Sh*t naturopaths say, part 4: Naturopathic oncology versus science

Last week, I revisited a topic I first discussed in 2014 a couple of times. It is a topic that I find simultaneously amusing and depressing at the same time, specifically a private discussion forum known as Naturopathic Chat, or NatChat for short—or, as I like to say, Sh*t Naturopaths Say When They Think No One Is Listening.

Except, of course, as we know now, someone is listening—and has been for nearly a year and a half.

It was that person listening, who goes by the 'nym NaturoWhat, who originally allowed me a peak at the rank quackery regularly recommended by naturopaths for their patients. Most recently, he (she or it?) allowed me to see how naturopaths react to that rarest of rare beasts, the pro-vaccine naturopath, in this case a man named Eric Yarnell. Let's just say that the reaction was one of suspicion to the point that more than one NatChat member suspected him of being the member leaking all that juicy information to skeptics and managed to persuade the hapless founder and moderator of the list, a naturopath named Mona Morstein, to temporarily ban him. The uproar was such that eventually she had to reinstate him, but it certainly wasn't evidence that the vast majority of naturopaths were particularly accepting of pro-vaccine views. Rather, it seemed to me from their discussion that Yarnell is well enough liked by his peers that his pro-vaccine opinions are viewed more or less as a quirk of his personality to be ignored when possible and barely tolerated when not.

When I last wrote about Yarnell's temporary excommunication (word choice intentional) from the NatChat church, I also learned three things. First, the naturopaths there really, really hate Britt Hermes, the former naturopath turned science advocate who has been revealing a lot about just how quacky naturopathy and naturopaths are on her blog Naturopathic Diaries. When the leaks from NatChat first appeared, she was the number one suspect of being the leaker, but she clearly is not. Second, I discovered that one of the two naturopaths most critical of Yarnell included Britt's former boss, Michael Uzick, who, NaturoWhat's transcripts revealed, was one of the naturopaths who had written to Morstein about Yarnell. Second, I learned that Colleen Huber is a "naturopathic oncologist" just like Michael Uzick. She's also incredibly antivaccine. Thus, I found out that two of Yarnell's harshest critics on the topic of vaccines happened to be "naturopathic oncologists." (My fingers seized up as I typed those words, demanding scare quotes.) Indeed, Michael Uzick ND (for "not a doctor) even sports the dreaded "FABNO" after his name, which among naturopaths stands for "Fellow of the American Board of Naturopathic Oncology." Personally, I like to change "FABNO" to "FAB? NO!"

Be that as it may, I've written about the quackery that is naturopathic oncology on many occasions, such as how the Cancer Treatment Centers of America have naturopaths on staff to ply their quackery, the disconnect between "naturopathic oncology" and science and reality, and what happens when a dying celebrity chooses naturopathic care. Perhaps what irritates me the most about "naturopathic oncology" is how its members took part in drafting guidelines for "integrative" oncology caring for breast cancer, thanks to the Society for Integrative Oncology (SIO). Even more irritating, the SIO takes great umbrage when accused of not being science- and evidence-based even as it allows naturopaths as members. Perhaps the most amusing (and, again, depressing) part of the SIO is that it will howl to high heaven when anyone criticizes homeopathy as part of "integrative cancer care," denying that its members could ever, ever use such pseudoscience, all apparently blissfully unaware that naturopaths not only train extensively in homeopathy but have to pass a section of their licensing examination, the NPLEX, on homeopathy. Basically, you can't have naturopathy without homeopathy, and many of those naturopaths who are members of the SIO do use homeopathy. Heck, as I pointed out, one of them, Dugald Seely, was even principal investigator on a clinical trial of homeopathy!

He was also a major contributor to the SIO's breast cancer care guidelines.

Seeing Michael Uzick's name and knowing that he sports the dreaded FABNO after his name, I was curious. What sort of care does he offer his cancer patients? I was particularly interested, after seeing this post to NatChat by him in the wake of the Eric Yarnell Inquisition, excommunication, and reinstatement. First, he attacks Britt Hermes again:

We are having a strange little drama in our profession which I think is really about one or two individual naturopaths and their own issues with themselves and each other that has become attached with this horrific betrayal of a naturopath resigning from the profession, joining the quackbusters and trying to severely damage us. These quackbuster/"science based" Nazi's originated from a vicious criminal conspiracy of a medical profession - the Chiropractors - in this US in the 1970's.

