I know I must be getting older because of Friday nights. I also know that I'm getting older because (1) there was no new post yesterday and (2) even today this post will look familiar to a significant number of our readership. Mea culpa, but trying to put the finishing touches on two R01 grants I've been working on takes a toll. Who knew? Things should get back to normal tomorrow or Friday at the latest. Be that as it may, let's get back to Fridays. After a long, hard week (and, during grant season, in anticipation of a long, hard weekend of more of the aforementioned grant writing), it's not infrequent that my wife and I order pizza, plant ourselves in front of the TV, and end up asleep before 10 or 11 PM. Usually, a few hours later, between midnight and 3 AM one or both of us will wake up and head upstairs to bed, but not always. Sometimes it's all Friday night on the couch.

Last Friday was a bit different. It wasn't different in that I did fall asleep on the couch sometime around 10 PM. However, unlike the usual case, when I woke up around 1:30 or 2 AM to head upstairs I was stone cold wide awake, feeling like Alex in A Clockwork Orange , eyes held wide open. So I did what I do when insomnia strikes. I popped up the computer and checked my e-mail and Facebook. Immediately, I saw messages asking me if I had seen Real Time With Bill Maher that night and, oh boy, I really should watch Maher. Apprehensive but curious, I fired up the DVR and watched.

And, shortly after the monologue, was totally appalled by this;

Funny, how the segment hasn't yet been posted to Bill Maher's YouTube page, as many of his interviews are. If he ever does post it, I'll switch out the video above for the "official" source. Somehow, though, I doubt that the video will ever be posted, the reason being that it contains an embarrassingly fawning 10 minute interview with "Dr." Samir Chachoua, better known (at least to skeptics) as Charlie Sheen's HIV quack. Somehow, when Charlie Sheen was on The Dr. Oz Show a couple of weeks ago, other things were going on and I didn't blog about it. Fortunately, Steve Novella did. Now, with Sheen's very own quack who failed him being fawned over by Bill Maher, it gives me a chance to take down three birds with one stone: Bill Maher, Dr. Oz, and, of course, Sam Chachoua. Sadly for Bill Maher, America's Quack Dr. Mehmet Oz comes off looking a lot better than he does, and that's saying something.

Prelude: Charlie Sheen does The Dr. Oz Show

When Charlie Sheen first announced that he was HIV-positive on the Today Show in November, it appeared to be an announcement that surprised exactly no one. Nor was it particularly surprising that he only went public because he had been discovered. As has been the case with any celebrity diagnosed with HIV, Sheen's revelation was an excellent opportunity to point out how HIV is no longer a death sentence and can be managed with a very effective cocktail of anti-retroviral drugs, such that the life expectancy of HIV-positive people is approaching normal. It was also a great opportunity to point out yet again that, if there is any one disease in our lifetime that demonstrates the power of science-based medicine, it is AIDS. Back when I was in medical school and early into my residency HIV was basically a death sentence. Patients, once diagnosed with full blown AIDS, did not survive long. Once diagnosed as HIV-positive, most progressed within several years to full blown AIDS (although some patients progressed very slowly or not at all, which helped to fuel the rise of the HIV/AIDS denial, a pseudoscientific belief system that claims that HIV does not cause AIDS). By the mid-1990s, a mere 15 years or so since the syndrome was first defined and only a decade or so after the identification of HIV as the cause of AIDS, there was effective antiretroviral therapy. Now, 32 years after the identification of HIV, HIV-positive people can expect to live a relatively long time, as long as they manage their disease and take their medications.

It sounds easy, but I realize that for patients it's not. The drugs must be taken according to schedule, and some of them have nasty side effects. It's not surprising that some people, when their viral titers fall to undetectable, might think they can get away with stopping their medications. It's similar to patients stopping their antibiotics when they start to feel better, letting their infections come roaring back, or parents of children facing two years of chemotherapy thinking that if the first course drives the tumor into remission the child doesn't need the remaining courses. It's human nature, and apparently it's just what Charlie Sheen fell prey to. With HIV, the drugs can cause spectacular falls in viral titers to the undetectable range, but that doesn't mean that the virus is gone. HIV can "hide" within certain cells in the body, where the drugs don't eradicate it. Stop the drugs, and it will reemerge. That's what Charlie Sheen did.

