Over the years, I've frequently made the points that the vast majority of physicians are not scientists and, in fact, that many of them suffer from a severe case of Dunning-Kruger when it comes to science. Even going back to the very early history of this blog, you can find examples, the most common of which seemed to be physicians denying evolution and embracing creationism. Of these, the doctor I wrote about most frequently back in the day was the creationist neurosurgeon Michael Egnor, but with the onset of the 2016 Presidential race there's been a new creationist neurosurgeon in town with arguably even more ignorant attacks on evolution. I'm referring, of course, to noted neurosurgeon Ben Carson, whose creationist stylings and other idiocies have been so bad that I had to use him as a reason to update my posts regarding how physicians are not scientists and often have an inordinate and unjustified confidence in medicine as a "check on BS."

Over the last couple of weeks since that post, unfortunately, Ben Carson has continued to spew statements that are nothing but downright embarrassing, be they his statement in the wake of the Oregon mass shooting that it would be advisable to attack an armed gunman during a mass shooting "because he can't get us all" or his many other statements that make me wonder how someone with so little critical thinking skills could get through medical school and a neurosurgery residency to become such a respected surgeon.

While I knew Dr. Carson shows an uncanny lack of critical thinking when it comes to most issues outside of medicine, I had never in general doubted his medical abilities. Oh, sure, I was disturbed and disappointed when during the second Republican debate, instead of repeating his full-throated defense of vaccines, he waffled and pandered to the G.O.P. base regarding Trump's antivaccine views, but I didn't think that was because he truly thought vaccines cause autism but because he was too cowardly to speak out as clearly as he had in the past. I expect behavior like this from Rand Paul, the other physician running for office, but not from Ben Carson, at least not based on his history.

Then, over the weekend, while I was away at the American College of Surgeons meeting, there was an article in the Wall Street Journal entitled Ben Carson Has Had Ties to Dietary Supplement Firm That Faced Legal Challenge. Unfortunately, I'm not a WSJ subscriber; so I can't read the whole article. Fortunately, there's enough of it excerpted out there in various blogs and other news outlets that I can get the gist of the story and what he said. Actually, I could experience everything he said in this 2004 YouTube clip of Ben Carson shilling for Mannatech, and now you can too:

The video is 1:19 long; so I admit that I haven't had time to watch the whole thing. What I have seen in it is quite disturbing. A bit of background was in order. Over ten years ago, Ben Carson faced prostate cancer at a relatively young age, his early 50s, and he went to an unexpected source for help:

Faced with a prostate-cancer diagnosis more than a decade ago, Ben Carson, the Republican presidential hopeful and retired surgeon, consulted an unusual source: the medical director of a Texas company that sells nutritional supplements made of substances such as larch-tree bark and aloe vera extract. The company doctor “prescribed a regimen” of supplements, Mr. Carson told its sales associates in a 2004 speech.

The video above is basically an infomercial for Mannatech. The video was taken down from the company website, apparently after the WSJ made inquiries about it, but the Internet never forgets, and so the video is still around. Fortunately the part about his prostate cancer diagnosis is near the beginning of the video; so you don't have to watch the whole hour and 19 minutes of it.

According to Carson, a couple of years before his talk, he was diagnosed with prostate cancer. He described himself as an individual who underwent routine medical screenings and annual physicals and had his PSA checked. However, he noticed that when he was in the operating room for long periods of time he became very interested in the clock because, unlike in the past, he couldn't go many hours without having to go to the bathroom. So he went to see the chief of urology at Johns Hopkins, who thought at first that he had some prostatitis and gave him antibiotics. The symptoms, however, didn't go away. So the urologist suggested that maybe he had some prostatic hypertrophy and gave him some Flomax, but the symptoms still didn't resolve. His PSA was checked again, and it was somewhat elevated; so a biopsy was recommended. Now, I have to admit, Carson is a very folksy and engaging speaker, particularly the part where he described undergoing his prostate biopsy. I can see why Mannatech would want him to shill for it: A famous neurosurgeon who is a very likable speaker (or at least was, as I don't find much of Carson's schtick that likable any more).