This is no imagined vaccine conspiracy, in case you don't know, the AMA was found guilty of conspiring to damage the Chiropractic profession by our US Federal courts in the 70's. These court battles led to the national licensure of the Chiropractors.

Or, perhaps Britt just came to her senses and joined team science. In fact, that's just what she did. Of course, naturoquacks like to rant on about the American Medical Association as being this all-powerful force that got slapped down for its efforts against chiropractors back in the 1960s, when what really happened was a lot more complicated than that and the antitrust suit aainst the AMA by chiropractors was in no way a vindication of chiropractic. The lawsuit did, unfortunately, make the AMA too gun shy to go very far in taking on quacks afterward, an unfortunate outcome.

Mr. Uzick once again repeats the claim that we are somehow "terrorizing" naturopaths:

They are talking to themselves. Most people either hate them or dislike them. Most people easily identify what they are about and no one is interested in "paid bias." People are generally repulsed by it and them. They are also terrorizing us. So we are talking all about it. I think that's very natural. But the truth is the majority of people are aligned with us. All human beings know that diet matters and inherently distrust those who deny it or are antagonistic to the natural world.

Of course, no one—and I mean no one—among the "quackbusters" claims that "diet doesn't matter." Mr. Uzick is truly delusional if he actually believes that that is the message we are sending. It is clear, however, that naturopaths vastly overestimate and oversell the effect of diet on health, to the point of seemingly viewing it as the be-all and end-all of health. Let's just put it this way. You can't cure cancer with diet alone, but I've seen quite a few naturopaths make that claim or come very close to that claim. As for "terrorizing Mr. Uzick," that is the farthest thing from my mind as I write this. Rather, my sole intent is to exercise my constitutional right to free speech to express my opinion on the quackery that is naturopathy.

Let's just put it this way again: Writing snarky criticism on the Internet ≠ "terrorism."

Neither does lobbying state legislatures not to license naturopaths (another constitutional right), to allow them to become primary care providers (a role for which they are completely unqualified), or to expand their scope of practice. As I pointed out again last time, it's the naturopaths who have the advantage. They have the money. They have the advocates. They have the motivation. Meanwhile in most states the various state medical organizations just don't seem to care very much. In our state, for instance, the Michigan State Medical Society is far more concerned about preventing the expansion of the scope of practice for advanced practice nurses than it is over licensing naturopaths. It's pathetic. So hearing someone like Mr. Uzick whine about being terrorized and persecuted leads to nothing from me but utter contempt for him.

Now here's where things get interesting:

Today, the quackbusters/science based scum appear on their own blogs, "internet magazines" they tweet, they take claim for unsuccessful legislative efforts. Today, no one cares about them. They appear no where. I've been told with confidence by those involved in our licensing efforts that Britt has no impact. Did I say hated and not believed? They can trick some people momentarily and terrorize a bunch of naturopaths. But beyond that, we thousands are making meaningful differences in peoples lives on a daily basis. We truly care about people, true science based medicine and everyone can tell we are genuine in our efforts. Their agenda is paid for and there's no lie or dark deed that's too low for them. They have no meaningful impact, because they have nothing meaningful to offer.

Compare coming to the aid of a terminal cancer patient and their desperate family, with Britt doing everything in her power to prevent that man from receiving his only hope. She was the doctor of these of his 3 beautiful children aged 7 through 11 and she did everything in her power to stop their father from receiving treatment and closing the clinic where he and so many patients with cancer come for received help. A treatment his oncologist said was a miracle. How do those two doctors compare? That's the difference between Britt and myself. As well as, the difference between Britt and every human being with a soul.

