Life and Death on Fringes of Medicine

In the early evening of March 17, the man Erica McLean had hired to cure her husband of cancer arrived at their ranch in Sunland.

David Chuah, a biochemist from Canada, carried a large brown bag brimming with pills, drops and powders, Erica recalls. Clive McLean, 60, was to take them in addition to the other therapies Chuah had prescribed during six months of treatment, she says.

On earlier occasions he had lingered comfortably, chatting, joking, sometimes pouring himself a drink -- but that night, she says, Chuah was in a hurry.

“He said, ‘I’m going to leave you with a bill,’ ” recalls Erica, who had already paid Chuah about $18,000 for his services. As the nostrums were pulled from the bag, Clive McLean lay nearby in a rented hospital bed, his once 155-pound body withered to 95 pounds. He had been unresponsive for days.

Erica asked Chuah how to use the new medicines. Instead of answering, she says, he asked to use the McLeans’ home computer, hastily typed out a bill for $120,000 and waited for Erica to write a check. He was planning to catch a flight home that evening to British Columbia, where he operated a clinic.

Stunned at the amount of money he was asking, Erica says she asked for Chuah’s Social Security number. When he said he didn’t know his number, her mounting frustration swelled to anger. She ordered him to leave.

“At that point it all hit me,” says Erica, sitting in the now-empty living room recently, wiping tears from her eyes. “I knew this guy was a fake and that I’d never see him again. At that moment, it all made sense.”

Clive McLean died March 29 of kidney cancer that had spread to his brain. The therapies for which he and his wife had paid so dearly -- using up much of their savings and forsaking traditional cancer treatments that might have prolonged his life -- were useless, doctors say.

Erica McLean says she has shared the details of her husband’s experience with the L.A. County Sheriff’s Department. Acting on her complaint, the department recently completed an investigation into the actions of Chuah and Feline Butcher, a Los Angeles nutritionist with a large celebrity clientele who often works with Chuah.

The case has been turned over to the district attorney’s office for consideration of criminal charges of grand theft and practicing medicine without a license.

Chuah could not be reached for comment for this article. Butcher’s attorney, Donald Etra, says no charges have been filed against her and that she is “totally innocent of the allegations.”

“There is no basis for any criminal action whatsoever,” Etra says. “Ms. Butcher had nothing to do with Clive McLean’s death.”

Such investigations are rare; such allegations aren’t.

So-called complementary and alternative medicine has gained a foothold in today’s medical world, garnering grudging respect from many mainstream physicians and researchers. Medical centers such as UCLA and Memorial Sloan-Kettering Cancer Center in New York City have created integrative programs, and medical schools increasingly offer courses in the field.

Several peer-reviewed journals are now devoted to the subject. And in 1998, Congress established the National Center for Complementary and Alternative Medicine to conduct research on promising and popular therapies. “Complementary” means unorthodox therapies used in conjunction with conventional medicine, while “alternative” means therapies used in place of conventional treatment.

But with this measure of legitimacy has come a rise in unprofessional, even fraudulent, practitioners. Using the Internet and word of mouth to promote their services -- and nuggets of science to defend their treatments -- these peddlers of unproven cures offer hope to desperately sick people in imaginative new ways.

Some fatally ill patients forgo traditional care; others burn through their savings. Diagnosed with ovarian cancer, Coretta Scott King recently sought care at a Mexico clinic, Santa Monica Health Institute, known for its fringe medical treatments. She died there Tuesday, and it was shut down Friday by Mexican health authorities.

Many such patients merge conventional care with alternative practices without telling their doctors, thus risking dangerous side effects or drug interactions.

“People who know the field well think that many cancer patients are harming themselves by engaging in dubious practices,” says Andrew Vickers, a research methodologist at Memorial Sloan-Kettering who has studied alternative medicine.

An estimated 80% of all cancer patients in the United States use some type of unorthodox therapy, according to a 2002 survey by the business research firm Datamonitor. The worldwide market for complementary and alternative medicines for cancer patients could be as high as $18 billion, the research firm says.

Today, says Dr. Wallace Sampson, clinical professor emeritus of medicine at Stanford University, no treatments can be called bad, only “unproven.” Sampson edits the Scientific Review of Alternative Medicine, a journal exploring the scientific validity of complementary and alternative treatments.

Proponents of unorthodox medicine have been quite successful at changing the language and the playing field, he says. “What we used to regard as illegal, immoral and unethical is now regarded as just a different way of thinking.”

But Erica McLean maintains that she was duped.

“When you’re dealing with something like this, you can believe anything and anybody,” Erica says. “We were so pulled by the promise of a cure. It was a betrayal.”

