Finally, the State of Florida acts against Brian Clement and the Hippocrates Health Institute

Every so often, it’s good to post some heartening news regarding quackery. After all, after a decade of blogging about this, preceded by five years in the trenches of Usenet battling quackery and Holocaust denial, sometimes it’s hard for me not to become depressed. After all, there are times when it really does feel as though we’re fighting a hopeless battle for rationality and science against unreason and harmful quackery. It’s a battle worth fighting, but I’m not laboring under any delusions that it will be won in my life time or even in the lifetimes of anyone currently alive. The various patterns of thought (such as easily confusing correlation with causation) are so hard wired into the human psyche that changing them for the better will take generations.

So it’s always a good thing to find out about a possible victory, even if it’s small:

The co-director of a controversial Florida health spa where two Ontario aboriginal girls sought natural treatment for leukemia after abandoning chemotherapy has been ordered to stop practising medicine by the state’s department of health.

The cease-and-desist order was made against Brian Clement of Hippocrates Health Institute in West Palm Beach on Feb. 10, according to documents obtained by the Star. He was also fined just over $3,700 for practising without a licence.
The institute has come under increased public scrutiny after the two girls abandoned their chemotherapy treatments in favour of indigenous medicine and other alternative therapies. They both travelled to Hippocrates. One of the two, 11-year-old Makayla Sault, died last month of a stroke, which her parents blamed on chemotherapy.

Clement did not return a request for comment. A spokesperson said he denies the allegations and intends to contest the order.

My only question is this: What the hell took the State of Florida so long? The Hippocrates Health Institute (HHI) has been operating in West Palm Beach since 1987, luring patients like Makayla Sault from all over the world to replace science-based medicine with Brian Clement’s quackery, which includes a veritable cornucopia of quackery consisting of practically every form of quackery I’ve ever heard of (and, as you will see, some that I haven’t heard of).

In the course of my discussions of Brian Clement, I’ve lamented time and time again the seeming inability and/or unwillingness of the State of Florida to do a damned thing to stop Clement’s preying on desperate cancer patients. Indeed, many in the comments have speculated that perhaps Clement has friends in high places who protect him from Florida authorities, while I’ve also realized that Florida has some of the weakest patient protection laws in the country that facilitate the existence of someone like Clement.

Of course, what Clement probably didn’t realize is that when he dazzled the mothers of two Canadian aboriginal girls with lymphoblastic leukemia, Makayla Sault and JJ (referred to as JJ in news reports to protect her privacy because of her parents’ legal proceedings seeking the right to use aboriginal traditional medicine to treat her leukemia), and they came to his “spa” and “educational facility,” that he would be bringing on himself far more attention from the mainstream press than is good for an operation like his. After all, operations like Clement thrive by flying under the radar while building up an online presence and a network of word-of-mouth recruiters using testimonials to sell his products. Unfortunately for Makayla Sault (who died as a result of her mother’s trusting Clement’s quackery) and fortunately for those of us who have been wondering how he could get away with it, internationally reported stories of two girls with leukemia being lured away from medicine with a good chance of curing them and having one of them die as a result was not good publicity. It even awakened some—but nowhere near enough—investigative journalism.

The media notices

Because I’ve adequately discussed the issues involving JJ and Makayla (that is, unless something new happens with respect to these girls’ stories), what I want to do now is to focus my attention more on Brian Clement himself and his practices. Over the last three years, I’ve spent considerable time and effort trying to pull the cover off of the machinations and abuse of clinical trial ethics by Stanislaw Burzynski. There’s been a growing thought in my mind that a similar effort should be directed at Brian Clement, because, although he doesn’t even make a pretense of doing clinical trials, he sells his cancer quackery the same way that Burzynski does: Through testimonials.