Hmmm. I wondered. What could this be about? Then I remembered from my previous post a reference to a RationalWiki entry on Michael Uzick. This entry pointed out that Mr. Uzick was reprimanded by the Arizona Naturopathic Physicians Medical Board about a year ago:

Consent Agreement for Letter of Reprimand From October 2013 through April 21, 2014, Respondent intravenously administered the nutrient Ukrain as part of his medical practice. Respondent obtained the Ukrain from a source not registered by the United States Food and Drug Administration or compounded by a pharmacy licensed with the State Board of Pharmacy. Respondent discontinued use of Ukrain in his medical practice before a complaint was made to the Board. A violation of A.R.S. 32-1501(31) (r ), (any conduct or practice that is contrary to recognized standards of eithics of the naturoapthic profession, any conduct or practice that does or might constitute a danger to the health, welfare or safety of the patient or the public, or any conduct, practicie or condition that does or might impair the ability to safely and skillfully practice as a doctor of naturopathic medicine.) A.R.S. 32-1501(31)(s) (failure to observe any federal, state, county or municiple law relating to public health as a physician in this state)., The practice of naturopathic medicine does not include the intravenous administration of nutrients which are not manufactured and supplied for intravenous use by a manufacturer registered with the United States Food and Drug Administration or compounded by a pharmacy licsned by the State Board of Pharmacy. A.R.S. 32-1501(15) and (28).

I had never heard of Ukrain before this; so I was curious. A bit of Googling lead me to learn that Ukrain sometimes goes by the designation NSC-631570. It didn't take me long to discover a systematic review from 11 years ago about the drug. Basically, ukrain is a natural product derived from the extract of Chelidonium majus (commonly known as greater celandine or tetterwort, nipplewort,[3] or swallowwort). It is a semisynthetic chemical based on alkaloids from greater celandine and Thiotepa, an anticancer agent used for several malignancies, originally created in 1978 by a Ukrainian chemist named Vasyl Novytskyi (also spelled Wassil Nowicky), who claimed to have cured his brother of testicular cancer using it.

Currently, it is sold with rather overblown claims, such as that ukrain "is the first and only anticancer drug accumulating during minutes after administration in cancer cells" and that because "it triggers apoptosis in cancer cells this drug is only toxic against cancer cells while, in contrast to chemotherapy, at therapeutic dose it leaves healthy cells undamaged." This is, of course, nonsense, because many chemotherapeutic agents trigger apoptosis in cancer cells. That's one way potential anticancer compounds are screened, for their ability to induce apoptosis in cancer cells. That doesn't mean they don't also harm normal cells. Given that ukrain is a natural product modified using thiotepa, an actual anticancer compound, it is not entirely implausible that it has anticancer activity. It is quite implausible that it would be the only compound that could save a terminal cancer patient, particularly if that patient had pancreatic cancer, which is one cancer ukrain seems to be sold for a lot. There's even a quote by Robert C. Atkins, M.D. (yes, that Robert Atkins, of the Atkins diet) that says, "Ukrain could replace chemotherapy in treating almost all cancers."

There's a huge red flag right there for any cancer therapy, the claim that it can treat all cancers and replace chemotherapy, not to mention the claim that it has no toxicity and "regenerates the immune system." It's also expensive, with costs for intravenous therapy estimated to run as high as €3,000 per week.

If you're familiar with a lot of alternative cancer treatments you won't be surprised at the story of ukrain: Case reports, some with miraculous cures of terminal patients, and some small clinical trials that seemed promising. Unlike a lot of compounds, there is a fair amount of preclinical evidence in cell culture that ukrain exhibits selective toxicity against several cancer cell lines and animal tumor models, all of which is good. However, many are the compounds that seem promising in preclinical models but fail when used in humans.

Edzard Ernst's systematic review discusses the issues with ukrain. He notes that the preclinical and existing clinical trial evidence, on the surface, appear very promising. However, the clinical trial evidence, upon closer inspection, leaves much to be desired:

None of the RCTs in this systematic review is without serious methodological limitations. The Jadad score [119] of most RCTs was low. Their sample size was usually small, and a sample size calculation to define the number of patients required was lacking in most cases. Even though most RCTs were non-inferiority studies by design and purpose, their statistical approach was that of a superiority trial. The majority of RCTs were conducted in Ukrainian research institutes and published in only two different journals. In several trials, there are clear signs of involvement of the manufacturer of Ukrain. Most RCTs have generally been poorly evaluated and reported, which possibly reflects the poverty of clinical science in Eastern Europe. Independent replications are not available. The only German study [125] has also been heavily criticised: its sample size (30 patients in each group) is minute, the report lacks statistical detail and there is an inequality of treatment cycles between groups [127]. It was also noted that this study (the only RCT not published in the same two journals as all the other RCTs) was published in a journal for which the senior author served as editor [127]. No RCTs were found showing negative or near neutral results; this might suggest the existence of publication bias for which we did, however, find no definite proof.

