I frequently write about the misinformation and disinformation about cancer, chemotherapy, and other modalities used to treat cancer spread by believers in alternative medicine and, in particular, in alternative cancer cures. If there’s one thing that characterizes the disinformation about chemotherapy promoted by cancer quacks, it’s an extreme demonization of chemotherapy as ineffective poison. Of course, chemotherapy is indeed toxic, although lost in the fear mongering is that the toxicity of chemotherapy depends a lot on the specific chemotherapeutic agents used. In other words, some chemotherapy drugs are not that toxic, while others are very toxic, with others ranging somewhere between the two extremes. Yet, to those promoting alternative cancer cures, “chemotherapy” is to describe all chemotherapy, which is always described in the most horrific terms. Recently, I came across an article by Kelsey Osgood entitled “Chemotherapy Truthers Are the New Anti-Vaxxers“.
I actually like the term “chemotherapy Truther” (or “chemo Truthers”). It’s a great term that captures the disinformation, conspiracy theories, and pseudoscience behind chemotherapy denial (another term I like to describe this phenomenon). I was going to quibble that chemotherapy denial is not a new thing (I’ve been encountering it for decades) any more than antivaccine pseudoscience is new, but then I saw that the article compares the rise of misinformation about chemotherapy on social media to that of antivaccine pseudoscience and asks what Facebook, Twitter, and other platforms are doing about it. Of course, I’ve long argued that antivaccine misinformation and disinformation are not the only “fake news” whose spread social media has greatly facilitated. I saw antivaccine misinformation as a good starting point in terms of figuring out how to clean up the cesspit of that is Facebook, Twitter, Instagram, and, increasingly, Tik Tok. (Yes, antivaxxers have discovered Tik Tok, and it’s as cringeworthy as you might expect. If you have a Tik Tok account just do a search for “vaccine injury” or “vaccine side effects” and you’ll see what I mean.)
“Chemo Truth” from “Cancer Truthers”
In 2017, a family member of mine was diagnosed with colon cancer. The sad announcement was sent via email, after which my (enormous) extended family sent a flurry of follow-ups. One detail stuck out: My family member had decided to forego chemotherapy after discovering the website of Chris Wark, a self-described health coach, blogger, and public speaker.
According to Wark’s site, in December 2003, when he was 26, he was diagnosed with Stage 3C colon cancer (meaning the cancer had grown into or through the outermost layer of the colon or rectum and may have spread to four or more lymph nodes). Wark had surgery to remove part of his colon, but when an oncologist told him he’d need up to a year of chemotherapy, he refused. Instead, he adopted a raw vegan diet, subsisting on juices, salad, and smoothies for months.
Today, he says he has a clean bill of health, which he attributes to his “radical” diet and lifestyle changes. He’s also part of a vocal community of holistic health advocates who decry traditional cancer treatments as ineffective at best and harmful by design at worst. Their enemy number one: chemotherapy.
I’ve written about Chris Wark before, particularly the name of his website, Chris Beat Cancer. Of course, as I explained, yes, Chris did beat colon cancer, but it wasn’t all the dietary interventions and quackery that he used. It was the extirpation of his cancer by a skilled surgeon. As I explained at the time based on Wark’s public description of his cancer, in the case of colon cancer, surgery is the primary treatment. Chemotherapy is adjuvant therapy, designed to reduce the risk of cancer recurrence as metastatic disease, and, depending on the cancer, chemotherapy can be very effective at that.
The conflation of adjuvant therapy after surgical extirpation of a cancer and chemotherapy as the primary therapy for such cancers is a common theme in alternative cancer cure testimonials. These testimonials are persuasive to the average person because most non-physicians (and even some physicians who don’t take care of cancer patients regularly) do not understand the difference. I estimated that Wark had stage III disease. I estimated that, by refusing chemotherapy, Wark decreased his chances of surviving his cancer by between 12-25%, and that he had a 30-64% chance of surviving with surgery alone. (I didn’t have full staging information, hence the uncertainty in estimates.) Of course, Wark couldn’t accept that, even going so far as to claim that surgery alone doesn’t cure stage III colon cancer, which is utter rubbish. Surgery can and does, but surgery plus adjuvant chemotherapy have a significantly better chance of curing that cancer. As I observed at the time, those odds (30-64% chance of long term survival) aren’t good enough. Why should we settle for such odds using surgery alone, when we can improve them significantly with chemotherapy?