Most recently, this increased scrutiny has come in the form of news stories that have been appearing in the Canadian press, two just over this weekend:

• “Florida health spa’s cancer claims under fire” and “Founder of Hippocrates Health Institute sued successfully twice“, Tim Alamenciak, The Toronto Star (February 21, 2015).
• “Questions about Hippocrates: Complaint filed against clinic that treated First Nations girl pulled out of chemo“, Tom Blackwell, National Post (February 21, 2015).
• “Contradicting cancer claims from Hippocrates Health Institute director“, Katie LaGrone, WPTV West Palm Beach (February 9, 2015).

I’ve already covered the WPTV story; so I’ll leave that out.

After having noted with sadness just how badly the Star screwed up with its execrable “exposé” on Gardasil (an exposé that the editors of the Star finally saw fit to withdraw under a barrage of well-justified criticism, although they clearly still don’t get it), I feel that in fairness I have to note that Alamenciak goes part of the way towards redeeming the Star after that journalistic debacle by actually traveling down to West Palm Beach and interviewing Clement, although Clement wouldn’t say anything on camera for this report:

What Alamenciak was allowed to see included several classrooms, the wheatgrass juicing room, and a greenhouse. Pointedly, they weren’t allowed into the Vida Building, where many of the alternative treatments are administered. (I wonder why.) Even more pointedly, Alamenciak was accompanied everywhere by HHI’s lawyer and PR person, as well as Clement himself. As you’ll note, Alamenciak and crew do a good job of putting the lie to Clement’s claims that he doesn’t promise he can cure cancer, using, conveniently enough, clips from Clement’s own talks in which he—you guessed it—tells his audience his raw vegan diet and wheatgrass can cure cancer.

Similarly, Tom Blackwell’s story quotes Clement as saying in one of his videos:

The appeal is powerful. Though he often insists he does not “cure” or heal anyone, Mr. Clement has repeatedly claimed impressive results.

“We have … the longest history on the planet earth, the highest success rate on the planet earth of people healing cancer,” he said in a Hamilton, Ont., talk, recorded and uploaded to YouTube in 2010. “We have dealt with mostly stage-three, stage-four catastrophic cancers — a big percentage of them, probably 25%, have been told they’re going to die. We have seen thousands and thousands of those people recover.”

Of course, Clement never manages to present anything resembling credible evidence to back up this claim.

There’s another segment as well with Steven Pugh, former Director of Nursing, HHI, who relates stories of Clement ordering blood work without a doctor and telling Pugh that he would review the results himself. This is what led Pugh to quit and sue. Because he is a registered nurse, Pugh can’t take orders for lab tests or other medical interventions from non-physicians. If Pugh’s allegations are true (and I personally have little doubt myself that they likely are), that is most definitely practicing medicine without a license:

“Almost every single patient there, the majority of patients, got an appointment with Anna Maria and/or Brian to go over their medical history, their labs, blood work, their disease process or just their wellness process and they would recommend treatment,” alleges Steven Pugh, Hippocrates’ former director of nursing and one of the ex-employees suing the facility.

Johnson offered a written response on Thursday to Pugh’s statement: “All blood tests are administered by a medical professional and reviewed by the medical director. As nutritionists, the Clements review the guests’ entire health history, which includes the blood tests, with a view toward nutritional recommendations. . . . The medical director is responsible for all medical decisions of any kind.”

Hippocrates, which houses as many as 100 people at a time, has one licensed medical doctor working for the facility — Dr. Paul Kotturan.

I had never heard of Dr. Paul Kotturan before; not surprisingly, I wondered what kind of physician would associate himself with an institute like the HHI. So I did some Googling. Dr. Kotturan appears to run an urgent care center, Hillsboro Urgent Care in Deerfield Beach, Florida. His role at HHI is described on its website thusly:

Under the supervision of Dr. Paul Kotturan, Hippocrates’ specialized therapies include hyperbaric oxygen therapy, cranial electrotherapy stimulation, IV nutrition and antioxidants, Aqua Chi detoxification therapy, advanced diagnostics, bio-frequency research, targeted supplementation, thermography and more.

