Quebec journalist quits chemo, sparking storm of controversy
In Quebec, you know you are famous — or about to become infamous — when you are invited to be a guest on the Radio-Canada television show Tout le monde en parle.
In English, that means "everybody is talking about it." And in French-speaking Quebec, that is true. Every Sunday evening, one in every four Quebecers tunes in. The next day what was on the show is in the news.
Tout le monde en parle is a talk show with a house band and an edgy host who delights in guests who are provocative and — rightly or wrongly — take on the establishment and sacred cows.
And that is exactly what Josée Blanchette did on Tout le monde en parle last fall.
The long-time Le Devoir columnist and broadcaster is a three-time cancer survivor. Her new book explains her own decision to quit chemotherapy and sharply questions the value of chemo in the treatment of many kinds of cancer.
On the show, she said she recognized the success of chemotherapy as a treatment for children with cancer, as well as for adults with leukemia. But she argued that chemotherapy does not work well for a majority of other adult cancers.
By the next morning, her 18 minutes on TLMEP had made its way into headlines, hospital waiting rooms and clinics.
Anecdotes are a good way of getting attention, even if they cannot be proved. They leave a mark, perceptions that may be false and that remain for a long time. No one is saying that chemotherapy will benefit everyone, but to say that all chemotherapy is useless is simply wrong and requires correction.- Letter from a group of Quebec oncologists , following Blanchette's interview
Prominent oncologists called her wrong-headed, reckless and dangerous.
Her book, Je ne sais pas pondre l'oeuf, mais je sais quand il est pourri became an instant bestseller. (Translation: I don't know how to lay an egg, but I know when it's rotten)
David Gutnick's documentary for The Sunday Edition is called, "I Did My Job: I Question."
'A lot of anguish'
Like more than a million-and-a-half other Quebecers, Dr. Denis Soulières was home that evening, watching television when Josée Blanchette dropped her bomb.
Soulières is a hematologist and oncologist at Montreal's CHUM cancer centre. He specializes in head and neck cancer and co-edited an oncology textbook.
"The next day, patients were questioning our reasoning, because they heard on Tout le Monde that chemo does not work and can only improve your chance of survival by two per cent. That is what they understood. And being told bluntly that you are being treated uselessly, that obviously created a lot of anguish," he says.
The next day an open letter — written by Soulières and signed by eleven other Quebec oncologists — was all over the news. They accused Blanchette of being insensitive to sick people and their families in the throes of life and death decisions.
Madame Blanchette seems to have forgotten to mention all of the people who chose chemotherapy knowing full well what the consequences might be, because they want to live longer and want to keep and improve their quality of life. And the medicines that are based on solid studies, analysed by specialists in federal and provincial health departments. There is no lobby, no corporatism, no collusion working against the best interest of patients.- Letter from a group of Quebec oncologists , following Blanchette's interview
'I'm quitting. This is it.'
Blanchette was told she had colon cancer with metastatic lymph nodes in April 2014. Her doctor sent her to see an oncologist and start chemo.
"After you know, you have to go in chemo and this is it. And this is the protocol because this is the protocol," says Blanchette.
A week later, she was at the hospital, sitting in a lounge chair, getting chemo. That session lasted for five hours. The side effects began immediately.
"My jaw was blocked. Nausea, everything," she says."One night in particular, my husband wasn't home and I was alone, and a friend was taking care of my son. And I was completely gone. I saw my death, and I said, 'No, they're going to kill me.' So I called the oncologist and I said. 'I'm quitting. This is it.'"
Blanchette decided she needed to find out more. Over the next two years, she read everything she could find on cancer, from peer-reviewed scientific studies about chemotherapy to articles about integrative medicine and alternative treatments. She interviewed dozens of doctors — oncologists, surgeons, public health care specialists — as well as cancer survivors and their families.
Today, she spends a lot of time in her light-filled apartment kitchen, preparing meals and mixing up capsules of turmeric, ginger and pepper she hopes are good for her health.
