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Cancer Medicine Pseudoscience Quackery

Drs. Alberto Garcia and Alberto Siller’s Clínica 0-19: A mother’s story

A mother writes to Orac about her experience at Dr. Alberto Garcia and Dr. Alberto Siller’s quack cancer clinic in Monterrey.

Last week, I was saddened to note the sad passing of Annabelle Potts, a girl who battled diffuse intrinsic pontine glioma (DIPG) and whose parents took her to a quack cancer clinic in Monterrey, Mexico, Clínica 0-19. In response to my three-part series published in June about this clinic, I received several emails from actual relatives of patients whose parents had taken their children to Clínica 0-19. Their stories, as you might imagine, were heart-wrenching, every bit as much as that of Annabelle Potts or another patient whose plight made the news, Annabelle Ngyuen, an Australian girl of Vietnamese descent whose parents took her to Clínica 0-19 and who was treated in Hospital Angeles in Monterrey, the main hospital out of which Drs. Garcia and Siller operate. As you might recall, this Annabelle suffered a number of complications while in Monterrey that landed her in the ICU at Hospital Angeles. There, she stayed, racking up $2,500 a day in hospital charges and her parents unable to fly her home to Australia because a medical airlift would cost $220,000.

Unfortunately, none of these parents were willing to have their story told publicly, and, as soon as I mentioned that I knew a reporter who was interested in doing a story on Clínica 0-19 and asked if they would be willing to speak with her, they ghosted me. It didn’t matter that, by the time this had happened a few times, I prefaced my request with ironclad guarantees that if they said no I would honor their wishes and never reveal their identities; they ghosted me just the same, to the point where I stopped asking. There was one exception, one parent who was willing to write up an account of her story and give me permission to post it, as long as I preserved her anonymity. I never asked her about speaking to a reporter, because it’s been months since I’ve been in contact with any reporter interested in this story, but she did give me permission to post her story, and here it is, unedited other than to correct minor typos (English appears not to be her first language):

My husband and I had one of the worst experiences in our lives with these doctors. They were totally arrogant, and what they are doing seem to be clearly unethical and unacceptable.

It’s hard for us to write about this because we don’t want to take hope away from all the parents that are here from different countries, I think they are doing the best they can to save their children…and as you said we can’t blame them. I’ve been there, and of course as a parent we do EVERYTHING for our kids. But the doctors seem to be taking advantage of the families’ situation just to make money.

We don’t understand why they don’t officially publish anything on their works, investigations and findings if they are certain that it works. They have been doing it for twenty years!!!

In our case didn’t work at all, our daughter had a brain tumor, not DIPG, but anyway it didn’t work.

She passed away. The doctors lied to us about many things and besides the intra-arterial drugs, they carried out other procedures neither discussed nor authorized by us.

They physically reviewed my daughter just once before the treatment because I asked them to…and never visited her after the treatment! I told them that she was doing really badly after the treatment and they didn’t seem to care at all! They just sent another doctor…and never went to see my daughter again. They didn’t answer my calls, they just didn’t care! We requested the list of the drugs that were used during the treatment to be able to review them with the doctors originally in charge of my daughter’s case, but they strongly refused to share their “magic formula”.

We are worried about all these kids and families that are coming from other countries because there is a lot of publicity about this. I have been doing some research and noticed that the treatments seem to just buy some time to the patients.

I repeat, it’s really hard for me to write about my experience, I don’t want to disappoint all these families that have done a tremendous effort in providing the best to the their children with the hope to save them.

But I think the families should know more about these doctors and the so-called treatment…

Very important too, we felt truly mislead about the MRI results which were apparently manipulated with contrasts and angles to show us supposedly that the brain tumor was reduced after the treatment.

They told me the tumor was a lot smaller, (actually that was the only visit from Dr. Siller at the hospital without looking at my daughter) but we ordered another MRI a week later just to realize that the tumor was even bigger and our original doctors confirmed the unfortunate interpretation of the images.

Our daughter was in a really bad shape after that treatment and she remained hospitalized for many many days to make her stable.. Of course with different doctors that really helped her a lot.

I don’t want to get anyone upset, but I had to let you know.

Maybe I’m wrong because I don’t have the information of all the international patients.

But I felt that I had to tell you my personal experience.

I don’t know how to help those families, they have to know about this…

As I said, this account is difficult to read. It tears me up to note how concerned this mother is with not taking away hope from other parents of children with DIPG or other brain tumors traveling to Monterrey to be treated by Drs. Garcia and Siller, of not upsetting them. After living through a tragic experience that most of us can only imagine with horror, she doesn’t want to cause distress in others living the same experience now. I must admit that I have a hard time understanding this perspective, but then I recognize that I’ve never faced what she has faced, nor have any of my relatives or friends. Unlike her, I don’t face these situations through personal experience. I approach them from the perspective of a skeptic and consumer advocate trying to warn other parents of what I consider to be fraud. As I’ve said many times before, I don’t blame the parents who take their children to Monterrey. Faced with the impending death of a child whom they love, they’re desperate and will grasp at any straw of a chance that might save their child’s life. I place the blame squarely where it belongs, on Dr. Garcia and Dr. Siller.

