Respectful Insolence

Cassandra Callender, the teen who refused chemotherapy, speaks out to a quack

Ty Bollinger attempts to turn tragedy into pro-quackery propaganda.

A recurring topic on this blog involves my discussion of stories about children with cancer whose parents refuse chemotherapy, thus endangering the children’s lives. These stories usually take this general form: The child is diagnosed with a deadly, but treatable cancer that has a high probability of cure with proper chemotherapy. The child receives the first round of chemotherapy. The parents can’t deal with the side effects. If they are woo-prone, they make the decision to use “natural healing” or some form of alternative medicine. Sometimes it’s in response to the child’s request. Sometimes it’s their decision. Sometimes it’s impossible to tell, given how much influence parents have over their children. Whatever the situation, the next step is usually that the authorities get involved. A judge orders the parents to treat their child. Once that happens, the alternative medicine woo-niverse goes nuts with cries of “medical fascism,” lies about how whatever quackery has been chosen to treat the child has a better chance of curing him than chemotherapy, and, of course, rants about “cut, poison, burn.”

The best resolution to these stories involves the court and doctors coming to an agreement in which the parents voluntarily make sure the child receives the needed chemotherapy. This happened with, for example, Daniel Hauser. Sometimes this happens after treatment has been delayed and the cancer has recurred, as was the case with JJ, an aboriginal girl in Canada who refused chemotherapy last year. In such cases, the chances of the child’s death increase dramatically. The worst possible outcome is that the child dies, as happened in the case of Makayla Sault. In between are situations that remain unresolved in which the child involved hasn’t received any more chemotherapy yet but hasn’t died yet, such as the case of Sarah Hershberger. Another possible outcome is that the child is forced to undergo chemotherapy, an outcome that doctors and nurses do not like because forcing a patient to receive treatment goes against our natures. The perfect example of this last outcome is a girl named Cassandra Callender.

I wrote about Cassandra Callender’s case in January, and even to me it is a bit of a troubling case. The reason is that Cassandra was 17 years old, which is old enough that she is almost of legal age to make her own medical decisions. Whether it was her decision, that of her woo-prone mother Jackie Fortin, or a joint decision, Cassandra refused chemotherapy and her mother backed her decision. Because Cassandra was a minor and won’t turn 18 until this fall, the judge ordered that she undergo chemotherapy, and she was kept involuntarily in the hospital in order to make that happen. As regular readers know, invariably in cases of younger children and even teens, I come down hard on the side of doing everything to save the life of the child. In this case, I was a little less certain—but just a little—because of how old Cassandra was. As I like to say, competent adults can choose any quackery or treatment they want, and Cassandra is almost an adult. However, a line has to be drawn somewhere, and legally she wasn’t an adult yet; so I could justify forcing her treatment.

Now, here it is, several months later, and Cassandra has been released from the hospital. Predictably, the cancer quackery brigade wanted to interview her, and they did, presumably with the permission of her mother given that Cassandra is still not quite 18. Also not surprisingly, it was cancer quackery promoter Ty Bollinger who interviewed her for the the quack website The Truth About Cancer under the predictably histrionic title The Medical Kidnapping of Cassandra C (Finally The Truth Revealed) – The Truth About Cancer Exclusive Interview. Also not surprisingly, the same video was hosted at NaturalNews.com:

It’s a disturbing listen.

The first thing we learn is that Cassandra’s diagnosis was delayed, perhaps because of an atypical presentation. She had severe abdominal pain and was worked up, but, according to her, the doctors couldn’t figure out what was wrong with her. Then her primary care doctor felt a very enlarged lymph node “the size of a golf ball” and treated it with antibiotics. It didn’t go away. So what happened next sounds like a series of needle biopsies, which apparently didn’t provide enough tissue for diagnosis. Ultimately a surgical biopsy was performed, which, according to Cassandra, “looked like” Hodgkin’s lymphoma but that they weren’t sure.

Reading between the lines, I tend to think that what happened here is that Cassandra and her mother didn’t really believe the diagnosis. Cassandra tells of going to another hospital “for another biopsy” and being told that it wasn’t necessary. Now, there’s nothing wrong with getting a second opinion. In fact, I almost always recommend it for my breast cancer patients if they are the least bit uncertain. However, it sounds as though what happened is that there was a second opinion that agreed with the first opinion, which recommended immediate chemotherapy. Clearly, Cassandra didn’t like her second opinion, because she keeps going on and on about wanting a second opinion but saying that Baystate wouldn’t do it for them. In reality, her definition of a second opinion appears to have been another biopsy and any opinion that didn’t involve another biopsy wasn’t a “real” second opinion to her. Indeed, later in the interview, she basically says as much, admitting that the doctors were sure about the diagnosis and telling Bollinger that the refusal of the doctors to do another biopsy made her suspicious.

In any case, Cassandra didn’t want chemotherapy, justifying her decision based on the long term effects of chemotherapy:

I was reading into it. They were saying possible organ failures and and difficulty doing physical activity the rest of my life, and I didn’t want that when I knew that there was homeopathic and natural ways of treating cancer.

Sadly, this is a very common rationale, fear of long term chemotherapy side effects. It’s not an unreasonable fear. However, when the alternative is death, the possibility of such long term side effects is not as unreasonable as it would be for a disease that was not so immediately life-threatening. It’s also a false equivalency. Sure, homeopathic treatments for cancer will be a hell of a lot less toxic. In fact, unless they’re contaminated, they’ll be nontoxic because they’re basically water. Of course, they also won’t do anything to treat the cancer. Cassandra would have felt much better taking homeopathy than taking five months of chemotherapy; that is, until her cancer progressed to the point of causing severe symptoms, which it inevitably would have.