What does that “more” include? According to Alamenciak’s report, it includes quackery such as:

One of the treatments often mentioned by Clement in videos is Cyber Scan — a machine that claims to read your “bio-frequency” and tells which diseases you have or are at risk for. The machine then spits out a magnetized card — similar to a debit card — that contains the “morphogenetic footprint” of whoever put their hand on the device.

For Pugh, the most surreal treatment moment came when he saw a man blowing a long alpenhorn on the feet of a guest at the centre. The man claimed to be removing “toxins,” Pugh said.

And, of course, supplements:

The institute also sells its own line of supplements, called LifeGive, as well as a store stocked with everything from $400 amulets that claim to block electromagnetic waves to a stool designed to angle one’s feet while on the toilet that is said to promote “more complete bowel evacuation.”

And, of course, there are stem cell treatments. Given that on the surface, the South Florida Bone Marrow/Stem Cell Transplant Institute looks relatively straightforward, treating hematologic malignancies with what sound like fairly standard-of-care treatments, “why Dr. Dipnarine Maharaj would affiliate himself with an entity like the HHI?” is the first question I asked. Surely it does not speak well of him to be featured on the HHI website.

But back to Dr. Kotturan. I was actually rather amazed that it was difficult to find out much about him. He seems to have kept a relatively low profile compared to other doctors administering dubious therapies, at least with respect to the ability of Google searches to reveal much other than his clinic. (And, make no mistake, the medical therapies administered at HHI are highly dubious, ranging from wheatgrass enemas, to the “Cyber Scan” test, to the most unbelievably quacky treatments like Aqua Chi “detox footbaths.”) One thing I was able to find out is that he was a site principle investigator of TACT.

For those who don’t remember, TACT stands for “Trial to Assess Chelation Therapy“; it was a $30 million unethical boondoggle of a multiinstitutional study designed to assess whether chelation therapy has any value for treating cardiovascular disease. It was basically a negative study, but its principal investigator, Gervasio Lamas, has been spinning it furiously as showing that chelation very well might work for cardiovascular disease and that, of course, “more study is needed” (preferably in the form of another large NIH grant to do a follow-up multiinstitutional study. In this Annals of Internal Medicine publication, Kotturan is listed as one of the investigators, which means he must have been administering chelation therapy during the timeframe of the study, which was several years. Certainly, Kotturan’s name comes up as offering chelation therapy and IV vitamin therapy for at least one “holistic retreat.” His name also pops up in this TACT Talk newsletter as one of the site investigators who won a Persistence Award in the 2005 TACT Derby for enrolling five patients over three months. He’s also a member of the American College for Advancement in Medicine (ACAM), a leading proponent of chelation therapy and what Dr. Kimball Atwood likes to refer to as a pseudomedical pseudoprofessional organization. His ACAM entry lists him as providing “Allergy, Chelation Therapy, Cosmetic Laser Surgery, Family Practice, Gynecology, Holistic Medicine, IV Therapies.” One wonders what else is covered in the “holistic medicine” part. Does he offer the same sorts of quackery at his own practice as he does at HHI? Inquiring minds want to know! Actually, I suspect that I do know. I rather suspect that Dr. Kotturan probably keeps it legitimate at his own practice and uses HHI as the outlet for his more “holistic” approaches, but that’s just an educated guess.

Marketing HHI: Testimonials a-go-go

If there’s one thing all three stories show, it’s that Clement makes a lot of money running HHI. Blackwell’s story, for instance, reports that filings to the IRS indicate that Brian Clement and his wife Anna Maria Gahns-Clement, the latter of whom serves as HHI vice-president, earned almost $1 million between them in 2013, even though the HHI is classified as a non-profit institute and therefore tax-exempt. Almenciak reports that Clement and his wife were paid $529,363 and $432,291 in income and benefits that same year and that the HHI reported receiving $15.1 million in fees for its “services.” Given that HHI has been operating in West Palm Beach since 1987, one can imagine how much wealth the Clements have amassed from its operations and their evangelizing speeches all over the world. It’s also not hard to see where he might “earn” such money, given that he charged JJ and Makayla $18,000 each for their “treatment.” All three stories feature photos and video showing just how large and fancy the grounds and facilities of HHI are.