Enter Dr. Oz.

About three weeks ago, Dr. Oz and Charlie Sheen's doctor, Robert Huizenga, staged an on-air "intervention" because apparently Sheen had gone off his HIV medications and sought out a doctor in Mexico who claims to be able to cure cancer, HIV, and all manner of diseases. (Don't they all?) This doctor was—you guessed it—"Dr." Samir Chachoua.

Initially in the segment, Dr. Oz, with Sheen's permission, shows a graph of Sheen's viral load, which was 4.4 million/mL. Treatment was begun on July 19, 2011, and by December 7, 2011 Sheen's viral load was zero, undetectable. There it stayed for three and a half years. Here's one video of it:

The official videos are here and here.

One thing that came out in this segment is the sort of thinking that leads to a decision as bad as Sheen's. He defends his action by saying that he didn't view it as "Russian roulette" (actually, his odds with Russian roulette would have been better) and says he's presenting himself as a "guinea pig" and that he doesn't recommend that anyone else do what he did.

Dr. Oz tracked down this Dr. Chachoua and found pretty much what I found (more on that later), namely that there isn't much to find out about him online. He managed to get Chachoua on the phone, where Chachoua claimed that Charlie Sheen is the first adult in history to go HIV negative and that conventional medicine has never done that. He even went further and said that Sheen's count went to zero after taking just his treatments. It's a rather remarkable claim, given that to prove it you'd need a lot of long term follow-up to show that Sheen's HIV didn't return for a long period of time after stopping his antiretrovirals and that antiretrovirals are very good at driving viral load to zero. We just know that the virus, although eradicated from the bloodstream, is "hiding" elsewhere, ready to emerge.

To get an idea of the magical thinking going on here, Sheen describes an "experiment" in which he mixed his blood with blood drawn from two friends, incubated it, and noted that all three samples had undetectable levels of HIV, an experiment that tells us exactly nothing. Perhaps the most shocking revelation from the Oz segment was that Chachoua drew some of Charlie Sheen's blood and injected himself with it, an act so reckless and stupid that it's hard to believe any physician would do it. Sheen also pointed out that this was not blood from a venipuncture, but rather drawn from a "lump" on his elbow (which sounded like a hematoma from an injury), which means it was old blood.

Through this segment, I kept asking two questions, which were never answered. First, when did Sheen stop taking his meds? Chachoua claimed that Sheen was HIV-positive again, but the graph shown in the segment showed Sheen HIV-negative as recently as December 3, 2015. So when was he suddenly "HIV-positive" again? December 3, 2015 to January 12, 2016 (when the show aired) is only six weeks. In any case, at the end of the segment, Dr. Huizenga (who looks just like the way I pictured him, all spray-tanned and with perfect hair) implores Charlie Sheen to start taking his medications again and makes a very moving speech about how HIV used to be a death sentence but isn't any more. In response, Sheen promised to start taking his meds on the flight home, asking, "What am I, an idiot?"

As Steve noted, the whole segment was ethically dubious, but probably good television, as was the segment where Oz took Sheen to a morgue to show him what drugs and alcohol can do to one's organs. Part of the answer as to when Sheen stopped his meds appears in a segment following him around as he visits Dr. Huizenga and to the Scripps Research Institute to interview a researcher about vaccines, who explained how HIV "hides" in the genome of certain cells in the body, to reemerge if HIV medications are stopped. Not surprisingly, there's a trip to Dr. Miles Farr, described as a "renowned integrative HIV specialist" (in other words, someone who combines quackery with science based medicine) and who has his acupuncturist give Sheen a session of what looks like auricular acupressure. It's after this that he admits that he has been off his medications for about a week and "feels great." It's not clear when this segment was taped, but, given that he tells Oz that he's still off his meds, it's unlikely that it was taped much more than a month or so before the show aired. So, whatever Chachoua says, Sheen was not off of his medications very long, fortunately. Unfortunately, just before going on the show, Sheen discovered that his viral load had started to rise again, which is likely what led to his agreeing to go back on his meds.

