is anecdotes, NOT data”

  85. #86 Terrie
    October 19, 2010

    Arlene, there is no such thing as “alternative” medicine. There is only what works and what doesn’t. (Unless the “alternative” stands for “does not work”).

  86. #87 stripey_cat
    October 20, 2010

    Dangerous Bacon, post 72. Your patient dying of DLBCL terrifies me. My father (my Daddy, dammit!), was diagnosed with that a couple of years ago. His was throughout his lymphatic system, but not spread beyond it; he was constantly tired and in pain. Now, he’s absolutely fine, apart from some indigestion problems as a result of his chemo. So scary to think that someone else will lose a parent (or other family member) because they were suckered by a homeopath, or scared of getting ill from the treatment. Yes, chemo does wipe you out for a while (my father was, I think, fairly middling in the severity of his side effects), but it’s a hell of a lot better than slow, painful death.

  87. #88 Composer99
    October 20, 2010

    Arlene, having also read Orac’s reply to your linked studies, I don’t really see how he “shot down” the studies, by which I assume you mean rejected out of hand.

    He merely indicates that the studies, due to their subjects (rats & cell cultures) and thir intents (to review cancer prevention provided by the substances, not treatment) are not slam-dunk proofs that Vitamin D or compounds in green tea and pomegranate juice are going to help with cancer.

    As this relates to the original post, please keep in mind that Hollie Quinn and/or agents acting on her behalf are misrepresenting her breast cancer treatment history and encouraging others to abandon the current standards of care for breast cancer in favour of ‘remedies’ with negligible clinical effectiveness.

    That people do this certainly upsets me. Shouldn’t it be more upsetting to Orac, who’s life’s work is treating women with breast cancer?

    Also, as summarized (insightully as ever) by Calli Arcade earlier, this blog is called “Respectful Insolence”. Perhaps you should not be all that surprised if the tone gets heated (although I daresay we’ve got nothing on the comment threads of sites like Joe Mercola’s or the Huffington Post article on Hollie Quinn’s book).

  88. #89 Lucille
    October 20, 2010

    So Hollie Quinn got lucky and now finds out that she only needed surgery to cure her and not the chemo and radiation that her doctors told her she would die without.

    What does this prove? That the doctors don’t know everything. Couple that with the arrogance and narrow-mindedness of some doctors like the one writing this blog and we are forced to hope that the industry takes a critical look at itself since none of us want to suffer from ever-vascillating treatment recommendations and poisonous protocols with dubious but fiercely-defended outcomes.

    Take this little news bit from today about public exposure to radiation from thyroid cancer patients: – “About one-fourth of outpatients said in the survey they never discussed with their doctors how to avoid exposing pregnant women and children to radiation. The survey found 56 cases in which a patient shared a bathroom or bedroom with a pregnant woman or a child, or had other close contact, which is strongly discouraged in medical guidelines.”

    Now we see who is dumb and dumber, but we would never have known unless some workers set off a radiation detector after they had been (unknowingly) where a thyroid cancer patient was.

    I think we should stop allowing the fox to guard the henhouse (and should definitely look into the hapless dispensing of toxins by doctors).

  89. #90 Composer99
    October 20, 2010

    Lucille:

    Not even Hollie Quinn claims her doctors “told her she would die without” the follow-up therapies. She merely claims they “strenously recommended” them – which they would be correct do do if the follow-up therapies conpstituted the standard of care in 2002 when Hollie had her surgery.

    Do you have some other corroborating evidence (you know, other than your say-so) to back up your claim?

    Frankly, I’m not sure how “the doctors don’t know everything” is a helpful conclusion. Certainly no doctor I know personally would admit to knowing everything. It is, however, reasonable to conclude that they know more than other people in their specific area of expertise more often than not. In particular, the writer of this blog is a surgical oncologist which means it is very likely that he knows more about cancer (and specifically breast cancer since that is his area of speciality) than, say, Hollie Quinn. Or, for that matter, you.

    You may wish to reconsider the “ever-vascillating treatment recommendations” comment. After all, not that long ago people would get surgeries like mastectomies without any kind of anaesthesia or painkillers. But those “ever-vascillating treatment recommendations” started to take anaesthesia into account when it appeared on the scene. Lucky for us, eh?

