Penn surgeons become world’s first to test glowing dye for cancerous lymph nodes

Author: Michael Tanenbaum, PhillyVoice Staff

Surgeons at the University of Pennsylvania have achieved a global first with the use of a fluorescent dye that identifies cancerous cells in lymph nodes during head and neck cancer procedures.

The study, led by otorhinolaryngologist Jason G. Newman, seeks to test the effectiveness of intraoperative molecular imaging (IMI), a technique that illuminates tumors to provide real-time surgical guidance.

More than 65,000 Americans will be diagnosed with head and neck cancers in 2017, accounting for approximately 4 percent of all cancers in the United States, according to the National Cancer Institute. About 75 percent of these cancers are caused by tobacco and alcohol use, followed by human papillomavirus (HPV) as a growing source for their development.

Common areas affected by these cancers include the mouth, throat, voice box, sinuses and salivary glands, with typical treatments including a combination of surgery, radiation and chemotherapy.

Lymph nodes, which act as filters for the immune system, are often among the first organs affected by head and neck cancers as they spread or resurface. Initial surgeries may leave microscopic cancerous cells undetected in the lymphoid tissue, heightening the risk that a patient’s condition will return after the procedure.

“By using a dye that makes cancerous cells glow, we get real-time information about which lymph nodes are potentially dangerous and which ones we can leave alone,” Newman said. “That not only helps us remove more cancer from our patients during surgery, it also improves our ability to spare healthy tissue.”

With the aid of a fluorescent dye, surgeons are able to key in on suspicious tissue without removing or damaging otherwise healthy areas. Previously adopted for other disease sites in the lungs and brain, the practice now allows Newman’s team to experiment with indocyanine green (ICG), an FDA-approved contrast agent that responds to blood flow.

Newman explained that since tumor cells retain the dye longer than most other tissues, administering the dye prior to surgery singles out the areas where cancer cells are present.

The current trial at Penn will enable researchers to determine whether ICG is the most suitable dye for head and neck cancers and provide oncologists with a deeper understanding of how cancer spreads in the lymph nodes.

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October, 2017|Oral Cancer News|

Lindsey Stirling Honors Her Late Father with Moving Routine on Dancing with the Stars: ‘I Felt Like I Was Dancing with My Dad’

Author: Karen Mizoguchi
Date: October 9, 2017

Lindsey Stirling has had an incredibly tragic year. The violinist is mourning the loss of her father, Stephen, who died of throat cancer. And on Monday night’s episode of Dancing with the Stars, she honored him with her routine for Most Memorable Year Week, choosing 2017.

“I am the woman I am today because of you and I love you so much,” she said on the reality dancing competition series.

To celebrate her dad’s life, Stirling and pro partner Mark Ballas — who wore her father’s hat and scarf as part of his costume — performed a touching Viennese Waltz. “I felt like I was dancing with my dad,” said Stirling, who was awarded a 26/30 by judges.

“I feel like I got to thank my dad in a way I’ve never been able to before. I was really looking forward to this dance, I was terrified to do it and I’m really happy,” she said. “When you’re dancing about something that is so important that means so much to you doing something I’ve never done before, I just wanted it to be so special. And I feel like it was.”

In January, the YouTube star announced the sad news on Facebook, Twitter and Instagram, writing, “My dad passed away early this morning. There is nothing to say that could express my gratitude for this amazing, selfless man.”

She added, “But I love you daddy. I’m the woman I am today because of you.”

Along with the loving message, the America’s Got Talent alum shared a childhood photo of herself and her father.

In June 2016, Stirling’s father, a religious educator and author, detailed his battle with cancer on his website.

“The pain in my throat persists. (That pain is likely the residual result of radiation and chemotherapy. In other words, I now suffer from the cure, now that the disease has fled.  Ironic.),” he wrote about his illness, which he was diagnosed for in late 2015.

The father of five wrote his final Facebook post. “As I prepare to write the next chapter of my life, I am not afraid. God be with you ’til we meet again,” he said.

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October, 2017|Oral Cancer News|

The Journey of a “Doctor” Who Joined the Cult of Alternative Medicine and Then Broke Out of It

Author: Akshat Rathi
Date: September 30, 2017

One Friday afternoon in May 2014, Britt Hermes was scheduled to treat one of her cancer patients with an injection of Ukrain. This wasn’t especially unusual; people often came to Hermes, a naturopath in Arizona, for the treatment. That day, though, an expected shipment of the drug hadn’t arrived, and Hermes’s patients weren’t happy. They had been promised that Ukrain given on a strict schedule would help them when nothing else was working. So she asked her boss what was going on.

“In response, he made an off-hand remark: ‘Oh don’t worry. Most likely the FDA [Food and Drug Administration] confiscated it. It’ll just arrive late,’” Hermes recalls today. When she asked him what he meant, he fumbled. “He realized that he may have said something he shouldn’t have.”

Complementary medicine therapies drawn from traditional practices, ranging from massage and vitamin supplements to acupuncture and meditation, are today becoming broadly incorporated into mainstream medicine as more scientific studies validate their efficacy. But naturopathy, a belief system built on the concept that “nature knows best” when it comes to healing, takes it a step further. Practitioners use a host of pseudoscientific techniques including energy healing and homeopathy that can be not only ineffective, but dangerous. Instead of thinking about the techniques as adjunct therapies to proven modern medicine, many naturopaths will reject the pharmaceuticals and other treatments that we know save lives.

Over her seven years of training and practice, Hermes had had doubts about naturopathy, but she had always found ways to dismiss them. This time, however, her boss’s comment worried her: Was she doing something illegal? Could she be in trouble?

Hermes went home and began to Google. She first looked up Ukrain, and uncovered reports of studies showing the drug to be ineffective at best, and worse, potentially the cause of nasty side effects like tumor bleeding and liver toxicity. She read on and realized Ukrain hadn’t passed the clinical trials required for FDA approval. She looked up some of the other therapies frequently used by naturopaths—ozone treatment, injections of hydrogen peroxide, bloody radiation therapy—and realized that none of them were FDA-approved.

