The non-public jet took off from the Caribbean island of Antigua in April carrying three extremely flammable tanks of compressed oxygen and a terminally sick most cancers affected person.

Kim Hudlow had chartered the aircraft for her husband, David. She crouched by his aspect on the five-hour journey to Florida, frantically adjusting the valve on one of many oxygen tanks as he struggled to breathe. A physician had simply instructed her he was dying. She was terrified he wouldn’t survive the flight.

It was an abrupt turnaround. Six days earlier, Ms. Hudlow and her husband, who had late-stage esophageal most cancers, had arrived on the tropical island filled with hope {that a} novel blood-filtering therapy provided there would save Mr. Hudlow’s life — or not less than extend it.

They had been amongst about two dozen households lured to Antigua by a California start-up referred to as ExThera Medical and its secretive billionaire companion, Alan Quasha.

ExThera, which has about 50 staff, makes a single product: a filter that it says can be utilized to take away the tumor cells that flow into in sufferers’ blood and allow most cancers to metastasize. Early final 12 months, the corporate offered hundreds of the gadgets to Mr. Quasha’s non-public fairness agency, Quadrant Administration, which started utilizing them on late-stage most cancers sufferers at a small clinic in Antigua.

Quadrant, which invests on behalf of Mr. Quasha and his household and doesn’t have exterior traders, charged $45,000 for every course of therapy and suggested sufferers to return to the clinic for normal classes. It additionally urged them to abstain from chemotherapy between remedies.

ExThera and Quadrant promoted the blood filtering to the Hudlows and different {couples} by citing a Croatian examine of sufferers with metastatic most cancers that they mentioned had yielded extraordinary outcomes, based on cellphone recordings obtained by The New York Occasions.

In a single name with the Hudlows, John Preston, an ExThera board member and longtime enterprise companion of Mr. Quasha, claimed that three sufferers within the examine had been cured of their cancers. Throughout one other name, Dr. Sanja Ilic, ExThera’s chief regulatory officer, instructed Ms. Hudlow that one of many examine’s sufferers had recovered from inoperable colon most cancers to such an extent that he was coaching for a marathon.

“I don’t know of another therapy out there on this planet, on this planet, that may do higher stuff,” Dr. Ilic instructed Ms. Hudlow.

However these statements have but to be backed up by any printed knowledge, and the Croatian examine — with solely 12 individuals — was too small to attract any dependable conclusions, based on the physician who performed it. There isn’t a knowledge from a human scientific trial exhibiting the system slows or reverses most cancers.

In the US, the Meals and Drug Administration has approved ExThera’s blood filter to be used solely in emergency Covid-19 circumstances. The filter seems to work properly for that function, having been administered efficiently to tons of of severely sick sufferers contaminated with the coronavirus.

Final summer time, the F.D.A. allowed ExThera to check the filter on 5 pancreatic most cancers sufferers in Oklahoma — the primary part of what’s prone to be years of scientific trials to hunt the company’s approval to make use of the filter to deal with most cancers.

By finishing up the remedies in Antigua, the place the F.D.A. has no jurisdiction, ExThera and Quadrant circumvented that lengthy, drawn-out regulatory course of. However Mr. Preston and Dr. Ilic might have nonetheless violated federal legislation by selling ExThera’s filter to American most cancers sufferers on U.S. soil.

In February, two months earlier than the Hudlows’ ill-fated journey to Antigua, Jonathan Chow, ExThera’s director of medical affairs, warned the corporate’s high executives in a letter that the Antigua operation amounted to an unethical and unsafe experiment on sufferers and urged them to close it down, based on three folks accustomed to the matter. Throughout a short go to to the island, Dr. Chow had witnessed sufferers bleeding from catheter wounds and screaming in ache. ExThera didn’t act on his pleas.

Greater than 600,000 People die of most cancers every year. For all of the medical advances achieved in latest a long time, the variety of therapies provided to sufferers whose most cancers has unfold to a number of organs stays restricted. Typically, the usual of care continues to be chemotherapy and radiation, which might purchase sufferers time however not often cures them.