    Kindly also provide a citation or link for your news bit. Preferably one which also indicates the medical guidelines to which you refer.

    Kindly also explain why we should let Hollie Quinn off the hook for her misrepresentations of breast cancer & its treatment and misguided recommendations to other women who may get breast cancer down the road on account of your tiresome collage of unsupported assertions and snide clichés.

  90. #91 Composer99
    October 20, 2010

    Apologies for the spelling error, should be constitued.

  91. #92 Composer99
    October 20, 2010

    Arrgh.

    Make that constituted.

    No more Starcraft 2 all-nighters for me.

  92. #93 Scott
    October 20, 2010

    Even if doctors don’t know everything, how does that demonstrate that anybody ELSE knows more? Or that Hollie’s decision was anything other than grossly misguided?

    Decisions can only be made based on the best information available. That’s a universal truth. In this case, the best information available said that she was decreasing her odds of survival by declining followup treatment, and that the herbal gunk most likely did nothing at all. The fact that she happened to get lucky is really quite irrelevant to that discussion.

    It’s possible to survive smashing into a light pole at 100 MPH. Does that make it a good idea? Hollie’s choice was different only in degree. And now she’s going around touting the health benefits of high-speed pole encounters.

  93. #94 Pablo
    October 20, 2010

    Even if doctors don’t know everything, how does that demonstrate that anybody ELSE knows more?

    Didn’t you know? “Doctors don’t know everything” means “therefore, everyone’s opinion is equally valid”

    It’s the “Nirvana Fallacy”

  94. #95 Calli Arcale
    October 20, 2010

    Lucille:

    I think we should stop allowing the fox to guard the henhouse (and should definitely look into the hapless dispensing of toxins by doctors).

    That’s actually why we all do this, criticizing dubious claims. Doctors aren’t the only potential foxes out there; giving people a free pass because their claim is bold or controversial is practically giving away all-you-can-eat coupons to the foxes.

  95. #96 Lucille
    October 20, 2010

    You guys are a fun bunch. Did any of you read the book? I haven’t (yet), but I DID “look inside” on Amazon, and while I am not going to spend all day providing links to lazy people, I will say that I’m pretty sure that the excerpt said that her doctors told her she would die without chemo and radiation (apparently VERY old, antiquated advice from way back in 2002, since now we can be VERY sure that surgery would have sufficed for Hollie, even though we haven’t seen her medical records or read her book).

    Now, a little lesson here. . .If you go to your search engine and type in “radiation exposure thyroid cancer” and hit enter, and then click the button for “news”, you will find stories that are about 13 hours old. I would provide the link after making this effort, but I believe it is important to encourage self-sufficiency to the greatest extent possible.

    I can’t provide a link or a search engine tip for you on this next one, but I would like to point out that I never did say, nor do I believe, that just because some MDs are inept (and/or prone to being led about by the nose) that we should encourage a free-for-all. In fact, I think we currently HAVE a free-for-some and their shrill accusations against what they seem to call “woo” probably indicate that they are desperate to protect the fabled emperor of the lovely, non-existent clothing.

  96. #97 Lucille
    October 20, 2010

    My apologies, . .in case you are unable to find the articles, you should probably know that the news is that doctors (not woo doctors, to my knowledge) are sending loaded thyroid cancer patients onto crowded subways and exposing the general public to radiation.

  97. #98 Chris
    October 20, 2010

    Lucille, did you miss the search box on the upper left part of this page? If you had used it you would have found this:

    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:

    Well, you are a bunch of fun yourself, Lucille! I would love to see how a person who has received radiation is radioactive! (though the problem that is more realistic are the patients with depressed immune systems getting coughed on in a crowd)

  98. #99 novalox
    October 20, 2010

    @95 Another cause of an ad hominem attack….

    How does someone who receive radiation become radioactive? AFAIK, the energy used in radioactive treatments damage the DNA of cancerous cells, causing the overall tumor to shrink. Nowhere during that process does the radioactive material enter the body.

