Has another celebrity embraced quackery? [Respectful Insolence]

I never in a million years thought I’d be writing a blog post involving Selena Gomez.

Gomez, as many, if not most, of you are probably aware is currently a young pop star and actress who got her start as a child actress. Oddly enough, she was on Barney & Friends with Demi Lovato. These days, Gomez specializes in the variety of overproduced, lightweight pop that I don’t really listen to, although, ever since I subscribed to Apple Music, I’ve been known to listen to songs by performers like Selena Gomez and Demi Lovato just to see if I could figure out why they’re so popular. So far, I haven’t been able to. Gomez clearly has a good voice, but it’s buried under sweetening, doubling, and other studio wizardry that, when overused as it seems to be in most pop music these days, irritates the rap out of an old fart like myself. But, hey, to each his own. Truly, I have become my parents, complaining that all pop music sounds the same. Of course, old fart that I am, I can’t help but mention that we have actual scientific evidence that, compared to 50 years ago, today’s pop music really does all sound alike because it’s even more formulaic. That’s not to say that there isn’t still great music out there. I discovered a lot of it over the last few years after having emerged from a period of being pretty much oblivious to any music more recent than the early 2000s. It’s just not on the pop charts.

Be that as it may, I only mentioned all this as kind of a background as to why I never thought I’d be writing about Selena Gomez. But then, the other day, my Google Alert for “alternative medicine” popped up a most unexpected story, Selena Gomez ‘Seeking Alternative Treatments For Lupus’: Organic Diet, Juicing & More. The first surprise to me was that Selena Gomez apparently has lupus. Being as oblivious as I am to the sort of pop music Gomez produces, I had had no idea that she even had lupus, but she was diagnosed a few years ago and has been .undergone treatment for lupus up to and including chemotherapy. I’ll get into that later. For now, here’s what the story I saw is reporting. I take it with a grain of salt because it’s not Gomez herself saying it but rather an unnamed source:

Selena Gomez, 24, has had it with pills, steroids, and bed rest. She’s planning to take her lupus, a disease in which the body’s immune system attacks healthy tissue, from a whole new angle: holistically. Selena told fans in early September 2016 that she’s struggling with lupus-related panic attacks and depression, but now she’s determined to turn her life around. She’s enlisted a new team of holistic doctors, naturopaths, and acupuncturists.

“Selena Gomez has not experienced a lot of relief from classic western medicine, and is seeking alternative treatments for her lupus diagnosis,” a source close to the singer told HollywoodLife.com EXCLUSIVELY. “She wants to begin ‘chelation therapy,’ which is a method of pulling toxins and metals out of the body. She’s switched to an all organic, grain-free diet, and thoroughly ‘detoxed’ her house. All her soaps, beauty products, and cleaning supplies are natural and organic.”

And that’s not all! “She’s also juicing 3 times a day. Her new team of doctors thinks drugs will only cover up the problem, but [these methods] will really help, if not cure [her lupus]!” Hopefully this works out for Selena! She revealed in 2015 that she had major problems with some of the traditional medicine that she tried. Selena told her fans that she had undergone chemotherapy to treat the illness. She was weak, nauseous, and her hair thinned as a result. Poor Selena!

OK, again, this is just an unnamed source interviewed by a Hollywood gossip website. Still, it doesn’t sound implausible. If it’s true, the only good thing I can say is that apparently Gomez herself is keeping it silent (unless, of course, she wanted that source to leak the information). Before I look at the quackery, let’s first take a look at lupus.

Contrary to Dr. House’s famous admonition, sometimes it is lupus. Systemic lupus erythematosus (SLE) is an autoimmune disease in which the body’s immune system mistakenly attacks normal organs and healthy tissue. The mechanism involves an immune response against the patient’s own tissues by autoantibodies (antibodies to self), most commonly antinuclear antibodies (ANA). The attack of these antibodies against normal tissue does what immune activation does: It results in inflammation. Unfortunately, the manifestations of SLE are protean, and its severity can range from mild to severe. Common symptoms include joint pain and swelling, rashes, hair loss, chest pain, mouth ulcers, lymphadenopathy, fatigue, and many others. It’s also a disease whose symptoms can wax and wane markedly, with periods of remission, during which the sufferer is relatively symptom-free, interspersed with “flares,” when symptoms become much more troublesome and serious. It’s a lot more common in women than in men, and it is not infrequently diagnosed

If you want a disease that is perfect for quacks, it’s SLE. Its manifestations can be so varied and its course can wax and wane so markedly that it’s been called the “great imitator,” with a delay in diagnosis of years being more the rule rather than the exception:

Imagine yourself as a young woman who by all accounts appears healthy. One day you experience flu like symptoms, see your physician, and are sent home with the usual: sleep, hydrate, take two of these, and you get better. But do you? Some time passes and you become sick again, this time with a different gamut of symptoms including recurring infections, joint pains, headaches, fatigue, depression, rashes, etc. As a result, you find yourself in and out of this complicated domestic health care delivery system, seeing one physician/specialist after another and are left with little to no answers.

Fast forward a few years. You’re now in your mid-twenties and have found a personal physician who took the time to listen to your story of diverse symptoms. After reviewing your current symptoms, laboratory tests, and medical history, you finally have the answer to the question you’ve been asking yourself for years: Why am I always sick? You have systemic lupus.

