To say that I, as a cancer surgeon, am not a fan of Ty Bollinger is a massive understatement. He’s not exactly one of my fans, either, but I view the hatred of a man like Bollinger directed at me as a badge of honor. Indeed, if a man like Bollinger didn’t detest me, I would view my efforts as a failure because I view him as a quack whose desperately deceptive film series The Truth About Cancer has been correctly dubbed untruthful about cancer by Harriet Hall and whose message has led cancer patients into rejecting conventional medicine in favor of treating deadly cancers with alternative medicine. Indeed, one such patient, a 22 year old woman named Carissa Gleeson, is clearly endangering her life listening to Bollinger, and he’s also clearly influencing an even younger woman with cancer to forgo the only treatment that has a decent shot at saving her life.
Unfortunately, I recently discovered through an article at the antivaccine website TruthKings that Bollinger has snared another one. How I found out was a little bit roundabout. I have Google Alerts set up for topics that interest me, one of which, not surprisingly, is alternative medicine. Yesterday, I saw a link to an article entitled Breast Cancer Patient Refuses Chemo Enrages Her Doctor. Then She Dumped Her Microwave &… pop up in my Google Alerts, where I learned of a breast cancer patient named Theresa DiNallo, who is portrayed as bravely rejecting chemotherapy and choosing alternative medicine and diet to treat her breast cancer. So I went to the source article used by TruthKings, which was a disturbingly credulous article from two months ago in the Lifestyle section of DiNallo’s local newspaper, The News-Herald, entitled Chester Township breast cancer survivor credits alternative medicine to her success. (Damn, my old stomping grounds: Cleveland.) There, I saw this paragraph:
The first book that DiNallo read about cancer was titled “Cancer: Step Outside the Box” by Ty Bollinger.
“This book taught me everything, it talks about food, juicing, supplements and so much more, ” she said.
Yes, another cancer patient, lured into quackery and potential death by Ty Bollinger’s misinformation. True, it wasn’t just Ty Bollinger. She read a lot of other things, both on the Internet and in books, but Bollinger’s was the first book she read; so he gets most of the “credit” for this.
So what’s her story? Sadly, it’s very much like so many alternative cancer cure testimonials that I’ve dealt with over the years:
Theresa DiNallo, 47, of Chester Township, discussed her initial feelings when given a cancer diagnosis three years ago.
“After completing a mammogram, they called me and put it very delicately, saying they think there is a mass in a certain area,” DiNallo said. “That’s when I immediately got scared and I remember being petrified the whole time.”
Later, an ultrasound was recommended to better visualize the mass. The results concluded that there was a mass present and she was advised to have a biopsy done.
“I was not taking it well at all,” she said. “But I wanted closure so I agreed to an ultrasound needle core biopsy done at Hillcrest Hospital.”
Following the biopsy, she received positive results for invasive ductal carcinoma.
“I was just devastated,” she said. “After that I stayed up at night researching on the Internet.”
This is, of course, a very common story. A woman undergoes mammography. A mass is seen. There is an ultrasound and a biopsy, and then the diagnosis of breast cancer is made. As is the usual case with stories like this, there is nowhere near enough information for me to tell what the clinical situation is. I did a bit of Googling, as I always do when I see alternative cancer cure testimonials to see if I could find out more and came across a more detailed (and, hard as it is to believe, more credulous) article in another local paper, the Geauga County Maple Leaf, entitled Overcoming the Cancer Odds: A Woman’s Holistic Journey to Health:
She says her doctors recommended surgery, radiation and possibly chemotherapy. More, including the stage of the cancer, would be known after surgery to see if it had spread to her lymph nodes.
DiNallo says she was told she might want to consider a double mastectomy as a preventative measure.
She met with a doctor at University Hospitals for a second opinion. That doctor concurred with the original diagnosis and treatment.
“All of it was scaring me to death,” DiNallo says. “I went home and read. I started to spend all my days and nights reading. I had to learn to decipher what was credible and what was not, but the Internet became my best friend.”
Ten days later, DiNallo, who, with husband David, has three children — Erica, 21, Natalie, 18 and Nick, 15 — made the decision she was going to treat the cancer using alternative medicine.
“I made the decision how I was going to heal from cancer,” she says. “My doctor kept calling and calling. I was researching and watching documentaries.”