After noting how effective chemotherapy can be, Osgood observes:
Still, a group of online cancer truthers have zeroed in on chemotherapy as the ultimate example of the hubris and greed of Western medicine and Big Pharma. They claim chemotherapy is ineffective, that it weakens the immune system, and even that it causes cancer. They say the only reason it’s the frontline treatment for cancer is because American physicians are beholden to pharmaceutical giants, incentivizing them to resort to drugs at the expense of prevention and general wellness education.
Part of the reason this message might be compelling to vulnerable people is because not all of it is outlandish. Drug companies do behave unethically: Federal prosecutors in Brooklyn are currently investigating pharmaceutical giants, including Johnson & Johnson and Teva, to determine whether they ignored distribution regulations to increase sales of addictive opioids. And primary care is seriously undervalued, which leaves some consumers suspicious that the health care establishment is less interested in preventative care than more lucrative, specialist-driven therapies.
If there’s a common theme in the denial of various science-based medical treatments, it’s tarring them with the ethical lapses and profit-driven activities of big pharma and the failings of our medical system. Antivaxxers certainly do this; it’s one of their primary tools, in particular falsely accusing anyone who has the temerity to defend vaccines against their disinformation of being on the payroll of big pharma, a trope I like to refer to as the “pharma shill gambit.” Of course, frequently, such attacks are projection, ignoring the fact that so many influencers in this realm (such as Joe Mercola) profit handsomely selling alternative medicine. In fact, Chris Wark himself recently released a book on how to “beat” cancer and has long sold web series, health coaching, and the like pushing the same message.
Osgood further observes:
Anti-chemo advocates have other commonalities: They often distrust government organizations, particularly the U.S. Centers for Disease Control and Prevention (CDC), they have rigid ideas about diet, and they are often Christian or lean heavily on New Thought ideology. If you spend time in their spaces, you see the same dubious, universally unproven “miracle” cures promoted on loop: the ketogenic diet, high-dose vitamin C drips, essential oils, coffee enemas, ozone treatment, all the herbs, detox regimens like Gerson therapy, and prayer.
One of the most prolific outfits in this universe is The Truth About Cancer, often abbreviated as TTAC, run by former bodybuilder and accountant Ty Bollinger and his wife, Charlene. Founded in 2014 after numerous members of Ty’s family died of cancer, TTAC’s website is a vast library of articles with titles like “30+ Natural Alternatives to Consider Before Chemotherapy” or “The Truth About Chemotherapy — Toxic Poison or Cancer Cure?”
Sound familiar? It should. Antivaxxers share many of these commonality as well, particularly distrust of the CDC. Ty Bollinger has been peddling cancer quackery for as long as I can remember. (I started blogging 15 years ago, and I don’t remember the first time I encountered him. It was at least several years ago.) His online video series, The Truth About Cancer is packed full of misinformation, pseudoscience, and promotion of ineffective quack cancer cures, including the promotion of a bogus “virotherapy” known as Rigvir.
Osgood also notes that there is increasingly an alliance between the antivaccine movement and the “chemo truth” movement. This alliance is nothing new, of course. If you go to “natural health” events or read “natural health” propaganda, you’ll quickly note that there is considerable overlap between the group of people believing in cancer quackery and those with antivaccine views, and that vaccines and chemotherapy are demonized using similar terms.
A recent example of this confluence between the two movements occurred in October:
In October of this year, the Bollingers staged a conference in Anaheim, California, called The Truth About Cancer Live. Three of the headline speakers featured are primarily known for their anti-vaccine views: Del Bigtree, producer of the widely criticized documentary Vaxxed; Robert F. Kennedy Jr., environmental lawyer turned anti-vaccine campaigner; and Andrew Wakefield, the author of the Lancet study that proposed a link between the MMR vaccine and autism. (Wakefield’s study was debunked and the Lancet retracted it; he’s since been stripped of his medical license.)
Footage from the 2019 TTAC Live event is no longer accessible online (unless you want to pay a minimum of $199 to access it) but I managed to catch speeches by Kennedy and Bigtree during the live broadcast. Kennedy’s focused on how the HPV vaccine Gardasil increases risk of cervical cancer. (The CDC maintains Gardasil is safe.) Bigtree’s speech was entirely about vaccines: He never mentioned cancer, except once, obliquely, when he gesticulated at a graph about vaccines projected onto a screen and burst out, “This is why we’re sick!”
