Yet another cancer cure testimonial that tells us nothing

Having gotten back from the Lorne Trottier Symposium, it occurred to me that my talk (not to mention much of my blogging about “alternative medicine” cancer cure testimonials) was nearly completely about breast cancer testimonials. This is, of course, not surprising, given that breast cancer is what I do for both patient care and research. However, there’s so much more cancer quackery out there than just for breast cancer, and there are more cancer cure testimonials out there than just breast cancer testimonials. Indeed, I happened to come across one on (where else?) that wretched hive of scum and quackery The Huffington Post. Granted, it’s nearly a month old, but, hey, I only just discovered it, and better late than never when it comes to applying some not-so-Respectful Insolence to such a testimonial. At least, that’s what I say.

This time around, it’s a woman named Meg Wolff. On the surface, Ms. Wolff’s story sounds incredibly inspiring on the surface:

When Meg was 33, with an infant daughter and 4-year-old son, bone cancer required her leg to be amputated. She picked herself up, moved on with life, and then … wham! Seven years later, she was diagnosed with invasive breast cancer. After a mastectomy, chemo and radiation, doctors told her the cancer would be back within a year.

Meg had run out of other choices when she fortuitously learned that a plant-based diet might help her. Rather than follow her doctors’ advice to “make her peace with God,” Meg replaced everything unhealthy in her diet with whole grains, beans and vegetables. And … she started seeing fast improvements. As each month passed, she got healthier and stronger. Now 52, Meg continues to eat healthy, and has been cancer-free for nearly 12 years.


Of course, regular readers of this blog will recognize that this is the classic case of taking both conventional therapy and alternative therapy and then attributing one’s survival to the alternative therapy. After all, Meg had not only surgery, but chemotherapy and radiation! From Wolff’s website, I learned that she had a stage IIIB cancer, which is not good, but it its eminently survivable, with perhaps a 50% chance of living 5 years with aggressive therapy. Not the greatest odds, I’ll agree, but certainly nowhere near hopeless, certainly nowhere near anything that would justify any surgeon or oncologist I know telling a patient to “go home and make peace with God.” It is thus not at all shocking that Ms. Wolff is still alive twelve years later; science-based medicine saved her. Still, on her website, she has all sorts of testimonials and appears to be selling various macrobiotic diets as treatments for cancer, all of which would be perfectly fine if her website didn’t leave one with the distinct impression that such diets can improve one’s odds of surviving cancer. As I always say, I have nothing against healthy eating; what I do detest is claiming more than the evidence supports.

The testimonial Meg Wolff is promoting on HuffPo is described in a post entitled From Stage 4 to Cancer-Free: One Man’s Plant-Based Recovery. You’d think from the title that this might be a challenging testimonial for me to take on. Well, yes and no, in that my speculation as to why the man at the heart of this testimonial is still alive. Here’s the story:

In the first class, I briefly shared my own cancer recovery story. Shortly after that first session, I got an email from one of the company’s managers, Scott Gill, thanking me for coming and saying he was inspired because he, too, is a cancer survivor. I was surprised to learn that he had survived stage four colon cancer by following a healthy plant-based diet and other alternative modes of treatment. It has been 20 years since Scott’s diagnosis and he remains cancer-free.

Wow! Stage IV colon cancer! Depending on exactly where it’s metastasized, stage IV colon cancer is potentially curable. Specifically, if the only place it’s metastasized to is the liver or lung, surgical resection of the metastases can still be curative. True, this is a minority of stage IV cancer patients, but I suspect you’ll see where I’m going with this before too long. First, though, let’s hear the rest of the story:

For several years during this time, Scott had suffered through bowel problems and multiple tests and doctor visits. By the time doctors caught the cancer, it was stage four (advanced) colon cancer. Even with the recommended chemotherapy, the prognosis was bleak. Because of his father’s experience with chemo, Scott decided to forgo these treatments and live his life, however short, the best way he knew how.

He remembered back to a younger, happy, healthy life, when he exercised daily and even played minor league baseball for the Detroit Tigers. He was inspired to start running again, and began running every morning. He knew that his work situation was so stressful that it was “killing him,” so he quit his job.

He happened to visit a health food store, where an employee recommended he change his way of eating. So he started cooking and eating whole grains, beans and vegetables. He had very rudimentary cooking skills, but he managed. He started mowing lawns to support himself and his family and later started managing properties, which was a lot less stressful. The stress took a toll on his marriage, and Scott and his wife divorced.