Overall, I'm glad that Sheen is (apparently) back on his antiretroviral medications, but there are so many unanswered questions that would better allow me to put things into proper perspective. Obviously, Chachoua's claims that Sheen was rendered "HIV-negative" with his treatment are worthless without independent verification and long-term follow-up. After all, I could give Charlie Sheen the proper cocktail of antiretroviral drugs and then, after his viral load drops to zero, tell him he's HIV negative. It'd be meaningless without long term follow-up, because the virus eventually starts replicating again.

So before I get to Bill Maher, who is this Samir Chachoua, anyway, and what is his treatment?

Samir Chachoua and the goat milk cure

Oddly enough, before Sheen was on Dr. Oz's show, I had never heard of Samir Chachoua before. I thought I knew all the major quacks out there, but obviously that's a conceit. I keep encountering new ones every month. Naturally, I went straight to Chachoua's website, which had many of the red flags of quackery right there on the first page, starting with this a statement that "There is no disease you cannot access. No disease you cannot improve. Nothing is incurable. No situation is ever so hopeless that you stop trying." Apparently his "cure" for cancer and HIV is based on something he calls "nemesis theory":

The nemesis theory first postulated by me in 1980 was that – "for every disease there is an anti-disease organism capable of destroying it and restoring health." It is not surprising therefore that every case of spontaneous remission investigated shows that cancer or AIDS or other disease may disappear miraculously even for a short period of time after infection with its nemesis.

Of course, this is far more a statement of philosophy than science. There is no a priori scientific reason why for every disease there is an anti-disease organism that can destroy it. This sounds far more like yin and yang in Asian philosophy and religion than it does science. Indeed, nemesis theory rather reminds me of homeopathy, which postulates "like cures like" in that there's no scientific reason to believe that this is true. Be that as it may, this idea lead Chachoua to develop "induced remission therapy" (IRT).

In the case of HIV, this "theory" led Chachoua to "discover" that a goat virus, Caprine Arthritis Encephalitis Virus (CAEV) is the virus that is the "anti-disease" organism, and that it is this virus that allowed him to make a "vaccine" that eliminates HIV and, as Chachoua puts it, produce an "effective therapy against cancer and other diseases with no side effects." Yes, this is another red flag of quackery, the claim that one's treatment cures many diseases with no side effects, and Chachoua's website has it in spades. In the case of HIV, CAEV is indeed a goat retrovirus, and some researchers have even speculated that it might be used as a model for HIV in in animal research. Based on this and little else, Chachoua claims:

In the greatest experiment done by nature, millions of Mexicans have drunk goat milk infected with CAEV (Caprine Arthritis Encephalitis Virus). I followed people from a small village in Mexico who were infected with CAEV, and thousands more were studied by USC, not one developed AIDS over decades of follow-up. Just like a cold will affect the nose and the flu the lungs, there are infections that will only infect cancer cells or other disease tissue. There are organisms that neutralize each other in nature, such as seen above in CAEV and HIV. Even measles and mumps can interfere with AIDS and leukemia and other types of cancer. These common infections have been reported to give long lasting remissions from these ailments, but there are strains and infection types that are far more efficient than others. I had developed, isolated and enhanced a library of organisms that could be used to create vaccines and therapies to eradicate cancer and AIDS. The therapies achieved phenomenal success and when American celebrities were cured, Cedar Sinai Medical Center and UCLA sought me out to work with them with promises of FDA registration and the healing of mankind.

Yes, Chachoua's "preliminary evidence" is the claim that people from a small village in Mexico drink milk from arthritic goats (I kid you not) and as a result none of them ever developed AIDS, coupled with the existence of a goat retrovirus that can cause this arthritis.