“The whole house of cards came crashing down”

“The whole house of cards came crashing down for me,” she recalls. “On Monday, once I had figured out the different pieces of the story, I was in a lawyer’s office getting representation.”

Months later, after giving up her job, Hermes began blogging about the problems she saw in the practice of naturopathy. She was rapidly embraced by a loose community of skeptics who dedicate themselves to promoting critical thinking and evidence-based medicine; it isn’t easy to find someone with Hermes’s intimate knowledge of the inner workings of alternative medicine—and who is willing to speak candidly about the problems of the field. In 2016, just over a year after she began blogging, Hermes’s blog “Naturopathic Diaries” won the Ockham award for the best blog of the year given by The Skeptics magazine.

Subject: A former patient saying hello:)
I was a patient of yours. Your recommendations yielded no greater relief of my symptoms than anything else I have tried before or since. I stumbled across your blog tonight and I must say my mind is a little blown in a good way. I hold no anger or resentment—you were doing your job to the best of your ability and no one was forcing me to see you. Thank you for your brave, clear writing. I hope it sheds light on some of the crazy out there.

Hermes has given up her dream of becoming a doctor and instead has dedicated her life to saving patients and would-be doctors from falling for the naturopathy claims that she once so confidently made. But larger forces now want to silence her.

Bastyr University, where she trained to become a naturopath and whose education she has been publicly criticizing in recent years, has threatened to take her to court unless she stops publishing what the school’s lawyers allege are “willfully false and misleading comments” with “express intent of disparaging Bastyr.” Hermes has no plans to be cowed by the threats.

Over hours of conversation, I found Hermes to be a sharp thinker and an articulate speaker. But something kept bugging me: How could it have been that someone like Hermes remained ignorant for so long in an age when Google is at nearly everyone’s fingertips? And more importantly: Why is it rare to find examples of people like Hermes, people who for whatever reason may have believed something demonstrably false but are able to change their mind when confronted with evidence to the contrary? As I tried to unpack her story, I realized it offered a rare peek into how troubling beliefs are created in the information age, how they are reinforced in echo chambers, and how some people can break out.

Hermes grew up in a rich neighborhood in Ventura County, in southern California, and she partially attributes her career path to the material comfort of her early life. “A lot of people with disposable income seem to be drawn to alternative medicine,” she says. “The community I grew up in was into wellness treatments, whether acupuncture or ayurvedic spas.”

Her first direct experience with alternative medicine came when she was 16. Red spots started showing up all over her body, and in less than three weeks she went from obsessing about lipsticks and nail polish to desperately seeking a cure for psoriasis.

Her mother, who also suffered from the life-long condition, booked an appointment for Hermes with her own dermatologist. And like he did for her mother, the doctor prescribed steroids for Hermes. But she had seen what the disease had done to her mother, who suffers from bad side effects due to years of medication, such scars on her skin and a severely compromised immune system. Hermes wanted an alternative.

“He brushed me off. ‘Suck it up and get over it, kid,’ he said.”
“I asked him whether diet or such could help,” she recalls. “He brushed me off. ‘Suck it up and get over it, kid,’ he said. That was a turning point in my life.”

She didn’t get over it. Instead, she went to the library. (It was the year 2000 and accessing the internet wasn’t always easy.) “I was using a card catalogue and reading any book that mentioned psoriasis,” Hermes says. Somewhere she read that cod-liver oil would help her, and then made her dad drive around to find a place selling the stuff. “My skin got better, and I’ve never had a psoriasis breakout like that first time,” she says. “I was taking steroids too, of course, but I attributed the remission to the alternative therapies I tried.”

Subject: Thank you from a medical student
Over the years I have seen my parents quit jobs, choose to spend what little money they have on expensive “natural” products, and sever relationships with family over beliefs of pseudoscience. I am tired of watching people get hurt or hurt others over warm-fuzzy ideas. From the bottom of my heart I want to thank you for your journey. I’m certain it has been incredibly difficult. You may not be practicing medicine with patients in the way you initially thought, but your efforts are making a difference that will inevitably help the sick.

After earning an undergraduate degree in psychology, Hermes decided she wanted to become a doctor—but not like the dermatologist who treated her psoriasis. That’s when she came across Bastyr University’s naturopathy course. It seemed perfect.

True believers say the first advocate of naturopathy was the Father of Medicine himself, Hippocrates. The more mundane truth is that the term was popularized in the early 1900s by the Benedict Lust, who learned his techniques from the German practitioner Sebastian Kniepp. Lust came to the US to spread the use of “drugless therapies,” and he found instant success, creating a base of followers. Naturopathy flourished in the country until the 1940s, when the American Medical Association (AMA) began campaigning against medical practices lacking rigorous evidence of efficacy. The result was the near extinction of naturopathy in the US, with only five states offering licenses in 1958.

True believers say the first advocate of naturopathy was the Father of Medicine himself, Hippocrates.

But since the 1970s, thanks to the “holistic health” movement, there has been a revival in interest in naturopathy according to University of Arkansas social anthropologist Hans Baer. Today, as many as 15 US states offer licenses to naturopaths (though only the state of Washington requires insurance companies to reimburse naturopathic treatment). There are also more than a half-dozen schools in North America that dole out Doctor of Naturopathy (ND) degrees—including Bastyr, which has campuses in Kenmore, Washington and San Diego, California.

“When I was looking at the Bastyr website and reading phrases like ‘supported by scientific research’ and ‘drawn from peer-reviewed journals,’ the keywords I was trained to look for were there,” she says. “Bastyr described itself as the ‘Harvard of naturopathic medicine.’ I felt like I was choosing a program that was preparing me to study medicine and research natural therapies and be part of the broader medical field.”

