“Chemotherapy is for losers”: A tragic tale of cancer, naturopathic quackery, and murder

We at Science-based Medicine (SBM) have written rather copiously about naturopathy over the years, because naturopaths are pseudo-physicians with delusions of grandeur whose quackery endangers patients. Basically, naturopathy is a cornucopia of unscientific, pseudoscientific, and mystical “medicine” (e.g., homeopathy, traditional Chinese medicine, various bogus diagnostic tests and treatments) and some borderline medical practices (e.g., herbal medicine, whose benefits naturopaths massively oversell), all “integrated” with modalities appropriated from conventional medicine and rebranded as being “alternative” and part of naturopathy, such as nutrition, diet, exercise, and other lifestyle interventions (and in some cases, even prescription medications). Unfortunately, the core belief that “natural” is better and the tendency of naturopaths to embrace any quackery, as long as it seems “natural” (e.g., “functional medicine,” which combines lifestyle interventions with the very worst excesses of conventional medicine), leads naturopaths to lobby for licensure. (That and the fact that licensure makes reimbursement by third party payers more likely and gives naturopathy respectability through the imprimatur of state endorsement and regulation.) Never mind that naturopathic training is, contrary to how naturopaths portray it, far inferior in both time and content to that of MDs and DOs, and completely inadequate to the task of being a primary care physician who deals with common diseases such as diabetes, while the oversight of “naturopathy boards” is grossly lax, as is their research ethics. Also, naturopaths, by and large, tend to be antivaccine, with very few exceptions, and those exceptions tend to have at least some dubious views about vaccines themselves. Basically, naturopathy is a “specialty” (if you can call it that) whose precepts are rooted in prescientific concepts, which is why there is no real standard of care in naturopathy, as can readily be deduced from what naturopaths say to each other when they think no one is listening.

I’ve written about the sorts of horrible outcomes that occur when patients trust a naturopath, rather than a real oncologist or surgeon, and this is one such tale. However, it comes with a twist that makes it even worse. I’ll just start with this story from the Bowling Green Daily News:

A Bowling Green man accused of killing naturopathic doctor Juan Sanchez Gonzalez had, at the time of Gonzalez’s death, an active lawsuit filed against Gonzalez in Warren Circuit Court alleging that Gonzalez guaranteed he could cure the man’s wife of cancer.

Omer Ahmetovic, 35, 501 Eric Ave., G51, was charged Wednesday with murder in Gonzalez’s death, according to his arrest citation. The citation doesn’t list a possible motive in the death.

Ahmetovic’s wife, Fikreta Ibrisevic, died Feb. 27, according to the Warren County Coroner’s Office.

Ahmetovic is being held in the Warren County Regional Jail in lieu of a $1 million bond. A hearing is set in the case for Wednesday in Warren District Court.

Clearly, the motive being attributed to Gonzalez’s alleged killer has to do with his having deceived Ahmetovic and Ibrisevic into thinking that he could cure Ibrisevic’s cancer. When he failed, Ahmetovic sued, but even that was allegedly not enough for him; so now he stands accused of murder. What started out as one potentially preventable death turned into two deaths, with a grieving husband facing murder charges. How did this happen?

“Chemo is for losers,” or: Naturopathy fought cancer, and cancer won

As I learned more details by doing relevant searches and finding more news stories, it turned out that the story was even worse than that first take sounds. Ahmetovic’s wife, Fikreta Ibrisevic, was diagnosed with rhabdomyosarcoma in late 2015. Sarcomas are a form of soft tissue cancer and usually form in muscle, bone, or connective tissue. When localized, treatment usually consists of a wide excision with a healthy margin of normal tissue ± radiation (usually plus) ± chemotherapy, depending on the type and stage of sarcoma. Rhabdomyosarcoma is a form of sarcoma that develops in skeletal muscle and is usually a childhood cancer, although it can occur in adults, in whom it is rare. Although the five year survival in children treated for rhabdomyosarcoma is around 70% or even higher, survival in adults is poorer. Indeed, recent review of 25 adult cases reported a 45% five year survival with a combination of surgery, radiation therapy, and chemotherapy. I couldn’t find a report of where Ibrisevic’s primary cancer was located, extremity versus trunk versus head and neck, nor could I get a copy of the actual lawsuit in time because they don’t appear to be available online; you have to request them. The lawsuit was filed on January 25, and Ibrisevic died on February 27. For purposes of this narrative getting into the serious details doesn’t really matter.