I perused the science sections of Chachoua's website, and found them…wanting. OK, it's a lot of horrifying pseudoscience based on a germ of real science. Sadly, that's the case with so many quacks' nostrums. See if you can see the problems in Chachoua's treatment:

Biological lytic and apoptosis agents are used to destroy disease cells and organisms. Vaccines made from Nemesis Organisms TM are used to optimize the above process and protect cells and tissues that have not been corrupted by disease (this essentially stops metastasis in cancer and prevents HIV from being able to progress). These vaccines also contain DNA correction enzymes that enables [sic] disease removal from our genetic blueprint. This process is both enzymatic and immunologic. In most disease cases the immune system is exhausted and a fresh younger version is supplied from a bank or from children of the ill person. This can be more than just a younger fresher system. For example, if the measles or mumps are used to tag and attack cancer, and blood from children recently vaccinated against measles and mumps is used, then the immune response from the children will directly attack any cancer cells carrying the measles or the mumps virus. This system, described as profound and exciting by Cedar Sinai Medical Center and UCLA, showed that the blood transfusions from children were an effective treatment for cancer and without side effects.

While Chachoua is correct that cancer is a genetic disease, he seems to vastly underestimate the complexity of the genetic derangements and mutations and how difficult it would be to correct them. As for blood transfusions curing cancer without side effects, first of all it's not at all true that transfusions are without side effects. They carry the risk of hypersensitivity reactions, disease, and the like. Second, using the MMR against cancer is highly experimental and uses an experimental genetically-modified MMR vaccine instead of the standard MMR vaccine. Using the blood of one's children recently vaccinated with MMR will not result in the child's white cells attacking the cancer, and certainly Chachoua provides no evidence or publications to indicate otherwise. Indeed, his entire website suffers from what I like to call cite-openia in that he cites no scientific literature directly and just makes a lot of claims that have nothing to back them up.

I then perused some of his case studies, particularly the breast cancer case studies. To call them unconvincing is to be flattering. For instance, the first breast cancer case study shows two mammograms, one in which it's claimed that the breast cancer is adherent to the chest wall (it doesn't look like it to me) and then one after treatment in which it is claimed that the film "Clearly shows that the oval Cancer structure has shrunk and receded away from the muscle wall. This mass is now easier to resect and remove. Response was after four weeks of Dr. Chachoua's therapy." To me the cancer looks roughly the same size and any differences in appearance look like differences in mammographic technique.

Indeed, if there's one thing that these "case histories" have in common it's that the images of scans are such poor quality that it's hard to say much about them one way or the other. Another thing is that frequently we're not looking at the same thing. For instance, Chachoua shows a "before and after" image of a liver tumor and claims that the "image below it clearly shows the disappearance of one of the metastases (black hole) with shrinkage of the other after four weeks of therapy." No, it doesn't. Bad film quality aside, it looks as though these films were taken at two different levels, and the contrast is so different that it's hard to say much of anything. Ditto the case with lung CTs. Another set of breast cancer "before and after" images shows no clear effect due to differences in technique of the mammograms. "Before and after" films of breast cancer metastases to the liver were taken at different levels.

At the bottom of the page, it states, "The slides and exhibit references all refer to evidence presented to the judge during Dr. Chachoua vs. Cedars Sinai. This is why they may seem non sequential." No kidding.

Then, in the testimonials section, there are a bunch of testimonials of the type that regular readers have no doubt become familiar with, such as a thyroid tumor disappearing after a biopsy (small ones sometimes do; sometimes the biopsy is enough to remove them); a melanoma not completely excised by shave technique that hasn't come back (this happens sometimes; incomplete excision increases the risk of recurrence greatly but the tumor doesn't always come back); and the like. As is the case with such testimonials, it's difficult or impossible to tell if Chachoua's treatment had any effect.