In any case, he related getting the news in the operating room that he had high grade cancer. Now, personally, if I were in the operating room and received news like that, I'm not entirely sure that I could "put it out of my mind" the way Dr. Carson relates, and continue with the operation. On the other hand, that's what surgeons do; patients must not be abandoned just because of our own personal traumas. Be that as it may, next Carson described getting an MRI and having a copy given to him without a radiologist reading. Looking at it, he saw "lesions up and down my spine."

So how did his association with Mannatech begin? Basically, somehow the news got out that Carson had some sort of cancer, and as a result people started sending him products from all over the world. The father of one of Carson's patients also apparently heard the news and asked him if he had ever heard of glyconutrients. This recommendation from his patient's father led Carson to contact Mannatech and a "Dr. Reg," who I can only assume must have been Dr. "Reg" McDaniel, who was at that time medical director of Mannatech and is now Director of Research at Wellness Quest, LLC, who doesn't appear to be particularly science-based. Let's just say that "Dr. Reg" is proud of having been awarded the "Discovery of the Year Award" by the American Naturopathic Medical Association n 1996 for his glyconutrient work and claims and that he's still selling dubious dietary supplements. In any case, Carson described how Dr. Reg sent him some product and prescribed a regimen. He began to take it, and "within about three weeks my symptoms went away, and I was really quite amazed." Carson even stated that "I actually toyed with the idea of not having surgery done, because it was recommended that I undergo surgery."

Let's stop right there for a second. According to his story, Dr. Carson was diagnosed with high grade prostate cancer. He apparently thought it had metastasized to his spine based on reading his own MRI scan. That's a terminal diagnosis, although prostate cancer can be fairly indolent and even at stage IV take a long time to kill. Yet, surgery was still being recommended to remove the prostate? Something doesn't quite add up here, because usually the treatment for metastatic prostate cancer is not surgery, but castration, because most prostate cancers are androgen-dependent. In the old days (back when I was a resident), that would have been surgical castration, but these days chemical castration is used. Castration can often give a long period of palliation before the prostate cancer becomes androgen-independent and starts growing again. As I listened, all I could think is that Carson's surgeon must have thought that the cancer was still localized and therefore potentially curable. Otherwise, it's doubtful he would have offered radical prostatectomy, which is an operation not without risk and significant morbidity.

In any case, Carson continued on about how he read up on the "theory behind" Mannatech, the "bolstering of the immune system," saying "this makes an awful lot of sense," and thought about whether the cancer could just be controlled. Now here's why he decided not to rely solely on Mannatech:

Then I began to realize that, having a high profile, if I did that, a lot of other people might follow that example too, but they might not be quite as diligent as I was about taking the product, and there might be a lot of needless deaths, and I didn't feel as though I could have that on my conscience. So I went ahead and had the surgery done.

So let me get this straight. He thought that Mannatech's product would work but that others would die if they followed his example because they wouldn't be as awesomely diligent as Dr. Carson. Yes, Dr. Carson's rationale for undergoing the surgery was, apparently, that he might be able to cure himself with Mannatech's supplements but others would die because they wouldn't follow the protocol closely enough. How many times have I discussed this victim-blaming explanation for the failure of alternative cancer cures? More times than I can remember. It's a common thread in alternative cancer cure advocacy, that if you don't follow the protocol to the letter it will fail and it will be your fault. So, awesomely selfless guy that Carson was, he underwent major surgery in order to save people from that fate. Or perhaps he didn't believe quite as strongly as he made it sound in his speech. Probably the latter.