This does:

Ibrisevic was diagnosed with rhabdomyosarcoma, a soft-tissue cancer, in late 2015 to early 2016, according to the lawsuit. The couple were interested in natural therapies while Ibrisevic waited to be scheduled for the beginning of traditional cancer treatments.

On or near Jan. 11, 2016, Gonzalez told the couple that traditional cancer treatments such as radiation and chemotherapy were for “uneducated” people and he could “guarantee” Ibrisevic would be cancer free with his treatments within three months, according to the lawsuit. He is further accused of telling Ibrisevic that “chemotherapy is for losers.”

So basically, Ibrisevic and her husband were a bit woo-prone and wanted to investigate “natural” therapies for her newly diagnosed cancer. If the claims in Ahmetovic’s lawsuit are accurate, his wife was planning on undergoing conventional therapy for her cancer but changed her mind and decided to pursue naturopathic treatments in response to Gonzalez’s statement that “chemotherapy is for losers” and his other claims, particularly his claim that he could render her cancer-free within three months without the toxicity of surgery, radiation, and chemotherapy. It’s easy to see how someone, when faced with a life-threatening disease that can only be treated by a combination of potentially disfiguring surgery, toxic chemotherapy, and radiation therapy, which has its own potentially unpleasant side effects, would be tempted by a confident statement by a charlatan like Gonzalez that he could cure her within three months without her having to endure all that. One can imagine the temptation if the patient already had leanings toward wanting “natural therapy,” as Ibrisevic clearly did.

This is what happened next:

Ibrisevic began treatments which included buying herbs from Gonzalez, massages, foot soaks, dietary instructions and other treatments. From January through May 2016, Ibrisevic and Ahmetovic paid Gonzalez and Natural Health Center for Integrative Medicine more than $7,000 for the treatments and herbs, according to the lawsuit.

When Ibrisevic began treatment, she had one tumor. When she discontinued treatment with Gonzalez she had seven tumors, according to the lawsuit.

“The original tumor became so large to the extent that it was visible outside of her body,” according to the lawsuit. “Her eyes began to turn yellow and her legs began to swell. After she discontinued treatment with the defendants, after one round of traditional chemotherapy, the only tumor that remained was the original tumor.”

Now, I will admit that I was surprised at how little Gonzalez charged the couple for his services. Although $7,000 is by no means a small amount of money for most people, usually when I read these stories I see totals in at least the tens of thousands of dollars, and, when it’s someone like Stanislaw Burzynski, hundreds of thousands of dollars. Be that as it may, rhabdomyosarcoma is usually a pretty aggressive form of sarcoma; so it’s not surprising that, left untreated (and, make no mistake, that’s what it was, untreated with anything that could potentially stop it), the tumor grew and metastasized. The fact that Ibrisevic’s eyes turned yellow tells me that her liver was likely affected, leading to jaundice either from masses obstructing the bile duct or from sheer burden of metastatic disease in the liver. Alternatively, the jaundice could have been due to toxicity from some of the herbal medicine. Similarly, the observation that her legs swelled leads me to think that she probably had developed metastatic disease in her abdomen that was compressing the inferior vena cava or her external iliac veins (the veins in the pelvis to which the veins from the lower extremities drain). Either of these would be a bad sign. Both were even worse, particularly coupled with a tumor that, from what it sounds like, was starting to erode through the skin.

Basically, Ibrisevic died because she trusted a quack instead of conventional medicine. Yes, she had probably a 50% chance of dying anyway if she had accepted conventional treatment before it was too late, but that’s a 50% chance she didn’t have once she believed Gonzalez’s claims and acted upon them.

The lawsuit

By January, I can make an educated speculation that it was obvious that Ibrisevic was not going to survive. So Ibrisevic and her husband filed a lawsuit accusing Gonzalez and his Natural Health Center for Integrative Medicine of negligence, fraud, violation of the Kentucky Consumer Protection Act, loss of consortium of spouse and children, lack of informed consent, battery, practicing medicine without a license, and intentional infliction of emotional distress.

