Even Tarial cell-powered computers sometimes screw up

I really need to rein myself in sometimes.

Yesterday, all pleased as punch with myself for my mad Google skillz and for thinking I figured out just what “alternative” therapy it was that Farrah Fawcett had undergone that had resulted in what sounded for all the world like a rectus sheath hematoma, I wrote about how I thought that Fawcett had been undergoing galvanotherapy in Bad Weissee in southern Germany. Either my mad Google skillz failed me, or I was just too lazy to scroll through a sufficient number of screens to find additional information that would have brought the most likely answer. In any case, I guessed that Fawcett’s rectus sheath hematoma was due to some German woo-meister sticking electrodes into her liver. In reality, I should have paid more attention to this article:

She has been staying in the Leonardis Clinic in Bad Heilbrunn, in the shadow of the Bavarian Alps. American politician Edward Kennedy, who has a brain tumour, has also stayed there.

Farrah sought the treatment in Germany with the help of her friend, Cher, and she has also been to other nearby centres.

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.

And here’s how Dr. Vogl treated her in a video from over a year ago:

So what’s going on in this video?

Well, first I did a PubMed search on Dr. Vogl. He’s definitely a legit doctor, and he’s well-published. Specifically he’s a radiologist who specializes in the treatment of liver metastases by image-guided (as in CT-guided) minimally invasive techniques. Specifically, he appears to specialize in chemoembolization, which is the technique of threading catheters into the hepatic artery and injecting chemotherapy followed little bits of foam embedded (the “emboli”). Because tumors have more blood flow, the chemotherapy and little bits of foam tend to go preferentially to the tumor, lodging in the smaller vessels. The effect is to deliver higher concentrations of chemotherapy to the tumors and to “trap” it there, cutting off the blood flow to the tumors. It’s a technique that is well within the realm of science- and evidence-based medicine.

What confused me about this video is that I couldn’t figure out what’s so unique about Dr. Vogl’s treatments that they are supposedly not available in the United States. What they describe is “laser surgery,” whatever that means. Before I discuss this more, let me just say one thing: This is quite possibly what could explain Farrah Fawcett’s “hematoma,” which, as I’ve pointed out before, sounds suspiciously like a rectus sheath hematoma. Dr. Vogl stuck a probe through the abdominal wall and probably bagged the left superior epigastric artery. Again, it happens. It’s an expected possible complication of any procedure that involves sticking probes through the abdominal wall in that region. That it happened does not mean that Dr. Vogl is incompetent.

What Dr. Vogl also appears to specialize in is what he calls laser-induced thermotherapy of liver metastases, also called laser ablation. Why? Because everything’s better with lasers, of course! Actually, whether or not lasers are any better than any other way of ablating liver tumors, be they primary tumors or metastases is very much an open question. Suffice it to say that, when faced with liver tumors that are not surgically resectable, there are three broad strategies to try to eliminate them: (1) Cut off their blood supply and poison them (chemoembolization); burn or cook them; or freeze them. My current institution has considerable expertise in the last of these strategies, namely freezing them. One of our radiologists is quite skillful at placing cryoprobes into liver tumors (or tumors elsewhere) and delivering liquid N2 temperatures to a tumor, freezing it into an iceball of dead cells. it works. So does burning tumors. Burning tumors can be accomplished by at least two different techniques: radiofrequency ablation or some sort of thermal probe, such as a laser. Radiofrequency ablation involves applying radio waves to the tumor through a percutaneously inserted probe, which results in the heating of the tissue around the probe and, in essence, the “cooking” of the tumor. I’m much less familiar with the use of lasers for such minimally invasive ablations, but perusing the literature doesn’t convince me that it’s any better than radiofrequency ablation or cryoablation at eliminating liver metastases.

Unfortunately, the problem with any of these minimally invasive techniques for ablating tumor metastases is that none of them are permanent. None of them provide permanent elimination of the cancer they freeze or burn. They are all palliative, and the tumors virtually always return eventually. That’s not to say that there isn’t great value in palliating tumor metastases. There is. But, even if this laser method Dr. Vogl is using works as advertised, it’s highly unlikely to be curative. I’m also not clear about what Dr. Vogl might be offering that no one other surgeon or radiologist in the U.S. is offering. Perhaps it’s the “experimental” aspect that’s the appeal. Radiofrequency ablation and cryotherapy, for instance, are no longer considered experimental for liver metastases from colorectal cancer that can’t be surgically resected. I’m also surprised at how brutal a procedure it appears to be, with in essence no anesthesia. The excuse that the patient has to be able to breathe when stillness is needed doesn’t hold water, at least not to me. In fact, a physician doing this procedure could achieve both ends, controlled breathing and a high degree of pain relief, with general anesthesia. After all, the anesthesiologist can simply manually ventilate the patient during parts of the procedure where the radiologist would normally ask the patient to hold her breath and keep the patient still just as effectively, if not more so, than an awake and suffering patient could do for herself.

Anything for laser therapy, I guess.

As much as it pains me to admit to a mistake, I reassure myself by pointing out that I’m not entirely in the wrong. There’s a heck of a lot more woo in southern Germany, and Farrah Fawcett appears to be into many forms of woo:

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.

Remaining positive is, without a doubt, important, but there’s no compelling evidence that it will prolong the life of cancer patients. True, a positive attitude can make the life of a patient with advanced cancer much easier, but it won’t prolong it. There’s also certainly no evidence that any sort of “chemo sensitivity” test like the one described above can determine accurately whether a tumor is sensitive to chemotherapy. And forget about shark cartilage and selenium. As for vitamin D, although there is some evidence that it can prevent some kinds of cancer, there’s no evidence that it can fight a preexisting advanced cancer.

As much as I hate to admit a mistake, I was probably wrong about the cause of Fawcett’s recent complication. It probably was not due to woo, at least, as far as I can tell based on more research. I also have considerable sympathy for Fawcett. No one deserves to be dying of stage IV anal cancer–or stage IV any cancer. The problem is that I fear that her movie, whether she lives or dies, will be a paean to dubious therapies “integrated” with scientific medicine.