Reading the News-Herald story, I wasn’t sure if DiNallo had undergone surgery or not and rather suspected that she had. If that were the case, it would have put her into the most common category of alternative breast cancer cure testimonial, that in which the woman undergoes either a lumpectomy or a surgical biopsy that happens to excise the whole cancer but then refuses everything else, such as chemotherapy and radiation. That is, for instance, the essence of Suzanne Somers’ alternative breast cancer cure testimonial and so many others that I’ve analyzed over the years. The reason it is important to know if a patient has undergone surgery is because surgery is the main treatment for early stage breast cancer (stage I and II), and surgery alone often cures it. The chemotherapy and radiation reduce the risk of recurrence, but are not the primary treatment. In other words, women like this are cured by the surgery but attribute their good fortune to whatever quackery they adopted after the surgery.
Reading the Maple Leaf story, however, I learned that DiNallo didn’t undergo surgery. This is a much less common situation, but even in this situation just because the patient is still doing well doesn’t mean that her cancer isn’t growing. I frequently cite the 1964 paper by H. J. Bloom, which looked at the survival of patients with untreated breast cancer over several decades spanning the 19th and early 20th centuries. The median survival was 2.7 years, but there was a very long tail to the survival curve, with some patients surviving untreated for up to 15 years:
I repost this graph every couple of years, because it is very informative. I also note that this graph should be interpreted in light of the fact that 125 years ago there was no mammography or ultrasound. Each and every cancer diagnosed was diagnosed when the woman had symptoms, the vast majority of a time a lump in the breast, often a large lump. Nearly all women were thus probably stage II and above when diagnosed. In fact, we have no idea of how many of those women already had metastatic disease at the time they were diagnosed. After all, there were no CT scanners, bone scans, or, in the early part of the time period covered by the Bloom and Richardson study, even chest X-rays. In other words, the expected survival of a woman with a mammogram-detected cancer that is untreated will, on average, be better than the above graph. I say that to address the misconception among the public that if Ms. DiNallo is still alive three years after her diagnosis it must mean that whatever she is doing is working. Ms. DiNallo’s continued survival and good fortune mean nothing of the sort, particularly if she is fortunate enough to have a relatively indolent, slow-growing cancer. In other words, she could be doing just as well now if her alternative treatments have no effect on the cancer, which is, of course, almost certainly the case here.
Ultimately, DiNallo decided to rely on a “holistic” physician in a Cleveland suburb named Todd Pesek, who treated her thusly:
DiNallo says Pesek took blood and hair samples and reviewed her supplements and new diet, which she had begun on her own. She says Pesek changed a few things in her regimen, including the quality of some of the supplements she was taking.
DiNallo then went on a strict vegan, organic diet, drinking specific vegetable and mineral blends and taking approximately 30 supplements a day based on the levels of certain elements in her blood.
“The first thing I did was cut out sugar,” DiNallo says. “Sugar feeds cancer. I thought I had been eating healthy. We never ate at restaurants and I always cooked for my family. I would make pot roast, chili. I had to learn why I needed to cut certain things out. I had to really get into the detail.”
A basic staple early on in her treatment was a blend of iodine, baking soda and organic sulfur, which, for awhile, she drank three times a day.
She also underwent intravenous high dose vitamin C treatments for a year, along with shots of vitamin D and B12 and a “detox” program that lasted several months.
It sounds to me as though Pesak practices “functional medicine,” a branch of alternative medicine characterized by measuring a whole lot of blood levels of a whole lot of markers, minerals, proteins, and the like and then adjusting the woo accordingly in a “make it up as you go along” fashion. So I wandered over to Pesak’s practice web page, VitalHealth Partners. It doesn’t mention functional medicine, but I found that Pesak offers a veritable cornucopia of quackery, including a 21 Day detoxification and purification program, chelation therapy, applied kinesiology, and acupuncture, diagnosed by unproven and disproven diagnostic tests like hair analysis, bio-meridian stress analysis, provocative testing for heavy metals, food sensitivity testing, and thermography. Suffice to say that I’ve discussed many, although not all, of these modalities right here on this very blog in the past; feel free to search if you don’t believe me that these are all modalities that are either unproven or disproven, unscientific and/or pseudoscientific. As for Dr. Pesak himself, he actually does have an MD, to the shame of the medical profession. Worse, he even trained at my old stomping grounds for surgical residency: Case Western Reserve University, and he has a faculty position at Cleveland State University.
