On leaping to conclusions about a neurosurgeon and Dr. Stanislaw Burzynski

Another Christmas is over, and we’re settling in to that strange week between Christmas and New Years when, or so it would seem, most of the world isn’t working except for retail. I’m half taking the week off from work in that I don’t plan on going into the office if I can possibly avoid it, but will be starting up a couple of grants for the February/March NIH cycle and dealing with a couple of nagging issues left over from before the holidays. Regular readers might have noticed that ScienceBlogs had a bit of a glitch beginning sometime in the early morning hours of Christmas morning and not ending until yesterday sometime. In essence, although you could read the blogs, you couldn’t comment, and all the bloggers were locked out of the Movable Type back end. Since that provided me an excellent excuse to take a day off from blogging, I did. I was still recovering from the food and wine coma of the last two days anyway and probably didn’t have anything coherent to say, if I ever do.

But what should await me this morning when I decided to take a look and see if ScienceBlogs were fully up and running again? It’s something I had hoped to be able to ignore until 2012, having blogged enough about it over the last month or so. I’m referring to the “brave maverick” cancer doctor Stanislaw Burzynski and his Burzynski Clinic. Read the links for the full, Orac-ian deconstruction of what Burzynski appears to be doing, but the brief version is that he uses what he calls antineoplastons, which he claims to have originally isolated from urine back in the 1960s and 1970s but now synthesizes chemically, to treat cancer. It turns out that these antineoplastons are nothing more than the metabolic products of a real drug, phenylbutyrate. This is a drug that was initially used to treat urea cycle disorders but has also shown (very) modest promise in treating some forms of cancer and that these days Dr. Burzynski appears to be switching over to using off-label phenylbutyrate but still calling it “antineoplastons” and charging outrageous sums of money to his patients. In addition, these days, seeing a profit opportunity, he’s jumped on the genomic bandwagon–incompetently–and started offering what he calls “personalized, gene-targeted therapy,” which, when looked at more closely, is really nothing more than a simplistic use of a commercially available test to pick out a witch’s brew of chemotherapy, targeted therapies, and antineoplastons phenylbutyrate, put together with little or no thought to synergistic toxicities or whether they interfere with each other’s actions or not. All of this, he sells as being “not chemotherapy” (it is; it’s just incompetently administered chemotherapy) and “natural” (it’s no more natural than taxol, which was originally derived from the bark of the Pacific yew tree and turned into a chemotherapy drug). Through all of this, Burzynski has tried, through his PR flack, to silence bloggers who criticize him and thereby protect the lucrative cult of personality he’s built around his name. Now, it appears that there is another aspect of Burzysnki’s practice I need to comment on, as mentioned on Pharyngula (crossposted here) and Furious Purpose, and that’s physicians who send their patients to Burzynski.

By way of background, I’ve noted before that there is a particularly disturbing aspect of Burzynski’s practice. That’s how his patients, convinced that Burzynski can save them (or, if they’re parents, that he can save their child) will, understandably go to extreme lengths to raise the often hundreds of thousands of dollars Burzynski charges to apply his science-y-sounding woo to cancer. It is not at all uncommon for these families set up charities designed to raise money, or, as I put it a couple of years ago, to harness the generosity of kind-hearted strangers to pay for woo. In fact, it was a couple of high-profile cases, one involving U.K. performer Peter Kay, who did two charity concerts for a Burzynski patient, that originally brought the attention of the skeptical blogosphere on Burzynski. More precisely, it was the reaction of one Marc Stephens, who claimed to represent the Burzynski Clinic and in that claimed capacity issued legal threats against bloggers, that brought the attention (and wrath) of the skeptical blogosphere down on Burzynski. In any case, I thought that that was the worse aspect of Burzynski’s activities, that he seemingly encouraged his patients with terminal cancer to go to such lengths to raise money, the better to enrich himself. There is now, however, another aspect that could be at least as disturbing. I haven’t made up my mind yet, because I don’t know if what I’m learning about this aspect of Burzynski’s activities. If what PZ and Furious Purpose write is accurate, then Dr. Teo is about as unethical as it gets. However, I suspect things are not as simple as what is being written.

Meet Dr. Charles Teo, a neurosurgeon currently in Australia. Apparently, he has a history of funneling patients to Burzynski, although it’s not clear at all to me whether it’s Dr. Teo who promotes Dr. Burzynski or whether he’s just working with patients who have decided to go to Dr. Burzynski. For example, here is one patient description cited:

After much research and the help of many friends we discovered Dr Charles Teo from Prince of Wales Private Hospital in Sydney, who performs surgery on inoperable brain tumors. Dr Teo is a neurosurgeon who has pioneered a method of minimally invasive brain surgery and has successfully performed around 5000 operations. Dr Teo has offered to operate on David and at this stage the operation is scheduled for Friday, 20th September 2002. David, with the support of his family will fly to Sydney on Wednesday, 18th September 2002.

This process is not a cure, however, it is designed to relieve the pressure by reducing the size of the tumor, he will need further treatment to kill off any remaining pieces of the tumor. The treatment being researched at the moment is antineoplastons treatment which is administered by the Burzynski Clinic in Houston, USA.

