When testimonials attack

As you may have noticed if you’ve been paying attention to the comments over the last few days, you may have noticed that we’ve had a bit of an infiltration of believers in “alternative cancer cures” (or, as I will abbreviate them, ACCs). The main focus of the infiltration appears to be in this post about Daniel Hauser, the 13-year-old boy who refused chemotherapy for his Hodgkin’s lymphoma and whose case was recently decided, with the judge ordering his parents to obtain repeat staging studies and then to get him to a science-based practitioner in order to get appropriate therapy. Oddly enough, one of the woos to show up is Happeh, whose wankery-filled (literally) website was the target of one of my editions of Your Friday Dose of Woo. His comments are too inane to bother with in a separate post, utterly devoid of educational value.

However, there were at least two commenters whose comments provide just the right “teachable” moment about ACC testimonials that I thought they’d be worth looking at in more detail. First, there was mertle:

I did a proven protocol for invasive breast cancer, I took the herbs and did the diet, plus exercise, prayer, purest water I could find. My tests were all clear of cancer the following year. I’m getting more tests, to see how I’m still doing. I did nothing else to cure it. I hope I’ve been faithful enough with herbs/diet to stay cancer-free. If not, I will go back to totally healthy eating/living, and get rid of it again. The same way.

Thousands have been healed of cancer thru proven plans of herbs/diet. It’s just ridiculous to assume the American people are such idiots to believe otherwise! Are we assumed to be so stupid that capitalism must murder us, it’s our fate…the chemo/radiation “ovens” that pay our doctor’s med school bills and fill up the cemeteries with our bodies…that there’s no other way? and no way to live well after cancer and live 20-30 years well???

God’s given us what we need to find healing, if we’ll stop being brainwashed and do His herbs and created foods.

Are you so angry and full of dead people’s money, that you continue to spout death and dying on the masses?

If you’ll only find your forgiveness in Jesus Christ, who died for our sins willingly, and then be a fountain of healing and life, it’s so so much better!!! You do have a great future with Him…He is full of life and healing, for you and for all.

I replied:

Do tell. Who are these “thousands”? Where is the documentation. Rest assured, if thousands had truly been “cured” by such regimens, medical science would sit up and take notice. Not surprisingly , whenever anyone tries to investigate these claims scientifically, they can never seem to find all these “thousands” of people.

But let’s get to the nitty gritty. What size was your tumor? Were your lymph nodes positive. How, exactly, was your cancer diagnosed? What kind of biopsy was done? Do you have the pathology report? What was the histology? What tests are currently showing you to be “free of cancer”? Answer those questions, and I may start to take your testimonial more seriously.

Mertle replied to me and other commenters who pressed her for more details:

My degree is a lowly B.A., I have a bro. who’s an atty, and etc. My daughter is a nurse. However, if I myself were in the cancer treating medical community, this is why I (without Christ Jesus) would not acknowledge actual cures existed:

(1.) I would hate to admit I’d been wrong and thousands had perished because of it, for decades.

(2.) I and the rest would lose TONS of money in all the facets of “cancer treatments”, should the cures be acknowledged publicly.I’d have to actually love people and their health, more than the money in my pocket.

And don’t a great God’s herbs/diet look “stupid” next to man’s great machines and knowledge? Well, we were all there, once.

Here is some work for you to do: Google… “Essiac”, and go to www.beating-cancer-gently.com. Also, google “Dr. Budwig”, “Dr. Brandt”…for starters! You don’t want to take everything in at once. The grief of realizing that the death and dying that’s going on, is because of raw capitalism and ignorance, not illness, is heartbreaking.

As for the particulars on the cancer I had, without the papers at hand, I can say it was a 9 mm tumor, a “needle” biopsy was done, it was invasive, and etc. The tests done were first a bloodtest, CA 27 29, a mammogram and an ultrasound. All clear. I would love your scrutiny! Let the challenge begin! You do your homework, I’ll do mine, by God’s grace.

I do so love a challenge.