Like Stanislaw Burzynski, a key element of the Clements’ marketing campaign includes patient testimonials. They can be found on the HHI website and YouTube channel. I very well might analyze several of these testimonials, either here or at my not-so-super-secret other blog, but for now, given the length of this post, I’ll just look at two.

First, there is this testimonial from Dr. Jackie Campisi:

Jacki Campisi’s story is horrifying. Basically, she started out by denying herself her one best shot at survival after her diagnosis. My observations on the brief video include:

• It is not clear in the video whether Dr. Campisi ever had surgery for her primary tumor or not. She says that she was told that she would require “chemo, radiation, and drugs.” Besides the chemo, which drugs? Tamoxifen? Arimidex? Herceptin? It turns out that she did have a mastectomy, but I had to do some Googling to discover this (and also to discover that she’s an optometrist, not a physician). In any case, that same link revealed that she embraced quite a bit of cancer quackery six and a half years ago, before she ever encountered Brian Clement.
• Dr. Campisi recurred six years later with spine metastases. Doesn’t that tell you that what she did wasn’t really working? Unfortunately, her spine metastases resulted in fractures, as spine metastases all too frequently do.
• It’s quite possible that Campisi had a fair amount of healing from her fractures while at HHI, but it’s obvious that she still couldn’t walk until after she had surgery. Also, her weight loss probably made a big difference.
• It’s good that her spine surgery helped her quite a bit. Surgery for malignant fractures usually does help. It’s unclear to me what operation she had, though.
• A four day hospitalization sounds about right for the surgery Dr. Campisi had, neither too long, but certainly not significantly shorter than the usual range.
• It’s very telling that Dr. Campisi doesn’t explicitly say whether she still has spine metastases or if her tumor is gone. She does, however, go on and on about the oxygen in her blood, her blood glucose levels, etc. I presume the cancer is still there.
• Overall (and fortunately for her) Dr. Campisi seems to have a variety of breast cancer that is slow-growing and indolent. That it took six years to recur suggests it’s probably estrogen receptor-positive, and that it doesn’t seem to have progressed much since also argues that it’s probably fairly indolent. If this is true, she could still live quite a long time with such a tumor, as it appears to have favorable biology. However, it would be interesting to know some things: Stage at diagnosis; status of estrogen and progesterone receptors; HER2 status; the specific operation she had.

Basically, here we have a woman who underwent surgery alone for a stage III cancer, apparently refused radiation and chemotherapy in favor of a raw vegan diet and other “alternative” treatments, had a recurrence in the spine, found Brian Clement, and is continuing to make the same mistakes. I’m glad she seems to be doing better, but, sadly, Clement is not going to save her. Nothing can. Fortunately, she might still live several more years because of the seemingly-favorable biology of her tumor. Unfortunately, she might have done even better if she had accepted standard-of-care palliative therapy. Also, she will likely credit Clement for how well she does.

Another testimonial, mentioned in Blackwell’s article, is Samantha Young:

One Canadian woman, Samantha Young, says she was given just months to live after being diagnosed with pancreatic cancer, and maintains she was rid of the frightening disease after visits to Hippocrates.

Young’s testimonial can be found on the HHI website as well, oddly enough, filed under “Depression,” rather than cancer:

Back in the late nineties I found myself suffering unimaginable fatigue, nausea and constant interrupted sleep brought on by the excruciating pain in my stomach. My physician conducted some investigative blood work which appeared completely normal. Finally, upon my insistence, she suggested an ultrasound. That revealed a ten centimeter mass in the tail of my pancreas.