To get an idea of how hard SLE can be to diagnose, take a look at the American College of Rhematology’s criteria for diagnosis. For purposes of diagnosis and inclusion in clinical trials, a patient has a diagnosis of lupus if any 4 out of 11 symptoms are present simultaneously or serially on two separate occasions.

1. Malar rash (rash on cheeks)
2. Discoid rash (red, scaly patches on skin that cause scarring)
3. Serositis: Pleurisy (inflammation of the membrane around the lungs) or pericarditis (inflammation of the membrane around the heart)
4. Oral ulcers (includes oral or nasopharyngeal ulcers)
5. Arthritis: nonerosive arthritis of two or more peripheral joints, with tenderness, swelling, or effusion
6. Photosensitivity (exposure to ultraviolet light causes rash, or other symptoms of SLE flareups)
7. Blood—hematologic disorder—hemolytic anemia (low red blood cell count), leukopenia (white blood cell count<4000>
8. Antinuclear antibody test positive
9. Immunologic disorder: Positive anti-Smith, anti-ds DNA, antiphospholipid antibody, and/or false positive serological test for syphilis
10. Neurologic disorder: Seizures or psychosis

You get the idea. When the criteria for diagnosing a disease are so broad, it’s a tough disease. So patients with SLE are frequently not diagnosed right away and misdiagnosed before the correct diagnosis is arrived at. Once diagnosed, the treatments can be difficult and not provide as much relief as patients would like. Basically, the treatment involves trying to prevent flares and decreasing their severity when they do occur. drugs used include nonsteroidal anti-inflammatory drugs (NSAIDs), antimalarials (which are also useful for lupus), steroids, immunosuppressives, and biologics (such as Belimumab (a type of agent referred to as a B-lymphocyte stimulator protein inhibitor).

The chemotherapy that Gomez received was almost certainly cyclophosphamide. It is a chemotherapy drug, one that is part of the standard of care multimodality treatment of breast cancer. The dose used in lupus is lower and the course of treatment is shorter, but the drug is the same. That Gomez received cyclophosphamide indicates that she must have had severe manifestations of the disease because the drug is so toxic that it is generally reserved for the most severe complications of SLE, such as severe kidney inflammation or other organ-threatening complications, such as brain inflammation. Basically, cyclophosphamide is an alkylating agent that targets rapidly dividing cells, and during severe inflammation immune cells are rapidly dividing. That’s the rationale.

So let’s circle back to alternative medicine for lupus. First of all, there is no known alternative medicine that affects the course of the disease. In fact, some herbal medicines can provoke or worsen flares. Reading between the lines, if this source is accurate, it doesn’t sound as though Gomez is using alternative medicine in addition to conventional medicine; i.e., as “complementary” medicine. Regular readers know that I’m no fan of so-called “complementary and alternative medicine” (CAM), now more commonly known as “integrative medicine” because integrating quackery with real medicine does not benefit patients and degrades the science of medicine by diluting it with pseudoscience.

Whenever I hear a story of someone getting together a “team of holistic doctors,” I get worried, because if the whole team is “holistic,” that generally means that there are no science-based doctors involved or, at best, there might be an “integrative medicine” practitioner who buys into the woo. Certainly the description of treatments being offered suggests this to be true, particularly given that the team is described as being composed of “holistic doctors, naturopaths, and acupuncturists.” I could have told you that there were naturopaths involved if you just told me the treatments Gomez is undergoing, nearly all of which consist of some form of bogus “detoxification,” such as the “grain-free” diet, the “detoxing” of her house, the juicing, and especially the plan to begin “chelation therapy.” As I’ve described before, naturopaths and other alternative medicine practitioners love to invoke The One True Cause of All Disease, and often that One True Cause is unnamed, undefined, but ubiquitous “toxins” that are making you sick. Unfortunately, chelation therapy is not only ineffective, but it is potentially dangerous. True, it’s probably safer than cyclophosphamide, but cyclophosphamide works. Chelation therapy doesn’t. So chelation therapy is all risk, no benefit. No doubt, if this story is true, Gomez is paying big bucks for these quack treatments.

Unfortunately, SLE is the sort of disease that quacks love because it is so difficult to diagnose and treat and because it has such variable manifestations and relapsing course. The drugs used to treat it have significant side effects and can even be toxic, which is unfortunately the case when drugs target an overactive immune system. Naturally, a young woman with a busy career that depends upon her ability to sing and dance would chafe at the limitations SLE imposes, the unpredictability of the disease, and treatments that are not as effective as we’d like them to be. Being only 25, facing the prospect of a life with this disease and lifetime treatment with these drugs must certainly be unappealing. So it’s understandable why Gomez might want to try something “nontoxic.” It’s understandable, but a mistake. Many are the SLE sufferers who discovered the hard way what a mistake going off their drugs was when their disease symptoms came roaring back.

What worries me about this story if it’s true is this. If Gomez experiences a prolonged period of remission while she’s using all this quackery, you can count on her publicist revealing it and there being laudatory stories about how “brave” she was to have chosen this course. This, in turn, might persuad others with SLE to follow a similar course. That’s the problem with celebrities choosing woo over medicine; they have influence. That’s why I’m hoping this story is nonsense but fearing that it isn’t.