To be sure what she was getting into was legit, Hermes even visited naturopaths.“It felt like a regular doctor’s office. There was a receptionist and a waiting room. Naturopaths were wearing white coats and had stethoscopes around their necks,” Hermes says. “The visual cues were there. They looked like doctors to me.”

Naturopathy appeals to many because it seems to offer more than medical doctors alone. “Naturopathic physicians now claim to be primary care physicians proficient in the practice of both ‘conventional’ and ‘natural’ medicine,” Kimball Atwood, an anesthesiologist and assistant professor at Tufts University, wrote in 2003. Experts who’ve looked at naturopathy’s claims closely have found mostly deficiencies. “Their training…amounts to a small fraction of that of medical doctors who practice primary care,” Atwood wrote. “An examination of their literature, moreover, reveals that it is replete with pseudoscientific, ineffective, unethical, and potentially dangerous practices.” But these deficiencies are not easy to find for an undergrad looking to sources and people that would only confirm her biases.

Subject: HELP!!! Just started Naturopathic School at Bastyr

I thought Bastyr would have more science-based natural medicine but I’m finding that it is not the case. The professor also discussed how Bastyr had an astrologist who would help with medicine. By this point in class, I’m terrified that I made the wrong decision.

When Hermes started at Bastyr University, it seemed like other medical schools she had read about. There were classes in anatomy, physiology, and pharmacology. Students dissected cadavers and got clinical practice, spending time with Bastyr naturopaths treating actual patients.

“When I enrolled, I thought ‘alternative medicine’ was mostly lifestyle, like diet and exercise—a practice that tries to mitigate the use of drugs,” Hermes says. “I wasn’t aware of all these different systems of medicine.”

Homeopathy has been shown to be at best a placebo.

Take homeopathy, for instance, which works on two principles. First, “like cures like.” So, for example, since chopped onions make you cry, it follows that if you want to treat hay fever, which also produces runny eyes, you should drink onion juice. Second, “dilution increases potency.” So the onion juice should be diluted to such an extent there isn’t a single molecule of it left in the solution—in other words, until the point where even if for some reason it did work, there’d be no way for scientists to determine that it was in fact a potent therapy. (There is no proof onion juice can treat the symptoms of hay fever.) Suffice it to say that these ideas go completely against any established scientific principle; homeopathy has been shown to be at best a placebo.

“I definitely had moments where I felt cognitive dissonance,” Hermes says. “In homeopathy class, for instance, what was being taught seemed to defy scientific principles. But at the same time, I felt, in order to be the best medical practitioner I could be, it was important to remain open-minded.”

To some extent, Hermes’ worries were alleviated by the training Bastyr was giving her in clinical practice. In the university’s outpatient clinic, Hermes was able to spend time on patient-care shifts, and she liked the approach the facility promoted. “A lot of the care we offered at the Bastyr clinic had counselling to it, because you spend a lot of time talking to the patient and really getting to know them by asking about minutiae in their lives: how many hours they sleep at night or what their stress level is like,” Hermes recalls. She enjoyed spending time with patients, and fell in love with the experience of working through their problems. That’s an aspect of this flavor of naturopathy from which the western model of medicine could stand to take a lesson. Experts have, in recent years, begun to push for a health care model that offers patients plenty of time with their providers, and asks doctors to consider a patient’s whole life—sleep, stress, diet, work, relationships—not just the one symptom that triggered a visit.

Still the doubts came back to haunt her. In physical medicine, for instance, she was exposed to “energy healing,” a belief system among naturopaths that says simple touching can manipulate biological pathways. Like homeopathy, there are no known scientific principles that support energy healing. (Bastyr University shared studies that conclude research in energy healing is limited.)

Halfway through her time in Bastyr, Hermes realized that maybe she had made a mistake. She started to think traditional medical training would have been a much better choice. But she was already $80,000 in debt. Worse, if she wanted to go to a proper medical school, she would have to study for and pass the MCAT exam, which wasn’t needed to get into Bastyr.

“I made a decision to become as much a physician as possible”

“The idea of starting over was too daunting. So I made a decision to become as much a physician as possible” within the naturopath system, Hermes says. “I did that by consulting medical sources instead of naturopathic sources. Instead of having a herbal medicine book on my desk, I had the drug formulary book. I was working hard to convince myself that I was practicing safely and effectively.” She became a licensed naturopath under her maiden name, Britt Deegan.

Things began to go downhill for Hermes soon after she graduated with her ND degree. The naturopathic remedies she was trained to use weren’t working on her patients. Some even had negative reactions to herbal therapies she had prescribed. But Hermes held back from acting on her doubts, until the Ukrain episode.

There are plenty of examples of naturopathic therapies going seriously wrong. Earlier this year, a California-based naturopath killed a 30-year-old woman by giving her an intravenous injection of turmeric. A report from the FDA found that the injection contained castor oil, which had a warning label that said “Caution: For manufacturing or laboratory use only.”

Then there’s the case of Ezekiel Stephan. In February 2012, David and Collet Stephan used naturopathic remedies rather than medical treatment to fight their 19-month-old’s bacterial meningitis. The infant died in March of that year. In 2016, David was sentenced to prison and Collet to house arrest for being “willfully blind” about the life-threatening risks to their son. The naturopath that the Stephans relied on wasn’t charged.

Subject: thank you
I am going through a divorce where the number one point of contention is my spouse’s insistence on naturopathy treatment of our mostly healthy five-year-old. Prior to reading your articles it was more of a belief that putting many non-FDA supplements into his body with the occasional prescription from his pediatrician couldn’t be a good thing. The irony I have found is highly qualified pediatricians won’t or can’t comment on non-FDA drugs while the naturopath is more than happy to talk about what pediatrician prescribes plus what supplements are needed instead or in addition to.

