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Cancer Treatment Centers of America: Revisiting the epitome of “integrative” cancer care

Three weeks ago, I mentioned in a post that the week of October 7 to 14 was declared by our very own United States Senate to be Naturopathic Medicine Week, which I declared unilaterally through my power as managing editor of Science-Based Medicine (for what that’s worth) to be Quackery Week. One wonders where the Senate found the time to consider and vote for S.Res.221, which reads:

S.Res.221 – A resolution designating the week of October 7 through October 13, 2013, as “Naturopathic Medicine Week” to recognize the value of naturopathic medicine in providing safe, effective, and affordable health care.

I know, I know, it probably took all of five minutes to consider and vote for this, thanks to Sen. Barbara Mikulski (D-MD), who sponsored it. In any case, as October 7 approached, I thought about how I could keep my promise to blog about naturopathy this week, and I came up with a way to do it. It’s a bit roundabout, but I think it fits. The idea derives from a discussion I was having a while back about one of my “favorite” hospitals, namely the Cancer Treatment Centers of America, in which a colleague of mine questioned why there were so many CTCA ads on NPR and why CTCA is sponsoring shows on PBS such as the upcoming The Emperor of All Maladies by Ken Burns. Although I can’t wait to see this particular series, I am a bit worried that the infiltration of quackademic medicine will make an appearance, given that CTCA is a major sponsor.

Of course, PBS has come under fire here at SBM for doing more than airing acknowledgments from CTCA. There are several examples, such as its running of infomercials for Daniel Amen and Mark Hyman, as well as the local Colorado PBS station running, in essence, an infomercial for Stanislaw Burzynski, complete with Burzynski’s very own propagandist, Eric Merola. Let’s just say that, when it comes to medicine, PBS isn’t exactly as scientifically rigorous as it once was.

With this as my entry point, I noted that CTCA is very much into “naturopathic oncology” and that it’s been over three years since I’ve written about this. Given that this is Naturopathic Medicine Week 2013, this seemed like an excellent way to begin, with a recap and update on the nonsensical therapies that CTCA provides. In many ways, CTCA is the very epitome of “integrative medicine,” and I don’t mean that in a good way. (Actually, there is no good way to be the epitome of “integrative medicine,” which “integrates” pseudoscience and quackery with real medicine.) Then, late last year, it was revealed that Richard Stephenson, the founder of CTCA, is also one of the primary funding sources for Freedom Works, a right-wing Tea Party organization that was a major player in the 2012 elections. It was an interesting little tidbit in that it is yet another reminder that the tendency towards medical woo is not limited to the stereotypical crunchy granola-eating left wing fringe. Be that as it may, let’s take a look at what CTCA is offering these days. When I did this, I found a lot of the same ol’ same ol’, but one new development that echoes another frequent topic of this blog.

“Integrating” pseudoscience with science

The first thing I noticed when looking at the list of treatments that CTCA offers is that there is no segregation between the woo and the real medicine. Acupuncture, naturopathic medicine, “mind-body” medicine, and chiropractic are all “integrated” seamlessly into the list with chemotherapy, surgical oncology, and radiation oncology. The next thing I noticed is that the woo is also highly “integrated” into the national leadership of CTCA. For example, Katherine Anderson is the National Director, Naturopathic Medicine and Director, Naturopathic Medicine, Southwestern Regional Medical Center, while the Chief Information Officer is Timothy Birdsall, a naturopath who was Vice President, Integrative Medicine, and National Director of Naturopathic Medicine & Research from 2002 to 2012 and was named as the physician of the year by the American Association of Naturopathic Physicians (and who was also quite adept at spinning negative studies about his favorite supplements). Then there are James Rosenberg, National Director of Chiropractic Care; Carolyn Lammersfeld, Vice President of Integrative Medicine; Katherine Puckett, National Director of Mind-Body Medicine, and Director of the Department of Mind-Body Medicine; and Karen Gilbert, National Director of Oncology Rehabilitation, who also boasts of being certified in Lymphatic Drainage Therapy and Auriculotherapy. One notes that auriculotherapy is basically ear acupuncture based on the idea that the ear is a microsystem which reflects the entire brain represented on the auricle, the outer portion of the ear. Yes, it’s basically the same sort of quackery that Col. (Dr.) Richard Niemtzow offers our troops as “battlefield acupuncture.” What’s really depressing to see, however, is that a formerly well-respected surgical oncologist, Edgar Staren, is the President and CEO, Medicine and Science, and President and CEO, Western Regional Medical Center. I used to see him present from time to time at surgical meetings. In fact, I might even have met him in person back in the 1990s when I was looking for a job near the end of my fellowship and interviewed at Rush University Medical Center.

But what does CTCA offer in terms of “integrative” treatments these days? I wandered over to the section on integrative oncology services, and this is what I found. Naturally, I couldn’t resist heading first to the section on naturopathic medicine, particularly given that this is naturopathic medicine week. This is what CTCA touts, after declaring that naturopathic clinicians are “specialists in natural health care who use natural, non-toxic therapies to support the whole person and encourage the self-healing process”:

Throughout your treatment, your naturopathic clinician will recommend natural therapies to support your immune system and reduce any treatment-related side effects, including:

  • Herbal and botanical preparations, including herbal extracts and teas.
  • Dietary supplements, including vitamins, minerals and amino acids.
  • Homeopathic remedies, extremely low doses of plant extracts and minerals that gently strengthen the body’s healing and immune response.
  • Physical therapy and exercise therapy, including massage and other gentle techniques used on deep muscles and joints for therapeutic purposes.
  • Hydrotherapy, which prescribes water-based approaches like hot and cold wraps, and other therapies.
  • Lifestyle counseling. Many medical conditions can be treated with exercise, improved sleep, stress reduction techniques, as well as foods and nutritional supplements.
  • Acupuncture. Your naturopathic clinician may also recommend incorporating acupuncture into your treatment plan.

