NC Medical Board Dr. Rashid A. Buttar Transcript - Page 5 of 16
different stages, what are some of the safeguards that are used in such research?
AWell, they'll have these data monitoring boards ‑- and I don't really do this work any more, so I'm probably somewhat out of date.
But they'll have data monitoring boards and this data has to be really -- at certain intervals depending on the trial -- if there's any ‑- and there's ‑- the physicians that have patients on these trials are required to report any ‑- any adverse reaction. There's a form they fill out.
Any adverse reaction that's reported is immediately investigated. If there's any indication there's a problem, a trial can be halted by the state or city monitoring committee.
And in addition to that, all of these institutions are monitored by the NIH and they come down a couple of times a years, they withdraw the data on all the patients to make sure that they aren't having what are called protocol violation.
You can't increase the dose or decrease the dose, very rigid criteria, for the cancer could affect blood counts with treatment and you're required mandatory reductions based on the blood counts and make sure that you are dose reducing appropriately or dose delaying appropriately or recording adverse events appropriately.
Does that answer ‑-
QWell, why are ‑- why are they necessary? That's ‑- why are these safeguards necessary?
AWell, you don't want to be giving unnecessary treatments. You want ‑- you don't want to be offering patients treatments that do not have proven benefit. And the FDA is in business in approving drugs only if they have a proven benefit.
QOkay. And I'd now like to turn your attention to Patients A, B, C and D. Okay. Did you review those records for the Medical Board?
AYes, I did.
QAnd do you have an opinion to a reasonable degree of medical certainty as to whether the treatment provided by Dr. Buttar to Patients A, B, C and D ‑- well, let's just go for A, B and C, to Patients A, B and C was within acceptable prevailing standards of medical practice for the treatment of cancer in North Carolina?
MR. KNOX: Objection.
MS. GODFREY: Objection.
PRESIDENT RHYNE: What is the basis?
MR. KNOX: The basis of my objection, he's qualified as hematology/oncologist and not as an integrative doctor and if I need to, I can at this point, but there's no evidence to show to the Board that he has qualifications in his deposition that says he knew nothing about alternative medicine or integrative medicine.
MR. JIMISON: This is a good point for me to respond to Mr. Knox. The law in North Carolina and I'll read it to you, is 90-14(a)(6) and during the closing arguments we argued this case to the Medical Board, we'll be stressing this and this is important.
It says under the disciplinary authority of the Board 90-14(a)(6), it says: Unprofessional conduct, including, but not limited to, departure from, or the failure to conform to the standards of acceptable and prevailing medical practice, or the ethics of the medical profession, irrespective of whether or not a patient is injured thereby, or the committing of any act contrary to honesty, justice, or good morals, whether the same is committed in the course of the physician's practice or otherwise, and whether committed within or without North Carolina.
They're saying that you have to conform to acceptable and prevailing standards of medical practice and that the label you put on your ‑- the doctor, the doctor's label is irrelevant. It is totally irrelevant. You have to conform to acceptable and prevailing medical practices for the disease that you're treating. That's the law.
Here and with your permission, Dr. Rhyne, I will hand up the Supreme Court case, In Re: Guess.
MS. GODFREY: I've got a copy.
MR. JIMISON: In the In Re: Guess case, the North Carolina Supreme Court was confronted head on with the argument that Dr. Guess who was practicing what's called homeopathy and could be judged only by homeopathic standards, that in order for the Board to judge him, he had ‑- the Board had to have other homeopaths come in and testify that there has to be a homeopathic standard and he can only be charged with ‑- he can only be judged under the homeopathic standard.
The In Re: Guess said, that, no, the statute permitting the revocation of a physician's medical license for unprofessional conduct based on acts which do not concern ‑- which do not conform to the standards of acceptable and prevailing medical practice in North Carolina.
They're just saying, you have to conform to acceptable and prevailing medical practices in North Carolina. That is the law.
This case has never been overturned.
Subsequent to the Guess case, the North Carolina General Assembly added the following language to the statute. And that statute is that the Board shall not revoke the license or deny a license to a person solely because of that person's practice of a therapy that is experimental, non-traditional, or that departs from acceptable and prevailing medical practice, unless by competent evidence the Board can establish that the treatment had a safety risk greater than the prevailing treatment or that the treatment is generally ineffective.
What the General Assembly is saying is that you have the right to regulate the practice of medicine so long as it's ‑- so long as it's outside, it departs from acceptable and prevailing practices.
What you can't do is revoke the license unless you make a finding that it's generally ineffective or has a safety risk. They tie the integrative medicine standard to the penalty. That's the law as it exists right now.
So what you have to decide are, what are the acceptable and prevailing medical treatments in North Carolina for the treatment of cancer. You take the patient, the standard is ‑- is pointed to the patient and what the patient has and what the patient is being treated for.
You can't slap a label ‑- a doctor can't slap a label on himself and say I'm outside the rules now. The statute does not say that. The George ‑- the In Re: George Guess, Dr. Guess case does not say that.
The only thing that has changed is that before the Board can revoke a license, they have to make certain findings.
Now, Dr. Peterson will also testify as to the other findings about whether it's generally effective or whether it ‑- or has a safety risk that's greater than the prevailing treatment, so he's qualified to testify to both.
But the law in North Carolina under this Guess case and under the way the statute is written right now, is that you only determine what are the prevailing and acceptable medical standards in North Carolina for the treatment of what the patient has.
That's what the law is and that law ‑- the Guess case has never been overturned and this law as you're aware of, because we did a wholesale revision to the Medical Practice Act just a year or so ago where we added additional disciplinary options. You know, we can do public letters of concern, we can do censures, we can do fines.