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Keeping Hopes Up

Clive and Erica McLean were receptive to a different way of thinking. Clive, an easygoing man with thick hair and blue eyes, was born in Scotland, moving to London at 15 to enroll in a prestigious art school. Although painting remained his lifelong love, he left England for the United States as a young man to further his burgeoning photography career.

At 60, he was a successful photographer at Hustler magazine and owned a production company with Erica that made adult videos. He smoked cigars, laughed easily and, with Erica, his wife of 15 years, had purchased the ranch in Sunland three years ago. There, the couple kept horses and enjoyed sweeping canyon views. When they moved in, he engraved their names, the date and a heart in wet concrete on the front step of the home.

His dream, Erica says, was to ease out of his current career, build an art studio on their property and return to oil painting and sketching. Clive was also committed to his health, having given up alcohol about 11 years earlier and choosing only organic foods for the dinners he prepared for Erica each evening.

He had been a client of Butcher’s nutrition practice for about 15 years, usually dropping by her office every month or two. He purchased vitamins and herbs from her to improve his energy levels and ward off colds. He even underwent intravenous vitamin therapy, containing vitamins B or C.

When Clive began suffering back pain and twitching on his left side in August 2004, he went to the emergency room at Cedars-Sinai Medical Center and was referred to Dr. David Hoffman, an assistant clinical professor of medicine at UCLA.

Hoffman diagnosed Clive with kidney cancer that had spread to his brain, and told the couple that Clive would probably die in a matter of months. But he didn’t give up hope. He told them that some therapies, including surgery, did offer a slim chance of remission.

“Dr. Hoffman said, ‘It’s serious but let’s work with it,’ ” recalls Erica, a petite woman who worked alongside Clive. “He said we had options.”

Clive turned to Butcher for advice, Erica says.

Butcher is listed in Medical Board of California records as the office manager for Dr. Charles E. Law Jr. of the Studio City Health Center. Etra, her attorney, says she is a “nutrition consultant” without a college degree but is “self-taught with 20 years of experience.” He said Butcher would not answer questions about the McLean case.

Butcher, a tall woman with a German accent who clients say exudes confidence in her advice and therapies, advised against surgery, Erica says.

Clive was torn. He first chose to undergo a treatment Hoffman recommended, gamma knife radiation surgery, to shrink the tumors in his brain that were causing his pain and twitching. The experience, Erica says, was “horrific.”

On the morning of the procedure, Clive arrived at the hospital early, worried but prepared to see it through. A head frame was then attached to his skull with pins so that, during the procedure, doctors could beam radiation into the tumors. The pain was searing, but Clive was unable to lie down because of the frame attached to his head. Although he was eventually given morphine to ease his discomfort, he didn’t undergo the procedure until 3:30 p.m.

Afterward, the couple left the hospital feeling as if the treatment, and what Clive had been forced to endure, had not been fully explained to them beforehand.

The experience made them even more receptive to the advice they had received two days earlier, Erica says, when Butcher dropped by to visit the McLeans with a guest in tow: David Chuah, a slight, unprepossessing man with a wealth of knowledge about alternative medicine.

Chuah described himself as a biochemist and a cancer doctor and told the couple he could cure Clive, Erica says. Then he provided a demonstration. Carting a briefcase containing rows of pills and a “dowsing rod,” he instructed Clive to hold various bottles of medicine while Chuah swirled the rod around him, Erica recalls. As she tells it: If the rod made large circles, Clive didn’t need that particular medicine; if the rod began spinning in small circles, the drug would be helpful.

By the end of the visit, Erica says, the McLeans had written a check for $450 for various medicines, two of which were called magic drops and C-3 drops.

“Chuah was guaranteeing that he could cure Clive,” Erica contends. “Here’s Western medicine with its horrible side effects, and here’s this holistic, gentle nutritionist who acts so concerned.”

After the radiation treatment, the McLeans informed Hoffman that they wanted to try alternative treatments instead of Hoffman’s treatment plan.

The doctor had already prescribed steroids for the swelling in Clive’s brain as well as an anti-seizure medication. But he had also recommended removal of the cancerous kidney and a course of interleukin-2, a drug that has been found to boost the immune system to fight solid tumors. Hoffman, an expert in the use of interleukin for kidney cancer, said about 10% to 15% of patients have a good response to the drug, sometimes surviving for several years.

Hoffman, an energetic, young doctor who prizes the bond he forms with patients, didn’t fight the couple’s decision to spurn traditional medicine.

Not only does he believe that patients have a right to make their own decisions, he viewed the McLeans’ preference for alternative medicine as imperturbable. He had trouble convincing the couple that his treatments could make a difference, Hoffman says, and given Clive’s poor prognosis, he was reluctant to try to dissuade them from something they believed could help.