One notes that this is from 2002 and 2003 and that it is not at all clear from the description above that Dr. Teo suggested that this family go to visit Burzynski or that this patient is evidence of Dr. Teo taking advantage of dying patients.

In all fairness, this case is a bit more damning:

However, Braydon’s mother Zoe Cobb hoped the Sebastopol toddler could begin treatment soon at the Burzynski Clinic in Houston, Texas.

“We’ll talk more about it with Charlie (Dr Charles Teo) this afternoon,” Zoe said. “We’re just off for the MRI scans now.”

The Burzynski Clinic, named after founder Stanislaw Burzynski, specialises in individual cancer treatments.

Zoe said they had discussed taking Braydon to Texas with Dr Teo, who said he felt it would be a good option for the four-year-old.

However, before you decide, take a look at this video:

And this one as well:

There is a type of surgeon who represents the true “brave maverick” in that he is highly skilled, highly confident, and willing to take on seemingly “hopeless” cases. Surgeons like this will often, as described above, operate on patients who have either been operated on before by other surgeons who couldn’t fix what was wrong or been turned down by other surgeons as “inoperable.” Of course, “inoperable” is not a hard-and-fast word in that what is inoperable to one surgeon might well be operable to another. It’s also a very fine line in that this is an area where science- and evidence-based medicine collide with personal surgical skill. There are surgeons out there who are just so good that they can physically do with their hands what other surgeons, talented and experienced as they might be, cannot. Alternatively, they are far less risk-averse than the typical surgeon in their specialty and are therefore willing to attempt things that other surgeons won’t, such as the resection of “unresectable” brainstem tumors. Where daring ends and recklessness begins is a very fuzzy line with surgeons such as these. When they fail, they fail spectacularly, but when they succeed sometimes the result is the patient described in the video above. Surgeons such as these might very well cause a lot of complications and unnecessary suffering through aggressive–even reckless–pushing of boundaries. However, they also push the envelope (which Dr. Teo even says explicitly that he is trying to do in the second video), which can lead to advances in surgery and can sometimes save patients thought to be unsavable. Where the balance between the harm and good done by such surgones lies is, again, not a trivial thing to figure out.

It probably doesn’t help that Dr. Teo has other aspects of the “brave maverick” doctor. For example, if you search for his name plus “cell phone cancer,” you’ll find a plethora of articles and videos featuring Dr. Teo warning against the dangers of cell phones as a cause of brain cancer:

Brain cancer surgeon Charlie Teo has urged people to put mobile phones on loudspeaker, move clock radios to the foot of the bed and wait until microwaves have finished beeping before opening them.

The controversial Sydney specialist told a Melbourne fundraiser that although the jury was still out on mobile phones and other forms of electromagnetic radiation, we should not take risks.

“Even though the jury’s not in, just to err on the side of safety I would try and limit the amount of electromagnetic radiation that you’re exposed to,” he said.

“The American government, for example, recommends that all electrical appliances should be put at the foot of the bed and not the head of the bed.

Then there’s this video:

At around the 3:35 mark, Dr. Teo is featured saying unequivocally that he believes mobile phones can cause brain cancer. Later, the reporter engages in a blatant bit of fear mongering by noting that mobile phones use microwaves and you wouldn’t think of putting your ear up next to a microwave oven.

The stupid in that video, it burns brightly, rather like what would happen if you put metal in a microwave oven.

So, we can see that Dr. Teo is not a very good judge of epidemiology or basic science. Yes, I’ve refused to concede on many occasions that a link between cell phones and cancer is physically impossible, as some physicists have unwisely done based on a Cancer Biology 101 understanding of cancer, but I do consider it incredibly implausible that there is such a link. Maybe not homeopathy-level implausible, but almost. Also, as I (and others) have pointed out time and time again, not only is a link between cell phones and cancer incredibly implausible based on what we know about physics and biology, but the epidemiological evidence is overwhelmingly against such a link existing. There’s no convincing evidence for an increase in the incidence of brain cancers and no good evidence that the laterality of brain tumors correlates with the side of the head people hold their phones to. In brief, there is no good reason, based on prior plausibility informed by basic science or on epidemiological evidence, to think that mobile phone radiation causes brain cancers.

But Dr. Teo believes it does, which makes me think it’s not all that much of a stretch to think that he would be susceptible to the fancy-sounding blandishments of a charlatan like Dr. Burzynski.

And that’s why I think that what’s more likely to be going on here is something way more nuanced than what PZ and Furious Purpose think. Subject to change as more information comes in, I reject, based on what I’ve been able to find out thus far, the contention that Dr. Teo is operating on patients with inoperable brain cancer in order to make money off of them. Certainly neither PZ nor Furious Purpose have made a convincing case for that. A far more likely explanation is that Dr. Teo is one of those “cowboy surgeons” who will operate on risky patients that other surgeons won’t. When he agrees to operate on someone with an “inoperable” brain cancer, from what I can tell he almost certainly believes that he can do what other surgeons can’t: Remove the tumor and possibly cure the patient. It appears that, often enough, he’s right. Based on what I’ve been able to find out, unless there is more information that I’m not aware of, I have little choice but to say that I consider it at best highly irresponsible (and–dare I say?–most unskeptical) and at worse downright scurrilous to leap to the conclusion that Dr. Teo is intentionally operating on inoperable brain tumors just to make money and then funneling patients to the Burzynski Clinic, as PZ claims here (and here):

Teo is an Australian surgeon who has a brilliant scheme for anyone with a bit of surgical skill and a complete lack of conscience. He performs surgery on inoperable brain tumors in kids dying of cancer, and then ships them off to the Burzynski clinic in Texas to get injected with urine and die.