So when they changed that act, they left this sentence in the law saying that, you know, still that tieing the integrative medicine standard or actually it's not integrative medicine standards, this 90-14(a)(6) in the disciplinary authority doesn't even use the word integrative.
It just says before you can revoke a license that departs from acceptable and prevailing medical practice, you have to make a finding of whether or not it's generally ineffective or it has a safety ‑- a greater safety risk, but you can still regulate. You can still regulate the medicine.
The other part of the argument would be that if you cannot do that, then everything goes. Then everything goes no matter what goes ‑- I mean, no matter what happens in a doctor's office, everything goes so long as, you know, the doctor can say, well, it's not hurting anyone or I have some effect.
The General Assembly did not say that. They only tied it to revocation. So ‑- so the argument that there is ‑- there is a standard for all other doctors and there's a different standard for integrative doctors is not supported by the statute. It's not supported by the In Re: Guess case.
And so the objection is ‑- is completely incorrect. It is just a totally incorrect statement of the law under the statute and under that In Re: Guess case.
And so therefore I think the qualification for Dr. Peterson to testify what are the acceptable and prevailing medical standards in North Carolina for the treatment of cancer is well within his authority, well within his expertise and well within the law. In fact, it is the law. So that's how I would respond to that objection.
MS. GODFREY: With all due respect to Mr. Jimison, I think he has misquoted the Guess case, first of all. The Guess case deals with the issue of ‑- of whether or not there has to be ‑- there has to be a showing of harm to the patient and it's back in 1990 and it went through the courts several times and finally the Supreme Court said that you can revoke a doctor's license without showing that they've harmed the patient. That's the holding of the Guess case.
The Guess case does not address this issue of standard of care and there's been a lot of evolution in the law since 1990 on the issue of standard of care. We are not saying that integrative medicine doctors need ‑- need to be judged under a special rule.
What we are saying is, is that the Medical Practice Act and the law of North Carolina is that you judge the standard of care by a doctor with same or similar training.
We are familiar in the medical malpractice arena that a general practice doctor cannot be held to the same standard of care for diagnosis and treatment of any condition as a neurosurgeon or any other kind of specialist.
And what we are saying is the way the Medical Malpractice Act is structured and the way the law of North Carolina is structured and the way those words are interpreted under the law of North Carolina, you have to judge each medical specialty by the standards of care of that medical specialty. It only makes sense.
And what we are saying is that although Dr. Peterson may be well qualified to judge the conduct of an oncologist treating cancer, we do not believe that he is well qualified to judge the conduct of Dr. Buttar who is not an oncologist, who is a doctor practicing integrative medicine which is defined by the statute and recognized by the statute as the diagnosis or therapeutic treatment that may not be a conventionally accepted medical treatment.
By it's very definition, integrative medicine is outside Dr. Peterson's standard of care because Dr. Peterson treats patients under the conventionally accepted medical practice. And that's fine, but sometimes the conventionally accepted medical practice fails.
And what we're saying is that patients have a right to seek an integrative medicine doctor who practices outside conventionally accepted medical practice and that doctor's right to practice his type of medicine ought to be protected the same as Dr. Peterson's is.
And so for that ‑- that's the basis of our objection to him testifying against this doctor.
They don't have another expert. They don't have an integrative doctor here, they have an oncologist and he has an opinion and he's entitled to that opinion, but his opinions should not be the standard upon which we judge Dr. Buttar because he's in a different field.
MR. JIMISON: If I can just respond quickly to that because I handed the case out to you and if I can draw the Board's attention to just some of the language in the case, I think it would be very instructive.
If you can turn to page 5, to what's called Head Note 1. I've highlighted it on my copy so you can follow along.
MS. GODFREY: What page are you on, Marcus?
MR. JIMISON: Page 5.
MS. GODFREY: Okay.
PRESIDENT RHYNE: And I can give you a copy of mine. It's Headnote 1. It says ‑- and this is the North Carolina Supreme Court talking. The provision of the statute in question here is reasonably related to the public health. We conclude that the Legislature in enacting 90-14(a)(6) -- for which Dr. Buttar has been charged with -- reasonably believe that a general risk of endangering the public is inherent -- and it quotes and italicized -- any practices which fail to form to the standards of acceptable and prevailing medical practice in North Carolina.
We further conclude that the legislative intent was to prohibit any practice departing from acceptable and prevailing medical standards without regard to whether the particular practice itself could be shown to endanger the public.
Our conclusions are buttressed by the plain language of the statute which allows the Board to act against -- and again it italicizes it -- any departure from acceptable and medical practice irrespective of whether or not a patient is injured thereby.
By authorizing the Board -- and this is a Medical Board case -- they're talking about this Medical Board.
By authorizing the Board to prevent or punish any medical practice departing from acceptable or prevailing standards, irrespective of whether a patient is thereby injured or injured thereby, a statute works as a regulation which tends to secure the public generally against the consequences of ignorance, in any capacity, as well as deception and fraud, even though it may not immediately have that direct effect in this particular case. Therefore, the statute is a valid exercise of the police power.
If you turn over to Page 6 on the second column and this is Dr. Guess arguing that, well, he's a homeopathic doctor, he should be judged only by homeopathic standards. It says: Dr. Guess strenuously argues that many countries and at least three states recognize ‑-
MS. GODFREY: Excuse me, Marcus. We have a different version of the ‑- of the case than you do. Can ‑- can you give me your version because we can't follow where you're ‑- you're on page 6?