Whatever the case, Carson underwent a nerve-sparing prostatectomy, which is designed to spare the nerves responsible for sexual and bladder function whose damage was a common complication of radical prostatectomy, later to discover that the MRI findings were a congenital abnormality of the bone marrow and not metastatic cancer at all. The cancer was within 1 mm of the capsule of the prostate, but still confined to the prostate, meaning that the surgery was potentially curative. Given that it's something like 12 years later and Carson is still alive and kicking, the surgery was just curative. In his talke, Carson attributed his good fortune to prayers more than Mannatech, but he was still basically shilling for Mannatech. In fairness, Carson also pointed out that, although people have told him that it was the glyconutrients that cured him—an odd thing to say, given that he still had cancer in his prostate that was almost to the capsule—he does advocate what might be called "integrative" medicine, at least with respect to Mannatech:

Now some people have concluded that I was cured without without surgery and that I was just cured by the glyconutrients. Maybe it would have happened, maybe it would not have. I do not advocate abandoning traditional medical cures that have been shown to work. What I would, however, advocate is using natural products to supplement what's done by traditional medicine. The two things do not have to be adversarial. In fact, they can be extremely complementary.

Oddly enough, he then said that he was not a Mannatech associate, because he didn't think that would be appropriate, nor was he a Mannatech spokesman, because he didn't think that would be appropriate either. Really? He just gave what amounts to a Mannatech cancer cure testimonial to an auditorium full of Mannatech associates! He might not have been an associate, but he was definitely an unpaid spokesman. He even pointed out how he set up a system in his office to people asking him about Mannatech to the "right people" and described how he and his wife were still taking Mannatech glyconutrient supplements every day and later said in a promotional video:

The wonderful thing about a company like Mannatech is that they recognize that when God made us, He gave us the right fuel. And that fuel was the right kind of healthy food. You know we live in a society that is very sophisticated, and sometimes we’re not able to achieve the original diet. And we have to alter our diet to fit our lifestyle. Many of the natural things are not included in our diet. Basically what the company is doing is trying to find a way to restore natural diet as a medicine or as a mechanism for maintaining health.

Fast forwarding in time, it turns out that this wasn't the only time Carson promoted Mannatech. He spoke at Mannatech conferences in 2011 and 2013 and spoke about glyconutrients for a PBS special just last year. His relationship with Mannatech thus went on for at least a decade, apparently only to be severed when he decided he wanted to run for President.

It must be emphasized just how dubious Mannatech is. As this National Review article points out:

Mannatech has a long, checkered past, stretching back to its founding more than a decade before Carson began touting the company’s supplements. It was started by businessman Samuel L. Caster in late 1993, mere “months,” the Wall Street Journal later noted, before Congress passed the Dietary Supplement Health and Education Act of 1994, which greatly loosened restrictions on how supplement makers could market their products. Within a few years of its inception, the company was marketing a wide variety of “glyconutrient” products using many of the same tactics previously described in lawsuits against Eagle Shield, Caster’s first company. In November 2004, the mother of a child with Tay-Sachs disease who died after being treated with Mannatech products filed suit against the company in Los Angeles Superior Court, seeking damages for intentional infliction of emotional distress, negligent misrepresentation, and conspiracy to commit fraud. The suit alleged that the Mannatech sales associate who “treated” the three-year-old had shared naked photos of the boy — provided by his mother as evidence of weight gain, with an understanding that they’d be kept confidential — with hundreds of people at a Mannatech demonstration seminar. The sales associate was further accused of authoring an article, in the Journal of the American Nutraceutical Association in August 1997, explicitly claiming that Mannatech’s supplements had improved the boy’s condition, even though the boy had, by that time, died. The suit also presented evidence that Mannatech was still using photographs of the boy in promotional materials on its website in March 2004, “with the clear inference that [the boy] was alive and doing well some seven years after his actual death.”

I also note that Mannatech's associates hawk one of its products, Ambrotose, as a near cure-all for everything from cancer to multiple sclerosis to AIDS. It's even been described as a sham in a journal article. I might have to do a post on Mannatech, but in the meantime if you doubt the dubious nature of the company and its products, Quackwatch has a resource.

As disturbing as Dr. Carson's advocacy of pseudoscience like creationism is, I find this revelation about his longstanding relationship with Mannatech to be far more disturbing, striking as it does at the heart of his strength, his reputation as a physician and neurosurgeon. It turns out that Carson's lack of critical thinking skills goes beyond just evolution, the Big Bang Theory, geology, and physics. As great a neurosurgeon as he was, he was so easily persuaded by pseudoscience that he was willing to promote nonsense like Mannatech as a treatment for prostate cancer.