As a breast cancer surgeon, I must express my outrage here. I just can’t help it. Dr. Pesek is an MD. Reading the quackery being used to treat DiNallo, I expected to find out that he was a naturopath, but he isn’t—although he might as well be, given the treatment modalities he’s using. Given that Dr. Pesek is an MD, however, there’s no way he should have been willing to go along with what Ms. DiNallo wanted to do. Treating a woman for breast cancer with ineffective methods like this and not urging her to undergo at least surgery to remove her tumor are astoundingly unethical lapses in professionalism. It’s not as though it isn’t well known that alternative medicine use among breast cancer patients is associated with significantly worse outcomes. Nor should he be telling patients things like this:
In January 2015, DiNallo went in to Pesek for routine blood work.
“After looking at all the labs and everything, Dr. Pesek said ‘This does not look like the results of a cancer patient,” DiNallo says.
Because of her healthy lab results, DiNallo says she and Pesek consider her to be cancer-free.
She has not been back to see her doctors at the Cleveland Clinic or University Hospitals, but says she may visit them at the five-year mark, a point at which she says conventional medicine would consider her cured.
Didn’t they teach Dr. Pesak anything in medical school or residency? You can’t declare a breast cancer patient “cancer-free” on the basis of blood work alone. There are no tumor markers for breast cancer that are reliable enough to do that. There are some blood markers for breast cancer that some oncologists actually do use, but they are quite unreliable, and no competent oncologist would declare a patient to be “cancer-free” on the basis of just blood work. There needs to be no detectable tumor on physical examination, mammography or other breast imaging (like MRI), or on other imaging, such as CT scans and bone scans, a state that we refer to as “NED” for “no evidence of disease” or “no evaluable disease.”
Similarly, conventional medicine doesn’t consider breast cancer patients cured at five years. We usually speak of ten year survival, because we know breast cancer, particularly estrogen receptor-positive breast cancer, can recur late, sometimes even 20 years later. Also, when an oncologist uses survival for five years as a surrogate for cure, it is assumed that the cancer has been treated and there is no detectable disease. DiNallo’s cancer hasn’t been treated, and her primary tumor in her right breast is almost certainly still there. Similarly, if you look at the graph above, you’ll see that the five year survival of untreated breast cancer was 18%, which means one in five women with relatively large cancers survived five years untreated.
In stories dated 2016, Ms. DiNallo doesn’t mention anything about whether her tumor disappeared or not, at least not as far as I can tell. In one part of this story, she says:
DiNallo says she immediately could tell a difference not only in how she felt but in the texture of the lump in her right breast.
“My breast tissue became soft and the the tumor went from a hard pellet to squishy,” she says. “My body was soaking up the iodine.”
Or, her body could have been reabsorbing a hematoma from her core needle biopsy. It is not at all uncommon for me to observe that a lump that the patient (and sometimes I) had thought to be a tumor was was in reality just a small hematoma (blood clot) from the biopsy. After all, this was a mammographically detected tumor, which means it was likely small.
Now, as is so frequently the case with believers in alternative cancer cures, unfortunately, Ms.DiNallo is now spreading the news. She’s formed a group called the Cancer Resource Coalition, a support group whose webpage urges people to “walk away from conventional cancer treatments.” Its Facebook page is loaded with recommendations for quack treatments, like coffee enemas:
Black molasses and baking soda cancer cures:
And, not surprisingly, antivaccine nonsense, because quackery often goes along with antivaccine pseudoscience:
You get the idea. She also promotes quack cancer treatments like laetrile.
One thing that simultaneously heartened and annoyed me about the Maple Leaf story about DiNallo is the followup story, Doctors Chime in on Woman’s Holistic Approach to Cancer. It featured Dr. Jill Dietz, director of breast center operations at University Hospitals Case Medical Center and Associate Professor of Surgery at Case Western Reserve University School of Medicine and Dr. Jame Abraham, director of the Breast Oncology Program at Taussig Cancer Institute and co-director of the Comprehensive Breast Cancer Program of Cleveland Clinic “chiming” in. Both of them quite correctly say that they don’t recommend using only alternative therapy to treat breast cancer, although Dietz doesn’t condemn alternative cancer cures as strongly as they should. Dr. Dietz correctly notes that most “refuseniks” (as a former boss of mine used to call them) don’t refuse all conventional treatment, but selectively refuse chemotherapy and/or radiation.