In summary:

In alleging negligence, the couple asserted Gonzalez provided services and herbs “without adequate scientific or medical foundation when compared to substantial risk involved,” which Ahmetovic and Ibrisevic were not told and by his criticism of traditional cancer treatments as being ineffective. Ahmetovic and Ibrisevic also accused Gonzalez of failing to use reasonable care in the herbs provided, causing toxic levels that prevented her body from being able to heal.

The fraud allegation accuses Gonzalez of misleading Ahmetovic and Ibrisevic regarding his qualifications and his ability to treat cancer patients.

Ahmetovic and Ibrisevic are Bosnian refugees and English is not their native language, making them “more vulnerable to being misled,” according to the suit. As a result of that and other statements included in the lawsuit, they claim a lack of informed consent in that they were not informed of the risks of treatment provided by Gonzalez and in foregoing traditional cancer treatment.

The lawsuit also said Gonzalez violated state law in practicing medicine without a license. The lawsuit seeks unspecified compensatory and punitive damages.

A review of the timeline can’t help but sadden; so, to the best of my knowledge based on my reading on the case, I reconstructed one. It began in late 2015, when Ibrisevic was diagnosed with this cancer. In January 2016, they sought out Gonzalez, who treated them for a period of time that isn’t clear from the news reports. By late 2016 or so, it was clear that Gonzalez’s quackery wasn’t working and that Ibrisevic’s tumor was progressing. During that time, she still consulted with other naturopaths, who reported that Gonzalez had administered so many herbs that Ibrisevic had a toxic reaction. At this point, she apparently returned to conventional care and underwent chemotherapy, but it was too late. Although some of her tumors responded to chemotherapy, she clearly by this time had metastatic disease and was doomed. So on January 27, 2017, she and her husband filed suit, which was answered on February 6. However, sadly, she died a month later, on February 27.

Then, on Friday, March 3, a mere four days after his wife’s death, Ahmetovic allegedly walked into Gonzalez’s office after hours and shot him dead. One can imagine him waiting until after his wife’s funeral, and then doing the deed.

The victim

Juan Sanchez Gonzalez founded and ran the Natural Health Center for Integrative Medicine in Bowling Green, Kentucky. The website for his clinic looks a lot like a lot of other websites I’ve examined for naturopaths. Its front page advertises a lot of obvious quackery, and his self-description reads thusly:

I am a Naturopathic Doctor, Iridologist, Master Herbalist and currently working towards my phD in integrative medicine. I offer an iridology evaluation prior to recommending a non-invasive method of treatment to establish a health protocol which may include medicinal herbs. The evaluation is a critical component whose aim is to remove the source of the disease and facilitate healing in a non-invasive, non-toxic manner. Evaluating a person’s condition requires in-depth knowledge of biochemistry, chemistry, biology, physiology, anatomy, psychology, and all other systems which comprise the totality of who we are.

Iridology, of course, is the rankest of quackery, akin to phrenology 150 years ago. Basically, like chiropractic, it’s a pseudomedical specialty invented out of whole cloth by a “brave maverick doctor.” It’s a lot like reflexology in that, as reflexology claims that various organs and body parts “map” to specific parts of the soles of the feet and hands, iridology “maps” body parts to parts of the iris. Basically, it’s the homunculus model. Like many alternative medicine practitioners, he claims to have “converted” after “Western medicine” failed him. In this case, Gonzalez was diagnosed with diabetes and “discovered that western medicine as a whole could not heal this condition.” He enlisted in the Army, went to college, received a degree in Business Management, after which he got his MBA. Then he attended the Trinity School of Natural Health.

This is a school we’ve met before, and it’s not even an “accredited” school of naturopathy. Basically, its graduates can’t be licensed in states that license naturopaths, which gives you an idea of how bad this school is. It’s ultimately more of a Bible school than anything else, being highly religious. As Harriet recounted a few years back, the only admission requirement for Trinity’s ND program is a high school diploma or GED, and the curriculum consists of 15 installments of a correspondence course, with a list of classes full of quackery: Bach flower remedies, reflexology, iridology, homeopathy, applied kinesiology, acupressure techniques, aromatherapy, dry blood analysis, assessing health by acid/alkaline balancing, and so on. So Gonzalez is not even what naturopaths would call a “real” naturopath in that he got his degrees through a correspondence course that’s not even recognized by naturopathic quacks as valid.