Also note other aspects of this mother’s story. First, there’s the unwillingness on the part of the quacks to interact with the patient’s family once their child’s condition starts deteriorating. How often have I heard that before, particularly about Stanislaw Burzynski? As long as the patient seems to be doing well, particularly if he’s doing better than the average patient with the cancer he has, quacks will be all jovial and happily interact with the patient. Once the disease begins its inevitable progression and the patient’s clinical situation deteriorates, they disappear. They don’t return phone calls. They farm out the patient’s care to one of their lackeys, as Drs. Garcia and Siller did here, or they basically ghost the parents.

I’ve also heard the part about misreading MRI scans before, too. You might recall that about Stanislaw Burzynski. In stories about patients treated at the Burzynski Clinic, I frequently heard of how Burzynski had told parents and patients that MRI scans showed much better results than they did. One example was the case of Amelia Saunders. Burzynski told Amelia’s parents that the formation of cysts in her tumor meant that his treatment was working when, as I discussed long ago, it didn’t necessarily mean anything of the sort; it could have meant that the tumor had simply outgrown its blood supplies and its center was dying. There are other examples of Burzynski telling parents and patients one thing about their CT or MRI scans and physicians at home telling the them something quite different; in all cases, Burzynski’s interpretation was unjustifiably optimistic.

This mother’s account is also consistent with the accounts of other patients of Drs. Garcia and Siller that I’ve read, such as Annabelle Ngyuen, where they gave the parents unrealistically optimistic interpretations of her brain scans and only provided a few images, nowhere near enough to determine whether Annabelle’s tumor had actually shrunk. They also used the wrong kind of scan to evaluate DIPG properly. Even worse, Dr. Garcia told Annabelle’s mother that she had been cured, but that if they stopped the treatments the tumor would grow back and she would die. (Hint: That’s not what “cured” means.) Still worse yet, when the tumor started progressing again, Dr. Siller recommended increasing the frequency of treatments in order to “get it under control,” thus extracting more money out of the parents.

This mother’s observation of the arrogance of Drs. Garcia and Siller rings true, as well. You might remember Dr. Garcia’s excuse for why he hasn’t done clinical trials. It’s the same excuse that quacks have used from time immemorial (or at least since the era of randomized clinical trials began), namely that he was “too busy treating patients” to do proper clinical trials. Meanwhile, Dr. Siller was quoted in a laudatory article that featured both Annabelles thusly:

The pair is scorned by the international medical community, some of whom label them as cowboys preying on vulnerable parents of dying children. They question their science, the drugs they use, and the scans they use to judge tumour size.

“I told an Italian doctor…’if you have something to give your patient getter than what we are using, feel free’,” Dr. Siller said.

Now that’s some arrogance and callousness. I’ll also quote again an email from a relative of a father of a child with DIPG who had traveled to Mexico for a consultation but ultimately decided not to have Drs. Garcia and Siller treat their children that I received after my original posts on the topic:

Prior to my relative travelling to Mexico I assisted him in preparing a list of approx 20 questions for Drs Siller and Garcia including requesting details of all the drugs that would be administered, specific outcome data on all patients they had treated, why their results weren’t published etc etc. The final question was on the ethics of withholding their treatment protocol from international colleagues and thereby precluding children being treated in their own countries without the costs and social disruption frequent trips to Monterrey entail. The answers to the questions were grossly inadequate and the final question made Dr Siller annoyed. My nephew, a lawyer, decided this treatment was not appropriate for his daughter and they returned to Australia. His daughter died in January this year.

As I said at the time, given that Drs. Siller and Garcia won’t answer these questions, I suspect that they know their treatment is unethical and probably doesn’t work. Also, quacks tend not to like to be questioned too closely (just look at how Stanislaw Burzynski reacts to criticism). Certainly, the abstract they published (which was hard to find) isn’t good evidence, as I will now discuss. Perhaps this is the answer to this mother’s question about why they haven’t published their results; their results are…underwhelming.

I end this post, as I end all such posts, by emphasizing that I am not criticizing the parents. The parents of Annabelle Potts, Annabelle Ngyuen, Parker Monhollon, Lucy Moroney, Edie Molyneux, the unnamed child whose mother gave me permission to publish her account, and all the dozens of other children treated by Drs. Garcia and Siller in Monterrey clearly love their children with an intensity that led them to go to incredible lengths to try to save their lives. It is this love that Drs. Garcia and Siller exploit to profit.

Others entries in the series

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

16 replies on “Drs. Alberto Garcia and Alberto Siller’s Clínica 0-19: A mother’s story”

Good ideas, Mike, but not enough. They would need to be backed up by enforcement: giving licensing authorities the ability to suspend or revoke licenses for repeat offenders, and licensing authorities that actually use those powers.