Chachoua has, however, added a section on Charlie Sheen to his website. In it, he seems to mistake regular statistical "noise" you'll see in any test of a very low to undetectable viral titer for actual effects, for instance mistaking a decline from 34 to undetectable as significant (anything under 50 is considered undetectable). There are some real howlers in it too:

It doesn't matter if Cedars played with the numbers or not when they found out what Charlie was going to say on air. And nothing in Charlie's history or life style would have taught him how viruses grow and spread. But if 700 is a true representation of what his counts were like after stopping Dr. Chachoua's treatment for a week, then the virus was still being controlled otherwise, it would have been in the hundreds of thousands or millions. When Charlie stopped conventional therapy for a day, his count went up to 34.

In other words, if it weren't for my woo, the viral load would have been hundreds of times higher! Of course, there's no way to know that. Also:

1.) Again, when he stopped Dr. Chachoua's medicines for two or three days, the virus remained non detectable and only went up after he abstained for a week. This makes it better than the conventional therapy.

Um, no. Just no.

2.) During the two months or so he was on this treatment, there was no detectable virus even though he was not taking any conventional medicine and was only taking Dr. Chachoua's treatment. The virus was at lower counts i.e. non detectable to the more sensitive tests. He had not been able to achieve this in 5 years of normal treatment. This makes it better than conventional treatment.

Except that during much of that time period Sheen appears to have been still taking his antiretrovirals, and it's not clear at all that Chachoua's treatment had anything to do with this. Admittedly, it's unclear exactly when Sheen stopped his HIV medications, but it doesn't appear to have been for more than a month or so.

To me, the bottom line is that Chachoua is a quack, and Bill Maher sure does love him some quackery, so much so that he irresponsibly promoted Chachoua, lips planted firmly on Chachoua's posterior, on Real Time With Bill Maher on Friday.

Bill Maher: Credulously promoting alternative medicine quackery

If there's one person who is living proof that being an atheist has nothing to do with being a skeptic, it's Bill Maher. Touting himself as being supremely rational in comparison to those "God botherers" and Republicans, Maher has himself embraced antivaccine pseudoscience, other cancer quackery, and general pseudoskepticism about "Western medicine." Nor is this the first time he's embraced HIV quackery, either. Indeed, I've been pointing out for more than a decade now just how much pseudoscience Maher embraces. Unfortunately, in some circles, that doesn't seem to matter. For example, in 2009 Atheist Alliance International awarded Maher the Richard Dawkins Award, which was likened to Jenny McCarthy receiving a public health award.

So I suppose it's not that surprising that Maher went full quack. I just never expected him to embrace so quacky a quack so credulously. My bad.

The first thing that bothered me about the interview was just how unethical it all was. Sure, I was a bit skeeved out by the things Dr. Huizenga revealed, but Sheen was right there and the doctor clearly had Sheen's permission to discuss his case. There was no such deal in the case of Chachoua, who gleefully started disclosing private medical information about Sheen (and did so on his website as well, as discussed above), in clear violation of HIPAA law and medical ethics in general. For instance, he claims that Sheen had severe encephalitis, which, if true, would indicate that he needed to be hospitalized, not treated by a quack. After Chachoua's description of Sheen keeping his house all dark, Maher quipped that that was because of the hookers. (Stay classy. That's all I can say.) Chachoua also claimed that Sheen had liver failure, which is certainly possible given his history of alcohol abuse.

Maher, for his part, does inject a little "skepticism" when he asks, in essence, how come nobody else knows about this if it's so great? Interestingly, as is so often the case (I'm talking to you, Stanislaw Burzynski), Chachoua has a lovely conspiracy theory in which he claims UCLA and Cedar-Sinai Medical Center "came courting" him to test out his work in the mid 1990s, which might actually be true given that the NIH was at the time being politically pressured to examine alternative cancer cures. As is the usual case, this collaboration, if it ever happened, didn't turn out well. If you believe Chachoua, "they published it on their own and buried it." Well, certainly there are no publications by Chachoua about it. Searching PubMed didn't turn up anything. There is another Chachoua who has published about AIDS, but it obviously isn't Samir Chachoua.