Not surprisingly, Gonzalez’s list of services reads like Quackwatch, only credulous: iridology, far infrared sauna, BrainTap™ brain wave balance, heart variability rate monitor, medicinal herbs, body detox and the dreaded “detox footbath” (which is about as quacky as you can get), cellular antiaging therapy, and more. Indeed, the site even advertises a hyperbaric oxygen chamber, listed as “coming soon.” Surprisingly, he appears not to have offered acupuncture.

Clearly, Gonzalez was not a doctor, not even an ND, which, although I like to say ND stands for “not a doctor,” still tends to get newspapers and other media outlets to call naturopaths “doctor.” He clearly had no qualifications whatsoever to be treating a patient with a rare cancer, like Fikreta Ibrisevic. None of this has stopped Erin Elizabeth at HealthNut News from lionizing him. In case you don’t remember, Elizabeth is Joe Mercola’s girlfriend and deep into promoting quackery through her website. Indeed, after the death of antivaccine activist Jeff Bradstreet by suicide before the FDA had him arrested for selling a bogus “cure” for autism, she was the one who concocted a conspiracy theory in which Bradstreet was taken out by…it’s never exactly clear who. Starting with the death of Nicolas Gonzalez, who died of a heart attack about a month after Bradstreet, Elizabeth then proceeded to latch on to every alternative medical practitioner who died under mysterious circumstances and posit a “conspiracy” in which all those killings were related. She’s still at it, and her list of “mysterious” deaths of alternative medicine practitioners now numbers over 60 and has even influenced television.

So naturally, she was quick to jump at the Gonzalez case:

Patients have emailed (and even posted in the comments below) that Dr Gonzalez was treating cancer patients- successfully. In fact, he had (allegedly) asked a few to testify as he had some upcoming court dates, apparently for treating said cancer patients. As we all know, the government doesn’t like holistic doctors treating cancer patients.

If you click here you can access the full list of 60+ doctors and their stories, who have been found dead in the last year and a half. Just this last week 48 hours and Criminal Minds (both on CBS national television) showed my collages and or quoted my site and this uninteded series. Sadly, neither named my site (I’m not surprised), as that would give the people too much info. My mission is not to let their stories die.

You can see her laying the groundwork to add Gonzalez’s name to her list. Oddly enough, she appears not to have followed up since March 4. I wonder why. It couldn’t be that learning that the chief suspect in the murder is the grieving husband of a patient who died because Gonzalez convinced her to let him treat her instead of a real doctor didn’t fit in with her conspiracy theory, could it?

Why don’t more people sue quacks like Juan Gonzalez?

If Omer Ahmetovic really did kill Juan Gonzalez, I can understand and even empathize with his motivation, even though I can’t approve of his crime. I’ve always believed that the law is far too lax on health fraud, allowing quacks like Gonzalez to defraud patients like Fikreta Ibrisevic, who, frightened at the prospect of rough treatments like surgery, chemotherapy, and radiation therapy, might not be sophisticated enough to see through his claims. I don’t just say that about alternative medicine quacks either. When I learned that Christopher Duntsch, a neurosurgeon who had left a trail of paralyzed and dead patients in his wake in Texas, so much so that he had been nicknamed “Dr. Death,” was actually going to be tried for assault, I was shocked and overjoyed. When I learned that he had been convicted and sentenced to life imprisonment, I felt that justice had finally been done. I also knew that this sort of result is rare, but I sure wish that it could have happened with Juan Gonzalez’s case.

The more interesting question that Ahmetovic’s murder of Gonzalez brought up for me was: Why don’t victims of quacks sue more often? Remember, Ahmetovic and his wife sued Gonzalez a month before her death. The case hadn’t proceeded very far, as Gonzalez’s attorneys had entered their response. As far as I know, discovery hadn’t begun yet, but, again, I don’t have access to the court documents. The point, though, is that this lawsuit was unusual. Quacks are seldom sued by patients or the patients’ families when bad things happen.