And it would have to be everywhere, or you would see, as we currently do with other aspects of dodgy medical practice, regulatory arbitrage by these sorts of practitioners. Burzynski operates in Houston because he can–Texas is notoriously lax in that regard. If Texas were to tighten up its enforcement but states like Arizona or Florida did not, he would move there; if it were difficult enough for a Burzynski wannabe to operate in the US, he would move to a place like Mexico (there is a reason you see so many dodgy medical facilities in Tijuana, which is directly on the US border, and Monterrey, which is a short distance south of the US border). Same thing with Mexico: if the state of Nuevo León[1] were to tighten up its enforcement, Clínica O-19 would probably move to some other part of Mexico with lax enforcement. It would take all of Mexico tightening up enforcement for these people to move to another country, which they probably would.

[1]For purposes of this discussion I am assuming that Mexico follows the US paradigm of having its states regulate doctors. I don’t actually know whether doctor licensing in Mexico is a state or federal function. But even in the latter case, enforcement could well vary with location–that’s certainly true of China, where things that wouldn’t pass muster in Guangdong are often routine in Inner Mongolia. The emperor is always distant, and the mountains are always high.

“It is this love that Drs. Garcia and Siller exploit to profit,” says Orac.

“What about the support staff at Clínica 0-19, do they also deserve some of the blame?” says MJD.

All parents love their children, fear losing them, and would do anything to prevent that; but not all parents turn to quacks when push comes to shove, so “anything” has limits for most people. I think this is an important point–not to criticize those who turn to the quacks, but to help find ways to prevent it through regulation and education. Why does Mexico tolerate this? (Actually, I know why as I looked into it when my BIL was, I think, at this clinic–there IS LITTLE TO NO regulation of this type in Mexico.) Do we have any diplomatic effort going on with them on this? Oh, I forgot–the only thing that matters with Mexico is THE WALL.

I think it’s probably more accurate, and more generally applicable, to say that parents would do anything that they think might help. The reason some parents avoid quackery is because they know it won’t work. The reason some choose it because they have been persuaded that it will (or at least might). The most pernicious thing about clinics like this one is that they very much give the appearance of being scientifically and medically sound. They do not present themselves as alternative medicine but as the bleeding edge of mainstream medicine. That can look exceptionally persuasive to parents.

Quacks are well aware that “anything” has limits, and they are skilled at presenting their offerings as being within those limits.

Why does Mexico tolerate this?
With drug cartels fighting pitched battles with the authorities, a mad Northern neighbour trying to build a wall and buying huge amounts of drugs from the cartels. , billions in taxes being lost to criminal cartels stealing and selling gasoline, it may not be a priority?

Mexico welcomes medical tourism (it’s already a multi-billion dollar industry) even when it involves tolerating quackery and less-than-ideal conditions in “mainstream” facilities (note the recent stories about horrendous infections afflicting bariatric surgery patients who traveled to Mexico, involving pathogens such as a strain of Pseudomonas resistant to virtually all antibiotics). And the $$ goes beyond that spent in medical clinics:

“Medical tourism also represents an excellent opportunity for the broad tourism business in Mexico. Patients travel to Mexico along with relatives who are interested in visiting places and like receiving a warm welcome upon their arrival. Spas and wellness programs become more relevant in this regard, which can be an attractive option for relaxation and patients’ recovery. Authorities should be more aware of the many advantages and impact that medical tourism has in the country and should develop a plan for creating the right conditions for incentivizing this business, including initiatives like the one in Tijuana should be implemented by the Government in collaboration with the private sector for improving infrastructure and allocation of resources in major destinations so as to boost medical tourism in Mexico.”

http://mexicosalud.com/medical-tourism-in-mexico-a-real-economic-opportunity/

Expect woo to be a big growth industry south of the border in the years to come.

Honestly, there’s a lot of familiar experiences here from regular hospitals too:

…racking up $2,500 a day in hospital charges
My husband and I had one of the worst experiences in our lives with these doctors. They were totally arrogant, and what they are doing seem to be clearly unethical and unacceptable.
…shades of Justina Pelletier

…In our case didn’t work at all,…
RI: …clinical situation deteriorates, they disappear. They don’t return phone calls. They farm out the patient’s care to one of their lackeys…or they basically ghost

A non-coercive, less monopolistic regulatory enviroment might mean that perhaps Oz shouldn’t quite so heavy handed on alternatives with some kind of track record. Might keep more of the business at home and produce recorded insights.

We use “snake oil” to over come prior medical failure.

The bottom line is that some of that “snake oil” produces results pretty much impossible with conventional medicine (then), but doesn’t get recorded well. In fact, even with substantial chops, it’s hard for outsiders to get professional or scientific quality results out of an alien hospital. Alien in the sense of outside. In another life, we would discard contract help like I’ve seen, for quality of effort, results and attitude, like used TP.

When discussing Justina Pelletier, lay the blame where it ought to be: factitious disorder are notoriously hard to detect. Medical staff seem to have overreacted and not hedged their bets. This should be a case where everyone should pause and reflect.

They are criminal, should be charged, this is clear child abuse causing them more pain and suffering. I’m so angry now. I still haven’t found a child who has survived more than 2-3 years, all these stories seem to follow the same pattern, how are people so blind, like all those who just trow money at them.

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