It’s rather amazing here how so many of the things that are wrong with “integrative oncology” are right there on a single page. Look at the list of therapies. They range from the purest quackery (homeopathy) to what should be science-based medicine (physical therapy and exercise therapy) and everything in between. I realize that most readers of SBM know what homeopathy is and why it is quackery, but in case there are new readers seeing this, I’ll briefly recap. Homeopathy postulates two main ideas, both of which have no basis in science: First that you relieve symptoms by using a substance that causes the symptom being treated, and, second, that diluting a substance makes it stronger. Of course, the substance must be diluted with strong shaking (known as “succussion” in homeopathy lingo) between each serial dilution step. Most homeopathic remedies are diluted so much that there is almost certainly nothing left of the original remedy. For example, Avogadro’s number (the number of molecules in a mole of a substance) is on the order of 6 x 1023. A typical homeopathic dilution is represented as “C,” where each “C” equals a 1:100 dilution. So, a 1C dilution is a 1:100 dilution; a 2C dilution is a 1:10,000 dilution (100 x 100); and so on. If you get to 12C, you’re talking a 1024 dilution, which is already greater than Avogadro’s number. That means that it’s unlikely that more than one molecule of the substance remains, and that assumes the homeopath started with a mole of the substance being diluted, which is rarely the case. Usually the homeopath starts with much less. Now consider that typical homeopathic dilutions are 30C (1060), more than 1036 orders of magnitude greater than Avogadro’s number, and just how quacky homeopathy is comes into focus. Sure, homeopaths will wave their hands about the “memory or water” or “nanoparticles,” but in reality homeopathy is nothing more than magical thinking. The same is largely true for acupuncture, which is nothing more than a theatrical placebo, and studies claiming otherwise are uniformly unconvincing.

Now let’s look at some of the other “integrative” treatments. They are a classic “rebranding” of science-based modalities as somehow being “alternative.” For example, physical therapy and exercise therapy have been well-accepted treatments for various musculoskeletal problems for a long time. There is nothing “alternative” or “integrative” about them. There is one caveat. Frequently, the “alternative” or “integrative” versions of these sorts of therapies get that way by “integrating” magical thinking into them. I can’t tell how much magical thinking has found its way into CTCA’s version of physical therapy and exercise therapy, but given who’s in charge of rehabilitation at CTCA (Karen Gilbert, certified in auriculotherapy and lymphatic drainage), I’m guessing that it’s probably a lot, particularly given the easy access to chiropractic and these recommendations for rehab:

Our massage therapists can help reduce your cancer-related pain and improve your quality of life during your cancer treatment. Some manual therapy options include:

  • Traditional massage
  • Stone therapy
  • Myofacial release
  • Soft tissue manipulation with passive stretching
  • Aromatherapy
  • Effleurage
  • Friction
  • Trigger point therapy
  • Acupressure
  • Reflexology
  • Chiropractic care

Chiropractic care

Our chiropractors treat bone, muscle or joint pain, without the use of drugs or surgery. Chiropractic care can also help to relieve symptoms such as neuropathy, nausea and headaches.

Auriculotherapy

This painless, non-invasive form of oncology rehabilitation, which involves stimulation of the auricle of the external ear, can help alleviate some of the side effects of cancer treatments, such as pain, nausea or fatigue.

Yes, indeed. It’s all there. Chiropractic, myofascial release, aromatherapy, acupressure, and, quackery of quackeries as quacky as homeopathy, reflexology.

Then there’s lifestyle counseling, which is a vague one. That can range in science-based practices, from practical advice on how to lose weight to exercising more and getting more sleep, but note how CTCA mentions nutritional supplements. It’s become increasingly apparent over the last several years that nutritional supplements are not necessary except in very specific (and relatively uncommon) cases of specific nutritional deficiencies, as long as the person eats a varied diet. Moreover, most studies of nutritional supplements for specific health conditions, with the possible exception of vitamin D, have been resoundingly negative.

One thing becomes clear as you peruse the treatment options offered at CTCA for virtually any cancer, and that’s that naturopathic treatments are deeply embedded (or “integrated”) into everything that is done at CTCA. Indeed, if you click on almost any cancer in this list, you’ll see three buttons. For instance, under the section on breast cancer, there are three buttons:

  • I’ve just been diagnosed
  • I’m searching for treatment options
  • I’m seeking integrative care

Also, take a look at this post on the CTCA blog about breast cancer awareness month. In it there’s a link to a page on naturopathic treatments for breast cancer, which recommends, in addition to the treatments in the list above, these treatments:

The following are additional ways naturopathic medicine can help combat side effects of breast cancer treatments:

  • Some hormone therapies for breast cancer can weaken the bones. Your naturopathic clinician may recommend vitamin D to protect the bones.
  • Chemotherapy for breast cancer may cause numbness or tingling in the hands and feet (peripheral neuropathy). Your naturopathic clinician can offer natural therapies to help treat this condition.
  • To help you fight nausea and vomiting, your breast cancer naturopathic medicine team may suggest ginger, peppermint oil, tea, sea bands, acupuncture and homeopathic remedies.
  • Some naturopathic remedies, such as green tea and melatonin, may help to decrease the risk of breast cancer recurrence.
  • Some endocrine treatments that are recommended for women with breast cancer are given for at least five years and have side effects that naturopathic medicine can help address. This allows you to tolerate these treatments and continue with important therapies to help decrease risk of recurrence.

