Public service announcement: No, drinking your own urine will not cure breast cancer

I consider posts like the one I’m writing now to be public service, an obligation. There are times when I don’t want to do them, when they become so sadly, depressingly repetitive in overall outline (and, unfortunately, likely outcome) that it takes an effort to begin. However, given that October is Breast Cancer Awareness Month and as a result these sorts of stories seem to pop out of the woodwork this time of year, I feel I must. It doesn’t matter that I just discussed another one of these cases a mere month ago. This time around, the article appears (as is so frequently the case) in The Daily Mail, and, as is so frequently the case with the Daily Fail, boasts a near-hysterical headline, Mother, 41, with advanced breast cancer REFUSES chemotherapy in favour of drinking her own urine, homoeopathy and a psychic surgeon to try and cure herself.

Let’s step back a minute and look at the world of alternative cancer cure testimonials as reported in the news. Sometimes these stories are exploitative. No, strike that. These stories always exploitative in a sort of “look at the crazy patient” kind of way, basically a freak show. However,sometimes they can be sympathetic, as in “look at that brave maverick patient bucking the status quo and choosing her own way.” Of course, the two takes on these stories are not mutually exclusive. Sometimes the spin is along the lines of, “This patient is crazy but quite brave. Look at her bravely choose her own way in her fight for survival.”

This particular article, about a 41-year-old woman named Sam Ravelle, strikes me as leaning more towards the exploitative freak show angle than the sympathetic portrait of a brave, “go her own way, damned the consequences” patient. The reason is obvious. She’s trying to cure her breast cancer by drinking her own urine! How crazy is that? But even freak show portrayals of patients, which this most definitely has the flavor of, besides bordering on the mocking of a desperately ill cancer patient, can still have unintended consequences. For one thing, by simply promoting such quackery as a viable option, such stories promote it. It doesn’t matter how many medical experts the article trots out to decry how stupid this is, how the woman is harming herself and needs conventional care. What a significant part of the population will see is that the woman is still alive, that she’s appealing and plucky, and that maybe her way will work, particularly when the article provides a link to her GoFundMe page and includes lots of pictures of Ravelle looking happy and vital.

So let’s take a look at the story:

A woman with breast cancer has refused chemotherapy and is instead trying to cure herself through drinking her own urine.

Former carer Sam Ravelle, 41, of Walton-on-Thames, Surrey, is also using homeopathic medicines, herbs and supplements in a bid to beat the illness.

She was diagnosed with an aggressive grade three tumour in her right breast in August 2012.

Doctors at Ashford Hospital, Middlesex, offered her a lumpectomy, radiotherapy and chemotherapy but she has rejected the treatments in favour of urine therapy and alternative medicines.

Urine therapy? There’s one alternative treatment whose rationale I’ve never been able to wrap my brain around. It’s also a rather strange incongruence. After all, alternative medicine is all about removing “toxins” from your body, and what organ does that better from the kidneys? Yet, here we have a woman drinking the very toxins her very effective kidneys have excreted, thus reintroducing them into her body in order to cure herself!

In any case, this story differs from the typical breast cancer alternative cure testimonial in that usually in these stories the patient has undergone surgery but decided to refuse chemotherapy. As I’ve described so many times, going back to the very earliest days of this blog, surgery is the main treatment for breast cancer, with the chemotherapy, radiation therapy, and hormonal therapy (as appropriate) decreasing the chance of its recurring. When a patient undergoes surgery but eschews chemotherapy and continues to do well, make no mistake; it was the surgery that cured her, and she was just lucky that she didn’t have a recurrence. In Ravelle’s case, she did nothing, other than drink her own pee and go to homeopathic quacks. (Does diluting them make them stronger?)

But what about her tumor? We don’t really learn how large it was upon diagnosis, only that it was grade 3. There’s more on her GoFundMe page, though:

My friend Sam Ravelle has the aggressive triple negative breast cancer. There is no ‘good’ type of breast cancer, but to those working in breast cancer treatment and research – and the patients that hear about it – the phrase ‘triple negative’ carries a heavy weight, and affects 15 – 20% of breast cancer patients, such as my daughter. The disease is notorious for having a poorer survival rate (only 14% using conventional aggressive treatments survive over a five-year period) and is less well understood than other types of breast cancer.

I remember Sam telling me what happened when she was diagnosed back in 2012. After being told she would die if she didn’t follow surgery, chemotherapy and then radiation. Sam asked her Oncologist what the alternatives to that were… whereupon Sam was yelled at and the Oncologists words were ‘there isn’t any and if you do anything else while I’m treating you then I’m not treating you!’