MR. JIMISON: Uh-huh (yes).
MS. GODFREY: At what headnote?
MR. JIMISON: Number 4, second column, midway down where it says, Dr. Guess strenuously.
It says: Dr. Guess strenuously argues that many countries and at least three states recognize the legitimacy of homeopathy.
While some physicians may value the homeopathic system of practice, it seems that others consider homeopathy an outmoded and ineffective system of practice. This conflict however interesting, simply is irrelevant here in light of the uncontroverted evidence in the Board's findings and conclusions that homeopathy is not currently an acceptable and prevailing system of medical practice in North Carolina.
While questions as to the effectiveness of homeopathy and whether its practice should be allowed in North Carolina may be open to valid debate among members of the medical profession, the courts are not the proper forum for that debate.
Then Ms. Godfrey talked about, well, patients should be able to have the right to chose whatever treatment they get outside of conventional standards.
If you turn to page 7, the Supreme Court addressed this issue very much as well. Headnote 6, right before you get to ‑- in the second column right before you get to Head Note 7, it's kind of up here. It says ‑- well, I actually have to start ‑- it starts at the very bottom of the first paragraph on Headnote 6.
It says: Regarding Dr. Guess's claim that the Board's decision invades his patient's right to select a treatment of their choice, we initially note that he has no standing to raise his patient's privacy interest in this regard.
The most ‑- the next sentence is the most important, after you get through the cites of cases.
Further, we have recognized no ‑- no fundamental right to receive unorthodox medical treatment and we decline to do so now. There is no right to seek any kind of treatment you want from anybody, any time, anywhere in North Carolina.
That's the law in Dr. Guess's case. It was a Medical Board case. It's from 1990. It's never been overturned. The statute has the exact same language as it did then.
The only change has been is that when we get to Phase II, if there is a Phase II and the Board decides they want to revoke Dr. Buttar's license, then and only then does it become relevant as to the two findings that you have to make about whether it poses a greater safety risk or whether it's generally ineffective. Both factors can be addressed by Dr. Peterson.
And there's nowhere in this case that says that specialties can only testify against other specialties and non-specialties or this specialty.
They're talking about what are acceptable and prevailing treatments for patients in North Carolina. So if a patient comes to a doctor with cancer, what is the acceptable and prevailing treatment for cancer for that doctor. And if that doctor is of a specialty, he still has to treat it within those acceptable standards of care. So ‑-
PRESIDENT RHYNE: I'm going to overturn this objection.
Mr. Jimison, if you would proceed.
MS. GODFREY: Okay.
MR. KNOX: Would you reserve us an objection to every time the question is asked or we can just notify the court reporter as we go through, if that's okay, without interrupting?
PRESIDENT RHYNE: That'll be fine.
MR. JIMISON: I agree to that.
Q(By Mr. Jimison) Okay. Dr. Peterson, do you remember the question?
ANo, I don't.
QLet me rephrase the question. Let me re-ask the question.
Do you have an opinion as to whether the treatments provided by Dr. Buttar to Patients A, B and C were within acceptable and prevailing standards of ‑- wait a minute.
Do you have an opinion to a reasonable degree of medical certainty as to whether the treatment provided by Dr. Buttar to Patients A, B and C was within acceptable and prevailing standards of medical practice for the treatment of cancer in North Carolina?
AYes.
QAnd what is that opinion?
AThat they were below the standard.
QOkay. Do you have an opinion as to whether the treatment provided by Dr. Buttar to Patient D was within acceptable and prevailing medical standards of ‑-
MR. KNOX: Objection.
Q‑- of medical practice?
AWhich one is D?
QThe non-cancer patient?
AYes.
QAnd what is that?
AIt was below the standard.
QOkay. Going back to Patients A, B and C, why is it your opinion that the treatment that was provided by Dr. Buttar in these three patients was below the standard of care?
AWell, he gave them treatment that had no proven benefit in cancer. There's no clinical trial ever published that's shown ozone or hydrogen peroxide therapy or chelation for heavy metals has any effect ‑- has any known effect at all on cancer or the patient's life.
QDr. Peterson, if you could turn to the exhibits in the thin notebook, to Exhibit 6.
MS. GODFREY: Exhibit, I'm sorry, what?
MR. JIMISON: Exhibit 6.
Q(By Mr. Jimison) Do you recognize those documents?
AYeah. I think these are the ‑- these are my notes and my ‑- the form I filled out from the review of the charts.
QYou reviewed the medical cases for the ‑- for the Medical Board and you filled out forms, correct?
ACorrect.
QAnd these are these forms.
ACorrect.
QAnd you sent in a cover letter regarding your forms to Mr. Ellis, the director of investigations?
AThat's correct.
QAre these a true and accurate copy of the documents that you sent to the Medical Board?
AYes.
MR. JIMISON: At this point, Dr. Rhyne, I'd like to enter the Medical Board's Exhibit 6 into evidence.
PRESIDENT RHYNE: Okay. Proceed.
MR. KNOX: We have the same objection as it includes his opinions.
PRESIDENT RHYNE: So noted.
MR. KNOX: Thank you.
Q(By Mr. Jimison) Okay. As to Patient A, Dr. Peterson, what did ‑- what did patient ‑- what was Patient A's diagnosis?
AI assuming that's the patient that has ovarian cancer, if it's the same one I'm looking at.
QYes.
AOkay.
MS. GODFREY: No, Patient A had cervical cancer.
MR. JIMISON: Okay.
WITNESS: That's the second one.