Then there is this video that recommends supplements to combat cancer- and treatment-related fatigue. Vitamin D, of course, is not anything unique to naturopathy; when indicated it should be a part of standard treatment, not something recommended by a naturopath as an adjunct. Second, acupuncture and homeopathic remedies do nothing for nausea, and the evidence suggesting that green tea might decrease the risk of breast cancer recurrence is weak at best. So is the evidence that naturopathic treatments can significantly alleviate the symptoms of estrogen deprivation due to anti-estrogen drugs used to treat hormone-positive breast cancer.

There’s so much more, of course, but I’m trying to train myself not to be as verbose as perhaps you’ve become accustomed to (anything over 5,000 words is too much). The bottom line is that CTCA is indeed the epitome of “integrative” oncology in the way it truly does seamlessly “integrate” woo with science-based medicine such that it’s difficult for patients to distinguish what is science-based and what is not. Indeed, even physicians sometimes have difficulty telling where the SBM ends and the woo begins, even as otherwise excellent physicians and surgeons actually working at CTCA fall for the common trope that somehow taking care of the “whole patient” and being “holistic” means embracing pseudoscience, even touting it as what “sets CTCA apart.”

Disturbing echoes of another major topic of this blog

I’m going to leave the topic of naturopathic oncology for the moment, because, if there’s anything about CTCA that’s new, it’s not the naturopathy. Rather, it’s a new service CTCA offers that sounds a lot like a service I’ve been writing about for the last year and a half offered by our old “friend” Stanislaw Burzynski, specifically, his “personalized gene-targeted cancer therapy.” It’s basically using genomic testing to try to pick combinations of targeted therapies and chemotherapy that are likely to be most effective on any individual patient’s cancer. Go back and read that post. Now take a gander at CTCA’s webpage on Genomic Tumor Assessment, which boldly states:

Every cancer is different. Genomic testing helps our doctors understand a patient’s cancer at the molecular level. Information about genomic changes that are unique to your individual cancer will help us determine treatments most likely to work for you. It’s the promise of precision cancer treatment — a focus on the individual tumor in the individual patient.

Take a look at the video on that page. It’s very slick. It uses lots of 3D graphics showing DNA double helices and cells dividing. It sounds very convincing. However, much of it is, when you come right down to it, repackaging of things that conventional doctors already do. For instance, there’s a long section about colorectal cancer and how we know the proteins that drive the growth of colon cancer and, depending upon whether key genes are mutated, know which chemotherapies to choose. Ditto for breast cancer, where if the HER2 oncogene is turned up to 11, so to speak, we have a drug that targets it. In reality, this part of the video looks as though it’s just referring to these oncogenes that we already test for in colon cancer, non-small cell lung cancer, and breast cancer. There are already commercially-available tests for mutations in these genes, for example this one from Quest Diagnostics. None of this is particularly new, at least not anymore. CTCA even admits as much for non-small cell lung cancer and breast cancer, albeit in the small print, where it says that these tests have been done for several years as “part of the standard care.”

Here’s where CTCA claims to go beyond this:

If you and your oncologist decide you are a candidate for genomic testing, the following steps are taken:

  • CTCA collects a sample of your cancer tissue (if available) or a biopsy of your tumor and sends it to a respected genomic sequencing lab.
  • Sophisticated laboratory methods will capture genomic information in the tumor cells. Scientists at the sequencing lab extract the DNA from your tissue or tumor sample.
  • Genetic information is encoded as a sequence of nucleotides – guanine, adenine, thymine, and cytosine – which form the building blocks of DNA. Scientists at the lab then sequence the genes in your tissue or tumor sample to uncover the order of nucleotides.
  • Sequencing the tumor’s genetic profile produces a large amount of data. Scientists at the lab analyze this data to identify mutations that are critical to certain functions of the tumor.

Your oncologist will review the test results to determine if the information is helpful in the selection of a good treatment option for you.

All of this sounds to me a lot like what the Burzynski Clinic does. The question then becomes: Is CTCA any better at it than Burzynski is, the latter of whom, through the arrogance of ignorance, either thinks he “pioneered” this field twenty years ago (and that cancer centers like M.D. Anderson are only now following in the footsteps of his brilliance) or lies about his expertise in genomic testing and gene-targeted cancer therapy? The information is way too sketchy on the website to tell for sure, but it’s instructive to compare how CTCA sells “precision” medicine to how M.D. Anderson portrays it in the description of its Institute for Personalized Cancer Therapy:

Our strategic plan for the Institute is focused on the goal of defining the new standard of patient care – making personalized cancer therapy standard over the next 5 years, revolutionizing the way we manage patients. To accomplish this goal, we will:

  1. Rapidly implement the expanded molecular pathology laboratories, technology, instrumentation, and infrastructure for personalized clinical trials;
  2. Develop best practices for obtaining and managing patient biopsies and specimens to implement personalized cancer therapy;
  3. Position MD Anderson to lead the way in therapeutic clinical trials based on the underlying genomic and molecular alterations in individual patient’s cancers;
  4. Establish broad internal and external collaborations and partnerships to enhance our ability to rapidly transform discoveries into clinical practice and standard of care.

Note the emphasis on research and implementation. M.D. Anderson understands that “precision medicine” is not yet ready for prime time and that we don’t know yet whether or by how much the use of this genomic data for each patient’s tumor will impact patient care and outcomes. That’s why it has a research institute to develop the infrastructure and methodology for carrying out clinical trials to test “personalized” or “precision” medicine. Indeed, there has been some criticism of a “genomic gold rush,” in which cancer centers are seemingly competing to be the “firstest with the mostest” when it comes to genomic medicine. Even optimists point out that medicine is a long way from deriving useful information from routine tumor sequencing, much less improving patient outcomes.