Irritatingly, though, both used the example of DiNallo to promote their “integrative oncology” programs—and regular readers know that both Case Western Reserve University and the Cleveland Clinic are heavily into “complementary and alternative medicine” (CAM) and “integrative” medicine and that both are very active at “integrating” quackery with conventional medicine. Their rationale seems to be that “integrating” quackery with real medicine might keep patients like DiNallo from leaving conventional medicine behind. I tend to doubt it, because later in the article DiNallo is quoted thusly:
DiNallo says the increasing popularity of integrative care is just a small step in the right direction.
“It’s one step but a very small step,” she says. “I don’t feel the medical community provides and educates on holistic options. They did not provide me with anything close to that. Not one doctor said to me, ‘Let’s look at what you’re putting into your body.’ It’s just about a quick fix, what can we cut out or what pill can we give you.”
DiNallo hopes one day, alternative medicine, not just integrative care provided by hospital systems, will be covered by insurance.
DiNallo is of a mindset that rejects chemotherapy, surgery, and radiation; it’s unlikely that she would have gone along with integrating “holistic” care with the evil chemotherapy. Patients like DiNallo are either so afraid of or opposed to chemotherapy on principle that integrative medical programs would be unlikely to keep them from “going alternative.” Indeed, there’d likely be an ethical conundrum, because patients like her would insist on only alternative treatments, and no ethical oncologist or surgeon, “integrative” or otherwise, could agree to be party to that.
As much as I detest integrating quackery with real medicine, I will give Dr. Dietz credit for saying this:
For those, like DiNallo, who claim western medicine “over-treats” cancer, Dietz does not entirely disagree.
“There’s a lot of women with early stage breast cancer that will not die of it (if left untreated),” Dietz says.
The problem lies in figuring out who will and won’t get worse, she says.
“The biggest problem we have is not being able to figure out which patients will go on to have invasive cancer so sometimes we are over-treating them,” Dietz says. “I think what’s going to happen in the future is we’ll get better at figuring out (who will and who won’t develop it).”
She’s clearly describing the phenomenon of overdiagnosis, which occurs when a screening test finds disease that would never progress to endanger the life of a patient. It’s been a frequent topic of this blog. Most overdiagnosis of breast cancer is of ductal carcinoma in situ (DCIS), or non-invasive breast cancer, much of which probably doesn’t progress to invasive breast cancer that will kill, but, as Dr. Dietz notes, the problem is that we can’t yet predict which DCIS lesions will or won’t progress. Invasive cancer can also be overdiagnosed, but it’s more likely to progress.
I like to put it this way, even if the highest estimate I’ve ever seen for how many mammographically detected breast cancers are overdiagnosed, one in three, were accurate and other studies that find that as many as one in five mammographically detected breast cancers might regress, I’d still say it’s a bad idea for DiNallo not to undergo effective treatment because in that case the odds would still be between 67 and 80% that her cancer will progress to endanger her life, especially given how young she is. In reality, her odds are almost certainly considerably worse than that because, as I’ve discussed before, most estimates of overdiagnosis are between 5 and 20%. Ms. DiNallo might luck out and be someone whose tumor doesn’t progress or even regresses, but I sure as hell wouldn’t recommend betting her life on it, which is exactly what she’s doing right now. So far she has gotten away with it, but the odds of her continuing to do so are not in her favor.
I actually do hope that Ms. DiNallo will be among the lucky ones, but fear that she won’t be. Whatever happens, though, patients like Ms. DiNallo are one reason why I so detest Ty Bollinger and the other quacks peddling alternative cancer cures. Their message seduces patients with curable disease into rejecting the very treatments that can cure them, but, even worse than that, they create “woo multipliers” like Ms. DiNallo who, with every good intention in the world, turn around and do the same thing as Bollinger: Seduce cancer patients into abandoning their best shot at survival in favor of unscientific and pseudoscientific medicine.