MR. JIMISON: Yes.
WITNESS: Yeah, they're not labeled A in here. Patient A had cervical cancer.
QPatient A would be ‑- the last name starts with an O.
AYeah. What was the question again?
AWhat ‑- what was her diagnosis?
AWell, cervical cancer, metastases.
QAnd what treatments did she receive from Dr. Buttar from your review of the records?
AI'd have to pull this chart. I think -- I think he gave her -- I don't ‑- my recollection is the chelation therapy and hydrogen peroxide. I'd have to look in the records.
QOkay. And Tab 4 in the big notebook under Tab 4.
AAll of this is the records of Patient A?
QYes, sir.
ALet me see. The flow sheets. It looks like vitamin C, GSH and hydrogen peroxide, something called adrenal 5 cc, something called PALT amino, EDTA, that is chelation treatment I believe, something called HZM1, DMPS, adrenal. I'm not sure what that is over there. And then something I can't read -- I can't read that. Scratched out and written over. It looks like it has been scratched out. And then there's something that looks like WFAM, SM2. It looks like that's what she was treated with.
QPatient B with the last name starts with K.
AOkay.
QWhat was her diagnosis?
AMetastatic ovarian cancer.
QOkay. And ‑- and she would be in Tab 3.
AOkay.
QAnd just look ‑- maybe I can speed things along. Does it appear that she received the same therapies as Patient A?
MS. GODFREY: What exhibit are you in?
MR. JIMISON: Tab 3.
AThe vitamin C, GCH, DMPS, so and so and so and so, EDTA, MSP. Yeah, it looks more about the same. Hydrogen peroxide here, vitamin C --
QOzone?
AYeah, it looks like the same.
QOkay. And Patient A, what was Patient A's diagnosis?
AWhat was that?
QIt ends with K-E. It's the middle patient.
AOkay. Adrenal cell cancer.
QOkay. And the therapies and he would be in Tab ‑- Tab 2. Did he get the same as those previous Patients A and B?
AYeah, has vitamin C and DMSP, yeah, DMPS, PSH and it looks like ozone. Yeah, it looks like the same treatment.
QOkay. The hydrogen peroxide for Patient B as well?
AYes.
QThese treatments, hydrogen peroxide, ozone, EDTA, DMPS, vitamin C, are any of these ‑- hyperbaric chambers, are any of these therapies indicative for the treatment of cancer?
ANo.
QDo you use any of these therapies in your ‑- in your practice?
ANo.
QAre you aware of any oncologists or cancer doctors using any of these therapies in their practice?
ANo.
QNow, turn to again Exhibit 6 in the thin notebook.
AAll right, I'm there.
QIf you could turn to your cover sheet ‑- your cover letter.
AYeah.
QYou wrote ‑- starting with the paragraph beside. Do you see that paragraph?
AYeah, the third one down.
QCould you read that to the Board Members, please?
AYeah. Beside the obvious fallacy of using EDTA, chromium and co-enzyme-Q, etcetera, to treat cancer patients which in my opinion is clearly rank fraud, there is the issue that none of these people were being managed for their other medical problems, as evidenced by the lack of physician involvement.
QRank fraud is kind of a strong term, Dr. Peterson. Why did you use that term?
AWell, because these people are being offered treatments that don't work, to me it suggested fraud. I mean, it's dishonest. It tells someone you've got treatment when, in fact, it has no effect.
QCould ‑- did these patients who went through the diagnosis ‑- at some point, did they all become Stage IV metastatic cancer patients?
AYeah, they were all Stage IV when they presented to Dr. Buttar's office.
QWe spoke earlier on and then we had sort of a thing with ‑- with the lawyers arguing in front of the Medical Board, but I'd like to draw your attention back to that earlier testimony about clinical trials.
Have any of these therapies that you have reviewed for the Medical Board for Patients A, B and C, have any of them been proven effective in any clinical trials that you're aware of?
MR. KNOX: Well, objection. He ‑- at that deposition, he referred to and said he didn't know what any of these medications were. I don't know how you presuppose he would know what's been tested or not been tested. He cannot identify any of them.
MR. JIMISON: I think Dr. Peterson should answer his own ‑- the question instead of ‑-
MR. KNOX: Well, I'm making an objection and I --
MR. JIMISON: I mean, Mr. Knox is answering the question for Dr. Peterson.
Q(By Mr. Jimison) Are you aware of any clinical trials ‑-
PRESIDENT RHYNE: You can answer.
MR. JIMISON: Okay.
QAre you aware of any clinical trials that have shown that any of these therapies have proven effective for cancer?
MR. KNOX: Objection.
ANo, I'm not. And I would know about them because alternative therapies that are ‑- trials that are done through the NIH are published in the Journal of Clinical Oncology. In fact, there have been numerous ones published and none of these have.
QWhat are some of the alternative medicine therapies that have been published as a result of clinical trials?
AOne of them is called shark cartilage and we actually tried it for a while and there was ‑- the National Cancer Center does have an office of alternative medicine trials and they do, in fact, do trials in alternative medicine just because of all the pressure.
And the initial trials showed there's about a 15 percent response rate to shark cartilage and I actually had some patients that would go and buy it. It's not a prescription drug. You can buy it from the GNC Nutrition Stores. But subsequently the clinical trials showed it was a failure.
QSo clinical ‑- there are people who do ‑- who treat cancer and do research cancer for conducting clinical trials regarding alternative therapies, correct?
AThat's correct. And there's another one actually, I forgot about this. There was herbal supplement in China. It was initially called PCC but they changed the name and right now I forgot what they call it now. But it ‑- it's an interesting story if you care about it.