The international science journal Nature notes that a comprehensive critical review of the chemical found in turmeric concluded that there is no evidence it has any specific therapeutic benefits.
'A rigorous evaluation … is urgently required'
On Tout le Monde en Parle, Blanchette did mention the conclusions of one key peer-reviewed medical article.
It was published in the Australian journal 'Clinical Oncology' in 2004. The three authors — all oncologists — reviewed studies on the five-year survival rates of adult patients treated during the 1990s who had chemotherapy for 22 kinds of major malignancies.
The authors found the chemotherapy success rates for some cancers averaged between 2.1 to 2.3 per cent. That is where Blanchette got the two per cent figure she referred to in her interview.
The authors conclude that, "Despite the early claims of chemotherapy as the panacea for curing all cancers, the impact of cytotoxic chemotherapy is limited to small subgroups of patients and mostly occurs in the less common malignancies. A rigorous evaluation of the cost-effectiveness of chemotherapy and its impact on the quality of life is urgently required."
Other cancer patients respond
Blanchette's TV appearance was a hot button subject at the Hope and Cope Centre in Montreal. It's a place where people with cancer come to meet counsellors or peer support groups.
A woman named Julie told David Gutnick that chemotherapy had worked quickly to kill her tumours. Brigette's breast cancer disappeared, but the side effects were heavy: she suffered a stroke.
Another woman, Anne, said after chemotherapy, her cancer is also gone. She suffered no side effects whatsoever.
These women had all hoped for an in-depth discussion about cancer treatment when they tuned in to Tout le Monde en Parle to hear Blanchette that Sunday evening. It did not happen.
"Maybe she wasn't doing it deliberately, but her message was chemo was bad for me, it's bad for everybody, you shouldn't take it, stay home and drink green juice and you'll be fine," said one woman. "That was the way it came off."
Costs and benefits
In Quebec, Blanchette's book is selling briskly. Now she can also point to a new article in the British Medical Journal called "Cancer Drugs, Survival Rates and Ethics," by endocrinologist Peter Wise.
After reviewing literature on chemotherapy treatment and survival rates, including the Australian study, Dr. Wise concludes: "Spending a six figure sum to prolong life by a few weeks or months is already unaffordable, and inappropriate for many of the 20 per cent of the population who will almost inevitably die from solid tumour metastases."
Blanchette says a more open conversation about the costs and benefits of chemotherapy is urgently needed.
Everybody used to say how going into chemo, ' Oh, that's so personal, you know.' Yes, sure, it's personal. But then I thought, you know, how much it cost the country. $65,000, that's the average cost for a chemo ... How are we going to afford this as a country?- Josée Blanchette
'I did my job'
Soulières says Blanchette has the right to make her own decisions, but he believes "she created anguish in patients … and she downgraded their hope that there is a system that is trying to work for them."
"I think she damaged the one thing that people value the most in their life," he says.
"Hope is what keeps patients going in their chemotherapy — the hope that the next day they are going to be better, the hope that they will get to be with their family as long as possible, and she was bringing down their hope in the way she was talking about having cancer."
As for Blanchette, she says she is satisfied with her testimony, and with the legacy she is leaving for her son.
"Maybe nobody has the ultimate answer, and maybe we can keep on questioning, and maybe as a journalist I did my job," she says. "I question."
Chemotherapy doesn't work? Not so fast…, from Science-Based Medicine
A series from The New York Times, exploring the use of immunotherapy in cancer treatment
- Faut-il avoir peur…de la chimiothérapie? (Should we be afraid of chemotherapy?), from the Montreal magazine L'Actualité
- Les chimiothérapies n'ajoutent que 2 % au taux de survie après cinq ans? Plutôt faux (Chemotherapy adds only 2% to the survival rate after five years? Rather false), from Agence Science-Presse
- Evidence, value and hope -- Allocating resources for cancer from the Journal of Cancer Policy
Click the 'play' button at the top of the page to hear David Gutnick's documentary.