So what is Chachoua's claim? Maher played an excerpt from this old news clip (the video quality stinks, unfortunately):

It's a story about a $10 million judgment against Cedar-Sinai for Samir Chachoua for allegedly taking or losing cultures of many of the microorganisms that Chachoua claimed to be able to use to treat and cure cancer and AIDS. (It was at this point that I asked: What kind of idiot gives anyone all of his cultures and doesn't save aliquots for himself?) It's a very credulous report. Of course, Maher neglects to mention a very important bit of follow-up information about that lawsuit, namely that it was dismissed (more on that in a moment), instead choosing to let Chachoua blather on about how he studied spontaneous remission and that led him to his ideas. Meanwhile, Maher waxes poetic about "groupthink" in Western medicine (irony meter destroyed—again) and how it's usually individuals not working for institutions who discover things (maybe 150 years ago, but not anymore, and of course, many of the examples cited did work for hospitals or universities).

He also let Chachoua outright lie. I'm sorry, but it's hard to see how I can characterize what Chachoua said when he claimed that all of Sheen's great tests were during his treatment, not his conventional doctors, any other way. Of course, the plummeting of Sheen's viral load happened in 2011, four years before he ever met Chachoua. Yet Maher never challenged even that blatant of a lie. Instead, he climbed up on his own cross, prefacing his question with an observation about how he would be attacked for featuring Chachoua (consider it done) and Chachoua had been called a quack (which he is). His question was: Does it last? In response, Chachoua claimed that his vaccine had eradicated HIV in a small country (Comoros). It was the sort of obscure claim that most wouldn't be able to check, but someone on Twitter did:

What's wrong, Bill? Couldn't your fact checkers have bothered to Google?

Finally, what really happened with the Cedar-Sinai lawsuit? The judge tossed it out on appeal, stating that the award was based on speculative testimony. Chachoua only received $11,250. HIV activist Peter Staley points out:

The $10 million case that "Doctor" Sam Chachoua claims he won from L.A.'s Cedars-Sinai Medical Center was another lie he told to Bill Maher. The court immediately reduced the "breach of contract" damages to $11,250 (in 2001). Cedars then successfully sued for recovery of their own court costs, in excess of that amount, and Chachoua started missing court dates after that. His own lawyer quit the case at that point. Cedars never paid him a dime. I paid small amounts to look at the case reports, which are endless, starting in 1997, and ending in 2004. One of the court's orders called it "the longest case in this court's history." If any of my legal friends want to provide a fuller account of these record [sic], which are accessible with a PACER account, you can find them all here: https://ecf.cacd.uscourts.gov/cgi-bin/HistDocQry.pl?891618340300786-L_1…

The central reason listed for dismissing the case was:

[Chachoua's] consistent refusal to comply with court orders regarding representation; his pattern of using medical excuses as a device to prolong the action unnecessarily, avoid appearances for deposition or other court proceedings, and obtain continuances at the last minute; and his pattern of substituting counsel in order to secure deadline extensions or continuances of potentially dispositive proceedings.

Staley and Gay City News reporter Duncan Osbourne have also pointed out that Chachoua charges big bucks for his "cures," with one patient paying him $603,000 and then another $21 million over time for treatments that didn't work. Even Stanislaw Burzynski isn't that greedy.

In the past, I've said that nothing Maher could say or do would surprise me anymore. I was mistaken. As highly critical as I've been of his promotion of antivaccine pseudoscience and outright quackery, even I never thought he'd fall for such an obvious cancer quack hook, line, and sinker like this or that he'd let this quack repeat such obvious misinformation, all while admiringly lapping it up. I mention destruction of irony meters, but at the end of his show, the rest of which was fairly standard issue Maher-led political commentary and snark, Maher declared that "Lies are the new truth" thanks to the Internet:

Now there's an irony meter so well and truly fried that it's been vaporized. Bill Maher just doesn't realize it, so far down the rabbit hole of antivaccine pseudoscience and cancer quackery he's fallen.

Oddly enough, Charlie Sheen seems less credulous now than Bill Maher. Once burned, he's now blasting Chachoua on Twitter, calling him, in essence, a liar.