It is of course, utterly untrue that Gardasil increases the risk of cervical cancer (quite the opposite, in fact), but this event does show how antivaxxers and chemotherapy truthers are natural allies. They both share an overblown belief that “natural” is always better, that humans have a near-total ability to keep themselves healthy through lifestyle and diet (and certain supplements, of course), and that pharmaceutical drugs cure almost nothing.
Ty Bollinger strikes back
Unsurprisingly, cancer quacks Ty and Charlene Bollinger were unhappy about Osgood’s article and published a response. Predictably and amusingly, Ty Bollinger’s response to Osgood’s article goes a long way to unintentionally amplify her points about the Bollingers. Bollinger begins by expressing faux outrage that Osgood published her article on the same day that his father would have turned 76 if he were still alive, implying that she did it on purpose. Somehow I doubt that Osgood even knew when Bollinger’s father’s birthday was, but such a framing is useful to Bollinger to frame the issue as though Osgood’s article was a personal attack on him. He also seems to think that the term “cancer truther” was a reference to him and his wife. It might have been, but if the shoe fits…
Bollinger’s responses are very predictable, consisting mostly of “cancer truther” or “chemo truther” tropes that I’ve deconstructed more times than I can remember:
According to a 2004 report by Morgan, Ward, and Barton (Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia): “The contribution of cytotoxic chemotherapy to 5-year survival in adult malignancies. … survival in adults was estimated to be 2.3% in Australia and 2.1% in the USA.”
In another study published in the February 2017 issue of JAMA Internal Medicine, researchers Rupp and Zuckerman looked at 18 FDA approved chemo drugs, and found that NONE of them actually helped cancer patients live longer.
Longtime readers will recognize that study and recognize the first claim by Bollinger as what I’ve dubbed the “2% gambit” about chemotherapy. I’ve deconstructed why it’s a deceptive gambit based on a crappy study before. The long version of the debunking can be found here, and the short version goes something like this: This is not an impressive study and actually appears almost intentionally designed to have left out the very types of cancers for which chemotherapy provides the most benefit. It uses 5 year survival exclusively, completely neglecting that for some common cancers (such as breast cancer) chemotherapy can prevent late relapses, and there were also a lot of inconsistencies and omissions in that leukemias were not included, while leukemia is one type of cancer against which chemotherapy is most efficacious. As I noted at the time, the very technique of lumping all newly diagnosed adult cancers together is guaranteed to obscure benefits of chemotherapy among subgroups by lumping in patients for whom chemotherapy is not even indicated.
Bollinger’s invocation of the second article is even more deceptive. The article is not about all chemotherapy. It is only discussing newer chemotherapy drugs that underwent fast track approval based on surrogate endpoints; i.e., endpoints other than overall survival. It is about 18 drugs approved between 2008 and 2012, and it is a criticism that the FDA is approving new cancer drugs too rapidly. It’s a criticism that I myself echoed just last year. What Bollinger likely knows but deceptively leaves out is that standard-of-care chemotherapy for various cancers is standard-of-care because it has been shown to prolong overall survival in appropriate randomized clinical trials.
Bollinger also neglects to note that cancer mortality has been falling for 30 years and that the most recent report from the American Cancer Society showed the largest single year drop in cancer mortality ever observed. In fact, chemotherapy is effective when used appropriately. Yes, many chemotherapy agents are toxic, but most patients consider the toxicity worth it in order to survive their cancer.
For some reason, Bollinger also notes that chemotherapy can weaken the immune system. I don’t recall seeing Osgood actually write anything other than that cancer truthers make that claim, much less try to refute it. So he cites BreastCancer.org and the American Cancer Society stating that chemotherapy can temporarily weaken the immune system. No legitimate medical group says otherwise. It’s basically a straw man argument. I can see why Bollinger made it, though. It’s the only thing he can say in reply that’s clearly factual; so he had to find a way to shoehorn it into his response.
Every oncologist knows that chemotherapy has “collateral damage” (aka side effects). It’s not a matter of “if” but “how much” collateral damage will be caused by the chemo. Just like when the USA strikes another country or terrorist cell, the decision is frequently based on deciding how much collateral damage to “civilian” populations is deemed acceptable.