Sufferers with grim prognoses are sometimes prepared to strive something which may provide hope. And loads of suppliers — a lot of them working in international locations with rules much less stringent than these in the US — are prepared to grab on that desperation.

Some sufferers have sought therapy from a health care provider in Austria who says he’ll remedy them with a machine he constructed underground that supposedly restores “steadiness” to cells. Others have gone to Mexico for injections of immunotherapy medicine straight into their tumors. Just like the blood-filtering classes in Antigua, these remedies are costly and never lined by insurance coverage, saddling sufferers and their households with monumental out-of-pocket prices.

However ExThera and Quadrant appeared to supply extra credibility than the same old offshore clinic. ExThera is a U.S. firm with an F.D.A.-approved system, albeit not for the aim it was being touted. Quadrant, too, is an American company, run by a rich investor with a profitable observe report. The therapy the businesses had been advertising and marketing was experimental, however its promoters had the veneer of legitimacy.

In hindsight, Ms. Hudlow mentioned, the potential of a miracle remedy acted on her “like a drug.” She added, “I really feel so duped by all these folks. The way in which this was spun up and the best way it was defined, they bought me.”

Mr. Quasha mentioned in an e-mail that Quadrant “made no suggestions for what therapies sufferers ought to obtain.” Sufferers opted for the filter remedies on their very own in session with their medical doctors, and the corporate took care to remind them “at a number of steps within the course of” that the remedy was experimental, he mentioned. He and Quadrant declined to handle the specifics of Mr. Hudlow’s or another affected person’s case.

Of the greater than 20 sufferers handled in Antigua, The Occasions has recognized not less than six who’ve died since their remedies. Nonetheless, one affected person, a lady from Oklahoma, did seem to learn from the blood filtering. Her husband mentioned that the remedies offered her important reduction from her pancreatic most cancers ache and that she not requires any ache medicine.

After The Occasions despatched ExThera a listing of detailed questions, the corporate mentioned it requested Mr. Preston to depart its board and instructed its staff it had parted methods with Dr. Ilic. It additionally mentioned it terminated its partnership with Quadrant. ExThera didn’t elaborate on the explanations, however Mr. Quasha mentioned it was a mutual enterprise resolution and “had nothing to do with our perception within the efficacy of the filter therapy.”

Regardless of the cut up, Quadrant says it continues to deal with most cancers sufferers in Antigua with ExThera’s gadgets. Quadrant has a number of thousand filters saved at a warehouse on the island.

A Navy Origin

ExThera’s blood filter got here out of a navy contest. In 2012, the Protection Superior Analysis Initiatives Company, the Pentagon division behind early variations of the web, solicited proposals for a brand new medical system that may take away pathogens from blood. The objective was to deploy it within the area to deal with troopers uncovered to infections or organic brokers.

ExThera, based within the San Francisco Bay Space by two chemical engineers, received the competition with a three-by-nine-inch clear cylinder containing greater than 20 million tiny beads. The beads are lined in heparin, a substance just like a molecule discovered inside blood vessels that pathogens bind to. When blood flows by way of the system, the beads mimic the interior partitions of blood vessels and seize viruses, micro organism and fungi. The system works in tandem with a dialysis machine, which pumps blood out of a affected person’s physique and into the system earlier than returning it, filtered of pathogens, to the affected person.

The European Union authorized ExThera’s filter, which the corporate christened the Seraph 100 Microbind Affinity Blood Filter, to deal with bloodstream infections in August 2019. When the pandemic reached U.S. shores six months later, Military medical doctors tried it on two critically sick Covid-19 sufferers. The sufferers’ viral counts plummeted, and each recovered. The F.D.A. subsequently authorized the system to be used on Covid sufferers on the cusp of respiratory failure. ExThera says its Seraph filter has since been used on hundreds of U.S. and European sufferers with Covid or bloodstream infections.