In other words, the clinical evidence is mildly promising, but weak. Certainly there is no evidence that ukrain is the miracle drug that Mr. Uzick seemed to think it was in his rant. Ernst elaborated on his own blog, ruefully noting that his systematic review, which basically concluded that there were too many problems with the existing evidence to recommend ukrain, although there was enough evidence to warrant larger, more rigorous randomized clinical trials, had an unintended effect:

Despite our caution, this article became much cited, and cancer centres around the world began to wonder whether they should take Ukrain more seriously; many integrative cancer clinics even started using the drug in their clinical routine. Dr Nowicky, who meanwhile had established his base in Vienna from where he marketed his drug, must have been delighted.

Soon, numerous websites sprang up praising Ukrain: “It is the first medicament in the world that accumulates in the cores of cancer cells very quickly after administration and kills only cancer cells while leaving healthy cells undamaged. Its inventor and patent holder Dr Wassil Nowicky was nominated for the Nobel Prize for this medicament in 2005…”

I've found that another red flag for quackery is the claim that the creator of a treatment was "nominated" for the Nobel Prize. Being nominated says nothing about how close one comes to actually winning, and the list of what the Nobel Prize Committee considers "qualified nominators" is fairly generous. For example, in medicine nominators can include holders of "established posts as full professors at the faculties of medicine in Sweden and holders of similar posts at the faculties of medicine or similar institutions in Denmark, Finland, Iceland and Norway" and holders of "similar posts at no fewer than six other faculties of medicine at universities around the world, selected by the Nobel Assembly, with a view to ensuring the appropriate distribution of the task among various countries."

So basically Mr. Uzick was busted for importing a drug that was not FDA-approved and giving it to desperate cancer patients. It's a drug that might have some promise but has not yet been validated and is certainly not a cure, contrary to Mr. Uzick's tirade against Britt Hermes for apparently having done all in her power to stop him from administering it to a terminally ill cancer patient. Because the regulation of naturopaths in Arizona is a joke, he appears to have gotten off with a slap on the wrist in the form of a reprimand, as long as he promised to be good in the future and stop administering the drug.

On his website, Uzick states:

I combine the best research supported Natural therapies from Nutritional, Botanical, Homeopathic and when required, incorporate conventional medications - often in safer, innovative forms.

So we know right away that Mr. Uzick uses what I consider to be The One Quackery To Rule Them All, homeopathy. He also uses:

• Diet & Lifestyle
• Nutrients
• Intravenous therapy - High dose Vitamin C
• Botanical medicine - (mistletoe)
• Homeopathy
• Hydrotherapy
• Circadian rhythms
• Immune enhancement
• Detoxification

At his Genesis Natural Medicine Center, which he founded, Uzick also offers chiropractic, acupuncture and traditional Chinese medicine (of course), colon hydrotherapy, far infrared sauna, and many other forms of naturopathic "medicine," if you can call it that.

If you want to know why I get so worked up when I read about "naturopathic oncology," look no further than Mr. Uzick and his clinic. I was relieved to be unable to find any evidence that he is a member of the Society for Integrative Oncology, but depressed to contemplate that he is certainly eligible to join if he ever decided to. He is not an outlier, either; he is apparently pretty famous and well-respected among naturopaths and "naturopathic oncologists," having served on the board of directors of the Oncology Association of Naturopathic Physicians (OncANP) and been vice president of the organization. He's even won awards and done a fawning interview with Thomas Seyfried, whose work I have deconstructed before.

"Integrating" naturopathy into oncology or any other branch of medicine does not make medicine better. Naturopathic oncologists like Mr. Uzick demonstrate that very well. And don't get me started on Colleen Huber.

Or maybe do. I can always use more blogging material for later this week.