I debated a while about whether I should take this particular post on. It’s not because there isn’t a lot of fodder there deserving of that special form of not-so-Respectful Insolence that only Orac, in his usual inimitable fashion, can provide. There most definitely is. The problem, as is sometimes the case when I get on a roll, is that it represents going back to a topic that I’ve already covered very recently. In fact, it’s a topic I’ve already covered twice, namely Steve Jobs and the insulinoma that ultimately killed him. Last week, I reposted what I wrote about him back in 2009 after he underwent his liver transplant, and then lambasted quack and skeptic alike for their appropriation of Jobs’ story to try to make a point. In particular, a post by all-purpose quackery promoter Mike Adams irritated me because he did what he predictably does after the death of any famous person and tried to point to it as “proof” that conventional medicine killed him. After that post, I thought I was done and could move on to other topics.
Little did I know that Joe Mercola had other ideas; so I guess I’ll take one more bite at the Apple. (Sorry, I know that was horrible pun. I don’t know what came over me.) Then I’ll move on tomorrow. I promise; that is, unless someone tops both Mercola and Adams. Then all bets are off.
Yes, Mike Adams’ main competitor for the title of King of Internet Quackery (in my opinion, of course) couldn’t let Adams have all the fun or monopolize the cranks’ effort to co-opt the story of Steve Jobs’ cancer to their ends. If Adams had a rant blaming conventional medicine for Jobs’ death and asserting that Jobs could have been saved if only he had used “alternative” remedies instead of that nasty surgery, radiation, liver transplant, and chemotherapy, then Mercola has to do him one better and publish not just a long article saying in essence the same thing but do an interview with Dr. Nicholas Gonzalez as well using Jobs’ story as a jumping off point to promote quackery.
You remember Dr. Gonzalez, don’t you? He’s the creator of the (in)famous Gonzalez protocol for pancreatic cancer. This protocol involves various vegetable and fruit juices, meat extracts, supplement pills by the handful, and, to top it all off, at least daily coffee enemas. Well, it turns out that Gonzalez thinks he could have saved Steve Jobs. Not only that, but he thinks various cancer
quacks alternative practitioners (like himself) have been unfairly vilified by physicians, scientists, and the press. You can see his interview and read it all in Mercola’s article from yesterday entitled A Tragic Decision That May Have Cost Steve Jobs His Life? Here’s the video:
It’s a long video and a long interview, full of broadsides against conventional medicine and boasts of the number of celebrities who have come to Dr. Gonzalez for consultations. Even though I will quote it extensively, what I quote will be but a small, small fraction of what is there.
Mercola first passes judgment on the decision to undertake a liver transplant:
This is not routinely done for two primary reasons. The first is that it in no way, shape, or form addresses the original cancer, and it can easily spread to the new liver. But more importantly, he had to be placed on large doses of drugs to suppress his immune system so he would not reject his new liver. Tragically this is the very system your body uses to help control cancers. The liver has enormous regenerative capacity, and if they only removed the portion of his liver that contained the malignant cells, he would not have to take those dangerous anti-rejection drugs.
Conventional cancer experts disagree with the approach that was taken for Steve.
” In contrast, with a liver transplant “the overall costs and complications … override its benefits, especially when compared with partial [removal of the liver].” Indeed, liver transplants for metastatic cancer “have been largely abandoned,” says Columbia’s Chabot, because the immune-suppressing, anti-rejection drugs “lead to such a high recurrence rate.
Interestingly, it appears Steve was not given any chemotherapy or radiation treatments after his liver transplant, which undoubtedly contributed to his living over seven years after his surgery.
