R.I.P. David Servan-Schreiber

One of the very first themes I started hammering on in this blog, dating back to its very inception, is the analysis of alternative medicine cancer testimonials. One reason was (and is) that I take care of cancer patients and do research into developing new treatments for a living. Another reason is that, to the average lay person, most of whom don’t have much of an understanding of cancer, alternative medicine cancer testimonials can sound extremely convincing.

For example, if you didn’t know that breast cancer can have a highly variable course spreading out over years, Kim Tinkham’s claim to have cured herself of cancer using cancer quack Robert O. Young’s acid-base woo can appear very compelling. Of course, when it is pointed out that she probably had a relatively indolent tumor and that there were inconsistencies in her story that led me to believe that her tumor was perhaps not as advanced as she liked to advertise in her media appearances, suddenly her prolonged survival doesn’t seem quite so remarkable. And, of course, like so many promoters of cancer quackery who were true believers, ultimately Kim Tinkham appears to have died of her disease last December. No doubt, if it hadn’t been for blogs like mine her death would have gone the way of previous deaths of people who made the tragic mistake of choosing quackery over effective medicine, namely into the great abyss of the forgotten. Fortunately, we were able to let people know what happened so that her death, as horrible as it is to contemplate, will at least not have been totally in vain nor will her cancer quack’s role in her death be forgotten.

Unfortunately, there are many others, some of whom write books about their choice. Some, however, become famous simply for surviving and, rather than attributing their survival to the science-based medicine they underwent plus luck, they attribute their survival to whatever health regimen they decided to undertake. For if there’s one thing that’s axiomatic about alternative medicine testimonials, it’s that the person giving the testimonial attributes his survival to the woo, not to the science. Like David Servan-Schreiber, author of Anti-cancer: A new way of life.

Unfortunately, like many promoters of alternative medicine testimonials, David Servan-Schreiber too has passed away:

David Servan-Schreiber, a psychiatrist and best-selling author whose cancer diagnosis at the age of 31 compelled him to explore and then popularize the use of natural and holistic methods in dealing with cancer and depression, died on Sunday in a hospital near Fécamp, Normandy. He was 50.

The cause was brain cancer, which had recurred last year, his brother Franklin said.

Trained as a neuroscientist, Dr. Servan-Schreiber imbued his books with his own story of surviving cancer for almost 19 years, one of diagnosis, surgery, remission, relapse and redemption.

Servan-Schreiber’s story does indeed have several remarkable elements. The first is how his tumor was discovered. At age 31, when he was a researcher at the University of Pittsburgh in neuroscience, quite by chance he underwent an MRI of the brain for a research project after the intended subject, for whatever reason, didn’t show up. In other words, there were no symptoms and no clinical indications for Servan-Schreiber to undergo an MRI, but he did anyway for his research. Shockingly, the scan showed a tumor described as the size of a walnut.

After this, Servan-Schreiber’s story becomes a bit less clear. He had “conventional” therapy for his tumor, which included surgery, but I’ve had a hard time finding out what kind of brain tumor he had, at least from the material on his own website and in his own book that I can access without paying for it. However, looking around, I find that Servan-Schreiber most likely had glioblastoma multiforme, which is what I would have guessed as the most likely type of brain cancer just playing the odds given that glioblastomas are the most common malignant brain tumor. In any case, after the successful resection of his tumor, according to Servan-Schreiber, doctors told him to eat what he wanted because it “won’t make much of a difference.”

Five years later, Servan-Schreiber’s tumor recurred. This time around, he underwent surgery, chemotherapy, and radiation therapy, during which time he became a convert to “alternative” therapies. Ultimately, he wrote his book and became a leading promoter of “integrative” medicine. To his credit, he always told people with cancer that they should seek out scientific medical treatment. Unfortunately, in the process, he also promoted the idea that diet could protect you from almost all cancers, that cell phones cause brain cancer, and that a number of other dubious health modalities could produces a “terrain” that was hostile to cancer, even though evidence supporting such claims was equivocal at best. Even so, his book Anti-cancer became phenomenally successful, being translated into 36 languages and spending several weeks high on the New York Times bestseller list in 2010, while Servan-Schreiber gave interviews in which he said things like this in describing his conversion to “natural” therapies after his cancer relapse:

Servan-Schreiber refused to simply accept his fate. He embarked on his own research and developed a method for helping his body protect itself from the disease. It drew heavily on natural defense mechanisms and a new lifestyle based on a changed diet and plenty of exercise and optimism. But it did not offer total protection, as he told Ode in an interview. “I’m not saying we can prevent cancer, because we may get cancer for reasons that are beyond our control. Even if you do all of the things I talk about in my book, there’s not a guarantee that you’ll prevent cancer. It’s about 80 to 85 percent protection, which is still enormous.”