Some therapies like meditation, which are often categorized as “alternative” or “complementary” medicine, may be helpful, and have some scientific evidence to back them up. Others are the sorts of things drawn from the canons of traditional and alternative medicine and are essentially harmless—like hydrotherapy, where patients are treated using water at different temperature and pressure, and massage therapy. But there are also many pseudoscientific treatments that lead patients into positions of great risk, including ozone therapy, which involves injecting or breathing ozone, a toxic gas made up of three atoms of oxygen (instead of the two-atom version of oxygen keeping us alive), and treating cancer with substances like baking soda, vitamin C, and other products that have been shown to have no effect.

Lumping all these types of therapies under the umbrella of naturopathy makes it difficult for patients to understand what is backed by scientific evidence and what isn’t. “Incorporating magical thinking into the realm of evidence-based medicine is both ethically questionable and professionally irresponsible,” researcher and journalist Alheli Picazo wrote about the Stephens case in 2016. In the end, most patients simply believe whatever the naturopath has to say.

Within days of finding out that Ukrain was not FDA approved, Hermes got a lawyer. She was worried that she may have been an accessory to a crime. The lawyer assured Hermes that she was safe, because she delivered Ukrain under her boss’s direction and without knowing then that the drug was unapproved. That gave her the confidence to do something about the guilt she was feeling about mistreating her patients.

“I was willing to do whatever it took to correct the wrong”

“I was willing to do whatever it took to correct the wrong,” Hermes says. She reported her boss, Michael Uzick, to the Arizona Naturopathic Physicians Medical Board and to the state’s attorney general. She also began auditing the websites of other naturopaths and realized that the use of unapproved drugs and therapies was widespread. “I was really shocked,” she recalls. “But it also felt like a lightbulb went on. It suddenly became so obvious to me that I was amazed I had missed it.”

“I needed to decide whether or not I could go back into naturopathy knowing that a number of my colleagues are blatantly breaking the law and putting patients’ lives at risk,” Hermes says. She didn’t have to struggle with the question for long. The naturopathic board did nothing more than reprimand Uzick. The attorney general never took up the case, but passed it on to the Federal Bureau of Investigation, which has not yet replied to Hermes.

Uzick, through his lawyer, says that the reprimand “did not result from any patient complaint, but from accusations made by a disgruntled practitioner who worked with Dr. Uzick and understood his treatments, and made no complaint until she abruptly left the practice.”

When she saw the case be tossed liked a hot potato from the board to the Arizona attorney general to the federal FBI, Hermes felt her moral choice couldn’t be clearer.

After Hermes stopped her practice in 2014, life’s other mundane, but unavoidable, problems became apparent. She had racked up a debt of more than $250,000 for her Bastyr degree, and needed a source of income to pay back the loan or risk letting interest pile on. She had also fallen in love and gotten married. When her husband was a offered a place to study for a PhD in archaeology at a university in Germany, it felt like an opportunity for a fresh start.

That’s when, in late 2014, she discovered the story of Edzard Ernst, author of Trick or Treatment? Alternative Medicine on Trial, written with science journalist Simon Singh. “I lived with the book on my bedside table for six months,” Hermes says. “It got me through a really difficult period.”

Ernst trained as a doctor and then learned homeopathy at a hospital in Germany. He would, like Hermes, turn on his profession, showing through his own peer-reviewed research how homeopathy was nothing more than a placebo. As someone who also stopped practicing alternative medicine and began speaking against it, he saw a bit of himself in Hermes. That’s why he encouraged her to blog.

“I remember putting up my first blog post and being overwhelmed with anxiety,” Hermes says. “I wanted people to read my words, but I was so afraid of what they would think. I felt exposed. I cried a lot.” After the Ukrain revelations, Hermes developed intense anxiety, and was eventually prescribed medication for the ailment. Blogging brought similar anxiety and she went back on the meds.

“I’ve found myself in grocery stores not knowing whether to buy organic bananas or regular ones,” Hermes says. “I find it upsetting that I don’t know how to navigate my life any more. It’s a product of living in a culture of misinformation for a very long time.”

Subject: Thanks for what you are doing!
I know the courage it has taken you to speak out about the fallacies of naturopathic medicine. I taught at a naturopathic college myself, so I know first hand that every thing you are saying is true. I have much admiration for you. Keep up the good work.

For the past few years, after realizing she had been swindled in her education, Hermes has waged a war on naturopathy. On blogs and in online publications, she has opened a window into a profession that resists external scrutiny of its training and practices.

“These schools of quackery operate like cults”

“A conversion story like hers is rare,” says David Gorski, managing editor of the non-profit, online publication Science-Based Medicine, which was among the first few places to publish Hermes’s writing. The choice of the word “conversion” is a deliberate swipe at alternative medicine, which Gorski says is more like a religion. Ernst says the schools are, in part to blame. “These schools of quackery operate like cults,” he says. “People are being brainwashed with books, by peers, through media and so forth.”

Bastyr is a nonprofit and private university that was founded in 1978, near Seattle. Its founders named it after John Bastyr, a naturopathy practitioner based in the city. Today, it offers undergraduate, master’s, and doctoral programs to its 1,000 students, but these are not accredited by the same body that accredits US medical schools. Instead, a council of naturopaths oversees the programs. Bastyr says its courses are are also accredited by the Northwest Commission on Colleges and Universities.

Bastyr now wants to keep Hermes, who has become a warrior for the truth, from speaking out. It’s an uneven fight from the start: a university with deep pockets against a student with huge tuition loans to pay off. (In response to questions from Quartz, Bastyr University says there are no updates to report since its July 21 letter to Hermes.)

“It’s an occupational hazard,” says Steven Novella, founder of Science-Based Medicine. “When we expose quacks and cranks, it’s no surprise we get personally attacked.” In 2014, Novella was sued by Edward Tobinick, a doctor claiming to treat neurological diseases with a drug that wasn’t approved for it, because Novella exposed Tobinick’s unsubstantiated claims. After two years of trial and appeals, Novella won the case but is yet to receive the tens of thousands of dollars he had to spend in legal fees to defend himself.