  99. #100 Jarred C
    October 20, 2010

    For those that care, here’s Lucille’s news article she refuses to link to: http://www.wtop.com/?nid=116&sid=2085854

    Notice how when Lucille quotes the “56 cases in which…” part, she somehow doesn’t note that it was an ONLINE survey, nor does she mention that it had over 1000 people take the survey (assuming no repeats). Interesting, no?

    Also, as a toxicologist, the “dispensing of toxins” part of Lucille’s post made me laugh.

  100. #101 Mephistopheles O'Brien
    October 20, 2010

    Actually, my wife had her thyroid and parathyroid checked out using radioactive iodine to highlight the organs (fortunately, nothing was wrong). She was certainly radioactive. I don’t recall being warned not to nuzzle her neck, though.

  101. #102 adelady
    October 20, 2010

    Radioactive?
    If you’re given radioactive iodine for thyroid cancer it circulates throughout the body. The patient *is* radioactive for a few days following adminstration. Here in Oz, the patient normally stays in hospital until scans determine they are no longer radioactive and can go home.

  102. #103 Mephistopheles O'Brien
    October 20, 2010

    FWIW – the doctor who injected her with radioisotopes did have an assistant, but he was not named Igor.

  103. #104 nybgrus
    October 20, 2010

    Anyone think “lucille” is really “arlene?” I can’t say for sure, but for whatever reason I have this niggling feeling in the back of my head about it.

    But yes, to elaborate a bit on the *very* tangentially related topic of thyroid cancer…

    The reason not to have a pregnant women in a room with a patient receiving chemotherapy is because there is a small but significant risk that the chemotherapeutic agents could be accidentally ingested or absorbed by the pregnant woman. Since all chemo agents are potent inhibitors of mitosis (as this is their basis of action through various means) this leads to very profound teratogenicity in a developing fetus. However, once leaving the hospital, a person is neither radioactive nor in any particular danger of passing on the chemo agent to the populace at large.

    I am also always amused how the party line of all pseudoscience trolls is “look it up yourself” as if somehow posting links to relevant data is spoon feeding someone and is a negative. But of course, this is easily explained by the fact that they have no relevant data and anything they *do* link to can (and is) easily dissected by anyone with half a brain – and to put it mildly the vast majority of people have significantly more than half a brain.

    And I will once again re-iterate my praise and admiration for Calli Arcale. I find your posts to be very informative and certainly better than mine. Thank you for your contribution.

  104. #105 novalox
    October 20, 2010

    @100

    Ok, I was mistaken in that point, at least for thyroid cancer. At least I will admit the mistake.

  105. #106 Lucille
    October 20, 2010

    “Also, as a toxicologist, the “dispensing of toxins” part of Lucille’s post made me laugh.”

    Yes, that’s what worries us. At least you stated your qualifications. Most of the “experts” here have not.

    Chris, did anyone SAY that she did not have surgery? Have you checked into what the non-woo doctors can do for your ADD?

    Anyway, did you read the article about the thyroid cancer patients or not? It was not my idea to call it to the attention of the world at large that cancer patients are setting off radiation alarms on public transportation systems. Don’t worry; just get your annual flu shot, sucker!!

  106. #107 squirrelelite
    October 20, 2010

    Lucille was probably thinking about this “article” which talks about patients “unknowingly exposing the public to radiation” after receiving radioactive iodine treatment for thyroid cancer.

    http://www.allabouttopnews.com/thyroid-cancer-patients-emitting-radiations-unknowingly/85780/

    This is a double laugh. If the guidelines they were sent home for were anything like these from the thyroid cancer survivors association:

    http://www.thyca.org/rai.htm

    they obviously didn’t read or understand them. Also, they probably didn’t listen to the medical personnel who probably reviewed them before releasing the patient to go home.

    What makes it a double laugh though is that most people in the world are exposing people around them to radiation (although not much) without thinking about it. Mostly it comes from carbon 14 and potassium 40 which are very common in the environment. Neither is especially dangerous as radionuclides go, but if we applied the rules on low level nuclear waste across the board, most human corpses would have to be disposed of as radioactive waste.