Have you heard of tamoxifen? It’s a breast cancer drug. Did you know that it’s classified by the World Health Organization and the American Cancer Society as a human carcinogen? According to the Report on Carcinogens, Fourteenth Edition, which is published on the NIH website,Tamoxifen is known to be a human carcinogen based on sufficient evidence of carcinogenicity from studies in humans. … Data from epidemiological studies and clinical trials indicate a causal relationship between exposure to tamoxifen and cancer of the uterus (endometrial type). … In rats, it promoted the development of … liver tumors in several studies and kidney tumors in one study.”In light of the above facts, does chemotherapy really make sense? Even if tamoxifen was effective (which increasingly it is not), does it really matter if it “cures” breast cancer only to cause endometrial or liver or kidney cancer as a direct result of the treatment?
This argument is deceptive in that tamoxifen is not generally considered chemotherapy, at least not in the same sense that cytotoxic drugs are. It’s a pill, one of the earliest routinely used targeted therapies. It’s an endocrine therapy that is directed against the estrogen receptor, whose activity fuels the growth of roughly 70% of breast cancers. It is true that on an absolute basis tamoxifen slightly increases the risk of uterine cancer. That’s been known for decades, but that slight increased risk of uterine cancer is very much outweighed by the benefits of tamoxifen in preventing breast cancer recurrence. As BreastCancer.org says (given that Bollinger likes to quote that website): “The breast cancer treatment tamoxifen (sometimes called by its brand name, Nolvadex) increases the risk of developing endometrial cancer, but not nearly enough to outweigh its benefits against breast cancer in most women”.
Bollinger also notes:
Additionally, in a 2009 study published on Science Direct, researchers Yan, Lu, and Yao demonstrated that chemotherapy not only enriches but also induces cancer stem cells. And a 2012 study from China indicates that chemotherapy can induce a phenomena [sic] called “stemness,” which occurs when the cells begin to express genes (such as p21 and p53) that are vital for maintaining stem cell functions. This, in turn, can drive the recurrence and speed the metastasis of cancer.
Amusingly, the first article was published in Bioscience Hypotheses, a journal discontinued in 2010. It’s not a study per se. It’s more like a commentary. The second study appears to be only a cell culture study. I can’t say for sure, though, because it is no longer available at the journal website online. Let’s just say that Bollinger did some mighty fine cherry picking. Of course, there is some evidence that chemotherapy can in some cases facilitate the spread of certain cancers (I even discussed one such study three years ago), but guess what? The benefits shown in clinical trials clearly outweigh harm from that possibility.
Here’s another amusing response by Bollinger:
KO asserts: Anti-chemo warriors have, perhaps unsurprisingly, joined forces with anti-vaccine advocates, whose crusading efforts have led to the resurgence of numerous preventable diseases like measles.
TB response: Despite the fact that neither Charlene nor I would take chemotherapy, we are not “anti-chemo” (and we’re not “anti-vaxx” either, FYI). We are for freedom to CHOOSE. That’s all. I think that’s where folks like Kelsey and others don’t really get it. And speaking of the measles … were you aware that it was a fully vaccinated 22-year-old theater employee in New York City who developed the measles in 2011 and was released without hospitalization or quarantine? Ultimately, she transmitted the measles to four other people, according to a May 2014 report in Clinical Infectious Diseases that tracked symptoms in the 88 people with whom “Measles Mary” interacted while she was sick.
There have been other measles “outbreaks” that occurred in fully (or almost fully) vaccinated populations, but the point is that if the measles vaccine (MMR) was effective, then there should NEVER be an outbreak in a fully vaccinated population.