Separately, Ernst and Singh were each legally threatened by two different organizations promoting alternative medicine. Though Singh won a landmark libel case, Ernst was forced to retire early from his job as a professor of complementary medicine at the University of Exeter, after finding himself unable to acquire the grants needed to continue research. Now it’s Hermes’ turn.


Subject: Thank you
I was about halfway through naturopathy school when I started having doubts about the profession again. I had been searching for a while to find the opinion of someone who had graduated and left the field, and when I found your blog I felt an amazingly strong sense of relief and joy to be able to read what you had written and relate to all of it. I only wish that I had read your blog before starting!

Each individual has to decide for themselves, but skeptics say these fights are always worth fighting. Each voice is unique and necessary, and each voice lost is a huge blow to the skeptic mission. On her blog, Hermes has separate resources section for patients, students, lawmakers, and journalists. She has a section where former or current naturopaths, patients, and healthcare workers who’ve experienced naturopathy can submit guest posts. “It is important for more voices to be heard,” she writes.

And the feedback she receives from readers, including medical doctors and patients looking to use naturopathy, reminds her she is doing the right thing and gives her the motivation to continue. (We’ve reproduced some of these emails, interspersed throughout this article.) Some praise her for being “brave”; others thank her for giving “the final push” needed to quit studying naturopathy; most are simply grateful for having Hermes speak when they themselves couldn’t. Her testimonies have been crucial in defeating two proposed legislations—one in North Dakota and another in California—which would have increased the power of naturopaths, from prescribing pharmaceutical drugs to practicing midwifery.

Subject: Hi Britt
I was in your class at Bastyr. I found attempting to practice naturopathic medicine a nebulous, daring venture. I absolutely did not feel qualified to be anyone’s physician. After such a huge investment in time, money, and energy, it took me a while to truly accept that I want to find another career path. It is nice to know there are others who feel as though their training was less than sufficient.
When Hermes was training to be a naturopath, the evidence against alternative medicine was easily available. But she was surrounded by believers and was personally invested in the success of naturopathy, so she found ways to dismiss any creeping doubts. It was only when she had a “crisis of conscience,” as Gorski describes the Ukrain episode, did she open up to contrary evidence. That was her moving from inside the cult to the top of the fence.

She found the evidence she needed to jump most easily in Trick or Treatment. “What Ernst and Singh were able to do so beautifully was provide information that felt nonjudgmental,” Hermes says. “I didn’t feel like I was being put down for having used naturopathy or having been a naturopath.”

“Everything I had read prior to Trick or Treatment about naturopathy from a critic’s perspective was written in such a way that it was impossible for me to digest the information,” she says. “As soon as I read the word ‘quack’ or ‘pseudoscience’ I couldn’t get anything from the article.”

The book’s matter-of-fact approach to debunking naturopathy influenced Hermes’s thinking on naturopathy. But her own persistence mattered too.“I certainly have a propensity for magical thinking and alternative medicine,” Hermes says. “Even now, whenever I get sick with cold, my first response is ‘I don’t want to take any medication,’” Hermes says. That’s why it helped to have a guide like Trick or Treatment on her bedside. “Every time I felt like maybe I shouldn’t be giving up naturopathy, I opened the chapter on naturopathy and stopped myself from making that decision.”

Today, Hermes says that when she writes, even if using the same material that’s readily available to anyone with internet access, she is able reach a bigger audience. “My training as a naturopath adds credibility to my claims,” she says.

Hermes is becoming a sought-after speaker at events organized by the skeptics community. Hearing a former naturopath helps other skeptics understand better how to reach their target audience. “Everyone knows someone who has tried alternative medicine,” Hermes says. “My advice to these people is don’t bombard them with information about how naturopathy doesn’t work. Instead, listen to why they believe in naturopathy, ask open-ended questions, understand their perspective, and then go from there.”

Going through her story again and again at these speaking events is painful. “I’m putting myself through torture every time I relive those memories,” Hermes says. Though she gets plenty of positive feedback, she receives a lot more hate mail. And for someone who has been through a great deal of change in her life, existential questions are a daily problem.

“Will it have a made a difference if I continued to do this for 25 years? Will I ever be able to convert people inside the cult?” Hermes says. “I ask these questions all the time, and I don’t yet have answers.”



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October, 2017|Oral Cancer News|

Blood test for HPV may help predict risk in cancer patients

Author: University of North Carolina Health Care System

A blood test for the human papillomavirus, or HPV, may help researchers forecast whether patients with throat cancer linked to the sexually transmitted virus will respond to treatment, according to preliminary findings from the University of North Carolina Lineberger Comprehensive Cancer Center.

HPV can cause oropharyngeal cancer, which is a cancer of the throat behind the mouth, including the base of the tongue and tonsils. Studies have shown that patients with HPV-positive oropharyngeal cancer have better outcomes than patients whose cancer is not linked to the virus.

Preliminary findings presented at this year’s American Society for Radiation Oncology Annual Meeting suggest a genetic test for HPV16 in the blood could be useful to help assess risk for patients, and could help identify patients suitable for lower treatment doses.

“Our work on this blood test is ongoing, but we are optimistic that ‘liquid biopsy’ tests such as ours may be useful in the personalization of therapy for many patients with HPV-associated oropharyngeal cancer,” said the study’s senior author Gaorav P. Gupta, MD, PhD, UNC Lineberger member and assistant professor in the UNC School of Medicine Department of Radiation Oncology.

To avoid over-treating patients and to spare them from toxic treatment side effects, UNC Lineberger’s Bhisham Chera, MD, an associate professor in the radiation oncology department, led studies testing whether favorable-risk patients with HPV-positive oropharyngeal cancer can be treated successfully with lower doses of radiation and chemotherapy. A phase II clinical trial using this de-intensified regimen have shown “excellent” cancer control, Chera said.