QSure.
AThere was a research scientist in Los Angeles whose father had prostate cancer and they were Chinese-American and, you know, stating there was a working association linked to China and she went to China and she came back -- and in fact her father responded and because of that fact she ran -- (inaudible) -- and in fact works and it's not a prescription drug, but it is available and patients can buy it and I have prescribed it to patients.
We think the reason it works is because it actually contains Coumadin or -- (inaudible) -- Coumadin, the blood thinner. Well, Coumadin actually does have anti-tumor effect.
In fact, back when I was a fellow at the University of Kentucky, they had a clinical trial using Coumadin to treat cancer. There are some responses but the responses are poor, but that's probably why that herbal supplement works.
So, yeah, they do do trials on these things and when they work, we are going to use them. As though the chairman of the oncology at the Virginia of Medicine, Charles Smith has a whole clinic up there and he's had quite a few experiments with using herbal supplements for prostate cancer and he's got proven clinical results in that showing that the clinical trials do work.
QOkay. Are you familiar with the American Cancer Society?
AYes.
QHave ‑- are you familiar with whether they may have taken a position regarding the recommendation of oxygen therapy for cancer patients?
AMy understanding is, yeah, they've said it does not work and should not be used.
QAre you familiar with the Sloan-Kettering Memorial Institute?
AYes.
QWhat is Sloan-Kettering?
AIt's a ‑- it's a cancer research treatment hospital in New York City. It's actually was founded by Alfred Sloan, who was the head of General Motors and Kettering was Charles Kettering. I don't know if you care about this, but he was the guy who invented the first electric-started Cadillac in 1912 and they gave the money and started Sloan-Kettering Memorial Cancer Center in New York City.
QWhat's its reputation for cancer research and cancer treatment in the country?
AWell, it's outstanding. It's one of the leading cancer centers in the world.
QHas it taken a position regarding oxygen therapies, that you know of?
AI'm not aware of it.
QIf you could turn to Exhibit 19.
MS. GODFREY: Well, objection. He's just said he's not familiar with Sloan-Kettering's position on oxygen therapy and we would object to Number 19. It's not going to --
MR. JIMISON: I can ask him to review the document.
MS. GODFREY: Well, I guess he could, but we would object under the Rules of Evidence that if he's not familiar with it, he's not entitled to testify to it.
PRESIDENT RHYNE: So he cannot testify to it, but he can examine it.
MR. JIMISON: No. He can examine the document and under Rule 803, if Ms. Godfrey is not familiar with Rule 803, expert witnesses can testify to medical references that they consider authoritative. And ‑- and I can bring you that rule.
Q(By Mr. Jimison) In fact, I hate to have you go back and forth, but ‑- while we're doing this, Dr. Peterson, can you just review Exhibit 19?
AYeah, sure. It's the same document I was referring to before. The American Cancer Society urges cancer patients not to seek treatment with hydrogen peroxide, ozone therapy, or other, quote, hyperoxygenation therapies. Oxygen therapies should not be recommended.
MR. KNOX: That's means he testified while you were looking up the rule.
MR. JIMISON: Well, let me ‑- let me just ‑- I'll move on. I don't want to --
PRESIDENT RHYNE: Just ‑- just move on.
Q(By Mr. Jimison) Do you recommend oxygen therapy to your patients?
ANo.
QWhy not?
ABecause it doesn't work.
QAnd is Dr. Buttar using these therapies to treat cancer from your review of the records ‑-
AHe was in these three patients, yes.
QWhat are some of the risks associated with Dr. Buttar's therapies?
AWell, I don't know if there's ‑- I don't know of any risks. The biggest ‑- I don't know if there is any risk so much as the downside as you're sitting there 40 hours a week in a chair and wasting your time and your money on something that's going to be for no good and you've lost all that time.
QFrom your review of the charts, who seemed to be the primary caregiver to these patients?
AThe nurses.
QDid you see physician contact between Dr. Buttar and the patients in the charts?
AI couldn't see any that was documented. It doesn't mean that it didn't happen, but I could not find any in the records that I was provided.
QDid you see the number of labs that Dr. Buttar ordered?
AYes.
QCould you characterize them as a small amount of labs or a large amount of labs? How would you characterize them?
AIt was a lot of labs. Most of them made no sense to me. I don't know what the purpose of checking them was. I mean, there was some legitimate chemistry labs that made sense, but a lot of them were in my opinion just bogus labs.
QWas there any evidence in the record that any of these lab tests were indicative for a cancer diagnosis?
AWell, no. I mean, he had some the standard chemistry which you would monitor anybody getting any kind of therapy, the creatinine and those sorts of things.
QIf you could speak up a little bit, Doctor. I think ‑- I'm having trouble hearing you and I think the Board ‑-
AIf I look up you can't, so I have to talk to this thing.
There were standard blood tests you monitor now on any patient, just renal function tests and, you know, glucose and certain whatnot, but then there were all these other tests, aluminum levels, antimony, arsenic levels, beryllium, bismuth, cadmium, lead, mercury levels and I mean, these have nothing to do with cancer.
QWas there any evidence in the records that you reviewed that any of these tests were linked to clinical decisions?
AIf it was, I couldn't see it.
QWas there any evidence in the records that any of the tests were even interpreted by Dr. Buttar himself?
ANot that I could see in the record, no.
QDid you review the cost of these treatments?
ANo, I did not.
QOkay. Turning to Patient D, did you see ‑- the non-cancer patient, did you see physician contact between Dr. Buttar and Patient D?