    More seriously, though, radioactive iodine is used as a follow up treatment after thyroid surgery BECAUSE it is selectively absorbed in the thyroid. It decays with a half life of about 8 days emitting a gamma ray which mostly escapes the body and a beta ray (electron) which is absorbed within 2 mm. So it is very good in this particular case because it goes right to the remaining possibly cancerous thyroid tissue where it deposits its energy and kills the remaining cells.

    The major risk to others is probably from radioactive iodine that might be excreted in sweat, saliva, urine, etc. and accidentally absorbed. Hence, the guidelines I linked to.

    Also, because of the 8 day half-life, 97% of it is gone in a month.

    But, such a treatment is completely unsuitable for breast cancer and most other localized cancers because the radiation goes to the wrong place. When radiation is used as an adjunct therapy for these conditions, it is generally from external beams of gamma rays, X-rays or electrons (orac certainly knows better than I which are most common in current therapies). These are calibrated to deposit as much of the energy from the radiation as possible in the local area of the cancer. And, they leave virtually no radioactive material behind to “unknowingly” irradiate other people.

    (There is a slight probability of a proton absorbing an electron, becoming a neutron and making a radioactive isotope nucleus.)

  107. #108 squirrelelite
    October 20, 2010

    BTW, Lucille,

    the Huffington Post article orac linked to never mentions surgery!

    Instead, it states

    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 mode

    and

    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)

    If they mention the surgery in their book, do you know which chapter it is in? Do they acknowledge that it helped save her life?

    And, what is the best study you know of demonstrating the effectiveness of herbs, supplements or acupuncture as a primary treatment (or even an adjunct therapy) for any form of cancer?

  108. #109 novalox
    October 20, 2010

    I see that Lucille has gone with an ad hominem attack. I guess that shows the weakness of her argument.

    Well, that, and the fact that she didn’t even bother reading the article that she posted as “fact”.

  109. #110 Orac
    October 20, 2010

    No one seems to have clicked on this link in the first paragraph:

    http://scienceblogs.com/insolence/2010/09/the_testimonial_of_hollie_quinn_the_huff.php

    Note, that I explain all about how I know Hollie underwent surgery.

  110. #111 Chris
    October 21, 2010

    Lucille:

    Chris, did anyone SAY that she did not have surgery?

    The point was that you were ragging us about using the search function in Amazon, so I pointed you to the page where Orac used that feature. The page that Orac just listed, again.

    I would suggest you read that page.

  111. #112 squirrelelite
    October 21, 2010

    I’m pretty sure I read your earlier article about Hollie Quinn’s “testimonial”. Obviously, Lucille did not.

    But, I should have given it a more careful reread before finishing my comment.

    Not that it’s likely to stop Lucille from setting up her little stand to dispense advice.

  112. #113 Lucille
    October 21, 2010

    “The major risk to others is probably from radioactive iodine that might be excreted in sweat, saliva, urine, etc. and accidentally absorbed. Hence, the guidelines I linked to.”

    Oh! The sweat, saliva, and urine are activating the radiation alarms on public transportation systems? Thank you for clarifying. (???!!!)

  113. #114 Lucille
    October 21, 2010

    “the Huffington Post article orac linked to never mentions surgery!”

    If you are going to comment on an author based on her book, you should probably read the book. Blaming Hollie for some perceived omission by the Huffington Post is ridiculous. Orac the scientist should know better. Or perhaps he is simply blaming Hollie for ruining Breast Cancer Awareness Month. Hard to tell.

  114. #115 Chris
    October 21, 2010

    Lucille, are you actually reading what people write? Did you read the previous article that has been linked to at least three times on this page?

    And you do understand there is a difference between thyroids and breasts, right? Or that the radiation treatment between the two are completely different?

    Thanks to those who explained the iodine tests, I learned quite a bit. I only knew a little bit about the breast cancer radiation treatments as years ago one of the soccer moms had markings on her, which she said was a target for the radiation treatment (she survived her breast cancer, and the last time I saw her a few years later her hair had grown back, and then we just talked about the trials and tribulations of building a house).