I suppose that, in light of how the big cancer centers are going all-in, it’s not surprising that a for-profit hospital chain would want to emulate them. After all, don’t think that cancer centers aren’t using their new genomic institutes as marketing tools. However, there is a difference. The big cancer centers are building their genomic institutes in order to do the research necessary that will ultimately validate (or fail to validate) specific hypotheses regarding the use of routine genomic testing of patient tumor samples. There is enough uncertainty that, given the huge expenses involved and the massive effort this sort of research project takes, some are questioning the wisdom of setting these institutes up when the finances of medicine are so constrained right now and cost-containment is the order of the day. Even so, the goal, clearly, is to do the clinical trials that desperately need to be done.

In contrast, CTCA is selling genomic testing and personalized therapy as though it were already validated, as though it’s as routine and simple as sending off a piece of the patient’s tumor, either from a biopsy or a surgical resection, to the genomics lab to have it work its magic on the specimen, be it cDNA microarray analysis or the more recent advanced techniques like next generation sequencing, and then reading off the results. The implication is that we already know how to use the terrabytes of data that result from a typical sequencing of a single tumor to pick the best chemotherapy and targeted drugs for their individual cancer. Sure, there are disclaimers, but the overall message, complete with this spiffy infographic, is that this is cutting edge and that it will help cancer patients who come to CTCA. While there might be much to criticize when it comes to the “genomic gold rush,” the intent is to find out whether these techniques and the information they yield can greatly improve cancer outcomes. Now look at CTCA’s section on clinical trials. I don’t see any testing its Genomic Tumor Assessment to see if it provides information resulting in improved outcomes. Why is this? Indeed, look at this article on CTCA’s social media campaign for its “Real people. Real Discoveries.” campaign:

By launching the “Real People. Real Discoveries.” Social Media Campaign, CTCA places emphasis on key aspects of its core care delivery of genomic tumor assessment by emphasizing the importance of the individual’s genetic response and the potential it has for determining the best course of medicine and treatment. This focus inherently drives thoughts of “hope” without a specific reference to the word itself.

Notice that there isn’t any mention that this is still considered experimental. Rather, it is a media campaign designed to “drive thoughts of ‘hope’” without actually using the word itself.

Naturopathy and CTCA: Joined at the hip forever?

I’d like to finish by coming back to the topic of naturopathy, which might seem strange after discussing the use of genomic testing as a marketing tool. This is, after all, naturopathic medicine week, which is why I chose this topic in the first place. However, it is very clear that naturopathy is so completely embedded in CTCA that it taints the entire enterprise irredeemably. As I mentioned before, the impetus for founder of CTCA Richard J. Stephenson, was the death of his mother, Mary Brown Stephenson, from cancer and his frustration with the current system. Tragically, as so many before have done, in his grief and frustration, Stephenson confused “holistic” care with an openness to quackery like naturopathy and incorporated such quackery into CTCA right from the beginning, “integrating” it with standard, even state-of-the-art, conventional cancer care to the point where you can’t always tell where the science ends and the quackery begins. (Well, except for the homeopathy.) Sadly, a lot of otherwise-talented doctors bought into the idea and have—if you’ll excuse the term—completely “integrated” themselves into the CTCA system. In doing so, they have become complicit in the blurring of the line between science and pseudoscience in medicine while believing that they are doing good for the patient by giving them “holistic care.”

Posted in: Cancer, Homeopathy, Naturopathy

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51 thoughts on “Cancer Treatment Centers of America: Revisiting the epitome of “integrative” cancer care

  1. Jeff Rubinoff says:

    Haven’t got all the way through this piece yet, but a couple quick notes:
    * Towards the top, you mentioned a Colorado PBS station that ran the first Burzynski infomercial. Is that the same Colorado PBS station that ran a 9/11 Truther “documentary”?
    * I’ve disliked CTCA since the 90s, when I saw them flood ads on daytime A&E shows. I thought advertising a cancer hospital was more than a little tacky.

    1. goodnightirenei says:

      It’s important to remember that each and every PBS local station is independent and chooses and buys its own programming. If you don’t like the ridiculous woo-ish informercials so many of them are choosing, you need to let your local station know and encourage others to do so as well. They WILL notice. Don’t blame the parent PBS corporation; although I think they could do more to discourage such practices.

      I learned all this from the PBS Ombusdsman, who explains it all regularly when people write him to complain. He has a regular column, which makes for some interesting reading.

      pbs.org/ombudsman

      1. LRosa says:

        Jeff: You are right that the same Colorado public TV station (CPT-12) that aired “Burzynski” aired the 9/11 Truther film, and a host of other nonsense films.

        goodnightirenei: People are right to complain to PBS when stations like CPT-12 violate their contract with PBS by airing commercial or religious programming. PBS chooses to turn a blind eye to the most outrageous of violations. Complaining to a local station will get a response but do squat to change their programming.

  2. Chris Hickie says:

    Well, at least they don’t treat children. I couldn’t easily find that on their web site, so I launched a chat session with one of their “specialists” who took a rather long time (5 minutes) to come back with the answer that all their patients are 18 years and over. But they told me I could contact the NCCAM and the Center for Mind-Body Medicine for a patient younger than 18 years (and gave me the contact information). Ack. Of course, since I practice in Tucson, home of Weil and all his “integration”, I’m sure they are working on infiltrating the heme-onc ward of the children’s hospital here.

  3. WilliamLawrenceUtridge says:

    It’s just so…crass. That “Real Patients” bit of marketing? Who is it aimed at? The triple-overlap of that Venn diagram is “patient capture”. Isn’t that basically “customers”?