ANo. No, not that I recall, no.
QAnd from your review of the record, could you discern whether Dr. Buttar made a diagnosis for Patient D?
AWell, my recollection is that it looked like he came in for constipation although I heard earlier today -- (inaudible).
QIf you could speak up, sir.
MR. KNOX: I cannot hear a word.
PRESIDENT RHYNE: Yeah, I couldn't hear that either.
AFrom my ‑- this thing is not working. I can tell you I feel like I'm yelling here.
My recollection of the chart was that she came there for consultation, but I had heard earlier today they disputed that she come for lead toxicity, but I did not see that reflected in the record that I reviewed.
QOkay. Is there any evidence in the record that Dr. Buttar personally made a treatment plan for Patient D?
ANot that I could see.
QYou mentioned ‑- how were people tested for metal toxicity in all four of these patients?
AWith urine tests.
QDo you have ‑- what is the standard for measuring metal toxicity in a patient?
AYou measure serum levels. Urine levels have ‑- do not necessarily mimic at all. For instance, if you would check ‑- the simplest example I can give you, and that is we check urine for protein. People with all kinds of renal problems will have elevated proteins in their urine. We cannot conclude they've got too much protein based on that, but the conclusion is the kidneys are wasting the protein.
So what's in your urine is not an accurate way to diagnose a toxicity of mercury or lead or iron. If you want to know those levels you measure the serum levels.
QDo you consider urine ‑- urine screening for toxicity reliable?
ANo.
QIn your opinion as a physician doing hematology and oncology, what is the standard test for metal measuring toxicity in a human?
AIt's the serum test.
MS. GODFREY: Objection.
QOkay. We discussed earlier on in the discussion between counsel whether there are acceptable and prevailing standards of medical practice for the treatment of cancer and I want to go back to those cancer patients. In your opinion, is there a universal standard for what's acceptable and prevailing for the treatment of cancer?
AYes.
QAnd what is that ‑- what is that standard?
MS. GODFREY: Objection.
AWell, it would depend on the cancer as to what the standard is. But say ovarian cancer, the treatment for what she received which is chemotherapy, carboplatin, cisplatin, Taxol base chemotherapy. If those don't work, second line therapies are things like Toxil, thoraxcine, taxon tier, gypsum, (phonetic) and combinations. There's also work done with intraperitoneal cisplatin and peritoneal -- (inaudible).
QOkay. Now, going back to what Dr. Buttar administered, hydrogen peroxide specifically. Is hydrogen peroxide therapy within the acceptable and prevailing standards of treatment for cancer patients in North Carolina?
ANo.
QHave you known hydrogen peroxide to have been proven effective in any clinical trial?
ANo.
QOn a scale from zero to 10, 10 being a cure, that the treatment provides a cure for patients for cancer and zero being they have zero effect whatsoever, what ‑- how would you rate hydrogen peroxide therapy on a scale from zero to 10 for ‑- for cancer?
AZero.
QAnd when I say cancer, I mean, all three cancers that these patients had, adrenal, liver, lung, ovarian, cervical. Is it still a zero for all those cancers?
AIt would be a zero for all of them, yes.
QWhat about the ozone, on a scale from zero to 10, what effect does it have on cancer?
AZero.
QVitamin ‑- intravenous vitamin C?
AZero.
QIV minerals?
AZero.
QTrigger point injections?
AZero.
QIs trigger point injections specifically called an IRR?
ARight. It has no efficacy.
MR. KNOX: Objection, he also testified he never heard of that.
MR. JIMISON: That can be argued. That's not a basis for an objection.
WITNESS: Actually, if I could address the issue. If you refer to it as an IRR as a trigger point, I know what that is. It wasn't referred to as a trigger point.
Q(By Mr. Jimison) Hyperbaric chambers, what ‑- on a scale from zero to 10, how effective is that for cancer?
AZero.
QChelation therapy, EDTA and EMPS, on a scale from zero to 10, how effective is that for cancer?
AZero.
MR. JIMISON: Okay. I have nothing further.
CROSS-EXAMINATION BY MR. KNOX:
QDoctor, looking at your vitae, it appears that you are the sole practitioner down in Sanford; is that correct?
AWell, I'm ‑- no, I have a part-time doctor, Dr. Kirby who is now in Chapel Hill.
QAnd Dr. Kirby is a doctor with who?
AShe works with me.
QOkay. But basically you run ‑- you run two separate offices, do you?
ANo, I just run my office in Sanford.
QAnd I looked at your ‑- according to your resume, you're not doing any research now, correct?
ANo, that's correct.
QAnd you've not taught since 1999; is that correct?
AThat's correct.
QAnd you've had two publications listed, one is an abstract and a book review, both from 1991; is that correct?
AThat's correct.
QAnd you've not published any reviews or articles at any place since then?
AThat's correct.
QAnd have you presented or lectured at a national or international conference on cancer anywhere?
ANo, I have not.
QAnd I believe you were asked about, you have not been to any particular Integrative Medicine Society meetings; is that correct?
AThat's correct.
QAnd there are no integrative doctors when you were presented down there?
AThere is a guy down there. I've forgotten his name now. At one point -- I think he's still down there, but I'm not sure -- I had very little contact --
QBut he has never sat down to talk with you ‑-
ANo.
Q‑- or any other integrative doctors about alternative treatments, have you?
ANo.
QAs I gather, you're a medical hematologist and oncologist? Did I say it right?
AThat's correct.
QAnd as a rule you don't treat cervical cancer?