I’ve discussed the issue of liver transplant for neuroendocrine tumors like insulinoma (which is what Jobs had) before. While it is arguable whether a liver transplant was the best decision for Jobs in 2009, it was certainly not outside the standard of care, nor was it unreasonable. Mercola also makes a very silly statement when he states that “if only” they had removed the portion of the liver containing the cancer, Jobs wouldn’t have needed all those nasty immunosuppressants. Well, duh! Give that man a prize for stating the obvious as though it were some brilliant insight! Here’s the issue: Transplant is not even considered for insulinoma metastatic to the liver unless the metastases are unresectable (i.e., they involve two or more lobes or are too close to major vascular structures). And what defines resectability? To boil it down to its essence, although there are certainly other considerations (the aforementioned vascular structures, for example) it’s basically the ability to remove the liver tissue containing all of the metastase(s) and still leave enough liver tissue behind to survive on. Contrary to what Mercola thinks, the liver’s regenerative capacity, although truly impressive, is not limitless, particularly if the liver is compromised by cirrhosis. Take too much liver, and the patient will die of liver failure because the liver can’t regenerate fast enough (or just enough) to achieve function consistent with life. In addition to that basic equation, we just don’t know whether Jobs’ liver had been damaged or otherwise compromised by the insulinoma; it’s possible that his liver wasn’t in the best shape at the time, leaving less capacity to regenerate.
Be that as it may, although somewhat controversial, liver transplantation remains an accepted standard of care for the treatment of neuroendocrine cancer metastatic to the liver, as long as the metastases are not rapidly growing and as long as there is no evidence of metastasis elsewhere. Indeed, a very recent analysis of the UNOS database examining transplantation for neuroendocrine tumors concluded:
Although surgical resection still should be considered the treatment of choice in patients with liver metastases from NETs [neuroendocrine tumors], transplantation for unresectable disease is indicated in patients with stable disease without disseminated metastases.
In other words, liver transplants for neuroendocrine tumors metastatic to the liver have not been abandoned and can produce a pretty decent chance of long term survival, compared with other metastatic cancers.
Mercola’s nonsense aside, let’s move on to Gonzalez’s nonsense instead. I must admit that I couldn’t watch the whole video; about 15 minutes in, I had to go to the transcript instead. The interview was long and repetitive. And, because I’ve already written so much about Jobs, I’d like to emphasize that abusing Jobs’ memory in order to promote quackery is only part of what Mercola and Gonzalez are about in this interview, although they do that with gusto, in particular in this exchange:
DM: There were some comments that he was leading up to his death, and people would post comments on Facebook and are asking why I couldn’t get in touch with him and offer him some therapy. I’m not a cancer expert like you are, of course, but I believe someone like you could have really made a difference. My understanding is that your therapy was offered to him, but could you go to that process of why he chose not to undertake a natural or alternative approach to cancer?
DG: He wanted to see an alternative. In fact when he was first diagnosed, he got some dietary program – again, he was very secretive of that – So I don’t exactly know what he did at that point. But through his acupuncturist, there was communication. He was getting acupuncture, and he was doing some alternative things as far as I know. This acupuncturist actually talked to me, discussing the situation. She was really anxious for him to come and see me. But he chose not to do that.
You know, I always respect the patients’ right to choose the therapy they want to choose, so I would never dispute that. The patients have to make the decisions based on what they want to do. But she was very adamant; in fact, she knew about all my works in the alternative world. He had seen alternative-type practitioners. She really wanted for him to come and see me. He chose not to do that. From my perspective, it was unfortunate, because he was such a gift to the world in terms of his inventions and genius in the past 30 years.
Ah, yes. How convenient. An anecdote from some unnamed acupuncturist who may or may not have treated Steve Jobs and told Gonzalez about Jobs’ situation and that she wanted Jobs to see him. There’s no way of verifying the story, no way of knowing if Jobs ever actually saw an acupuncturist, much less that an acupuncturist discussed his case with Gonzalez and tried to persuade Jobs to see Gonzalez. Particularly vomit-inducing is the way Gonzalez turns around the argument based on a “patient’s right to choose.” Frequently, those of us who support science-based medicine, when confronted with the story of a patient who chooses quackery instead of medicine and suffers harm or dies as a result, will sadly say that a competent adult has the right to choose quackery if that’s what he wants, mainly because he does. Self-determination is a basic human right. Here, we have Dr. Gonzalez turning that argument on its head, sadly shrugging his shoulders and expressing regret that Jobs had the right to choose his own course and chose SBM instead of quackery. After his flirtation with some sort of diet and unknown “alternative” therapies, Jobs appears to have turned to scientific medicine and never looked back, at least as far as we can tell based on the limited information available from press accounts. There’s one thing that’s for sure, though. If SBM couldn’t save Jobs, Gonzalez sure as hell couldn’t save him either, his claims otherwise notwithstanding. Now that Jobs is dead, Gonzalez’s claims have the added bonus for him of being unfalsifiable, even though Gonzalez’s methods have already been shown to be worse than useless for pancreatic cancer.
