Update: Dan Rheil has a good round up on the questionable Ms Smith. – end update

There has been valid criticism over the Obamacare Infomercial held here in VA recently, where the first question went not so coincidentally to an Obama worker. The worker told a heartfelt story about renal cancer and lack of insurance. The question posed by one of my readers with the same condition as she claimed is – was it all an act?

Here is the claim made by Debbie Smith of Appalachia, VA, who was invited to the event by the White House (now that is having some serious connections):

Debby Smith, 53, of Appalachia, Va., was fighting tears as she told the president of suffering from renal cell carcinoma in 1998. The tumor was treated with radiation, but she was no longer able to work and has no health coverage now.

“Now I have a new tumor,” said Smith, explaining that she cannot get treatment, cannot get disability from Social Security, cannot get Medicaid, has dependent kids at home.

Emphasis mine. One has to wonder why she is not been able to work, and why she is not covered under medicare/medicaid (supposedly she is a Veteran, and would easily be covered). But beyond these basic questions comes a scientific one – renal cell carcinoma does not respond to radiation treatments, especially a decade ago in 1998. So is this all staged?

Here is reader SBD to explain, being a victim of the exact same disease:

As someone who has been postinbg to this site and performed in depth investigations into certain subject matter, I never thought that the one subject matter that I have investigated the most in my life would ever be the subject of a post on AJ’s blog, but here it is.

In January of 2006, I had a full body scan done not because I needed it, but just to accompany my father who was having health issues that his doctors could not diagnose. We had been trying to get him to do a full body scan to see if it could find what was ailing him. Finally in December 2005 he said he would to it if I did it with him. I was just 33 at the time and had no health issues to complain about.

We had the scans on Friday the 13th of January 2006. It turned out that my father was fine, but I on the other hand was told that something had showed up in my kidney and another scan was needed with a contrast dye to determine what it was. I had no symptoms of any kind and frankly thought it was nothing to worry about. I had the second scan on February 1, 2006 and was given the results on February 3, 2006. I was told to see my doctor because what they found was a 2.3 cm tumor in my right kidney.

I was diagnosed with Renal Cell Carcinoma after a pathology report that occurred after surgery. Biopsy is rarely if ever used for kidney tumors due to the risk of spreading the cancer from the kidney to other parts of the body.

How this woman was definately diagnosed with Renal Cell Carcinoma without removing the tumor is beyond me and how she can state with a straight face that she did not have her kidney removed because she was caring for her father when removal of the tumor is the only effective treatment for kidney cancer is frankly insulting to me and other kidney cancer survivors. What is even worse is how the NIH website now all of a sudden lists radiation as a treatment for RCC when it has been proven to ineffective for RCC.

Use of radiotherapy

* Renal cell carcinoma cells were the most radiation-resistant cells among 694 cell lines (271 tumor-derived and 423 fibroblast-derived), with D = 4.8Gy (compared with for example melanoma D = 2.51Gy)
o Paris, 1996 (France) PMID 12118559 — “A review of human cell radiosensitivity in vitro.” (Deschavanne PJ, Int J Radiat Oncol Biol Phys. 1996 Jan 1;34(1):251-66.)

* Copenhagen Renal Cancer Study Group, 1987 (1979-84) – PMID 3445125 — “A randomized trial of postoperative radiotherapy versus observation in stage II and III renal adenocarcinoma.” Kjaer M et al. Scand J Urol Nephrol. 1987;21(4):285-9.
o 72 pts. Stage II-III. After nephrectomy, randomized to RT vs observation. RT was 50 Gy in 20 fx to kidney bed, ipsilateral and contralateral nodes
o No benefit for relapse rate or survival. Unacceptable toxicities from RT.

The second study above was [for] after surgery [is] performed because removal of the tumor is the only acceptable treatment because chemo and radiation don’t work on kidney cancer.