ANo, we do, but what will happen is most GYN oncologists don't give chemotherapy, some do, but typically treatment is sending them to -- ask the medical oncologist to give the chemotherapy. But when I treat, it's always in conjunction with a GYN oncologist and the radiation oncologist.
QSo you always have somebody else and you do the chemotherapy, is that what it is?
AThat would be correct, yeah.
QThat's basically what you do, you do chemotherapy on cancer patients. Is that a fair statement?
AWell, in cancer patients, but I also do a lot of hematology. Of course, it's not --
QWe'll talk about it in just a minute.
How may ‑- how frequently do you treat ovarian cancer?
AWell, I probably see a half a dozen or a dozen cases a year.
QAnd how about adrenal cancer?
AThey're uncommon and I probably treated a half a dozen in the last ten years.
QSo you don't see many as a rule, correct?
ANo, nobody does. It's a very uncommon tumor.
QIn taking your deposition you talked a lot about you use chemotherapy, but don't you use many experimental drugs? Is that correct?
ANo, when a patient needs experimental drugs, I typically refer them to Duke.
QOkay. And you don't use radiation, you send those people out?
ARight. I'm not a radiation oncologist.
QSo basically what you do is you either diagnose cancer and treat it with chemotherapy in your office and you do some hematology work as well?
AThat's correct.
QOkay. Talking about the cost of medical treatment, I believe you said it's about $5 million a year that goes through your office; is that correct?
AYeah, that being overhead plus wholesale costs.
QOkay. And then you add to that your labor or whatever you charge seeing people?
ARight.
QHow many people would you see a year, Doctor, 300 maybe?
AAre you referring to new patients?
QWell, let's talk about it. How many ‑- what's your patient inventory? If I walked in today how many new patients and old patients would you see?
AI'm not sure I ‑- you mean, per day, per year, per month?
QPer day, per month, per year.
AI see roughly 300 new consults a year.
QAnd so you have $5 million worth of drug costs that goes through that office, plus whatever labor costs you have, plus whatever the value of your services are; is that correct?
AThat would be correct.
QSo cancer treatment is a very expensive thing in its own right, am I right? That's a fair statement?
AThat's very fair and they're going up. If you care about this, my drug costs in 1998, the same office, the same set up, $750,000 a year; in 2007 it hit a $4.9 million. To give an example of the rate of inflation in cancer care, that's correct.
QAnd is that at the Sanford office or ‑- where is the other doctor? Does she practice there?
AShe practices in my office in Sanford.
QAnd in ‑- and where? You said she practices where?
AIn my office in Sanford. She also has a research lab at UNC.
QI beg your pardon. When did she come with you, recently?
AShe's been ‑- I'm going to say since 2003.
QYou had one doctor recently leave you; is that right?
ANo. I worked for a while with Dr. Mark Graham in Cary and the three of us ran two offices, but I ended that relationship I'm going to say two years ago.
QOkay, I'm sorry. So the two doctors ‑- I believe you said you were getting 1099s out the ying-yang and that means it's very expensive to treat cancer.
AIt's very expensive.
QAnd I read where there's maybe 240 different cancers. Have you read that?
AThere's over 2,000 in the textbook about cancer and oncology.
QAnd they'll changing annually. They're ‑-
AWell, they keep subdividing is the problem, so there's no such thing as breast cancer any more, there's breast cancer, basal B, basal A, Interleukin-2 negative. I mean, they keep subdividing and subdividing and subdividing those tumors as we get more molecular information.
QSo you don't know how much it cost you to do one treatment of chemotherapy?
AOh, it would really depend on the drugs. Some drugs are dirt cheap. 588 is one that's from anywhere from a dollar. Interleukin is $5,000 or $6,000.
QWell, if a patient has ovarian cancer and you were going to treat them with chemotherapy, what would it cost and how many times a week might you give that person some type of chemotherapy?
AWell, currently Platinol Taxol is a typical standard. Those drugs are now in generics, they're not that expensive any more. I don't know of the exact cost. I can take a stab and say one treatment is probably around to $500 to $1,000 and you have that every three or four weeks. So roughly ‑- I'm going to take a stab and say $1,000 a month or less.
QOkay. But you didn't examine Dr. Buttar's financial records about these costs, did you?
ANo, I didn't.
QAnd I assume that you don't have any idea about the relative costs that he's charted other than you saying that the services had no value. Is that your testimony?
AIt appears so, yes. Not only does it have no value, you're taking 40 hours a week of their time.
QWell, how many ‑- if an ovarian cancer patient had ovarian cancer or if another person had to have some type of intravenous treatment, might they sit in your office seven, eight hours at a time per day?
ANo. The longest treatment I would give -- the absolute longest is tox scan and that's once a month and that could take six hours. A typical carboplatin Toxol, you can do in two and a half to three hours and it's once a month, not every day.
QI believe you said 33 percent of your current patients are hematologic cancer patients; is that correct?
AProbably, it's a guess, but probably.
QAnd you were talking about the use of experimental drugs, that you didn't believe in them. There are some you said that was being used by different people and I believe you said today there were a lot of experimental drugs being approved and some of them are used even if they're not FDA approved; is that correct?
ANo, I don't think that's correct. I don't think I ever said that.
QWell, did you say that we know that the FDA is going to approve it and they'll going on to administer them? Do you remember that?
ANo, I don't remember that, but I cannot get a non-FDA approved drug.
QWell, I believe you said you send people up to Duke and they're doing experimental, of course that's a controlled environment, but they're doing it even though they may not be FDA approved.