The researchers used a number of selection criteria to identify patients who can benefit from lower-doses: patients had to be positive for HPV, and they had to have smoked fewer than 10 pack years. Chera said this system is not perfect, however. The researchers have seen cancer recur in non-smoking patients as well as “excellent” cancer control in longtime smokers.

“This has led us to question whether we can get better prognostication with other biomarkers,” Chera said.

They developed a test that can detect HPV16 circulating in the blood, and found that circulating HPV16 DNA was detectable using the test in the majority of a group of 47 favorable-risk oropharyngeal cancer patients.

In a finding that seems counterintuitive, they discovered that very low or undetectable HPV16 pretreatment levels in their blood actually had higher risk of persistent or recurrent disease for chemotherapy and radiation treatment. In contrast, patients with high pretreatment levels of HPV16 in their blood had 100 percent disease control.

They hypothesized that, potentially, the patients with undetectable/low pre-treatment HPV16 levels in the blood may have different, more radiation/chemotherapy resistant cancers.

“Our current theory is that these patients with low or undetectable levels of HPV16 have a different genetic makeup—one that is perhaps less driven purely by HPV, and thus potentially less sensitive to chemotherapy and radiation,” Gupta said. “We are performing next generation sequencing on these patients to search for additional genetic markers that may give us a clue regarding why they have a worse prognosis.”

They also identified a subset of patients who rapidly cleared the HPV16 from their blood. Researchers hypothesize that they could use their findings to further stratify patients who may be eligible for lower intensity treatment.

“A tantalizing – and yet currently untested – hypothesis is whether this subset of ultra-low risk patients may be treated with even lower doses of chemoradiotherapy,” Gupta said.

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October, 2017|Oral Cancer News|

Can even moderate drinking increase the risk of cancer?

Author: Luisa Dillner

Alcohol may be a social lubricant but WHO and Public Health England say it can cause cancer. Last week the alcohol industry was accused of downplaying the link between alcohol and the increased risk of seven cancers: mouth, throat, oesophagus, liver, breast and colon. A research paper in Drug and Alcohol Review found that “responsible drinking” information funded by the alcohol industry tends to push the message that only heavy drinking increases the risk of these cancers. But the paper says the risk starts with low levels of drinking, even though the risk itself is low. So is the recommended number of alcohol units a week – 14 – too high?

The solution
Even less than 1.5 units a day – a small glass of wine – can increase the risk of mouth, throat, oesophagus and breast cancer (in women), according to a UK government committee. While the toll of heavy drinking on the liver and pancreas is well known, the link to cancers, especially breast and colorectal, is less so. There are more than 100 epidemiology studies showing an association between breast cancer and alcohol, the risk increasing with less than one daily glass of wine. Research at Harvard found that while light to moderate drinking was not significantly associated with an increased risk for men (unless they smoked), it did increase the risk of breast cancer for women.

Edward L Giovannucci, professor of nutrition and epidemiology at Harvard School of Public Health and the lead author of the report, says that the increase in risk is modest. And there are some health benefits from occasional drinking that make the true risk to health harder to quantify. He points out other research that shows that one drink per day reduces the risk of diabetes for women. “So the overall effect on health for women might still be positive,” he says. “For colorectal cancer, the risk for men and women is low until you reach more than two drinks per day.”

There are also individual genetic differences in metabolising alcohol that can increase the risk of cancer. Ethanol in alcoholic drinks is broken down into acetaldehyde, which is toxic to cells, damaging DNA and proteins. Some people have genetic variations that are less effective at getting rid of acetaldehyde, and they may have a higher risk of oesophageal cancer.

Giovannucci says that overall he wouldn’t recommend drinking alcohol to improve your health. “But if one enjoys a glass or occasionally two a day as part of a healthy diet, and doesn’t smoke, I think the increased risk of cancer is small,” he says. “For those with a family history of colorectal or breast cancer, I’d suggest not drinking or not exceeding one glass per day.”

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October, 2017|Oral Cancer News|

HPV and cancer: Key mechanism may suggest treatment

Author: Maria Cohut

New research from Georgetown University in Washington, D.C., investigates how the human papillomavirus promotes cancer. The findings might point to a potential new and improved strategy for targeted treatment.
The human papillomavirus (HPV) refers to a group of viruses transmitted through sexual contact. Some types of HPV cause various kinds of cancer, including mouth, anus, and cervical cancer.

According to data from the Centres for Disease Control and Prevention (CDC), around 1 in 4 people in the United States are infected with HPV.

Although treatments for HPV-related conditions do exist, they either target non-cancerous outcomes (such as genital warts) or they focus on the prevention of cancer through screening of abnormal cell activity.

Treatments for cancers caused by HPV include surgical interventions and chemotherapy, but at present, none of the options specifically address the viral source.

Researchers from Georgetown University Medical Center in Washington, D.C., have now identified the mechanism that promotes the survival of cancerous cells due to HPV. The study, which was led by Dr. Xuefeng Liu, describes a molecular apparatus that renders cancer cells “immortal.” Understanding how this apparatus works may lead to better targeted treatments in the future, the researcher suggests.

“There is no targeted treatment now for these cancers since German virologist Harald zur Hausen, Ph.D., discovered in 1983 that HPV can cause cervical cancer,” says Dr. Liu.

“Recently,” he adds, “the numbers of HPV-linked head and neck cancers have increased in the U.S. Now we have a chance to develop and test a very specific, potentially less toxic way to stop these cancers.”

The researchers’ findings are published in the journal Oncotarget.

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October, 2017|Oral Cancer News|

A Wellness Blogger Who Lied About Having Cancer Has Been Fined $322,000

Author: Kaleigh Rogers
Date: September 28, 2017

There are serious consequences that come from hawking pseudoscience online, including harming your readers or yourself. But in case physical harm isn’t enough motivation to quit slinging shady “wellness” advice online, here’s another reason: you could wind up getting fined.