So let’s look at mertle’s story in a bit more detail. What I can reconstruct is that mertle apparently had an abnormal mammogram. At least, that’s a reasonable assumption because 9 mm is less than half an inch. It’s fairly uncommon to find such a small tumor by physical examination alone, unless it’s very close to the surface of the breast. By a needle biopsy, it’s likely that she had either an ultrasound-guided core biopsy or a stereotactic biopsy under mammographic guidance. Either way, a large core needle would be used to take pieces of the tumor and a small metallic clip left behind. The reason the metallic clip is left behind is because in the case of small lesions it can be hard to find them again. That’s why it doesn’t matter to me that mertle claims that her mammogram and ultrasound are all clear; that means nothing with respect to whether the tumor is still there or not. It almost certainly is, although it’s possible that it was removed by multiple needle biopsies given how small it was. Occasionally, I have operated on women with small cancers who have undergone needle biopsies, only to find no tumor left behind.

One should also be aware that blood tests for breast cancer, including tumor markers like CA 27-29 are notoriously unreliable. Sometimes they can be useful in advanced disease, but in the case of women with tiny tumors like mertle’s it’s pretty worthless as tumor markers go. It’s not very specific, and it’s definitely not very reliable. Indeed, I can’t figure out why so many oncologists still bother with it. Indeed, the NCCN guidelines for breast cancer state: “In addition, the Panel notes no evidence to support the use of “tumor markers” for breast cancer…” If there’s one area of breast cancer therapy that isn’t as science-based as it should be, it’s the common use of tumor markers by so many oncologists.

What all this means is that mertle’s story is not evidence at all of being “cured” by whatever natural woo it is that she is using. Not that that should come as a surprise. Either one of two things has happened. Either her tumor has been removed by the needle biopsy, and mertle is cured, or she still has her tumor. In the latter case, because it was so small, it could take years to progress. Indeed, in the natural history of untreated breast cancer, there is a small, but detectable, rate of ten year survival, and the median survival is 2.7 years. These were from large tumors from 100 years ago. For small tumors, such as mertle’s 9 mm tumor, the median survival is probably much higher. Moreover, as I’ve described before, there is evidence that some small breast cancers detected only on mammography either spontaneously regress or never progress. It’s probably not the 20% estimate claimed, but it’s also probably not as rare as we used to think. In other words, taking into account the biology of untreated breast cancer, mertle’s story is no evidence whatsoever that she has been “cured” by woo.

Here is more detail of her story:

The protocol ended in December, 2007. Woo-hoo! What joy. In February, 2008, I was granted a CA 27 29 bloodtest for breast cancer, which would also be elevated if other reproductive cancers were present. Well within the reference range of 0-38.6, it returned at 5.5. I was elated. A mammogram and ultrasound followed in June-July of 2008. The doctor’s first report stated the tumor was “no longer evident”. Later, after two letters confirming this statement, he said nothing had changed and that I was refusing surgery. This called for a second opinion. A friend of the family, a doctor by profession, volunteered his time and effort to view the films himself. His report? He could find “nothing of concern”. Two nurses, one my own daughter, viewed the films. The metal clip on the grayish tumor in the before films was clearly visible in the after films. However, that murky mass around the clip, was replaced on the after films by clear, black space. No more gray! Praise the Lord!

First off, what that “friend of the family” said about the mammogram is pretty meaningless unless he is either a mammographer, a radiologist, or a surgeon or other specialist who routinely treats breast cancer. In fact, I routinely tell patients that for subtle abnormalities don’t trust my reading. I’m not a mammographer. In any case, what this story most likely signifies is that the tumor was probably removed (or mostly removed) by the needle biopsy. If that’s the case, I’m actually happy for mertle. What I’m not happy for her is that she’s using her story, which is no evidence at all for the efficacy her Essiac woo (which, as Quackwatch points out, has no evidence supporting its efficacy in cancer whatsoever). Neither do the other forms of woo mertle is using, including colon cleanses, her herbal concoctions, and various other woo.

In other words, mertle’s testimonial tells us nothing about whether she is “cured” or whether her “proven” regimen did anything whatsoever.

Now, armed with the knowledge I’ve imparted over the last four years, let’s see if you can handle analyzing the second testimonial, that of Micki. Here’s a hint how to do it.