Notice how Bollinger’s response basically makes Osgood’s point for her. Antivaxxers frequently say, “I’m not antivaccine. I’m pro-freedom” or “pro-parental rights.” Bollinger says the same thing, just substituting chemotherapy, “I’m not anti-chemo. I’m just pro-freedom to choose.” Then he pivots to a particularly brain dead antivaccine talking point. Later, he cherry picks a single table that suggests that the risk of cervical cancer with Gardasil is higher, ignoring utterly all the other high quality data (summarized by a friend of the blog here) showing that Gardasil and Cervarix (the other HPV vaccine) are very effective in preventing cervical intraepithelia neoplasia, the precursor to cervical cancer. He even repeats the claim that that Maurice Hilleman “admitted” that polio vaccines tainted with SV40 used until the early 1960s caused an epidemic of cancer. Sorry, Mr. Bollinger, but the evidence shows that they didn’t. He even trots out the antivaccine lie that Wakefield’s paper, although retracted, has never been debunked. (I rather think that Brian Deer would have something to say about that, given how fraudulent Wakefield’s study was.) He even echoes the Alex Jones wannabe Mike Adams about thimerosal in one of the remaining thimerosal-containing flu vaccines. (I laughed out loud when I read that.) Thanks, Mr. Bollinger, for making Osgood’s point for her again about the confluence between the antivaccine movement and the cancer/chemo truth movement!
Social media versus cancer misinformation
What can social media do about this spread of misinformation? I discussed this issue a couple of times last year, specifically what Google and the various social media platforms are doing to try to rein in the worst of the medical misinformation, starting with antivaccine misinformation. It’s an unenviable task, but one that the social media companies brought upon themselves by being so resistant in the past to any sort of content moderation. The let the problem fester for so long that it’s out of control now.
Noting that such companies have made efforts to rein this in, Osgood also notes, quoting yours truly and others:
But the system remains imperfect. In October, when BuzzFeed alerted Facebook and YouTube about groups promoting “black salve,” a tissue-eating paste hawked as a treatment for skin and breast cancer, YouTube removed the content, but Facebook declined to. (The Bollingers hyped the benefits of black salve on a recent live Q&A.) And when I loaded The Truth About Cancer and Chris Wark’s page on Facebook in early December, neither had a disclaimer about possible health misinformation.
“It’s hard to stay on top of the keywords and phrases that they’re using,” says Renée DiResta, the 2019 Mozilla fellow in media, misinformation, and trust. “Sometimes when new narratives emerge, they kind of get a bump until the platform reacts.”
Gorski is skeptical that algorithms alone can handle the monumental amount of misinformation online, or be able to reliably distinguish between valid and invalid material. “Even huge companies like Facebook don’t have the resources to hire the hordes of moderators it would require to do it with humans,” he says. “Their tools are kind of blunt.”
It is, as noted in the article, and arms race, and I remain skeptical that algorithm-based methods alone can ever rein in such health misinformation, for this reason:
When I look up Erin Elizabeth on Twitter, the algorithm suggests I follow Del Bigtree, The Truth About Cancer, and numerous anti-vaccine advocacy groups. This is one of the tech giants’ blind spots: They can dissuade you from entering the echo chamber in the first place, but once you land on one of these pages, you’ll still be directed to others with similar views. I also noticed that some anti-vaccine activists and cancer truthers have started avoiding certain flag-worthy terms or intentionally misspelling them — such as replacing the c’s in “vaccines” with apostrophes — which the human and digital monitors haven’t caught on to yet. As Gorski says, “It’s an arms race.”
Erin Elizabeth, you might know, is Joe Mercola’s longtime girlfriend. Those who follow me on Twitter might also know that she’s really, really unhappy with me right now.
In any event, it is an arms race. One thing I’ve learned is that antivaxxers forming new Facebook groups are very careful not to mention vaccines in the title and instead use terms like “medical freedom” or “parental rights” or other antivaccine dog whistles. Algorithms are dumb. They do what they’re programmed to do and can thus be gamed for a while before their creators realize they’re being gamed and tweak the algorithm to account for the gaming. There will always be a need for human moderators, and even Google realizes this, but none of the tech companies appear to care enough to hire enough moderators or to pay them enough to retain quality people. Maybe someday artificial intelligence will be the answer, but I wouldn’t put too much faith in computer-only solutions.
In the end, “Cancer Truth” or “Chemo Truth” are just another kind of misinformation and disinformation based on conspiracy theories and, as such, highly resemble antivaccine misinformation. All of these fear-mongering conspiracy theories based on pseudoscience and misinformation can cause significant harm, the antivaccine movement to public health and the “cancer truth” movement to cancer patients with cancer who are misled into pursuing ineffective treatments, thus lessening their chances of surviving their disease. Dealing with this sort of misinformation in medicine will be the primary challenge of science communicators for the foreseeable future.