    That whole organization is weird, why do they have a naturopath as their head IT person? Unless the “information” part of his title is PR? Perhaps he’s responsible for their definition of homeopathy, “extremely low doses of plant extracts and minerals that gently strengthen the body’s healing and immune response”. Emphasis added, and I wonder – does he classify homeopathic moonbeams (sadly a real thing) as “plant” or “mineral”?

    That genomic profiling of cancer is sickening. Either they’re charging you extra for standard care, or they’re charging you extra for unproven therapies. I wonder if you can go to the CTCA and say “can I just have the real medicine please”?

    1. windriven says:

      “That “Real Patients” bit of marketing? Who is it aimed at? The triple-overlap of that Venn diagram is “patient capture”. Isn’t that basically “customers”?”

      Customers. Yes. As Dr. Gorski touched on, CTCA seems as much or more about monetizing the credulity and anxiety of cancer patients and their families than delivering best-in-class oncology treatment.

      “I wonder if you can go to the CTCA and say “can I just have the real medicine please”?”

      Why bother? There are many fine institutions that offer state of the art cancer care. But I’ll bet the CTCA cafeteria has really good coffee.

  4. AnObservingParty says:

    I was looking forward to the documentary as well, as Mukherjee’s book was absolutely fantastic. I was unaware it was being sponsored by CTCA, and find it personally confusing, as Mukherjee’s practice is heme-onc, and if there is ANYTHING CAM hackery shouldn’t touch it’s hematological malignancies. We’ve had patients snuck “herbal supplements” during induction or conditioning regimens and have been struck by fungal infections, or developed secondary BSIs from random bacteria found in wheat-grass coming into contact with their mucositis or gut GVHD. While we’re introducing those things to injured mucosa, why don’t we also put in a reptile/water fowl petting zoo and a fungus garden?

    @ Jeff

    Advertising isn’t necessarily an indication of lack of qualification or competance, my institute advertises locally, we’re NCCN. I’ve also seen ads for Sloan-Kettering and Karmanos whilst on travels.

    1. goodnightirenei says:

      “Advertising isn’t necessarily an indication of lack of qualification or competance, my institute advertises locally, we’re NCCN. I’ve also seen ads for Sloan-Kettering and Karmanos whilst on travels.”

      Any advertising for medical institutions (or drugs) opens the door to a really huge Pandora’s Box. It was much better when we didn’t allow any of it. Same goes for lawyers.

      Too many people confuse advertising with “information”. Even the most benign institution cheapens its mission with the use of “marketing” in place of simply making sure they practice the very best medicine. I’m sure some try to do both, but it is money that would be better spent on research in my view. Marketing is especially insidious because it attempts to create a “need” where little or none existed.

      1. windriven says:

        “Advertising isn’t necessarily an indication of lack of qualification or competence”

        No, it isn’t. But the style and content can be. The media markets in the PNW are inundated with CTCA advertising, most of which makes my skin crawl in its smarminess.

        Compare and contrast with the advertising of a local (PNW) hospital group that features conversations with patients who are revealed to also be physicians in that hospital group. The message is: I work here. I know the good and the bad. When my health was on the line I chose my own hospital because I believe in the care we deliver.

      2. AnObservingParty says:

        Sometimes money can’t go towards research, believe it or not. Much of my facility’s marketing/PR comes from donations that specify use. Just like we can’t use monies donated for research purposes for marketing, the reverse is true.

        I don’t necessarily agree that it creates a need. Sometimes it creates awareness, and many people don’t know what things like “NCCN” or “FACt” until they see it in a commercial and look it up. And if that’s enough to get a second opinion with us, a comprehensive cancer center that is research-based, it may save their life. Our local hospitals are good at referring to us for oncology care, but that’s not always the case elsewhere. It is slippery, I agree, but it’s not all the smarmy nonsense apparently CTCA does. I know of them from internal news, etc, but I’ve honestly never seen a commercial for them. Much of our marketing it targeting providers. And, when it comes down to it, more money coming in does mean more resources for research, treatment, and supportive care that goes above and beyond. So I will defend my reputible, research-based, NCCN-designated institute’s use of local marketing. It does nothing to cheapen our mission or our ability.

        We do have a local group trying to sell “cutting edge treatment that no other institute in …. offers” which is just radiation. And we do offer it. We see many people who start there, and end up here. So, it can be bad, but I in no way feel it takes away from us or our reputation.

    2. windriven says:

      “Advertising isn’t necessarily an indication of lack of qualification or competence”

      No, it isn’t. But the style and content can be. The media markets in the PNW are inundated with CTCA advertising, most of which makes my skin crawl in its smarminess.

      Compare and contrast with the advertising of a local (PNW) hospital group that features conversations with patients who are revealed to also be physicians in that hospital group. The message is: I work here. I know the good and the bad. When my health was on the line I chose my own hospital because I believe in the care we deliver.

  5. oldmanjenkins says:

    I have seen a lot more commercials on various local channels as well as some paid channels (History and Discovery come to mind) from CTCA. Of course all they present is anecdotal testimonials and no evidence. They follow the same script as the Passages Malibu does for their quackery regarding substance abuse treatment (“we treat the cause of substance abuse”). Unfortunately even Moffitt Cancer here in Tampa has under their “Services” section

    “INTEGRATIVE MEDICINE

    Healing and wellness services including acupuncture, massage and meditation”

    So the “woo” appears to be every where.

    1. Lucario says:

      oldmanjenkins, where did you hear that Passages Malibu was quackery? News to me. I’ve never heard Orac or any of the other quack-fighters tackle them yet.