You’ve got to admit, marshaling the resources of a hospital, opening up a child’s skull, and diddling about with a knife inside without killing them is an amazing feat of impressive showmanship, sure to make devastated parents think something is being done worth $20-60,000 — even if there is no evidence at all that poking a glioblastoma with a pointy object offers any therapeutic benefit at all. I wouldn’t be at all surprised to learn that Teo is actually a very skilled surgeon. The problem is that brain surgery is not a panacea, and sometimes it is a totally inappropriate approach to deal with some cancers.

Or as Furious Purpose claims here:

From reading the stories of those desperate parents of children with inoperable brain tumours, I must conclude that Dr Charles Teo may deliberately choose to operate on children with tumours he knows these kids will die of, because current medical science has no cure to offer them. He then removes the tumour or at least some of it for what is said to be between 20000.- and 60000.- dollars for the surgery at Prince of Wales Hospital in Sydney and the high dependency care required afterwards, and he then recommends to the parents for their child to have additional treatment with “antineoplastons” at the Burzynski clinic in Houston, Texas. Treatment that is not FDA-approved, that has not been shown in trials meeting current scientific standards to be effective, and that is given only in exchange for exorbitant sums of money, and may be refused if the money is not forthcoming.

Charles Teo and Stanislaw Burzynski appear to be making money from the desperation of parents of dying children. Teo seems to be offering hope through surgery when there is none, and he then seems to be referring those same desperate folks for more false hope, and more expenses, to the Burzynski clinic in Houston.

Nonsense! Neither Furious Purpose nor PZ has anywhere near enough evidence to justify accusing Dr. Teo of something so vile and despicable.

It’s far more likely that Dr. Teo’s just an aggressive surgeon who thinks he’s doing his best for his patients by trying to remove tumors that other surgeons consider unresectable. Again, there’s a fine line between being surgically aggressive and surgically reckless, and there’s also insufficient evidence in the public record for me to judge whether Dr. Teo has crossed that line.

The second part of the accusation against Dr. Teo is a bit trickier. Is Dr. Teo funneling patients to Dr. Burzynski after having operated on them for in essence no reason? We only have two cases to go on, one of which doesn’t describe Dr. Teo as saying anything about the Burzynski Clinic or antineoplastons, the second of which quotes Dr. Teo as saying that he felt it would be a “good option” for his patient. Whether Dr. Teo suggested it or the patient’s parents latched on to the Burzynski Clinic and Dr. Teo gave his blessing is not known. From what we know, at best we can conclude that Dr. Teo’s grasp of science is not the greatest and that he’s prone to dubious science, as evidenced by his enthusiastic embrace of the “cell phones cause cancer” pseudoscience making the rounds. It’s quite possible that he’s similarly prone to being impressed by bad science and pseudoscience like that promoted by Dr. Burzynski. If that’s true, it’s bad. Very bad. However, it might not be true. We only have two cases that we know about over 8 or 9 years to go on, and Dr. Teo operates on hundreds of patients a year. These two cases could easily be outliers.

It’s clear that Dr. Teo is a controversial figure. He’s wrong on mobile phones and cancer. He also seems to have a bit more of the flamboyant showman in him than is good for a surgeon to have, a point that several of the stories I’ve cited make, and he definitely seems very cocky, perhaps more so than is necessary to be a neurosurgeon. (After all, it takes a certain amount of cockiness to have the confidence in yourself that you can crack open someone’s skull and remove part of his brain without leaving him permanently disabled.) It’s also pretty clear to me that Dr. Teo is the type of surgeon who pushes the envelope, perhaps bordering on recklessness at times. If that’s the case, he should be called out for subjecting patients to operations that can’t help them. However, I’m not convinced that that’s the case. In fact, it is not in the least bit clear to me that Dr. Teo is the sort who operates on patients whom he knows he can’t cure in order to make money, and I wish I didn’t have to point that out. When it comes to whether there’s any sort of relationship between Dr. Teo and Dr. Burzynski, I can only conclude that it’s possible–likely, even–that Dr. Teo is a bit too credulous about Burzynski’s results but that there is nowhere near enough evidence that I’ve been able to find to conclude that Dr. Teo and Dr. Burzynski have some sort of relationship in which Dr. Teo sends patients Dr. Burzynski’s way after operating on them. If there is such a relationship, then I would condemn Dr. Teo in the strongest possible terms–but I need a lot more convincing than either PZ or Furious Purpose has provided before I can come to a conclusion.