“Our usual caveat is as long as it’s not impoverishing you or making you feel sick, it’s OK,” says Hoffman of his patients’ unorthodox therapies. “They were not asking me what to do. They were telling me what they were going to do.” Besides, he adds, “our track record with this kind of tumor is pretty dismal.”

The dowsing rod, the magic drops and the other proposed treatments were not mentioned, Hoffman says.

“The outlandish claims about a cure -- I didn’t hear about that until the end,” he says, when Erica told him of their experiences.

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Issues of Trust

The image -- and, often, reality -- of contemporary cancer treatment has fueled the public’s search for medicine they see as gentler and practitioners they view as more empathetic.

Traditional treatments can be described as “slash, burn and poison” -- surgery, radiation and chemotherapy. Alternative therapies, many of them herbal, can seem safer, more natural.

Similarly, traditional care often relegates patients to long hours in waiting rooms and only minutes with their doctors. Alternative practitioners make a point of lavishing time and emotional support on their clients.

And while traditional doctors may be blunt when issuing a prognosis, alternative practitioners frequently emphasize hope and a sense of self-destiny.

People who pursue fringe alternative therapies “develop a false belief in the effectiveness and a false or unwarranted trust in the information source,” says Dr. Stephen Barrett, a retired psychiatrist who operates the website Quackwatch, devoted to debunking unproven medical claims. “If you’re not sick, what you do doesn’t matter a lot. But if you’re sick, you have to make a decision on where to go, and that’s where quackery comes in.”

The belief in alternative medicine has grown amid distrust of the medical establishment. In a study published in August from the American Cancer Society, 27.3% of Americans surveyed agreed with the statement: “The medical industry is withholding a cure for cancer from the public in order to increase profits.”

“That was really shocking,” says Dr. Ted Gansler, the lead author of the study. “The great concern is that it implies there is a lack of trust.”

Gansler, a researcher in the department of health promotion for the American Cancer Society, also found that 7% of people said they believe that “all you need to beat cancer is a positive attitude, not treatment.” And 41% believed that treating cancer with surgery could spread the disease throughout the body. Neither is true.

The use of nontraditional therapies without regard to scientific proof has become culturally accepted and even encouraged, says Sampson of Stanford University. One study found that 73% of breast cancer patients used a complementary or alternative medicine and that most did so at the urging of friends, family members or because of information presented in the media -- not because of a scientific study or a credentialed doctor’s recommendation.

Experiences such as those Erica describes are thought to be common, although few cases of suspected fraud are reported and prosecuted. With many alternative practitioners unlicensed and unregulated by medical boards or state agencies, there is little recourse for consumers except to file a complaint with local law enforcement agencies. But those agencies’ resources for identifying health fraud are thin, experts say.

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Unconventional

For much of the fall and winter, Erica says, Clive devoted himself to taking nearly a dozen pills and drops and powders that Chuah provided -- a daily regimen she kept on a large whiteboard in her kitchen. And, almost daily, she says, Clive underwent intravenous vitamin drips or colonics -- a treatment to cleanse his colon with water.

Chuah also treated Clive with a Rife machine, Erica says, a computer-sized, black machine with blinking lights that supposedly emitted low-level energy to kill cancer cells. During another visit, Chuah asked everyone in the house to wear copper bracelets to “neutralize negative energy,” Erica recalls. The treatments seemed bizarre, Erica acknowledges, but the couple tried to stay upbeat. Believing was part of the therapy.

“Every day was positive. Every day we said we are going to beat this,” says Erica, who had T-shirts made up for herself and Clive emblazoned with the words “trust and believe.”

Rife machines, which have existed on the fringes of alternative medicine for several decades, are not approved by the Food and Drug Administration. The agency not only prohibits marketing of the machines but also has denounced them as ineffective in curing cancer. The attorneys general in Minnesota and Wisconsin have also banned the devices; one called the machines “medical quackery, pure and simple.”

The Federal Trade Commission has charged at least one manufacturer of ionized metal bracelets with making false and unsubstantiated claims, such as the statements that the bracelets correct an imbalance between positive and negative energy to stop pain or heal disease.

Practitioners of colonics, the FDA stipulates, cannot make therapeutic claims to cure or prevent disease. But Clive endured the procedures, Erica says, because he was told they could wash out the cancer cells dislodged by the Rife machine. Vickers of Sloan-Kettering calls such use preposterous. As for vitamin treatments, there is no evidence that natural substances alone can alter the course of cancer, Vickers says.

“Proponents of vitamin therapy obscure the difference between prevention and cure,” he says. “They’ll say there are a lot of links between diet and cancer. But prevention is a completely different biological event than a cancer cell growing. They make it sound scientific. But if you take it apart, it’s meaningless.”