As an aside, interestingly the surgeon quoted above, Dr. John Chabot, was the first author on the paper that demonstrated that the Gonzalez protocol was far, far inferior to even chemotherapy, which doesn’t do very much for metastatic pancreatic cancer to begin with. However, as wimpy as chemotherapy is for metastatic pancreatic cancer, Gonzalez’s therapy was far worse. Indeed, median survival in patients who got the Gonzalez therapy was about 1/3 of that of those who underwent standard-of-care chemotherapy. To me, that makes the following passage, where Gonzalez claims just the opposite in light of boasting about how he consulted with Michael Landon after his diagnosis of pancreatic cancer and how Landon died within three months, both hilarious and appalling at the same time. After Gonzalez says, “If I had a patient who died in three months, I’d walk in front of a bus,” Mercola, sycophant that he is, chimes in:
DM: That may sound like a boast, but you have two decades of experience that shows that when patients with pancreatic cancer come to see you, they don’t die in three months.
DG: Not everyone, of course, gets well. But even the ones who have failed, live a lot longer than they should have. One of the limitations of pancreatic cancer is – since the pancreas is a major digestive organ – their digestion is often compromised, and often they’ve had crazy surgery that interferes with their ability to eat or take supplements. So sometimes there could be management problems, and sometimes they can’t do the full program – they need to do half of it. They just look well beyond expected.
Once again, I’ll point out that the best study done thus far has shown resoundingly that, not only doesn’t Gonzalez cure anybody, but his patients do very poorly. In fact, if you compare the survival curve of patients on the Gonzalez protocol, you’ll see that not only do these patients do worse than patients receiving chemotherapy, but they do worse than historical controls as determined by the SEER database. Those are the cold, hard numbers. Gonzalez might have anecdotes. He might have his infamous eleven patient case series in which his patients appeared to do a lot better than historical controls with pancreatic cancer. What he really appears to have had is a massive case of selection bias. Kimball Atwood has covered the whole sordid saga of the original case series by Gonzalez in extensive detail (part 1, part 2, part 3, part 4, part 5). It’s well worth reading.
Much of the rest of the interview consists of Nicholas Gonzalez whining long and loud about how he just “don’t get no respect.” And, boy, does he whine! He goes on and on, complaining that conventional oncologists who take care of celebrities are lauded as heroes, while he’s widely viewed as a quack. For example, he is particularly incensed about Linda McCartney getting a bone marrow transplant for metastatic breast cancer back in the 1990s. This was a therapy that was thought to be efficacious at the time but was ultimately shown not to result in any better survival than chemotherapy, while producing a high level of morbidity and mortality. In particular, he was incensed by press coverage that painted McCartney’s oncologist as heroic, while he and his fellow “alternative” practitioners are portrayed as quacks. Of course, the difference is that at the time there was evidence that bone marrow transplant could improve survival in advanced breast cancer. More importantly, when the evidence came in that it didn’t work, oncologists abandoned the procedure. Contrast this to Dr. Gonzalez. When his protocol was shown to be worse than useless, what did he do? Certainly, he didn’t give it up. Rather, he lashed out at the investigators and threatened to sic his buddies in Congress on them. Now he lashes out against all oncologists with viciousness and then invokes the old “science as religion” canard, one of the oldest canards in the book of crank strategies. In order to give you a flavor of his rant, I’m going to quote a rather long passage. There’s a lot more there–painfully more–but this should give you an idea:
That’s why you have to look at this as a religious phenomenon rather than scientific issue. Conventional academic medicine is the last religion left in America. We’ve become an irreligious society. The media would never trust a politician, a religious leader, or anyone in the position of the government. But when it comes to academic medicine, if some guy in white coat says, “Boo,” everyone would say, “Oh my God he said ‘boo,’ let’s go right an article.”