  6. BobbyGvegas says:

    Wow. I too am always bothered by their slick TV ads. Didn’t know about the founder’s Tea Party connection. Those people are selling political Woo all the time.

  7. Chris Hickie says:

    For some reason I picture a naturopath’s version of IT to be a whole room full of abacuses as “servers”.

    1. WilliamLawrenceUtridge says:

      Nope. Abacuses work. It’d have to be one of those bits of horn or wood from 40,000 years ago with marks on them that people think are calendars but nobody really knows.

  8. David Gorski says:

    Unfortunately even Moffitt Cancer here in Tampa has under their “Services” section

    “INTEGRATIVE MEDICINE

    Healing and wellness services including acupuncture, massage and meditation”

    So the “woo” appears to be every where.

    True. That’s what’s so sad. It’s just that CTCA is further along than any academic medical center I can think of, with the possible exceptions of the University of Maryland or Beth Israel, in “integrating” quackery with SBM. The efficiency of the market, I fear.

  9. You should come to the Oncology Association of Naturopathic Physicians conference, might meet a few of CTCA guys.

    I listened to a talk by one of the CTCA naturopaths, and one of the questions was how many patients at CTCA receive naturopathic care, the answer was all of them do, its a truly an integrative practice, many steps ahead of the rest of the industry.

    A naturopathic oncologists job is to make sure the supplements a cancer patient is taking do not adversely interfere with the chemotherapy treatment. Cancer patients take a lot of supplements, without professional advice, often in large doses. Integrative practice encourages these patients to openly discuss their alternative treatment efforts with a holistic medical specialist.

    1. David Gorski says:

      I listened to a talk by one of the CTCA naturopaths, and one of the questions was how many patients at CTCA receive naturopathic care, the answer was all of them do, its a truly an integrative practice, many steps ahead of the rest of the industry.

      That is exactly the problem with CTCA.

    2. WilliamLawrenceUtridge says:

      A naturopathic oncologists job is to make sure the supplements a cancer patient is taking do not adversely interfere with the chemotherapy treatment. Cancer patients take a lot of supplements, without professional advice, often in large doses. Integrative practice encourages these patients to openly discuss their alternative treatment efforts with a holistic medical specialist.

      And it should be a doctor’s job to ensure that the patient isn’t taking any medication, including supplements, that isn’t indicated. That’s why the science-based among us are annoyed. Not to mention, all those useless costs – bottles of supplements, consulting fees, even overhead for office space – must be downloaded to cancer patients and their families who rely on doctors to give them the best chance for survivial. Call me old fashioned, but I think it’s tacky to benefit unnecessarily from a patiet’s cancer diagnosis.

      If you were real, science-based practitioners, you could inform them that taking all those unnecessary supplements may not help, they may harm. You might wait until testing before recommending treatments, which would have a twofold benefit – the discovery of new ways of treating patients, and fewer might die faster, in greater pain. Of course, if you were science-based practitioners, you might have the scientific and ethical appreciation to realize you shouldn’t recommend useless or harmful supplements to your patients.

      And in a final point – current practice is for doctors to discuss any medications, including herbs, vitamins and even useless sugar pills, with their patients. Once again, you are either redundant, or a useless waste of time and money.

  10. AnObservingParty says:

    Moffitt? Oh, they’re designated too. And they do HSCTs. It’s scarier than I thought…theses places are academic, research-based instutions. Time to batten down the hatches I suppose.

    I need to go frantically search our public site. I’ve witnessed past attempts and shut-downs, but now I’m worried something got through.

  11. Carl says:

    I know it was a tangential comment, but every time “battlefield acupuncture” is mentioned it just floods my brain with shock and awe. Mitchell and Webb’s homeopathic emergency room is actually slightly less ridiculous than the real version, what with the bullets flying by and all.

  12. RobRN says:

    FBA: We’re all still awaiting valid evidence resulting from high quality well conducted peer reviewed RCTs of “integrative” modalities! Except – I’m not sure I’d trust that we’d get effective and non-biased peer review from a relativistic integrative practitioner as a peer! Also – accredited health care organizations are mandated to develop quality assurance programs. I cannot imagine how to effectively measure outcomes related to “integrative” practices and establish that practices are improving as everything is placebo effect – and “perception is reality” reigns.

    1. windriven says:

      I think we should take FBA at his word: that he actually is a fast buck artist far more interested in the lucrative sCAM payoff than any actual demonstrable clinical benefit.

      If you think about it his comments fit the conclusion that his intention has nothing to do with presenting arguments intended to convert scientists to the notion of sCAM having benefits. Instead his intent seems to be to seed doubt in the minds of the medical consumers who read these pages.

      ” I cannot imagine how to effectively measure outcomes related to “integrative” practices and establish that practices are improving as everything is placebo effect – and “perception is reality” reigns”

      You’ve answered your own question. Any measure of sCAM effectiveness is necessarily subjective. NCCAM has spent more than a billion dollars looking for a needle in the haystack of sCAM and so far it has found only hay.

      The beauty of the sCAM model is that they get the mark – sorry, I mean patient – in, apply the sCAM and ask: there, now isn’t that a little better? If YES, then respond: good, come back in 2 weeks for another ‘treatment’. If NO, then respond: I was afraid of that. Your condition is pretty advanced. Come back next week for another ‘treatment’. If the mark eventually says they’ve had enough, then respond: If only you had come to me sooner.

      I think I’ll go into the homeopathic concoctions business. I already have all the necessary equipment: stainless steel mixing tanks, RO water system, vibration (succussing) tables . Then I can be a fast buck artist too. I went on line and found ocsillococcinum for $11.55 for 6 doses, .04 ounces each. That amounts to $770 for a pint of water and some colorful packaging.