  115. #116 Lucille
    October 21, 2010

    “And, what is the best study you know of demonstrating the effectiveness of herbs, supplements or acupuncture as a primary treatment (or even an adjunct therapy) for any form of cancer?”

    Have I said a single thing about the effectiveness of these therapies for any form of cancer? No. I think I’ve limited my comments almost exclusively to the sloppy, unwarranted faith people here seem to have in the non-woo doctors.

  116. #117 Chris
    October 21, 2010

    Lucille:

    If you are going to comment on an author based on her book, you should probably read the book.

    Orac used the Amazon search feature on her book. Did you miss where I pointed that out? Also, the first HuffPo piece was not written by Hollie Quinn. Did you miss that too?

    Perhaps you should go back and read that article that has been linked to at least three times on this page.

  117. #118 Lucille
    October 21, 2010

    Chris, I must confess to being completely confused as to your inclusion of breasts in the discussion of public exposure to radiation. I was commenting on an article about doctors sending radioactive patients into public places, and I’m not sure if YOU are talking about radioactive breast cancer patients or radioactive thyroid cancer patients. But what does it matter? The news today is that NON-WOO DOCTORS, who have the implicit stamp of approval of many posters here, are presenting dangers to the public health as verified by the detectable levels of radiation on public transportation systems. As the story that was pertinent to my point was about THYROID CANCER PATIENTS, I have NO IDEA why breasts are relevant to the discussion of this particular point. (Now please don’t tell me that Hollie Quinn had BREAST CANCER–I know that.)

  118. #119 Lucille
    October 21, 2010

    “Orac used the Amazon search feature on her book. Did you miss where I pointed that out? Also, the first HuffPo piece was not written by Hollie Quinn. Did you miss that too?”

    I applaud Orac for doing that. He must as chagrined as I that people are accusing Hollie Quinn of lying. And, yes, I am well aware that the Huffington Post article was not written by Hollie Quinn.

    So, Chris, are you basically upset because Hollie’s story and the Huffington Post article are ruining Breast Cancer Awareness Month? Perhaps Orac can arrange for all text here to appear PINK for the rest of the month; that should raise the awareness that will magically find the cure. Be aware, think pink and think positive breast cancer thoughts!!

  119. #120 Chris
    October 21, 2010

    Lucille:

    Have I said a single thing about the effectiveness of these therapies for any form of cancer?

    Squirrelite was referring to the original HuffPo article, which were those words that were indented with a funny dotted line on the left hand side. He was pointing out that you never read the article that has been linked to three times on this page.

  120. #121 Chemmomo
    October 21, 2010

    Lucille,

    It was not my idea to call it to the attention of the world at large that cancer patients are setting off radiation alarms on public transportation systems. Don’t worry; just get your annual flu shot, sucker!!

    I’m confused: how is the flu shot going to protect against radioactive cancer patients?

    I did read some of the iodine articles. Did you read this one?
    http://www.wtop.com/?nid=116&sid=2085854

    It reports that the alarm in the Lincoln tunnel was set off by a I-131 patient who was on the bus. He ignored the doctor’s instructions, and took the bus to Atlantic City. Saliva, sweat, and urine have nothing to do with it. He set off the alarm.

    There’s also one other important piece of information: it’s the Nuclear Regulatory Commission which relaxed the guidelines for the I-131 patients (thanks to squirrelite for beating me to the I-131 details) back in 1997. This set the stage for outpatient treatments instead of mandatory hospitalization.

    The article also notes that the NRC is rethinking the recommendation in light of these issues.

    I don’t have any real evidence about how well outpatient I-131 clinics inform their patients of the risks to others. Anecdotally, I do know two people who had I-131 treatment within the last few years. One, if I recall correctly, was absent from work for about two weeks. The other one had it stressed to her to stay away from her young children.

    But the bottom line here is that it’s hit the news because it’s a problem that is being addressed – both by the regulatory agency in charge (Note: that’s the NRC, not the AMA), and congress.

    Tell me again how any of this relates to getting a flu shot? Or even how it relates to Hollie Quinn and her refusing chemotherapy, an entirely different type of cancer treatment?

