Farrah Fawcett, anal cancer, and “alternative medicine cancer cures”

Note the followup post to this one, in which Orac admits error. You just have to read it, given how rarely Orac messes up when speculating…

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Our cancer center has a large, open area interspersed with patient waiting areas, one of which is the clinic where I see patients, that I frequently must traverse to get to the elevators that will take me to my lab. In each patient area is a large-screen television to help patients pass the time during the inevitable wait to be seen by their doctors. As I happened to be wandering through that area on the way to my lab and office, I noticed on one of the TVs tuned to an all news channel that they were talking about Farrah Fawcett. I stopped, curious. The reason is that I have written about Fawcett’s battle with anal cancer and her choice to go with “alternative” medicine after it had recurred. That was nearly a year and a half ago, and back then news stories emphasized that Fawcett was doing well.

Apparently, things are worse for Farrah Fawcett than we had originally been led to believe:

Farrah Fawcett, who was hospitalized for swelling and bleeding following an experimental cancer treatment in Germany, is facing an even tougher battle than first reported.

Her spokesman, producer Craig Nevius, announced late Monday the cancer has spread to her liver.

The actress was diagnosed with anal cancer in 2006 and was originally treated at The Ronald Reagan UCLA Medical Center with chemotherapy and radiation. But several unsubstantiated reports say Fawcett has been receiving stem cell treatments in Germany, possibly for more than year.

Nevius said those reports are completely false.

“It’s never had anything to do with stem cells or alternative treatments like shark cartilage, coffee enemas or unproven detoxification diets,” Nevius told the Associated Press.

“It’s much more scientific than that. It’s not a fringe treatment,” he said, and the doctors have “multiple, multiple degrees.”

If what her producer says is true, Fawcett has stage IV cancer, which is incurable, and only around a 20% chance of surviving five years.

At this point, I think it’s worthwhile to review a bit about anal cancer. It’s a relatively uncommon cancer that arises, as you might expect, in the anus. Specifically, it arises where the mucus membrane of the lower rectum meets the anoderm, or the skin that runs partway up into the anus. The cell type from which it arises is not the type of cell that lines the rectum, but rather epithelial cells similar to the types of cells that line the vagina and urethra. One thing that’s unusual about anal cancer is that it’s one of the only solid malignancies that is not treated primarily with surgery. True, in the “old days” it used to be treated with a radical (and, quite frankly, rather brutal) operation known as an abdominal-perineal resection (APR). In this operation, the entire anus and rectum are removed, and the patient is left with a permanent colostomy. Obviously, that was not a popular operation among patients, as you might guess. Personally, as a surgeon I didn’t particularly like doing the operation, either, back when I still did that operation.

Distaste for this operation and a desire to improve outcomes led to the development of a method of treatment known as the Nigro protocol, which involves chemotherapy and radiation therapy. In many ways, this intense combination of chemotherapy and radiation is actually arguably as brutal as surgery, but its advantage is that it spares the anus, and thus has a high probability of preserving continence. Unfortunately, the treatment of local recurrence of anal cancer then usually does involve an APR, although in some cases if the recurrence is small, it’s possible to excise it locally and then treat with more radiation, although the risk of incontinence rises when that’s necessary.

One thing that piqued my interest about this story is how vehemently Nevius denied that Fawcett was undergoing any form of “alternative” therapy. Whenever I see a denial like that, especially when no information is actually given about the treatments being used aside from vague descriptions of a complication from a procedure they wouldn’t identify, my skeptical antennae start twitching something fierce. This is even more true, given that I know from earlier reports that Fawcett had been treated at an “alternative” clinic in Bad Wiessee in southern Germany in conjunction with chemotherapy at the University Clinic in Frankfurt. All of this made me wonder very much what this “alternative” therapy could be.

So, armed with the description of Farrah Fawcett’s complication and the almighty power of Google when wielded by someone with some background knowledge, I think I have come up with what I think to be a pretty likely guess as to what therapy Fawcett is undergoing, and it’s not stem cell therapy, contrary to other reports. (Yes, I realize it is a great power I have, but I try to use it only for good.) First, let’s try to figure out what the complication Fawcett suffered is, starting with this news report:

In separate phone interviews with The Associated Press, Fawcett’s producer and her doctor said that Fawcett is in a Los Angeles hospital, recovering from complications from a medical procedure in Germany, and is “not on death’s door,” as the producer put it.

“She had a minor procedure. That procedure led to a small amount of bleeding into a muscle in her abdominal wall,” which created a hematoma — a sac of blood that caused pressure and pain, said her Los Angeles cancer specialist, Dr. Lawrence Piro. It was “a simple procedure” and a standard one, although Fawcett has also pursued experimental treatments in Germany, he added.