That’s what happened to disgraced Australian wellness blogger Belle Gibson, who has been fined $322,000 for claiming she treated her brain cancer without conventional medicine. Gibson had said she overcame an inoperable brain tumor, stroke, and cardiac arrests through clean eating, and avoiding dairy, gluten, and coffee. Conveniently, these claims helped her to sell her book The Whole Pantry, and app of the same name, raking in nearly half a million AUD. But in 2015, an investigation by Australian Women’s Weekly—complete with Gibson’s confession—revealed it was all a hoax.

In response, Consumer Affairs Victoria brought a case to federal court, and in March Gibson was found guilty of five breaches of consumer law. On Thursday, Gibson was ordered to pay the fine of $410,000 AUD ($322,000 USD).

It’s not the first time shady wellness tips have caused controversy for bloggers. Gwyneth Paltrow’s venture, Goop—the epitome of pseudoscience profiteering—has been called out for flogging all kinds of questionable goods, including a jade vagina egg that some gynecologists warned could cause infections.

Or the wellness trend of eating whole aloe vera leaves that led one vlogger to be hospitalized after eating a poisonous agave plant by mistake.

When wellness bloggers tell the truth, and really do try to fight off cancer without any conventional treatment, it doesn’t usually work out so well. A popular 30-year-old blogger died in 2015 after she tried to cure her cancer with coffee enemas and raw juices. And in case you’re inclined to trust your blogger of choice, lest we forget the former naturopath who told us how easy it was to create and sell a detox diet scam.

Wellness blogging is a trendy, profitable market right now, but let this be a warning: all that easy money can come at a price.

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September, 2017|Oral Cancer News|

B.C. to begin providing free HPV vaccines for Grade 6 boys

Author: Darcy Matheson
Date: September 26, 2017

For the first time in British Columbia, boys in Grade 6 will be receiving free vaccinations for the Human Papillomavirus.

HPV is one of the most commonly sexually transmitted infections and B.C. health authorities say three out of four sexually active people will get it at some point in their lives.

Often showing no physical symptoms, HPV can lead to cervical, vaginal, and vulvar cancers in women and penile cancer in men – and can also cause anal and throat cancer in both men and women.

Up until now, the vaccine to protect against HPV was only provided free to girls in Grade 6, with the assumption that boys would be indirectly protected through “herd immunity.”

Vancouver Coastal Health will soon be sending out letters to parents and caregivers through children’s schools regarding upcoming clinics for both girls and boys.

People can also be immunized through health-care providers, family doctors and local public health units.

Dr. Meena Dawar, medical health officer for Vancouver Coastal Health, said that immunizations are key because the symptom-less virus is often passed onto others without knowing it.

“Most often an HPV infection will clear on its own but sometimes HPV won’t go away and cells infected with the virus can become cancerous,” Dawar said in a statement.

Cancer survivor Sandy Yun had her 14-year-old daughter immunized as part of the B.C. program. She was going to pay for her 11-year-old son to get the vaccine but now she will be getting it for free.

“I wouldn’t want my kids, or anyone else, to go through what I went through,” the mom said in a statement.

“We have an easy way to protect our children from cancer, parents: this is a no-brainer.”

Each year in B.C. 200 women will get cervical cancer, and 50 will die from the disease.

B.C. joins Saskatchewan, Newfoundland and Labrador and New Brunswick in offering the vaccine for free to boys starting this month.

A study published this summer by the Canadian Medical Association Journal said the number of HPV-caused oral cancers has risen sharply in Canada — about 50 per cent between 2000 and 2012.

The majority of the cases featured in the CMAJ study – about 85 per cent – were men.

Researcher and co-author Sophie Huang, a research radiation therapist at Princess Margaret Cancer Centre in Toronto, said men have a weaker immune response to HPV than females, which may explain the higher incidence of oral cancers linked to the virus in men.


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September, 2017|Oral Cancer News|

Treatment That’s Easy to Swallow in HPV+ Throat Cancer

Author: Nick Mulcahy
Date: September 27, 2017

SAN DIEGO, California ― Daniel Ma, MD, of the Mayo Clinic in Rochester, Minnesota, treats a lot of relatively young patients with human papillomavirus (HPV)-related oropharyngeal cancers who are cured by various standard combinations of surgery, radiation therapy and chemotherapy and then have “another 30 to 40 years of life ahead of them.”

But that life expectancy can be marred by the “potentially life-altering side effects” of standard treatment, including dry mouth, loss of taste, and, in about one half of patients, difficulty swallowing, he said.
These patients inspired the genesis of Dr. Ma’s phase 2 study of an “aggressive dose de-escalation” of adjuvant radiation in this setting, he said.

The investigators evaluated experimental radiation doses of 30 to 36 Gy, which is a 50% reduction from the current standard of 60 to 66 Gy.

At a median of 2 years’ follow-up among 80 patients, the treatment de-escalation has resulted in locoregional control rates comparable to historical controls, low toxicity, and, perhaps most notably, no decrement in swallowing function or quality of life, Dr. Ma reported here at the American Society for Radiation Oncology (ASTRO) 2016 Annual Meeting.

The toxicity and swallowing results are “the most exciting data,” Dr. Ma told a standing-room-only crowd at a meeting session today.

“It’s the first clinical trial in head and neck cancer to demonstrate no injury to swallowing function after radiation,” he told Medscape Medical News. In other words, patients’ ability to swallow was no worse post treatment. In fact, patients’ ability to swallow improved slightly at 1 year following radiation therapy compared to pretreatment (P = .03).

“It’s an exciting concept. Everyone’s going to want to hear more about it,” said Thomas Galloway, MD, of Fox Chase Cancer Center in Philadelphia, Pennsylvania, who was asked for comment about the trial.