The rest of the story is predictable in that Scott is portrayed as having cured himself with diet and meditation. Not being satisfied to rely on a secondhand description of what actually happened, I decided to see if I could find out some independent information on Scott Gill. Unfortunately, I had a hard time. For one thing, the Doctor Who and Torchwood geek in me noted that there is another Scott Gill, who just so happens to be John Barrowman’s (Captain Jack’s) partner. Clearly, this was not the same Scott Gill. Unfortunately, I couldn’t really find anything about the Scott Gill described by Meg Wolff other than what is in Wolff’s HuffPo article. So, as thin a gruel as this testimonial is, let’s take a look.

As is all too common with testmonials like this, there is very little information that is sufficiently concrete to say a lot about this one other than that by promoting the idea that Scott somehow survived by giving up his stressful job, changing his diet, and starting to meditate, HuffPo is once again living down to its reputation for promoting dangerous nonsense. This leaves trying to dissect this case, which boils down mainly to looking at what it left out that might explain Gill’s good fortune. And what did this story leave out?

Surgery.

Yes, there’s a recurring theme in these cancer cure testimonials, and it’s a tendency not to go to deeply into what conventional therapies the person giving the testimonial underwent. In Gill’s case, the questions are two-fold. First, exactly where did the tumor spread to make it stage IV? As I mentioned once before, not all stage IV colon cancers are created equally. There’s a big difference between widespread tumor involvement of multiple organs and a tumor that has only spread to the liver or lung in single metastases or small numbers of metastases. that can be surgically resected. The former has a much more dismal prognosis than the latter. True, all stage IV cancer is far more likely than not to die before five years are up, but stage IV cancer that can be resected completely from the colon and the involved organ is survivable with a five year survival rate of 30% to 40%.

Twenty years ago, it wasn’t uncommon that some surgeons (particularly older surgeons trained in an earlier generation) would take patients with colon cancer to the operating room without detailed CT scans. I know, because that’s when I was in residency. In any case, the big argument back then was whether a surgeon who palpated a liver metastasis at the time of undertaking curative surgery should remove that metastasis during the same operation or wait and come back for another operation. However, if the liver metastasis was small and didn’t require an extensive liver resection to remove, there was almost universal agreement that it could be safely resected during the same operation in which the primary colon cancer is removed. In any case, if all the cancer was surgically removed, it is then quite possible that the oncologists would have recommended chemotherapy afterward.

Then, of course, there is the other possible explanation, which is that Gill never had cancer at all. This is a surprisingly common explanation for alt-med testimonials. We have no description of whether or not Gill had a definitive biopsy or what specific type of cancer (if any) that biopsy showed. Absent that information, it’s impossible to know what sort of cancer Gill may or may not have had, what its estimated prognosis was, and whether it is in the least bit plausible that his chosen treatment worked. Even if he did have cancer, it is quite possible that Gill was an outlier. We have no way of knowing. That’s why promoting a therapy based on a single anecdote is irresponsible in the extreme, which is just what Wolff does:

I felt that Scott’s story really reconfirmed what I did 12 years ago — changing my diet and lifestyle to increase my odds of survival from cancer. I was impressed that he had the strength to leave his job and do the things he knew he needed to do to get well in order to save his life. He self-reflected and decided to decrease the stress and clean up his diet, looking beyond the status quo. He chose a holistic path that made sense to him looking at all the areas of his life that were contributing to his illness, not just treating the symptoms.

Scott Gill trusted himself, let go of the outcome and lived. Today, at 52, he is cancer-free and healthy. I think there’s a lot to learn from his story.

Ah, the post hoc ergo propter hoc fallacy! Because Scott Gill chose some sort of plant-based diet, began meditating, and lived, that means the plant-based diet and meditation were responsible for his survival! Maybe. More likely not. There’s no way of knowing based on one anecdote, particularly a low-quality anecdote. This is not as though we have the story of a patient with stage IV pancreatic cancer whose tumor miraculously melted away. (The mortality of stage IV pancreatic cancer is about as close to 100% as it’s possible for a tumor to be.) In such a case, even one or two such anecdotes would be fairly persuasive evidence that there might well be something to a treatment given. Rather, this is a vague story that leaves out enough information to let us know whether Gill had cancer, what kind of cancer it was, and what its true prognosis was.

Of course, Meg Wolff needs testimonials like this. She’s selling books (Breast Cancer Exposed: The Connection Between Food and Survival), and herself on the basis of claims that she has recipes that will help fight cancer, including breakfast. She sells these with a plethora of testimonials for breast cancer and other conditions.

After all, the purpose of testimonials is to sell products, and testimonials work. Madison Avenue has known that for decades.

I really do have to thank Wolff, though. She’s provided me with a number of cancer cure testimonials. I’ll certainly be incorporating at least a couple of them into future talks, and, when blogging material gets scarce, maybe I’ll take them on one at a time.