I have to admit that I was totally stumped by this. My first thought was that perhaps she developed a hematoma in her abdominal wall from core needle biopsy of the liver, which can happen. But then, I realized that the key to figuring out what probably happened is location, location, location. Through the magic power of Google, I found that the most likely clinic in Bad Wiessee where Fawcett was treated is Klinik Winnerhof. Moreover, I learned that the “alternative” cancer therapy for which Klinik Winnerhof is best known is galvanotherapy, also sometimes called bio-electric therapy:

In April and May of 1999 when I began investigating German cancer therapies from my base of operations at Klinik Winnerhof in Bad Wiessee, Bavaria, Germany, Dr. med. Pekar contacted me through my friend and cancer consultant Helmut Keller, MD, and asked that I, as a medical journalist who specializes in writing on complementary and alternative medicine (CAM), provide broader exposure for his cancer treatment. The doctor desires to allow more patients access to the benefits of his therapy’s efficacy for cancer. He believed that galvanotherapy or bio-electrotherapy was too little known outside of German-speaking medical circles, and he was correct.

Today, at age 90, this inventor of galvanotherapy wants to leave behind a legacy of healing. Consequently, he has given me written permission to quote freely from his 1997 monograph, and I have done so. Here is my interpretation of the monograph Percutaneous Bio-Electrotherapy of Cancerous Tumours by the treatment’s inventor, Dr. med. Rudolph Pekar.

Note one thing right away. Dr. Pekar never published anything in the peer-reviewed medical literature about galvanotherapy. Indeed, PubMed search for articles on galvanotherapy yields only nine articles, only three of which are in English and only one of which, as far as I can tell, has anything to do with cancer. None of them are authored by Dr. Pekar. Whenever you see a practitioner who has practiced many years using a therapy that, according to him, can produced amazing results but is “little known” outside of his clinic, in general there’s a good reason why his therapy is “little known,” especially if he’s never tried to publish his results and instead only publishes a monograph when he’s 90 years old. Be very, very skeptical.

In that spirit, let’s take a look at what is claimed for galvanotherapy:

With great success, the Pekar treatment has already been administered to an estimated 65,000 patients throughout Europe and a few other parts of the world. The bioelectrotherapy (BET) used for galvanotherapy has advantages over surgical intervention. BET does not provoke metastasis. It does not stress the cancer patient. Frequently, its nonanesthetized application hurts in the form of a stinging electric current. But this stinging or burning sensation may be controlled effectively by the patient’s first receiving local injections of lidocaine, xylocaine, or another dental-type anesthetic at the administration site of GT.

Negatively charged particles called anions migrate to the positively charged pole, an anode, in the electrochemical cell. Positively charged particles called cations migrate to the negatively charged pole, a cathode. Between the poles, a charge separation or dissociation occurs. This dissociation damages malignant tissue in the following manner: extremely acidic tissue plus chlorine is generated at the anode; conversely, a markedly alkaline environment plus hydrogen is generated at the cathode. According to their charge, small and large ionic particles such as those in proteins, separate inside of the electrical field. The cancer cells caught between this electrochemical reaction completely depolarize, so that they become permeable and accepting of various substances poisonous to them. Meantime, therapeutic agents are being administered intravenously to the patient. Thus, the tumor tissue at the treated site can no longer maintain its specific equilibrium, and it destabilizes.

Of course, if galvanotherapy has been administered to 65,000 patients, there should be lots of data out there on clinical outcomes, shouldn’t there?

Crickets chirping.

As I often ask of such purveyors of “alternative” cancer cures, where are all these people saved by this modality? Dr. Pekar makes this claim:

From his own practice experience with cancer treatment, Dr. med. Rudolf Pekar says that a 73% rate of remission for not less than three years is what bio-electrotherapy achieves. He does qualify his statement with these words: “It should be noted, though, that in my practice, I have only been able to treat mild and moderate tumours.”

Of course he has. Haven’t they all?

Also, the whole physiological basis described for galvanotherapy is simply nonsense. The simple reason is that, although there are differences in electrical conductivity between normal and tumor tissue, electrical current has the same basic affect on normal and tumor tissue. There’s no basis for differential toxicity towards malignant tissue compared to normal tissue, at least not sufficient to allow a low level electrical current to have such a differential effect. Indeed, to have the effect advertised, the current used would have to be a lot higher, and if it were there wouldn’t be sufficient difference between the conductivity of tumor cells and normal cells to produce the “frying” of the tumor without significant collateral damage. Any cell membranes rendered permeable by electrical current in tumor cells would be matched by a similar effect on normal cells.

I couldn’t find what voltage and current levels are typically used in Dr. Pekar’s galvanotherapy (although the closest thing I could find called it the 9 volt battery cure, but upon further reflection what galvanotherapy reminds me of more than anything else is either Bill Nelson’s Electro Physiological Feedback Xrroid machine, which claims to cure cancer through “quantum” effects but in reality delivers electrical pulses of around 5 mV, or Hulda Clark’s “zapper,” which claims to “zap” parasites using similar low voltage electricity. Clearly, there is a subset of woo involving low voltage electricity. My guess as to the reason is that it’s just so damned easy to make devices to deliver such electricity and then gussy them up with claims such as this one by Dr. Pekar:

Besides the chemical reactions between matter, an additional, more profound countereffect has been observed since Dalton introduced his theory. Matter, particularly biological matter, radiates electromagnetic fields at all times. And Dr. med. Rudolf Pekar, even as a young physician, realized this fact. He states in his book: “Every biological process is also an electric process. Health and sickness are related to the bio-electric currents in our body.”