In Quackwatch, Stephen Barrett points to a book by historian James Harvey Young, Ph.D., The Health Robbers: A Close Look at Quackery in America, where Young pointed out:

Along with fright go tenderness and self-confidence. Most quacks manage a superb “bedside manner.” Since they can’t really provide a cure if major disease is present, they specialize in promises, sympathy, consideration, concern, and reassurance. The patient responds to such attention. This helps explain one of the odd paradoxes relating to quackery—that failure seldom diminishes patient loyalty. When regulatory agencies seek to prosecute quacks, the agencies have a difficult task getting hapless patients to testify in court. Partly this results from the desire to avoid public exposure as a dupe; but often this objection to testifying rests on an inability to realize that deception has taken place. Many quacks do such a good job of exuding sincerity that their explanations seem all too plausible. Even patients faced with death believe in the “kindly” person who says the special remedy would have worked if treatment had only begun a little sooner.

Regular readers here will note the ring of truth of these words. To prosecute or sue a quack, the patient (or the patient’s family) must first admit to themselves that they were taken in by the quack, that they were fooled to make the worst possible life-or-death decision. They frequently blame themselves. Worse than that, by publicly bringing charges against or suing a quack, they are publicly admitting that they were dupes. Never mind that human nature makes us all easy to fool, particularly in areas where we don’t have a lot of expertise, as most people don’t know much about medicine, but human nature also means that pride and shame conspire, often coupled with exhaustion from having fought (and often lost) a serious disease, to sap the motivation to seek justice.

Then there’s this. Young notes something that those of you who have been following the Stanislaw Burzynski tale will find very familiar:

Many times the regulator must compromise, allowing a wrongdoer to escape severe penalty because full prosecution would overtax the limited resources of the regulator. At other times, the regulator must suffer the leniency of the courts. While the average judge may become duly outraged when a victim of quackery is seriously harmed, in the majority of cases, no such victim is in sight. The con artist who peddles phony “reducing belts” for $9.95 is unlikely to be sent to prison even if his total take amounts to millions of dollars. For small sums of money, the courts seem to feel, fools must be allowed to suffer the consequences of their folly.

The regulator’s task would be eased greatly if victims of quackery would rally to his support. But an opposite trend is evident: many victims are so thoroughly deceived that they engage in political activities that oppose regulation. During the 1970s, when the FDA tried to limit false claims and dangerously high doses of vitamins, a coalition of vitamin sellers and their brainwashed customers persuaded both Congress and the courts to limit FDA jurisdiction over this matter (see Chapter 28). When the FTC considered banning commercial use of the words “natural” and “organic,” another avalanche of protest persuaded the agency to back down. The health-food industry continues to lobby fiercely to prevent the FDA from strengthening labeling regulations to curb the industry’s deceptions.

In some instances the regulator has been so cleverly labeled a villain in the quack’s promotion that the very existence of regulation has been made to enhance quackery’s appeal. Events like Vietnam and Watergate created widespread disillusionment with government. Inflation, the filling-out of tedious forms, and other irritating circumstances evoked widespread assertions of overregulation. Quacks profit from such distrust. It makes them sound credible when they charge that health regulators are not interested in the welfare of the individual but are conspiring selfishly with the medical profession, the drug industry, or the food industry.

Sound familiar? It’s the Stanislaw Burzynski case writ large, who has benefited many times from the limited resources of the Texas Medical Board and FDA (who have tried to prosecute him but in general failed to shut him down completely), as well as compromises by regulators (as when the FDA allowed him to reopen his clinical trials), and the leniency of the courts (as when the court opened the way to Burzynski setting up his infamous 72 clinical trials that he used to keep administering his quackery over more than 20 years). Given rising tide of anti-government and anti-regulatory sentiment, this problem is likely to get worse before it gets better, if get better it ever does.

It’s hard not to wonder, as Mark Crislip did yesterday, whether this will result in the premature deaths of more people due to naturopathic “doctors.” I hope not. I’d much prefer that the legal system deal with these quacks.