      1. WilliamLawrenceUtridge says:

        You might be right about FBA, s/he does have that “let the buyer beware” stink of anti-consumer protection Republicanism.

      2. I think I’ll go into the homeopathic concoctions business. I already have all the necessary equipment: stainless steel mixing tanks, RO water system, vibration (succussing) tables . Then I can be a fast buck artist too.

        Homeopathy is more than liquids. There are ointments, tablets, syrups, creams, tinctures, sprays, tablets. Pharmacies like to deal with a supplier who can offer the full range, not just an item or two.

        Personally I own shares of Boiron, the leading producer of homeopathic remedies, Up nearly 100% over the last 12 months, that should give you a hint how well homeopathic medicine is doing.

        Homeopathy isnt the fastest growing or most popular medical practice (I think chiropractice would take that crown) but the profit margins are fantastic.

        1. WilliamLawrenceUtridge says:

          Homeopathy is worthless, everything else is greed and ignorance.

          And people criticize Big Pharma for being greedy and lying to people.

        2. Lawrence says:

          Of course homeopathy has awesome profit margins – water is free (for the most part)…..

        3. Harriet Hall says:

          Should we accuse you of being a Big Homeopathy shill? :-)
          See http://www.sciencebasedmedicine.org/answering-our-critics-part-1-of-2/ #1 and #7.
          Is there a name for the logical fallacy of arguing that it must work because it’s making me rich? Argumentum ad pecunium?

          1. Should we accuse you of being a Big Homeopathy shill?

            Its more accurate to say I am a Homeopathy Enthusiast. I find the concept of strenghtening the body’s Innate Vital Force with highly diluted nanoparticles quite original and even mystical.

          2. WilliamLawrenceUtridge says:

            And there we go, greed and ignorance. How can you sell homeopathic preparations given the consistent failure of clinical trials to find any benefit? Greed. How can you be an enthusiast given the completely ludicrous hypothetical mechanism? Ignorance (but I’m mostly going with greed here again).

            You may find it “mystical” but that doesn’t mean it “works”. Not that you care, right? As long as you are making money, who cares that the consumer suffers or impoverishes themselves?

  13. CloakMaker says:

    Acupunture does have legitimate use for pain management, and has been scrutinized recently. The team pooled the results of 29 studies involving nearly 18,000 participants. Some had acupuncture, some had “sham” acupuncture, and some didn’t have acupuncture at all. Overall, acupuncture relieved pain by about 50%. The results were published in Archives of Internal Medicine in 2012.

    Whether from the placebo effect, self hypnosis or actual effect, I personally had found pain relief from acupuncture. As such, it can be a beneficial option that adds to quality of life rather than curing, and should not be discarded as quackery. However, it should not be confused with treatments that actually affect cancers and CTCA makes no distinction between palliative and cancer affecting measures in its literature.

  14. Sawyer says:

    Well thanks a lot SBM. Because of you and your damn “science”, I can’t make it through a single show on NPR without cringing at the sponsors list. In the past year you’ve criticized 23andme, then Lumosity, and now Cancer Treatment Centers of America. Why ya gotta hate on public radio?

    The only current medical-related sponsor of NPR that hasn’t been ripped apart here is Novo Nordisk. Clearly more evidence of Science Based Medicine being part of the Big Pharma Conspiracy!!!! (sarcasm)

    1. David Gorski says:

      Don’t even get me started on 23andme. One of these days I need to do a post about it.

      1. mousethatroared says:

        You should!

        1. WilliamLawrenceUtridge says:

          That “thunking” noise is me mashing my finger where the “like” button should be. Perhaps I should try my mouse?

          *click*click*click*click*click*click*click*click*

          Nope, that didn’t help either.

          What I’m saying is – comments should have “like” buttons.

  15. Clearly more evidence IGXE online store of Science Based Medicine being part of the Big Pharma Conspiracy.

    1. WilliamLawrenceUtridge says:

      Spam, since the store in question is apparently used to buy gold in online games.

      1. Lucario says:

        This website needs some way to report spam. A simple “Reoprt Post” link would do.

  16. Robert says:

    Wow, you people call yourselves scientists? Your approach is so biased. You don’t see the science because you are not looking for it. As they say, in the eyes of a carpenter everything looks like a nail. You need to get your mind out of your box and accept that you may not be as smart as you like to think you are. Just one tiny example: You call myofacial therapy a quackery, seemly your favorite word. Yet, real science has demonstrated, the chemical/physical thixotropic characteristics of connective tissue matrix and its influence on skeletal muscle tissue physiology. Specifically, waste management and tonicity. Now before you demand I present the proof, I suggest you look for it yourself. I’ve been there and done that. My suspicion is that you won’t risk upsetting your pseudoscience paradigm.

    1. Chris says:

      “Yet, real science has demonstrated, the chemical/physical thixotropic characteristics of connective tissue matrix and its influence on skeletal muscle tissue physiology. ”

      Citation needed.

      And, yeah, despite trying to weasel out by saying “ow before you demand I present the proof, I suggest you look for it yourself.”… If you make a claim, you provide the evidence.

    2. WilliamLawrenceUtridge says:

      But Robert – if you have the proof, why be so coy about presenting it? Science is a public endeavour. Are you just repeating what someone else said to you – in other words, you can’t provide a citation because all you have is somebody else’s superficially convincing technobabble?

      Scientists ask for, and require, publicly demonstrable proofs that can be verified, in principle, by anyone. You saying “I have proof but won’t give it to you” is really quite the opposite of the public nature of science – making your criticism of the contributors here as “not scientists” rather hypocritical.