The answer is not yet known, but the 2-year results from Dr. Ma are encouraging.

Two-year data indicate that after de-escalated treatment, the rate of locoregional tumor control was 95%, which is comparable to results with standard radiation (60 Gy) from the Radiation Therapy Oncology Group (RTOG) 0234 trial.

In the Mayo Clinic trial, three patients experienced local recurrence, and one patient experienced a nodal recurrence.

Fox Chase’s Dr. Galloway also observed that, in the new trial, patients received 30 Gy delivered in 1.5 Gy twice a day over 12 days (along with weekly docetaxel, 15 mg/m2, days 1 and 8). Twelve days is a lot shorter than the standard 6 weeks for 60-Gy therapy, but the twice-daily schedule may not be suitable for all patients, he pointed out.

De-escalation radiation therapy is experimental, but a phase 3 study that seeks to confirm the approach, known as the DART-HPV trial, is now underway.

“This is not incremental change,” he told Medscape Medical News. “It’s a stark change from the current standard of care.”

Dr. Galloway and Dr. Ma both said that HPV-positive head and neck cancers are necessitating change, because patients with these cancers are younger and healthier than patients without the virus, whose cancers are typically caused by smoking and alcohol consumption.

Some HPV-positive patients are now being treated without surgery. “What the perfect recipe for treatment is, no one knows for sure,” Dr. Galloway told Medscape Medical News about treatment combinations.

Paul Harari, MD, of the University of Wisconsin, Madison, said the HPV-positive head and neck cancers, including oropharyngeal cancers, “warrant different treatment approaches.” Standard treatment is toxic ― “make no mistake about it,” Dr Harari commented while acting as moderator at a press conference featuring the dose de-escalation trial.

However, cutting the radiation therapy dosage, he said, prompts a “tense question: can you maintain the cure rate?”


More Study Details, Including Toxicity

About half of the study patients, all of whom had oropharynx squamous cell carcinoma, had the above-described 2-week-long treatment schedule. But 43 patients had extracapsular extension, a marker of aggressive disease, and thus received an additional radiation boost to the affected areas, for a total dose of 36 Gy.

Data for both groups of patients were combined in the statistical tallies.

All of the study patients had no evidence of residual disease following surgery and a minimal smoking history (eg, less than one pack per day for 10 years or less). The median patient age was 60.5 years. All patients had stage III or IV disease.

There was also a “very dramatic reduction” in side effects, compared with standard treatment, said Dr. Ma. No patients required percutaneous endoscopic gastrostomy (PEG); by contrast, with traditional radiation therapy, one fifth to one third of patients undergo PEG.

The PEG feeding tube is inserted through the abdomen into the stomach. Typically, one fifth to one third of patients will receive such a feeding tube during standard treatment for oropharyngeal cancers, he said.

The rate of grade ≥2 toxicities 2 years post radiation therapy was 10%. Again, this compared favorably with 55% rate reported in RTOG 0234.

No patients had grade 3+ toxicity at 1 or 2 years following treatment.

All 14 patients (18%) who experienced cumulative grade 3+ toxicity did so within 3 months of treatment, and all cases resolved by 6 months post treatment. One patient experienced acute grade 4 toxicity related to a chemotherapy reaction, which quickly resolved.

Patient quality of life either improved or did not change following treatment, except with regard to xerostomia. Patients reported worse salivary flow following treatment (P < .0001).

Dr. Ma, his coinvestigators, Dr Galloway, and Dr. Harari have disclosed no relevant financial relationships.

American Society for Radiation Oncology (ASTRO) 2017 Annual Meeting. Abstract LBA-14, presented September 26, 2017.





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September, 2017|Oral Cancer News|

Halving radiation therapy for HPV-related throat cancer offers fewer side effects, similar outcomes

Author: Mayo Clinic press release

Mayo Clinic researchers have found that a 50 percent reduction in the intensity and dose of radiation therapy for patients with HPV-related throat cancer reduced side effects with no loss in survival and no decrease in cure rates. Results of a phase II study were presented today at the 59th Annual Meeting of the American Society for Radiation Oncology in San Diego by Daniel Ma, M.D. a radiation oncologist at Mayo Clinic.

“A common approach for treating HPV-related throat cancer is a combination of surgery followed by daily radiation therapy for six to 6½ weeks,” says Dr. Ma. “However, the radiation treatment can cause a high degree of side effects, including altered taste, difficulty swallowing, dry mouth, stiff neck and damage to the jaw bone.” Dr. Ma says that patients with HPV-related throat cancer tend to be young and, once treated, are likely to live a long time with possibly life-altering side effects from the standard treatment. “The goal of our trial was to see if an aggressive reduction of radiation therapy (two weeks of radiation twice daily) could maintain excellent cure rates, while significantly reducing posttreatment side effects, improving quality of life and lowering treatment costs.”

Researchers followed 80 patients with HPV-related oropharyngeal squamous cell cancer with no evidence of residual disease following surgery and a smoking history of 10 or fewer pack years. That’s the number of years smoking multiplied by the average packs of cigarettes smoked per day.

At two years following the aggressively de-escalated treatment, the rate of tumor control in the oropharynx (throat) and surrounding region was 95 percent. Of the 80 patients in the trial, only three experienced a local cancer recurrence. One patient experienced a regional cancer recurrence. Patient quality of life largely improved or did not change following treatment, except for some dry mouth.

“Patients in our trial had a very dramatic reduction in side effects, compared with standard treatment,” says Dr. Ma. “For example, no patient in our trial needed a feeding tube placed during dose-reduced treatment; whereas, close to a third of patients had feeding tubes placed with traditional radiation therapy doses on other recent clinical trials.” Dr. Ma says the reduction in side effects did not lead to any reduction in cure rate, as survival rates were similar to traditional survival rates for HPV-related throat cancer.

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September, 2017|Oral Cancer News|