Um, no. I study triple negative breast cancer. I treat triple negative breast cancer. It’s true that triple negative breast cancer (TNBC) has a poorer prognosis, stage for stage, than cancer that is estrogen-receptor positive. Compared to these cancers, TNBC tends to be very sensitive to chemotherapy initially but to develop resistance rapidly and to recur early. I have to question where Mr. Tor Hoie, who wrote the above passage, got the 14% five year survival figure. To put it in perspective, the five year survival for women with metastatic breast cancer is 22%, and Hoie is claiming that, among all comers with TNBC treated with conventional therapy, five year survival is 14%. Unless Ravelle had distant metastases at the time of her original diagnosis—I note that nowhere does it say that she did and her being offered surgery rather argues that she did not—an estimated five year survival of 14% is not credible. In fact, I know where that 14% survival figure came from, and it applies to African-American women with late stage TNBC. In fact, here is an estimated survival curve for TNBC:

And here is a comparison of survival by stage in TNBC patients versus non-TNBC patients:

As you can see, TNBC patients do worse, but the prognosis is nowhere near as grim as Hoie claims, nor would we expect it to be only a 14% five year survival for Ms. Ravelle, who is neither African-American nor had stage IV disease upon diagnosis. According to the story, her cancer was stage III when diagnosed. So, if you look at the second figure, you’ll see that her expected five year survival is in the 40% range, and since that graph also includes stage IV patients I’d expect it to be somewhat higher, perhaps 50% or a bit higher. I understand that a 50% chance of surviving five years sucks. It’s a horrible blow to endure and a horrible uncertain future for a 41 year old woman to face. But it’s not hopeless by any stretch of the imagination. Choosing quackery instead of medicine is what renders Ravelle’s future “hopeless.”

And, make no mistake, the cancer is progressing. Yes, it’s progressing slower than I would have predicted, given that it’s been three years since Ravelle’s diagnosis, but it’s grown:

Miss Ravelle said she felt well until February 2014 when she decided to start treating herself, despite having no formal medical training.

She spread herbs over the tumour in her breast, which has left an ‘apricot-sized hole’ in her breast, in a bid to ‘bring out’ her cancer.

‘The first time it worked well and brought three lumps out of me- it collects into a scab which falls off and then heals over- but the second time it was hell and I was in agony,’ she said.

That’s because what Ravelle is using is commonly called black salve, and what it does is to chemically burn the skin. There’s a photo of the side of her breast with an ugly black area on it from the burn. Black salve can “work” (if you can call it that) sometimes, albeit in a painful, imprecise, and needlessly disfiguring way, for cancers of the skin, but it’s useless for cancers beneath the skin, like breast cancer. All it does is to burn, and sometimes spectacularly. It’s incredibly painful and quite imprecise; yet patients like Ravelle choose it even though surgery would be far less painful and wouldn’t leave nearly as nasty a scar. Indeed, Hoie describes her scar thusly, “She has a hole in the side of her breast larger than a large apricot that needs constant tending for hours each day (I’ve seen it; it’s not pretty).” One notes that the photo of Ravelle’s breast in the article doesn’t actually match Hoie’s description, which makes me think it’s an old photo.

I know what happened, of course. I’ve seen this from time to time over the 25 years I’ve been in surgery. Her breast cancer grew to the point of eroding through the skin and outstripping its blood supply, which led it to die inside. What died started rotting, as any dead meat rots, liquified, leaving behind that hole. I’ve seen these locally advanced cases of breast cancer. They’re incredibly disgusting and sometimes very painful. At times the smell is almost unbearable, even for a surgeon like me. Even if Lavelle managed to clean up the wound so that it’s begun to heal some, she still has a big hole in the side of her breast that will never heal because there is still cancer there. We almost never see this sort of thing in patients who undergo treatment; it is, thankfully, rare that we lose control of the local disease so horribly. Unfortunately, this sort of presentation is not uncommon in patients who refuse conventional therapy. (Indeed, these are the only patients I’ve seen this sort of problem in.) At the very least, even if surgeons and oncologists couldn’t have saved Lavelle’s life, they could almost certainly have prevented this big hole in her breast and her going through 200 dressings a month taking care of it, as she describes on her GoFundMe page.

Overall, Ravelle’s having survived three years with untreated stage III TNBC is a bit unusual. It is not, however, in any way miraculous. Breast cancer exhibits considerable variability in its biology, with different cancers progressing at very different rates and taking widely different amounts of time to metastasize For instance, Ravelle herself states that she didn’t start treating herself until February 2014, a year and a half after her diagnosis, the implication being that she did nothing during that time. What happened during that time? Likely her tumor slowly progressed and then, as happens not uncommonly, its rate of progression sped up. Indeed, her GoFundMe page indicates that she had to stop working in August 2014, which is why she’s asking for money.

Unfortunately, biology finally appears to be winning. Indeed, there are enough hints in the Daily Fail story and Ravelle’s GoFundMe page that her cancer has likely progressed to stage IV. For instance, in the story:

Now the illness has left her feeling sick and having trouble breathing but she is still determined to go on without chemotherapy.

‘I’m using homeopathic drops and I’m going to give that a chance now,’ she said.

I suppose that using water is better than drinking urine.

Why is she feeling sick? Why is she short of breath? My money’s on the likelihood that she has lung metastases and, quite possibly, a pleural effusion (fluid around the lungs) due to those metastases. Indeed, in the photo of Ravelle wearing a hat, said to have been taken earlier this year, she most definitely does not look entirely healthy, even with the Photoshopping.