And giving interviews like this:

One can’t help but note a few howlers in this interview, such as the claim that the reason that cancer is more common is not because the population is aging and must be something else. For one thing, cancer incidence rates, although they did rise in the 1970s, leveled off long ago and have been essentially flat since the early 1990s. In other words, there is no cancer “epidemic” currently detectable. Worse, Servan-Schreiber has been a major promoter of the myth that sugar causes cancer because cancer “feeds on raw sugar.” This is basically just a myth based on a misunderstanding of basic biochemistry. He also spouts misinformation about “toxins” and cancer-fighting foods that supposedly soak up those toxins. All in all, it’s depressing to read and watch him.

In fact, Servan-Schreiber went beyond that. Schreiber promoted a “Secret”-style wishful thinking in which he claimed that fatalism resulted in worse outcomes. In fact, there’s no good evidence that this is true. No matter how much we would like to believe otherwise, the latest research is consistent with the conclusion that patient attitude does not affect his chances of surviving his disease. That’s not to say that having a positive attitude doesn’t have numerous other benefits, but improving the odds of survival is just not among them. Dr. Servan-Schrieber has even gone so far as to write a book entitled Instinct to Heal, which advocates what he calls the “new emotion medicine” and methods that, he claims, can “cure stress, anxiety, and depression without drugs or psychotherapy.” These methods include obvious woo such as heart coherence, eye movement desensitization and reprocessing, and even what he calls the control of qi through acupuncture.

His Anticancer website also includes dubious recommendations, such as describing these as “anticancer products“:

  • Natural deodorants without aluminum
  • Natural and organic cosmetics free of parabens and pthalates
  • Pesticides made from essential oils or boric acid
  • White vinegar or natural cleaning products (without pesticides) or the European Ecolabel
  • Glass or ceramic containers for use in a microwave
  • Flawless Teflon, or else non-Teflon pans, such as stainless steel 18/10

It is, of course, a myth that aluminum-containing deodorants cause breast cancer. The idea was first published in the crank journal Medical Hypotheses and spread and metastasized from there. That Servan-Schreiber fell for this story did not give me a high degree of confidence in his judgment. As for the rest, well, they’re, as the Hitchhiker’s Guide to the Galaxy would say, mostly harmless. But neither is there compelling evidence that any of these items are powerful anticancer measures, either.

Like many advocates of “integrative medicine,” Servan-Schreiber’s advice is often reasonable. Of course, it’s a good idea to get more exercise. Of course it’s a good idea not to eat so much fatty food. Sure, it’s a good idea to take time to relax. None of this is “alternative” or anything but based on science, but science itself says that this isn’t the anticancer panacea that Servan-Schreiber suggests that it is nor that it is able to treat an already established cancer. Unfortunately, Servan-Schreiber “integrated” a whole bunch of woo into the mix, along with a philosophy that’s uncomfortably close to The Secret in that Servan-Schreiber is saying, in essence, almost that you can will yourself not to get cancer through a positive attitude and the right diet. The flip side of this is the same dark underbelly of much of alternative medicine: It blames the patient. If you get cancer, it’s your fault. Either you ate the wrong foods, didn’t eat the right foods, didn’t get enough exercise, didn’t think happy enough thoughts, or some combination of these. This belief led Servan-Schreiber to write:

This book is above all my testimony as a witness and fellow sufferer. I had cancer. I’m cured now, and I wanted to share what I learned with other people. Being a doctor doesn’t protect you from cancer. But because I’m a doctor and a scientist, I was able to take my knowledge to its limits and learn to look after myself. I wanted to write the book I would have liked to read – the book that, if it had existed, would have helped me to avoid falling ill, and that would have helped me learn very quickly how to give my cancer treatments the best possible chance of working.

Does Servan-Schreiber’s death mean his method didn’t work? Or did it mean that it did work and held his disease at bay longer than anyone would have thought possible. Or was Servan-Schreiber a man who was fortunate enough to have a less aggressive form of brain tumor that responded very well to conventional therapy and was very slow to relapse, taking this latest time 15 years before recurring and then leading to his death? Most likely, it was the latter, because there just isn’t any strong evidence that Servan-Schreiber’s methods are anywhere near as effective as he claimed they are.

One thing that needs to be understood is that glioblastoma is indeed a nasty cancer. Untreated, the median survival is on the order of three months. Even treated maximally, fewer than one in four patients with the disease survive longer than 2 years and fewer than 10% survive five years or more. However, it is known that there are types of glioblastoma with a prognosis that is not quite as grim, although it is grim enough. For instance, younger patients tend to survive longer, as do patients with methylation of the promoter of O-6-methylguanine-DNA methyltransferase. In the end, however, little is known that can accurately predict who is likely to survive long term after treatment of glioblastoma and why, much as little is known that allows us to predict accurately which women with advanced breast cancer will survive for long periods of time and why, other than very crudely and unreliably.

What this all means is that Servan-Schreiber, for all his scientific prowess, nonetheless ended up behaving like Suzanne Sommers, Lorraine Day, Hollie Quinn, and any number of other cancer patients who were successfully treated with conventional scientific medical therapy and also chose pseudoscience, after which they attributed their good outcome more to the pseudoscience than to the real medicine. Fortunately for him, he did very well and lived a lot longer than the average brain tumor patient. Unfortunately, during that time he promoted a profoundly misleading view of cancer therapy.