Now one thing that I find hard to believe and, if true, disturbing, is Cassandra’s account that twelve squad cars’s worth of police and Connecticut Department of Children and Families (DCF) case workers came to take her to the hospital. Certainly, this sounds like massive overkill unless there was reason to believe that there might be violent resistance. Her mother wasn’t there, either; so all we have is Cassandra’s word for the story. She also tells a story of running away from a foster home and the police threatening to put her mother in jail. How much of the story is accurate is, again, impossible to tell; it’s only one side of the story, and her doctors are bound by patient confidentiality and cannot tell their side of the story. I do believe her account of being forced to undergo port placement. It sounds as though she really fought the medical staff until they were able to sedate her.

We also learn that Cassandra’s cancer might not have been completely eradicated. She refers to a PET scan she had in July that “didn’t look good” and how she’s waiting for new scans. Not surprisingly, this leads Bollinger and Cassandra—but particularly Bollinger—to express disgust that “they” forced Cassandra to undergo chemotherapy and yet there might be some cancer left. Well, as far as the chemotherapy goes, Bollinger needs to get over it. No treatment is 100% successful, and sometimes the first cycle doesn’t completely eradicate the disease. Cassandra relates that in February they thought she was in remission but in July her scan “wasn’t clear” and there was something that lit up. The doctors aren’t sure what it is. That, of course, is why chemotherapy for lymphoma requires so many cycles. We found out the hard way decades ago that just one cycle leaves the patient with an unacceptably high risk of recurrence. it takes multiple courses, including initiation, consolidation, and maintenance therapy, to reduce the risk of recurrence as much as possible.

That’s why in Cassandra’s case I really, really hope that there is no residual disease visible on her followup scans. If there is, she’s as good as dead, not because residual Hodgkin’s disease can’t be successfully treated but rather because she will be turning 18 on September 30. When that happens, there’s no doubt that she will immediately abandon conventional treatment of her cancer and start using some form of quackery or other. Indeed, before then, she will be getting a lawyer and that alone would almost certainly successfully delay any medical treatment until after she turns 18, when she can refuse it. She basically says that that’s what she will do.

One particularly despicable aspect of this video comes at the 19:20 mark, when Bollinger promises Cassandra that he can help her and show her ways to remain cancer-free, while offering to help to get her to September 30 without having to take chemotherapy. To this Cassandra responds that she has seen people who have used “natural and homeopathic” cancer treatments and that it worked. There is, however, a statement that is key to understanding how people choosing alternative medicine to treat cancer. Bollinger states that he thinks the “right” to choose natural healing is a fundamental human right, to which Cassandra responds:

I think it’s true. Either way I’m still doing something for my health. A lot of people in media have misinterpreted, saying that I wanted to die of cancer instead of treatment, but that’s not true. I simply didn’t want the chemotherapy, something that was less harmful to your body. Cancer is harmful enough to your body. Why would you want to add more to that?

Later, she says:

I never wanted to die. I wanted another way to live.

Cassandra also has a fundamental misunderstanding of chemotherapy and cancer:

Your statistics drop if you do chemo and then have to do it for a second time. I had an 85% survival and that won’t be the same if I have to do it a second time. And if they couldn’t cure me at 85, I don’t have any hope that they could do it for anything lower with chemotherapy.

Notice how she attributes the the lower survival rate in patients who relapse after treatment to the second cycle of chemotherapy, rather than to having disease that was too resistant to be eradicated by the first course of chemotherapy. I can undersand lacking faith that a second round of chemotherapy could cure her after the first one failed; that’s understandable even in patients who accept science and conventional therapy. But her relapse—if relapse it is—is an indication of bad disease with a bad prognosis. It’s not the chemotherapy that made it that way. It’s the fact that she has stage III-IV Hodgkin’s disease, as she reveals on her GoFundMe page.

Indeed, Cassandra demonstrates magical thinking at every level. She thinks that there really is another effective way to eradicate her cancer “naturally” or with homeopathy. There isn’t. Would that there were! I mean, seriously. If there were, doctors would be falling all over themselves to use them, because we don’t like having to give patients drugs that cause severe toxicity and then dealing with that toxicity and watching our patients suffer.

Cassandra’s had her best shot at surviving her cancer, thanks to science and conventional medicine. Given how close she is to turning 18, there will be no more, and she knows it. Indeed, she and Bollinger discuss how she should engage in a delaying action, pushing tests, appointments, and scans back as far as possible, so that there is less time for her to receive any treatment again. Cassandra even notes that if it’s only three weeks before her 18th birthday no judge is likely to order her to undergo treatment when it will stop in three weeks anyway. So there’s no doubt in my mind that, if Cassandra’s cancer really has recurred, she will receive no further treatment because she will successfully run out the clock. Instead, she’ll go to Ty Bollinger, who will hook her up with practitioners who will detox her, give her laetrile and/or sodium bicarbonate and/or medical marijuana, put her on an alkaline diet, and subject her to whatever cancer quackery sounds most appealing.

That’s all the more reason to hope against hope that her scans show no evidence of cancer. If she does still have cancer, sadly, she’ll be as good as dead, and her death will not be pleasant. That it will also probably be unnecessary is the greatest tragedy of all.