The doctor explained that if I were older, she would believe that the tumor was benign. However, because I was young she suspected it might be cancer. Just that word instilled so much fear in my heart. My mind started to race, ruminating on all the medical statistics about the increase of cancer and how treatments most often are more harmful than helpful. Of course the doctor advised that my options were surgery, chemotherapy, and radiation.

What could that benign diagnosis have been? If there are any general surgeons or gastroenterologists reading, I bet they know. I’ll get to it momentarily. In the meantime:

Finally, my physician suggested that I see a specialist, Dr. Taylor, who supported the pancreatic cancer diagnosis with finality. Thank God my five daughters came and nurtured me. They adjusted their schedules and stayed with me at the onset of this sad period of my life. They described my color as gray green. Every day seemed insurmountable. On top of all of this the doctors finally admitted that although chemotherapy and radiation treatment were suggested, they ultimately would not make any difference in my case, nor would they prolong my life. They told me, “I am sorry, Samantha, get your house in order.”

We’ve heard this story before. Of course, a 10 cm mass in the tail of the pancreas would make me consider something other than pancreatic cancer in the diagnosis. Run-of-the-mill pancreatic cancer, the kind that kills most patients within a couple of years of diagnosis even if operable and successfully resected (expected five year survival after a Whipple operation, for instance, for pancreatic cancer is only on the order of 25%), generally doesn’t grow to 10 cm without metastasizing. That this one did implies that it’s either a less aggressive form of pancreatic cancer or not pancreatic cancer at all. Notice, in any case, that nowhere is there a report of a biopsy confirming the diagnosis. (Actually, rereading the testimonial, I don’t see any evidence that Young ever had even a CT scan, which is considered mandatory for determining whether a pancreatic cancer might be resectable.) Of course, if pancreatic cancer has already metastasized, then expected survival is measured in months. So what happened? Young found Dr. Clement, of course, and this happened:

I slowly adopted the program and was so impressed when I microscopically viewed cancer cells thriving on cooked food. This wrenched me into the full adoption of the living food diet. Slowly but surely, my color returned to a more acceptable yellow pallor, and as time passed my normal complexion prevailed.

In addition to the diet I also used far infrared therapy to gently heat my body up to 40 degrees Celsius. I also made sure to include lots of massage and reflexology, as well as continuing my medication and creative visualization, along with copious amounts of wheatgrass.

After two years the tumors had shrunk from 10 centimeters to 4.5 centimeters.

Before I knew it, I was in remission. Now I understood fully that cancer can be beaten.

In other words, she did nothing to treat her presumed cancer. Of course, I doubt that she ever had cancer in the first place. Given her clinical history, what I rather suspect (and, I bet, any general surgeons out there suspected) is that she really had was a pancreatic pseudocyst. Pseudocysts often arise after a bout of pancreatitis. Early in her testimonial, Young describes herself “suffering unimaginable fatigue, nausea and constant interrupted sleep brought on by the excruciating pain in my stomach,” all of which can be symptoms of pancreatitis. Not knowing more of her clinical course, I find it not hard to envision that Young suffered pancreatitis and developed a large pancreatic pseudocyst, which slowly resolved spontaneously, as many pancreatic pseudocysts, even ones larger than 5 cm, do. Moreover, pancreatic pseudocysts are sometimes misdiagnosed as cancer and vice-versa, but less commonly these days given that virtually any large pancreatic mass can be biopsied pre-operatively, something that wasn’t necessarily true 20 years ago when I trained. Again, we have no evidence of a tissue diagnosis anywhere to help guide us, and, given that, I rather suspect that this was indeed a pancreatic pseudocyst that resolved.

In Blackwell’s story, we learn:

Mr. Pugh said it is quite possible that some of the cancer patients at Hippocrates are cured, but in the little over a year that he worked there, he was not personally aware of any such successes.

“I would get emails occasionally from a family member saying a patient had succumbed to cancer,” he said.

