If the data weren’t convincing enough, the infomercial-style video would hammer the point home. In it, Lederman introduces Noel Weiss, a sprightly 60-year-old retired cop with inoperable liver metastases. “He was hopeless before he met us,” says the doctor in a voice-over, before going on to interview Weiss in an examining room:
Lederman: “It’s been two months since your treatment. What’s happened?”
Weiss: “More energy, great outlook on life. I walked into a cemetery and found an exit marked MARDI GRAS.”
Lederman: “How does body radiosurgery compare to chemotherapy?”
Weiss: “Chemo is like doing a 150-foot bungee jump without the bungee. Body radiosurgery is like having a pleasant dream.”
Lederman, despite his showmanship, is actually a pioneer of sorts. Eight years after he first started performing body radiosurgery, few oncologists would dispute that the image-guided technology he uses will soon be favored over traditional radiation treatment for many types of cancers. But rather than go through clinical trials, with their rigorous protocols, Lederman has opted to take his research directly to the consumer. Tannenbaum, the department’s former head administrator who now has a second career selling real estate in Florida, explains his approach this way: “As a Realtor, we do a lot of marketing. I don’t explain everything in my marketing. My goal is to put enough real information out there to get you interested enough to call. Then, I’ll explain everything in greater detail. The same is true in every other field.”
The details Lederman omitted are significant. Take the claim of 94 percent successful control of primary pancreatic cancer. The statistic comes from an abstract that Lederman published in 2000 about 45 patients he treated for the disease. Curiously, only 17 were evaluated for the study; it was 94 percent of that much smaller group whose cancers were controlled. What happened to the other 28 patients? “Not every patient would agree to send films,” Lederman explains. And when patients die? “If they die, then they don’t send in films,” he says, though he claims that it isn’t only the patients with good results who follow up.
“This is retrospective review,” says Robert Timmerman, a professor of radiation oncology at the University of Texas–Southwestern Medical School who is currently conducting a study of stereotactic radiation therapy for lung and liver cancer. “Retrospective data analysis results in claims of control and survival that have shown to be very different from reality. It’s just so flawed that it’s almost not worth doing.” And what does “control” of pancreatic cancer mean, anyway? “Local control is one thing,” says Albert Koong, a Stanford radiation oncologist who recently published the results of his study on treating pancreatic cancer with stereotactic radiosurgery. “But if you have patients who’ve had the disease spread outside the primary tumor, what’s the point? It’s like slamming the barn door shut after the horse has run out. You can control the tumor locally, but that’s not what’s going to kill you. What’s going to kill you is the metastases, and that’s clearly the role of chemotherapy.”
Lederman doesn’t disagree with this assessment and says he treats metastasized pancreatic cancer to palliate, or reduce the pain of, a patient. He would certainly explain the difference between local and systemic treatment and the vast gulf between local control and cure before he put anybody under the beam. “It’s hard for me to believe that anybody with metastatic cancer truly felt that I was promising a cure.”
In an attempt to show “the other side of Gil Lederman,” the doctor gave me the telephone numbers of dozens of former patients, who all told compelling stories about his kindness, compassion, skill, and how whatever he did with his machine managed to buy their loved ones some valuable extra time on Earth. Noel Weiss, the star of Lederman’s body-radiosurgery video, wasn’t on that list. That optimistic Mardi Gras future of his lasted only weeks after the taping.
“Look,” says Lederman, “just because someone died doesn’t mean they died of the cancer or the treatment.”
I want to see this guy lose his license to practice medicine,” says attorney Matthew Lifflander from behind his cluttered desk. An avuncular 72-year-old, whose round face makes him look a bit like Burgermeister Meisterburger, Lifflander is a different animal from the kind of shiny-suited malpractice lawyers Lederman has encountered in the past. He’s a Ralph Nader type, a former director of the State Assembly’s Medical Practice Task Force who still sees it as his duty to police the medical community.
Lederman first came to Lifflander’s attention when he was asked by Olivia Harrison’s lawyer Paul LiCalsi to assemble her case before the State Board of Professional Medical Conduct. That case may be over, but Lifflander is not nearly done. In June, he filed a $31 million suit in federal court against Lederman, SIUH, and Philip Silverman, another doctor in Lederman’s practice, on behalf of a Florida woman whose husband died after receiving radiosurgery for his pancreatic cancer. “What Lederman is is a greedy ghoul,” says Lifflander. “It’s billing-based medicine.”
Thomas Ryan, a former Brooklyn Public Library employee who’d retired to South Florida, heard about Lederman through his son in New York. He requested a packet from SIUH, which touted a 99 percent success rate for controlling pancreatic cancer. According to the complaint, Silverman told Ryan’s son that he didn’t know whether the treatment would give his dad an additional one or ten years, but that radiosurgery would provide “good quality of life.”
In a last-ditch effort to beat his cancer, Ryan abandoned his circle of friends and comprehensive treatment to come to Staten Island in the spring of 2002. He carried Lederman’s pamphlet with him wherever he went, like a security blanket. According to attorney Richard Reich, who’s working with Lifflander on the case, CT scans from late April show that by the time Silverman was treating Ryan’s pancreas for cancer in May, there were already as many as four clearly identifiable metastases to his liver, which rendered the treatment to the pancreas pointless. By June, his liver looked “like the night sky, with stars,” says Reich. Still, according to the lawyer, Silverman recommended another round of radiosurgery to treat four of what Reich claims were 50 sites of metastasis. “There was no medical reason to treat this man,” Reich says. Ryan died less than a month after his final treatment.
Lifflander is going after Lederman not just for malpractice but for false advertising. He’s taking the novel approach of citing the New York State General Business Law’s statute regarding false and misleading advertising, most commonly used against car dealers who sell lemons. The statute states that if advertisers withhold material information from consumers, they could be held liable for fraud. Lederman’s materials did include wording like “successfully controlled in the treated area,” but if a jury decides that a reasonable consumer interpreted that as a guarantee of a cure or a longer life, Lederman could be in big trouble. And malpractice insurance typically doesn’t cover fraud damages.
Lifflander acknowledges that Ryan was terminal, but he hopes to put a price tag on the last months of a man’s life. “Let’s say you know you have three months to live,” Lifflander says. “Are you going to spend them puking and heaving and pissing in your pants in Staten Island? What’s that worth?”