  17. Mike Abrams says:

    The first red flag with CTCA is related to claims that the first question they ask any potential patient is whether they have an insurance plan that they accept.

    Obviously any treatment center wants to be compensated, and deserves to be compensated (though the idea of certain tertiary care and teaching hospitals treating the uninsured is a much more complicated topic for another day).

    Another concern is that I don’t see their doctors presenting abstracts at ASH annual conference and I don’t come across their research papers anywhere else. I don’t see their doctors at patient educational conferences either, and I don’t come across clinical trials being offered at their treatment centers.

    Are they not at the forefront of research, or are they operating on more of an underground basis?

    I would assume (always dangerous) that CTCA oncologists are well trained, and care about their patient outcomes. I also like their idea of a more personal approach vis-a-vis the large cancer centers. However, are they collaberating, and is their overall corporate mission in the best interest of patients?

    Imho, either CTCA has become their own enemy, or has appealed to an underground market that is anything but mainstream.

  18. Badly Shaved Monkey says:

    Just a small question. Even if quacky therapies including herbs actually did alleviate the undesirable effects of anti-oestrogen therapies in breast cancer patients why should we assume this is a good thing? Might it not be that in doing so they would undermine the useful effects of anti-oestrogen therapy on the cancer itself? The net effect would require controlled trials. I wonder whether any exist.

    Dr G., what do you think?

  19. BionicHips says:

    THANK YOU!!!!!! THANK YOU!!!!!
    My wife died of metastatic breast cancer a bit over two years ago. She was treated by a local very competent oncologist, but I checked into Sloan Kettering which was not an option for a variety of reasons. I contacted CTCA but my wife was happy with her oncologist so I dropped it. Even thinking there was something fishy about CTCA desperate people do desperate things. But based upon the emotional appeal of their ads I have always felt “if only.” Now I know she achieved the best result possible (but not the best possible result) and I know not only intellectually but emotionally she made the best decision.

    Thanks again.

  20. Ellenwood, Georgia says:

    My mother has been going to the cancer center for 1 1/2 years now. She has Pancreatic Cancer. She had 30 rounds of Radiation and 6 months of Chemotherapy and survived through those awful treatments. Today, on November 15th, she gets a call stating that she is not allowed to get treatment anymore and that she was mean to the nurses and doctors. My mom has never been mean to anyone there, she has just tried to be involved with her treatment. I see they dont like patients to ask questions about their healthcare, it made them feel uncomfortable. The bad part about not just leaving her hanging in the wind, she changed her insurance policy in order for them to get paid for her treatments and now she cant change her insurance back which leaves her hanging in the wind about getting further follow ups. Why couldnt them bastards say that there was nothing else they could do for her instead of coming up with something stupid?

  21. Donna S says:

    How many of you here who are so critical of CTCA are patients or have loved ones who are patients. My husband is currently being treated there for returning prostate cancer.

    The first time he was treated 7 years ago was in a cookie cutter treatment center where patients were rushed in and out because the facility had to treat X number of patients per day. There was no real care, no real feeling of being cared for. And now we doubt they even did the treatment correctly, seeing as it’s now come back.

    CTCA has treated my husband with the utmost respect and the doctors there have delved into his cancer farther and deeper than anyone ever did before. Every aspect of his well-being is looked at, not just his cancer. That’s the way a serious illness should be treated. It should about the whole patient, not just his/her disease and CTCA does just that.

    No one has told my husband he HAS to practice homeopathic medicine or that he HAS to do accupuncture. Those things are available to patients as one of many ways to treat their pain, their nausea, and many of the side affects of cancer and cancer treatments.

    Wait until YOU face cancer and then decide which treatments and which doctors and facilities are best for YOU. Until then, don’t criticize what other patients, in their time of illness, find helpful to THEM.

    1. WilliamLawrenceUtridge says:

      Hi Donna. I hope your husband gets better. But you’re really just underscoring the point of the article – if you go to the CTCA you will pay a premium for medical care that places heavy emphasis on patient satisfaction, without necessarily any improvement in actual outcome. It’s like going to a hotel while on vacation. You can pay $100 per night to stay in a basic hotel that provides a locked room, a bed, a bathroom and little else. Or you can pay $20,000 to get the Presidential Suite in the Four Seasons, with adjoining guest rooms, your own private dog butler and unlimited macadamia nuts.

      Either way – you’ve got somewhere to sleep at night, the basic purpose of a hotel.

      It’s great that you have the money to afford care that places a premium on catering to your emotional needs as well as your physical. But if the US had a country-wide health care system, and all attempted to mimic the CTCA’s approach to care, you would have to divert a whole lot more money into health care, taking that money away from other areas. It would be great if we could provide tax-funded, high-quality care for all patients that addressed their emotional and physical needs, and allowed doctors to take the necessary time to explain and satisfy patients, answering all their questions and easing all their concerns. It would be really, really great. And really, really expensive (though other countries with national health insurance manage to do so at lower cost both overall and per patient, so perhaps advocating for Obamacare to be turned into a health care system rather than health insurance reform would be a good use of your time). But no matter what, treating more than just the patient’s disease costs money, which can often mean other patients will get less care (or other areas of government services get less money; or in your case perhaps, your insurance premiums go up or your personal savings are depleted).

      Regarding the competence of your husband’s initial treatment, it’s quite possible he’s in the approximately 15% of patients whose cancer recurs even after appropriate treatment.

      And regarding the use of homeopathy and acupuncture, they are complete wastes of time and money, they do nothing whatsoever to help any patient, beyond perhaps some illusory sense of control. That money would be much better spent on counselors or some other form of mental health support.

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