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Lymphoma and Pets
The Ruse That Never Quits: Deliberate Deception and Cancer Treatment Centers of America
If you're like me you watch every commercial from the Cancer Treatment Centers of America with an extremely critical eye.
One commercial they've been running lately raises a host of red flags.
It features a rather young and attractive couple, and a sleight of hand: Although the woman has the cancer, the focus here is on her husband, the caregiver. And how CTCA can act as a caregiver to the caregiver.
As the narrative of the overwhelmed caregiver plays out, CTCA quietly informs us in text that the woman, whose name is Jeana Churchill, has "a complex form of pancreatic cancer."
This paralyzes us. No cancer subtype has a poorer prognosis than pancreatic cancer. If cancer is the 'Emperor of All Maladies', pancreatic cancer is the dark overlord of all malignancies. A prognostic nightmare, the 5-year relative survival rate of metastatic pancreatic cancer (which is when it is usually discovered) is a grisly 1.8 percent.
What that means: imagine at one moment in time you have 1,000 people diagnosed with advanced pancreatic cancer and another 1,000 not diagnosed with it. In five years, all 1,000 without cancer are still alive (or at least not dead from cancer), while just 18 people from the other group are still alive. Compare that to medicine's greatest anti-cancer accomplishment, the five-year relative survival rate of Hodgkin's lymphoma, 76.7 percent (up 76.7 percent from 0 just fifty years ago).
But wait a minute. The median age at diagnosis for pancreatic cancer is 71. Jeana Churchill doesn't look a day over 40. Red flag.
The commercial plays itself out with the usual CTCA theme of holistic (meaning 'whole-person, not-just-disease') patient-centered care that is just so spectacular we should all be going there for treatment.
Never mind the inherent sexism (that such a commercial would likely never feature a woman as the overwhelmed caregiver) and instead focus on the subtext: By noting her cancer type, CTCA is communicating an ability to successfully treat pancreatic cancer. Red flag.
Sure, they've done this before with the Peggy Kessler and Roger Stump testimonials. But this particular ad wasn't even finished before I had my doubts about precisely how straightforward CTCA was being. My first suspicion was that Churchill didn't have pancreatic cancer at all, but a non-Hodgkin's lymphoma subtype with the primary site being the pancreas.
This was not true. However, according to information shared by Jeana Churchill herself during her appearance on the 8 April 2013 episode of the Stupid Cancer Show (and possibly at earlier times), she doesn't have 'pancreatic cancer' either. Well, not really.
Two Main Faces of Pancreatic Cancer
Our pancreas is a gland. It is primarily composed of so-called exocrine cells. These cells make digestive enzymes for the body. When cancer begins in one of these exocrine cells, we know it better as that prognostic nightmare, pancreatic cancer.
A very tiny portion of the pancreas is composed of endocrine cells. These cells produce hormones for the body. When cancer begins in one of these endocrine cells, we call it a pancreatic neuroendocrine tumor. We do not call it pancreatic cancer.
Whereas the National Cancer Institute records about 44,000 new cases of pancreatic cancer annually, it only records about one thousand new cases of pancreatic neuroendocrine tumors.
Pancreatic cancer ≠ Pancreatic neuroendocrine tumor. These are heterogenous diseases, as independent of one another as cancers of the breast and testes.
Think this is just a matter of semantics? The National Comprehensive Cancer Network's clinical practice guidelines in oncology includes a publication devoted solely to 'Pancreatic Adenocarcinoma' or traditional pancreatic cancer, and another wholly separate publication devoted to Neuroendocrine Tumors, which includes a chapter on 'Neuroendocrine Tumors of the Pancreas', or Islet Cell Tumors (which is yet another name they go by).
Make no mistake, pancreatic neuroendocrine tumors can be deadly. Steve Jobs died from a pancreatic neuroendocrine tumor.
Still, this is classic CTCA stuff. Is it factually incorrect to refer to her tumor as a form of pancreatic cancer? Of course not. After all, these are pancreas cells. But they are deliberately misleading the viewer by saying she has pancreatic cancer, knowing full well how anybody remotely connected to the disease will react. This is especially sick when one recalls the 5-year relative survival rate for pancreatic cancer compared to that of pancreratic neuroendocrine tumors (see below).
Take nothing away from Churchill. She has endured more than her share beginning with her symptoms, through her difficult path to a proper diagnosis, and the many treatment regimens she has undergone. And it can't be overlooked that she and her husband have four children.
On top of that, she is not out of the woods, having just completed treatment in 2012. When this disease is still localized and resection (surgery) is possible, the five year survival rate is about 55 percent. When the tumors are not resectable, it is just 15 percent. Overall, including all stages of the disease, the five year survival rate is 42 percent.
The Stupid Cancer Show
The Stupid Cancer Show is part of Stupid Cancer which is part of Stupid Cancer Inc, which is a 501(c)3 tax-free non-profit charity. Its largest contributor is, who else, Cancer Treatment Centers of America.
And in fact this episode comes across as an infomercial for CTCA. Churchill's praise for the health network sounds entirely genuine—as does she herself. In fact, she seems charming and charismatic—far removed from the dour and often unsmiling woman featured in the commercial.
The hosts of the show on the other hand sound like CTCA cheerleaders, doing what CTCA does in their ads: attack and ridicule the decisions of non-CTCA oncologists by painting them as two-dimensional automatons incapable of human compassion.
At one telling point in the show, Churchill explains how her tumor was found, by accident during a CT scan ordered for a reason she doesn't describe. The surgeon who she finds that can perform the resection tells her he wants to wait six months before performing the surgery, which is understandably distressing to Churchill, as she wants the tumor removed as soon as possible. The co-hosts enthusiastically support her here, and take a few jabs at this surgeon's recommendation. For the sake of convenience, they do not mention that in many cases, careful observation is considered the best initial therapy.
The Final Straw
The extended video that tells the story of Jeana Churchill can be found at the CTCA web site. While it departs from the story Jeana tells to the Stupid Cancer Show in several small details, I can overlook most of these minor discrepancies from an editorial standpoint, understanding that CTCA has an anecdotal story to tell and limited time to tell it in.
However, I can't overlook the deliberate misdirection. CTCA publishes its own statistics regarding how their treatment of various cancers match up to the 'national averages' and as you might expect, they claim to outperform those averages. So where do they get their figures?
They cite an independent biostatistician, whose identity I have tried on multiple occasions to find out, only to have my requests ignored.
Furthermore, when they do take national averages, they are including the likes of county hospitals, where the treatments have been shown to be sub-standard. Additionally, as a private, for-profit health network, CTCA has the right to pick and choose which patients it is willing to see, thereby performing selection bias in the hopes of boosting their numbers.
Finally, on the Stupid Cancer Show, Churchill relates how she came to contact CTCA in the first place: a relative saw the Peggy Kessler commercial, and passed on the recommendation to Churchill.
Assuming (and I can only assume) that Kessler had pancreatic adenocarcinoma, this makes the ruse all the more incredible.