I’d be willing to bet that no one at HHI survives cancer due to anything done for them at HHI. Indeed, as Alamenciak reports, there are testimonials on the HHI website whose stories have not been updated to report that the patient died, patients like Annalisa Cummings, who died in 2009.

Cancer quackery unfettered

The more I learn about Brian Clement, the more I wonder: How on earth has this guy been operating for three decades in Florida? Clearly, the State of Florida has utterly failed to protect its citizens from quackery. In fact, given how many people, such as Makayla Sault, come from all over the world, Florida has failed to protect everyone. Clement and his wife are both registered as nutrition counselors. Clement’s PhD in nutrition comes from the University of Sciences, Arts and Technology, a school licensed by the government of Montserrat, an island in the Caribbean with a population of about 5,000. It’s widely viewed as a diploma mill. Yet, thanks to a loophole in Florida law (see below), the Clements continue to get away with making promises they can’t fulfill, all the while with a “wink-wink, nudge-nudge” disclaimer that they “don’t promise cures,” even though everything they say in their promotional literature and talks would lead one to think that they can cure stage III and IV cancers where scientific medicine can’t.

What’s going on is so obvious, too. The Hippocrates Health Clinic has a Massage Establishment license, issued by the Florida Board of Massage Therapy. Also, the Florida Agency for Health Care Administration (AHCA) licenses health care facilities, such as health care clinics and hospitals, and processes complaints about the quality of care in these facilities. Further, it is known that a complaint was filed with ACHA against the HHI for operating a health clinic without the proper state license. However, as our resident Florida lawyer and SBM regular contributor Jann Bellamy informed me when I asked her about it, under state law, only clinics receiving reimbursement from third-parties, such as public or private insurers, are required to have an AHCA-issued license. Because Hippocrates is a cash-only business, AHCA was apparently without jurisdiction to take action. The result of this gap in state law is that clinics offering only unproven treatments, which aren’t reimbursed by insurance, are the very ones who are outside the reach of state supervision. Meanwhile the FTC won’t say whether it’s investigating or not.

In both the WPTV report and Tim Alamenciak’s report, Clement is asked about accusations that he gives cancer patients false hope. He immediately replies, “There is no such thing as false hope.”

Wrong, wrong, wrong, wrong. Hope is important, but cancer patients need that hope to be tempered with a realistic assessment of their prognosis. Clement takes that away from them, and he’s damned callous about it too, as his answer to Alamenciak’s same question reveals:

When confronted with the testimonials people wrote — testimonials full of hope, that have not been updated to indicate those who later died — Clement says:

“That’s not false hope. I’m going to die. Do you realize that? You’re going to die,” he says. “I have hope that I’ll become a multi-billionaire some day and be able to change the world. Is it going to happen?

“I would never tell somebody don’t do chemotherapy. I’m not a medical doctor, nor do I believe I should tell them to do that … I’m going to die; they’re going to die. Does it mean that I did something wrong because they came here? Maybe they were very, very sick at some point and they went home and eventually died? What do I have to do with that? Explain, what does Hippocrates have to do with that?” said Clement.

In response to questions about Stephanie O’Halloran, Clement is quoted thusly:

” … From a one-hour lecture in Dublin, this woman decided that I could heal her? That’s not even realistic when you think about that,” said Clement said in an interview in his Florida office.

These are, of course, the sorts of questions that a con man asks when confronted to deflect responsibility from himself to his marks. It’s not his fault they believed him!

As good as it is that the State of Florida has finally done something, I’m under no illusions that this is a major victory. It’s simply a victory in one skirmish in a war that’s likely to go on a long time. After all, a $3,738 is nothing to a guy like Clement, and he surely has high price lawyers who are even now fighting this order. Given the laxness of Florida’s laws protecting patients, it wouldn’t surprise me if he won. But there was no chance that he could lose as long as the State of Florida stood by and did nothing. At least now there’s a chance the HHI could be shut down.