Conventional academic medicine is like religion. Of course, they have their temple – if you look at Sloan-Kettering, it looks like the Mormon tabernacle. It looks like a temple. The priests – the doctors – they wear their own robes, like the ancient Hebrew priests. They have strict regulations about their dress or robe. These guys were robes, too, and they have the priesthood as the status quo. You know, the white code. They’re very distinguished-looking, always impeccably dressed and with shiny shoes and all. And they have their own language – the priesthood or whatever religion always has its own specific spiritual religious language that the rest of the mortals don’t understand. Of course, doctors have this scientific gibberish that the media don’t understand. The most cynical journalist who wouldn’t trust anything a politician says, when Sloan-Kettering sends out a press release, reprints it as literally the word from God.
So the way you have to look at medicine is not as a scientific profession, but rather a religious profession. It’s the last reigning religion in America. The NIH, NCI, or American Cancer Society has its temples, priesthood. It has its irrational beliefs. It has its own special language. It has its tools, it has its rituals. The doctor known for making rounds is a ritual. You learn very little making rounds as a doctor. It’s all ritual for the patient – it’s a religious ritual that doesn’t have much of a value to the patient. So they have rituals and all these things that are equivalent to kind of a priesthood class of religion, rather than an objective thing. Once you realize it, you’ll go, “Oh, that makes perfect sense.”
The reason Linda McCartney went for a bone marrow transplant is not because she read the data and realized it would work for her. It’s because she believed in it – it was a faith issue. She was going to this priesthood kept in a temple in New York City. They had resources, and she could pay for them. So it was religion to her. Patrick Swayze to the best of the best – Stanford is the West Coast mecca. It’s a religious temple. When he went there, it was faith, even though there’s not a single piece of evidence they gave him that chemo would cure him and would lead to substantial results. He did it because of faith – irrational faith, because it’s the belief that academicians really have these special secrets that none of us have and none of the lay people (we mortals) know. Their special knowledge, wisdom, or rituals would make us better.
The fact that they don’t make us better – Landon died, Patrick Swayze died, Linda McCartney died; I could list 20 celebrities that consulted or called me, never did my program, and are dead because they went to the conventional route.
Why didn’t they do mine?
I don’t have a temple. I don’t even own a white coat. I can wear a white coat – a good one – but I don’t have one on purpose. I’m not part of the academic priesthood, so I don’t wear a white coat. Yes, I have a stethoscope and a medical office like any because I need that, but I’m not part of the academic priesthood.
Michael Landon picked that up right away. In fact, his press agent, Harry Flynn, wanted him to come and see me. Harry and I remained close friends. He was really upset, and one of Landon’s comments about me is that I wasn’t fancy enough. I wasn’t fancy enough, so he went to the priesthood. He went to Cedars-Sinai.
I find this entire rant very telling. The resentment is palpable, as is the inferiority complex. Gonzalez is clearly intensely envious of oncologists and very angry because he isn’t taken seriously. Of course, to be taken seriously, it helps to have the goods, as far as science goes. He doesn’t. What he has is an idea based on long-discredited notions of how cancer forms and grows that doesn’t work and harms cancer patients. He has chosen his path, the path of medicine not based on science, and now he is paying the price. He is not respected because he does not deserve respect. He is not taken seriously because he has not earned it. And he’s really mad about it.
He’s not so angry, however, that he can’t recognize an opportunity when he sees one. Steve Jobs dies of a form of pancreatic cancer, and there’s his opening. He can tell some unverifiable story that some acupuncturist who was allegedly treating Steve Jobs after he was first diagnosed had urged him to go and see Gonzalez and that Jobs had declined. He can spread the claim that if only, only Jobs had listened and had come to see him, he could have saved Jobs’ life with his woo. Again, how convenient.
On the other hand, it’s good for business, and the types who are prone to falling for Gonzalez’s woo will likely eat it up.