I understand how scary breast cancer is. Remember, my mother-in-law died of triple negative breast cancer six years ago and had brain, bowel, lung, and skin metastases when she died. I can understand the desperation. I also understand the fear of chemotherapy that drives patients to seek other options. Unfortunately, whether they’re well-meaning true believers or con men, cancer quacks take advantage of that fear to sell their wares, leading women like Ravelle to jump from urine drinking, to homeopathy, to psychic surgery (yes, the story lists her as having undergone psychic surgery), to Fred Eichhorn:

Here’s an extract from Fred on cancer: “To many people are still looking to “KILL” cancer it because they think it is an outside invader, they do not realize that the cancer cell has the “SAME PHENOTYPE” which means it was designed by the person’s DNA and made by the body, therefore, not affected by the immune system because the immune system only goes after cells with a different phenotype than the body’s phenotype. These are the results of mutations. Instead of toxic applications, simply correct the atmosphere which caused the body to produce it. Then the “incorrectly made cell” can no longer survive in the corrected environment and will die from its own starvation. Society does not seem to understand that cancer and non-cancer conditions are results from incorrect biochemistry, not outside invaders. Upon correcting the biochemistry, domino effects are corrected, results are corrected. The body is a simple machine of “Action causes Reaction” totally dependent of what you supply it to cause the initiating “Action” to “Cause” the “Reaction

www.cellect.org
www.ncrf.org
http://www.essentialsfactor.com
https://www.facebook.com/groups/Cellect
www.facebook.com/groups/NCRF2011/?fref=ts
www.fredeichhorn.com

When I came across Fred’s work I got rather excited as here was an expert who has all the research and knowledge on what I had come to discover for myself over the last couple of years.

It is true that cancer consists of the body’s own cells gone wrong (so to speak) and that there is indeed a contribution to what we in the biz call the “tumor microenvironment”; i.e., the cellular environment immediately surrounding the cancer. Tumor microenvironment includes the surrounding connective tissue, the normal and tumor blood vessels, the immune system, and basically any cell that comes in contact with the tumor, and is an active area of cancer research. Indeed, we even have a whole program at our cancer institute dedicated to studying tumor microenvironment. Here’s the problem. Nothing in the above quackery corrects the “incorrect biochemistry,” and mutations are forever. As I’ve pointed out, by the time cells become cancerous, their DNA is really, really messed up. Moreover, the body is most definitely not a “simple machine.”

If you want an idea of how bad Eichhorn’s and the NCRF’s understanding of cancer is, just get a load of this question:

Killing cancer cells is not the answer. How can you kill a cell made by the body as per DNA instructions without expecting the body to manufacture more after you killed it????

My answer: It is quite possible to kill cells without the body manufacturing more. For example, if I kill neurons (perhaps by reading idiocy like the above passage), the body does not manufacture more neurons.

I hadn’t heard of CELLECT before, though. I might have to do a whole post on it, but the CliffsNotes version is that CELLECT is a powdered concoction that you mix with water or food or that can be purchased in capsule form. (If you get it in capsule form, though, be aware that one serving equals 25 capsules.) Its manufacturer says that you also have to take it with cod liver oil gelcaps. What’s in CELLECT? Just a bunch of vitamins, shark cartilage, hydrolyzed collagen, milk thistle, minerals, and what’s described as 74 trace minerals.

The hilarious thing is that the CELLECT website directs readers to a page on the Memorial Sloan-Kettering Cancer Center page on it, which states explicitly:

Cellect has not been shown to treat cancer in humans.

And:

It is thought to help maintain the body’s normal functions, to boost the immune system, and to help fight cancer by fixing the body’s chemical imbalances. However, none of these claims are backed by scientific evidence. Some of the ingredients such as milk thistle may cause drug interactions.

And:

Purported uses:

• Cancer Treatment: No scientific evidence supports this use.
• Health maintenance: There are no published data to back this claim.
• Immunostimulation: There is no scientific evidence to support this claim.

And:

Cellect has not been studied in clinical trials and there is no evidence that it can be used to prevent or treat any diseases in humans. We do not support using this product as a cancer treatment.

No wonder there’s a Quack Miranda warning on the front page of the CELLECT website.

It always depresses the hell out of me to see a young woman with a treatable cancer falling down the rabbit hole of abject quackery, such as CELLECT, homeopathy, black salve, and urine drinking. Sam Ravelle appears to have thrown her life away unnecessarily. Is it possible that she could have undergone surgery, chemotherapy, and radiation and still died? Of course it is. TNBC is a nasty cancer, and she had stage III disease. Conventional medicine makes no guarantees, nor can it save everyone with a life-threatening disease. Unfortunately, because of quacks like Fred Eichhorn, homeopaths, and the sellers of CELLECT, Sam Ravelle traded a fighting chance for no chance, and now it’s very likely too late. Unfortunately, while seemingly presenting her as a cautionary tale, the Daily Fail actually made her rather appealing and provided a link to her GoFundMe page, virtually guaranteeing more donations to help her pay for her quackery.