The care and attention Clive received from Butcher and Chuah was intensely personal, even devoted, Erica recalls. And after each treatment or visit, she says, the McLeans wrote checks: $175 for a vitamin drip, $150 for a session on the Rife machine, $75 for colonics.

“When you’re sick, you think that money doesn’t matter,” Erica says. “I wanted him to get well.”

Altogether, Erica says, she wrote checks totaling approximately $20,000 to Butcher, $18,630 to Chuah and $18,000 to Law for treatments performed at the Studio City clinic, although Erica says Clive did not receive any direct care from Law. (Ultimately, she says, Chuah didn’t pursue the additional $120,000 he requested.)

By February, Clive had grown weaker and was having trouble walking. Butcher suggested that the McLeans not return to Hoffman for care or to undergo tests, such as an MRI, because the procedures would further deplete him physically, Erica recalls. The tests, she knows now, would have shown the status of the disease.

Instead, Erica says, Butcher offered “to help Clive pass over to the other side.”

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‘My Best Friend’

Erica now fights to control the guilt she feels over the therapies she purchased on Clive’s behalf, the trust that they could somehow succeed where modern medicine had failed.

Although she recently returned to work, nine months later, she still won’t change the message on her home answering machine -- Clive’s sonorous voice with its Scottish accent.

“Clive was so thrilled with life,” says Erica, sitting in the living room of her sun-washed home. A pink Virgin of Guadalupe candle burns on the fireplace mantel beside a portrait of Clive, with his tousled white hair and brilliant smile. “We would sit around at the end of the day and just laugh. He was my best friend.”

And, Erica says now, he may have lived longer -- or achieved a remission -- had he chosen conventional medical care. The couple could have taken the cruise around Mexico that Clive had suggested. “But I told him, no, we shouldn’t interrupt his treatment to take a cruise,” Erica says.

She regrets the unrelenting pain he endured, the “wear and tear” on his body from the daily trips for colonics and IV drips, the exhausting excursions that left him little time to groom his horses or paint. It’s simply not true that Clive McLean had nothing to lose, says his wife.

“It wasn’t just the money they took,” says Erica. “It was the time.”

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(BEGIN TEXT OF INFOBOX)

Alternative medicine resources

National Center for Complementary and Alternative Medicine

(888) 644-6226; https://nccam.nih.gov

This federally funded institute is charged with investigating the scientific validity of complementary and alternative therapies and making the results of those studies known to the public. It operates a clearinghouse to answer requests for information, but does not actively warn consumers about bogus or disproved treatments.

Food and Drug Administration

(888) 463-6332; www.fda.gov

This federal agency is charged with ensuring the safety of food, cosmetics, drugs and medical devices, including complementary and alternative medicine products. It sets limits on what health claims can be made and advises consumers on allowable health claims at www.cfsan.fda.gov/dms/hclaims.html.

It also compiles consumer complaints regarding products and devices under its purview. Consumers can call (800) 332-1088 or go to www.fda.gov/medwatch/report/hcp.htm to file a complaint. The agency usually posts information on any enforcement action on its website at www.fda.gov/oc/enforcement.html. Warnings on supplements can be found at www.cfsan.fda.gov/dms/ds-warn.html. In the past, the FDA has focused its alternative-

medicine enforcement efforts on Internet health fraud and HIV fraud. The agency has too few resources to effectively enforce laws to prevent all fraudulent practices.

Federal Trade Commission

(877) 382-4357; www.ftc.gov

This federal agency enforces consumer protection laws and halts deceptive marketing practices, such as those surrounding bogus health products. Consumers can find out whether the FTC has taken action against the promoter of a product by visiting its website. Those who believe a health product is being falsely advertised can file a complaint by phone or online.

The most aggressive federal agency targeting health fraud, the FTC established Operation Cure.All to advise consumers on how to recognize health fraud online and guide businesses on how to market health products and services truthfully (https://www.ftc.gov/bcp/conline/edcams/cureall/index.html). But the agency has limited resources and can’t prosecute all falsely advertised products.

American Cancer Society

(800) ACS-2345; www.cancer.org

The society’s guidelines urge doctors to ask their patients whether they are using complementary or alternative medicine. Surveys show that as many as 40% of cancer patients don’t tell their doctors they are using such therapies. The cancer society’s website offers educational materials and guidelines for such treatments.

Society for Integrative Oncology

(856) 423-3201; www.integrativeonc.org

This nonprofit organization helps doctors who treat cancer find the most effective combination of conventional and complementary therapies, but it does not actively warn the public about fraud or quackery.

Source: Los Angeles Times reporting