16-280 Attorneys’ Textbook of Medicine (Third Edition) P 280.130

AUTHOR: Pamela Charney, M.D.Kate Casano

P 280.130 TUMORS OF THE KIDNEYS

[6] Treatment

Radical nephrectomy (total surgical excision of the kidney and surrounding tissues) is the accepted treatment for renal cell carcinoma. Other conventional cancer treatments are ineffective or only have a role in the treatment of metastatic disease. Immunotherapy is an investigational treatment that seems a promising new approach for advanced disease.

[d] Radiation Therapy Radiation therapy has little role in localized or metastatic renal cell carcinoma. Preoperative or postoperative radiotherapy in patients with primary renal cell carcinoma has not proved effective in prolonging the interval before disease recurrence; however, radiotherapy can sometimes palliate symptoms in patients with advanced disease. Many chemotherapy regimens have been investigated in metastatic renal cell carcinoma, but response rates have been disappointing. Hormonal therapy also appears ineffective, despite encouraging results of early studies.

[7] Prognosis Untreated renal cell carcinoma has an extremely poor prognosis. The natural history of renal cell carcinoma–that is, its course if left untreated–has been a subject of great interest because of its unpredictability. Spontaneous regression of metastatic renal cell carcinoma sometimes occurs following resection of the primary tumor, but not often enough to recommend resecting a tumor in the hopes of inducing a remission of metastatic disease (Neuwirth, et al., 1990). The primary tumor and metastases have variable growth rates and may sometimes grow quite slowly. However, renal cell carcinomas usually are not diagnosed until they are large, metastatic disease usually progresses rapidly and renal cell carcinoma is highly lethal.

The misinformation from this so called town hall meeting is simply outrageous!! The possibility that radiation might be an alternative to surgery was investigated for the first time last year and the results have not even come close to becoming in use by the urologists and oncologists who treat this disease.

Int J Radiat Oncol Biol Phys. 2008 Nov 1;72(3):828-33. Epub 2008 Apr 18.

Carbon ion radiation therapy for primary renal cell carcinoma: initial clinical experience.
Nomiya T, Tsuji H, Hirasawa N, Kato H, Kamada T, Mizoe J, Kishi H, Kamura K, Wada H, Nemoto K, Tsujii H.

Research Center for Charged Particle Therapy, National Institute of Radiological Sciences (NIRS), Chiba, Japan.

PURPOSE: Renal cell carcinoma (RCC) is known as a radioresistant tumor, and there are few reports on radiotherapy for primary RCC. We evaluated the efficacy of carbon ion radiotherapy (CIRT) for patients with RCC.

CONCLUSIONS: This is one of the few reports on curative radiotherapy for primary RCC. The response of the tumor to treatment was uncommon. However despite inclusion of T4 and massive tumors, favorable local controllability has been shown. The results indicate the possibility of radical CIRT, as well as surgery, for RCC.

SBD

It took no effort to confirm SBDs claims (while I had little doubt of SBD’s veracity, I had to make sure).

Renal cell carcinoma (RCC, also known as hypernephroma) is a kidney cancer that originates in the lining of the proximal convoluted tubule, the very small tubes in the kidney that filter the blood and remove waste products. RCC is the most common type of kidney cancer, and the most common type in adults, responsible for approximately 80% of cases.^[1]. Initial treatment is most commonly a radical or partial nephrectomy and remains the mainstay of curative treatment.^[2] Where the tumour is confined to the renal parenchyma, the 5-year survival rate is 60-70%, but this is lowered considerably wheremetastases have spread. It is resistant to radiation therapy and chemotherapy, although some cases respond to immunotherapy.

Now, could Ms. Debbie Smith possibly be mistaken in what she had, simply using the improper term? It’s possible I suppose. But since the entire event was clearly staged with hand selected people in the audience whome Obama knew to call on, I am now wondering if the stagecraft went beyond just handpicking the questions. I wonder if there was fiction to the stories being told as well?

SBD provided and update on his condition, and more references that question the veracity of the entire made-for-TV drama.