  121. #122 Chris
    October 21, 2010

    Lucille, do you have issues with reading comprehension? Did you not know that Orac is a surgical oncologist specializing in breast cancer?

    I am not upset about anything. I am annoyed that Ms. Quinn has downplayed the role that her surgery had in her health, but that is all. Many would call that “lying by omission.”

    I am still trying to figure out why you think treatment for thyroid cancer with radioactive iodine is the equivalent to the radiation used in breast cancer. If you have issues with thyroid cancer treatments, then please go to the blog of a thyroid oncologist and complain there. Because your arguments make no sense here.

  122. #123 Adela
    October 21, 2010

    It could be worse. There are some, shall we say “over the cliff” feminists that insist medical treatments for breast cancer are part of the patriarchy profiting off of the mutilation of women. Reject modern medicine in the name of female empowerment becomes another selling point for the woo industry.

  123. #124 squirrelelite
    October 21, 2010

    Thanks for carrying the load last night, Chris!

    The Society of Nuclear Medicine had an article a couple of years ago about a woman who set off a radiation detector. She had received a dose of radioactive iodine. She was told to avoid public transportation for two weeks, but decided to go out after only 24 hours. She set off the alarm!

    38 days after the dose (about 3 1/2 half-lives), she was tested to see how much radioactive material remained, it was low and she traveled without setting off the alarm.

    http://jnm.snmjournals.org/cgi/content/full/49/2/337

  124. #125 Vicki
    October 21, 2010

    I highly recommend comp.risks/the RISKS forum on risks to the public from computers and related systems for both notes on risks you might not have heard of, and a sense of proportion. Yes, patients have died because of hardware and software problems with radiation machines; this is neither a new nor a trivial problem (see Therac-25), but it’s not a reason to abandon radiation treatment.

    You can give the best safety advice in the world, but not everyone will take it. A friend of mine had radioactive iodine treatment for cancer earlier this year; when they sent her home, they told her to sleep alone for the next few days, so as not to irradiate anyone else (eight hours or so in close proximity wouldn’t have killed her partner, but it wouldn’t have been good for him either). She listened. Not everyone does. And it’s not necessarily the doctor or other medical workers’ fault if they don’t.

  125. #126 Chris
    October 21, 2010

    Vicki:

    . Yes, patients have died because of hardware and software problems with radiation machines;

    Discussed here at Unforgivable medical errors and Unforgivable medical errors, revisited.

  126. #127 stripey_cat
    October 21, 2010

    Hang on, is Lucille blaming doctors exclusively for patient non-compliance with post-treatment care recommendations? That’d be like blaming the surgeon who just patched my boyfriend’s hernia if he tears it out lifting weights or something. If it wasn’t explained clearly to him, three times in person and given in writing twice, that he needs to recover strength slowly, then maybe he’d be able to blame the medical team; however, it was made bloody clear to us what and what not to do post op. Similarly, if the instructions to keep your family safe were buried in pages of legalese, then you could forgive someone for missing them and blame the medical team for not making it clearer; but the survey doesn’t suggest that, only that a small but non-zero minority of patients fail (for whatever reason) to follow instructions. Considering underlying causes for non-compliance is important (and should be considered when setting standards of care), but it’s not automatically the result of poor systems – some people have good reasons, some don’t understand, and sadly, many seem to think they know better than the specialists.

  127. #128 Chris
    October 21, 2010

    I saw an article about the thyroid patients this morning. As a cost cutting measure the patients no longer have to stay in the hospital, and were assumed to act like adults. Obviously some did not follow directions.

    Still has nothing in common with breast cancer treatment.

  128. #129 Composer99
    October 21, 2010

    Lucille, you were the one who asserted that “doctors (not woo doctors, to my knowledge) are sending loaded thyroid cancer patients onto crowded subways and exposing the general public to radiation” (cited from your own comment #96).

    Since that was the claim you made, the burden of providing the evidence to back it up was upon you, not upon all the other people who ended up taking the time to find articles.

    Trying to escape that burden by accusing others of laziness is not going to impress. All the more so since what others discovered, upon digging, was that the situation appears to have arose due to patient non-compliance.