Although to someone who doesn’t know anything about physiology this sounds profound, but in reality it’s about as banal as saying that “every biological process is also a chemical process.” The reason is that cells have an electrical potential across their plasma membranes, and the mitochondria depend upon proton gradients to generate ATP and thus energy. Equally banal is Dr. Pekar’s statement about why his method never caught on, “”Medizin ist ein Geschäft [Medicine is about making money/Medicine is where a lot of money is and can be made]. And with the method I have developed, there isn’t much money to be made.”

I think Bill Nelson would beg to differ, given that he charges $20,000 a crack for his EPFX machine. Dr. Pekar’s mistake is that he never made galvanotherapy “quantum” enough to rake in the cash hand over fist, as Nelson did.

So here’s my guess about what happened to Farrah Fawcett. I could be totally wrong, but I think it’s a better guess than any I’ve seen thus far based on what I’ve been able to find out. My guess is that woo-meisters at the Klinik Winnerhof tried to treat Fawcett’s liver metastases by percutaneously (through the skin) placing electrodes into her liver in order to do a bit of galvanotherapy on them, but they got into trouble. Specifically, I think they caused a bit of bleeding into her abdominal wall. My guess is that she developed a rectus sheath hematoma when her doc bagged the superior epigastric arteries with a needle used to introduce an electrode. Again, I admit that this is pure speculation, but it’s also educated speculation and it appears to fit the known facts, especially since Fawcett was using a wheelchair and rectus sheath hematomas can be quite painful. I also note that apparently her producer/publicist thinks that, just because the treatment involves electricity, it isn’t “alternative.” He also apparently thinks that keeping things secret will improve the marketability of a made-for-TV documentary Fawcett has made about her pursuit of alternative therapies that is set to air on NBC soon:

An upcoming documentary on which Fawcett has worked for several years, “A Wing and a Prayer,” co-produced with Nevius and others, will air on NBC soon and give details, he said.

Because in Hollywood, dying celebrities = money.

It’s a very horrible thing that Farrah Fawcett is going through. If she does indeed have liver metastases from her anal cancer, she is going to die, and she’s unlikely to make it five years. More likely it’ll be sooner than that. It’s perfectly understandable that she might be desperate and ready to try any dubious treatments that promise to cure her without chemotherapy or surgery. Unfortunately, far too many purveyors of “alternative cancer cures” are all too willing to sell them to her.

ADDENDUM:

Hmmm. It’s possible I was wrong, but we’ll see. I just happened to have found a report from The Times that I had somehow missed last night, Brave Farrah Fawcett has crossed the world in search of a cancer cure – but can she find a miracle? Perhaps my Google-Fu is not as strong as I thought it was. On the other hand, if we believe Nevius’s strong denial that Fawcett is undergoing treatment with shark cartilage or radical diet or “detox” regimens, then galvanotherapy sounds more plausible. Let’s see.

Key excerpts:

In the University Clinic of Frankfurt, she has been treated by Professor Thomas Vogl, 50, who is one of the world’s leading cancer experts. He treated her with a catheter filled with chemotherapy drugs.

Another of her specialists is Dr Ursula Jacob, of the Alpenpark Clinic in Bad Wiessee, 40 miles from the Leonardis. Dr Jacob uses vitamin preparations that she says boost the immune system.

A third specialist is Dr Norbert Pfuetzenreuter, of Mednord centre in Munich. One of Germany’s best-known specialists, his approach is more mainstream.

My first thought was that that “catheter full of chemotherapy drugs” could have accidentally punctured her portal vein, assuming it was being used to infuse those drugs into the liver, but that would not explain an abdominal wall hematoma. On the other hand, Dr. Jacob is into some serious woo, such as alkalinization therapy and the Gerson diet.

More:

The Leonardis clinic claims to have one of the highest success rates in Germany. On admission, Farrah’s blood was analysed as part of a ‘special chemo sensitivity test’. ‘This involves using DNA to detect your sensitivity not only to chemos, but also to various herbal and nutritional therapies,’ a clinic source said.

According to sources, Farrah was given liquid shark cartilage to stop angiogenisis (the process by which tumours develop their own blood supply), injections of the mineral selenium, injections of vitamin D and calcium and an amino acid mix to protect her liver from chemotherapy.

A clinic source said: ‘She has been having conventional and alternative treatments, and she remains positive, which is the main thing.

Oh, well. I might have been wrong; if the report above is accurate, Fawcett she isn’t at the clinic where I had guessed her to be However, none of the dubious therapies above explains how she got what sounds very much like a rectus sheath hematoma as well as my explanation can, unless they’re doing some of those injections right into the rectus sheath deep enough to hit one of the epigastric vessels. Also, this is the only source where I’ve found all this other information on the specific alternative medical woo that Fawcett is supposedly undergoing, which makes me wonder about its accuracy as well. I suppose we’ll have to wait for her movie to find out.

What this also makes me wonder about is this: Why are there are so many clinics of woo in southern Germany near the Alps?