AThose are clinical trials in a process I just described that's under FDA supervision.
QOkay. Have you had any training or experience with complimentary alternative medicines?
AOnly the ones I mentioned shark cartilage and -- (inaudible).
QCan you define for me what C-A-M or CAM is?
ANo, I cannot.
QSo you don't have anybody that's doing the conventional and alternative medicine simultaneously, nor have you read about it or seen it occur? Is that fair?
AThat would be fair.
QNow, the question is, how sick are the people after they have been in your office anywhere from three to six hours?
AWell, some days they really don't get very sick. It's kind of surprising. About 36 months ago they came out with two drugs and since they have come out, the nausea and vomiting have almost disappeared. I'd say vomiting with chemotherapy is only 10 percent now.
QOkay. So that's improved some?
AIt's improved dramatically. And for instance, the drug Cisplatin, I just quit using it, it was so -- the vomiting was so bad we made them switch from Cisplatin. Well, it came out with new drugs, we've been able to go back to Cisplatin with minimal toxins.
QNow, you say that the integrative concepts of medical drugs or the alternatives, you can use CAM, didn't provide much beneficial effect and sometimes that's true of chemotherapy, isn't it?
AIt is true, but we can tell you we have clinical trials that show there is a proven clinical benefit. We can tell you what the percent response rate is and the percent of non-response rate. And in addition, you get two doses of reassessments not responding and quit, we just don't keep pouring it in.
QOkay. And then you talked about the alternatives like PCSPES for prostate cancer. You do know about that?
AYes.
QOkay.
AI want to believe that name was changed recently.
QThe question was asked you by Ms. Godfrey, do you know what integrative medicine is and your answer was you did not know. Is that correct?
AI think she asked me to define integrative medicine, but, anyway, it's ‑- no, I don't know exactly.
QAnd you don't really know what the definition is?
ANo, I do not.
QDid you hear me read the statute this morning?
AYeah, I did.
QIs that the first time you had ever seen that or heard it?
AI think unless you read ‑- I think you read it to me during the deposition.
QAnd not to be redundant, but you've never read about integrative practice?
ANo, that's not true. It's in our journals. I mean, they have articles like I said in the Journal of Oncology book, there's a whole section on alternative therapy and I read that.
QLet me ask you this question, the question was put to you by Mrs. Godfrey. Do you know anything about the standard of care for an integrative medicine doctor and you answered with no. That's correct?
AThat's correct.
QAnd you don't profess to offer an opinion about what the standard of care for an integrative doctors is; is that true?
AYes, it is.
QThere are some Phase I vaccines that's been tried by people as alternatives, correct?
AA Phase ‑- you're speaking of a Phase I trial?
QYes.
AThat I would not call an alternative under a Phase I trial.
QWell, vaccines on the Phase I patients or in Phase I of therapy ‑-
MS. GODFREY: To increase their immune system.
Q‑- to increase their immune system?
AI don't think that's alternative medicine at all. I think that is standard medicine. I mean, you're trying to use vaccines to fight cancer for probably 50 years. The most successful to date has been Interleukin-2. I think we went into this in deposition that Interleukin-2 is in fact an FDA approved drug and used in therapy to fight both renal cell and melanoma and some carcinomas. It's not terribly effective, but it does have about a 10 percent response rate.
QBut it's given to help the person's immune system?
AYes, but it's not an alternative therapy. It's standard medical therapy.
QI guess we can argue about that. My ‑- my question is, they give the vaccine to strengthen the person's immune system so they can help fight the cancer. Is that fair?
ANo, it's not fair. When you give the immune therapies that have been proven to work in clinical trials because we've shown that they treat the cancer and we document it with CAT scans.
QSo it's your testimony that the vaccines that you use attack the cancer and do nothing to the immune system or does it do both?
AIt does not do both. The immune system Interleukin-2 ‑- (inaudible) -- and vaccines are an attempt to stimulate the immune system to react -- (inaudible). For instance -- (inaudible) -- spent 30 years on Melanoma vaccine and never could get one that works, but he tried and tried and tried. He's retired now.
And they continue to do that and there are trials out there trying to use antigens to stimulate the immune system to get the body's own immune system to fight the cancer. So far other than Interleukin-2 and -- (inaudible) -- Interferon and -- (inaudible) -- and critics out there even try success -- (inaudible).
QInterleukin-2 is that given to boost the immune system after chemotherapy?
ANo. It's given to bring the white cells back up after chemotherapy and it has no anti-cancer effect and it's never had an anti-cancer effect.
QI understand that. But if my white cells go to 10,000 or 15,000, my immune system is ineffective. If somebody gives me this particular drug to bring my white count back down, it would probably have to be pretty sick if that were to happen. The idea is to get my total system in better condition, isn't it?
ANo, it's not.
QSo if my white cells go to 15,000 ‑- and I'm not a doctor -- but if they go to 15,000 and I get Interleukin, that's going to attack the cancer?
ANo.
QIt's going to help the immune system?
Dr. Buttar Truth Quotes
“Whoever undertakes to set himself up as a judge of Truth and Knowledge is shipwrecked by the laughter of the gods.”
—- Albert Einstein
“Truth is generally the best vindication against slander.”
—- Abraham Lincoln
"All truth passes through 3 phases: First, it is ridiculed. Second, it is violently opposed, and Third, it is accepted as self-evident."
—- Arthur Schopenhauer
"There is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success than to take the lead in the introduction of a new order of things because the innovator has for enemies all those who have done well under the old conditions and lukewarm defenders in those who may do well under the new."
—- Machiavelli, The Prince