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.