However because the pandemic ebbed, ExThera’s gross sales to hospitals peaked at a couple of million {dollars} after which started to say no. The corporate started on the lookout for new makes use of for its filter. One concept was to see if the heparin beads might additionally seize the tumor cells that float in most cancers sufferers’ blood. Often called circulating tumor cells, or C.T.C.s, they play an essential function in enabling most cancers to metastasize.

The preliminary indicators had been encouraging: A small German laboratory examine confirmed that, not less than in check tubes, C.T.C.s connected to the heparin beads.

ExThera took the analysis a step additional within the spring of 2023. Dr. Ilic, who had labored at main medical system corporations earlier than changing into ExThera’s chief regulatory officer, met a Croatian physician named Vedran Premužić at a convention in Zagreb, and over dinner at a seafood restaurant, they determined to check the filter on most cancers sufferers, based on an individual accustomed to the matter.

The examine started with eight sufferers in September 2023 and later expanded to 10 after which to 12 sufferers. Usually a examine to gauge a tool’s effectiveness at treating most cancers could be run by an oncologist, however Dr. Premužić wasn’t a most cancers skilled. He specialised in kidney ailments.

In December 2023, Dr. Ilic mentioned promising early findings from the examine with ExThera’s high executives, together with outcomes for a lung most cancers affected person whose tumor appeared to have shrunk and a number of other sufferers whose biopsies had come again unfavourable, based on an individual with data of the matter.

Just a few days later, Mr. Preston, the ExThera board member, knowledgeable the corporate that he knew somebody who was all in favour of changing into its companion within the Caribbean. It was Mr. Quasha, with whom Mr. Preston had labored on non-public fairness offers for 15 years.

Mr. Quasha had deep pockets. Over 4 and a half a long time, he had quietly constructed a fortune shopping for up corporations and restructuring them. Considered one of his early acquisitions was a Texas oil agency whose chairman was the long run president, George W. Bush.

Following Mr. Preston’s introduction, ExThera shared the Croatian most cancers knowledge with Mr. Quasha. Impressed, he invested $3 million within the firm.

He additionally created a subsidiary of his funding agency referred to as Quadrant Medical Care and appointed his daughter, Dr. Devon Quasha, a doctor at Mass Basic Hospital in Boston, as certainly one of its executives. Quadrant Medical Care paid ExThera a further $10 million — a number of occasions what ExThera was producing in annual income — to turn into its Caribbean distributor.

A ‘Doubtful International Operation’

In early January 2024, Dr. Ilic and one other ExThera official loaded a dialysis machine and tons of of filters onto Mr. Quasha’s non-public jet at an airport in San Diego and flew them to Antigua. On the best way, the jet made a refueling cease within the Bahamas, the place it picked up Mr. Quasha. Dr. Chow, ExThera’s director of medical affairs, adopted on a business flight two days later.

Quadrant had contracted with an area clinic to start administering the therapy. The ExThera workforce was touring to the island to show the clinic workers learn how to use the filter. In contrast to the F.D.A., the federal government in Antigua had approved Mr. Quasha’s agency to make use of the system on most cancers sufferers.

The operation had the potential to be profitable. Quadrant was paying ExThera round $1,000 per filter, based on an individual with data of their contract, and three filters could be used per therapy routine in Antigua. With a $45,000 price ticket for sufferers, the revenue margins for Quadrant may very well be large.

However when the ExThera staff arrived in Antigua, a few of them shortly grew anxious.

The clinic Quadrant had employed lacked fashionable medical gear, and the physician in cost, a surgeon named Joey John, was making incisions underneath some sufferers’ collarbones to put in dialysis catheters with out utilizing any medical imaging or ample anesthesia, based on two folks accustomed to what the ExThera workforce encountered. Dr. Chow witnessed sufferers bleeding profusely and, in a single case, screaming in ache. He was additionally alarmed to study {that a} affected person was forgoing chemotherapy, a pillar of most cancers care, for an experimental therapy.

ExThera had flown in Sarah Mobbs, a nurse who had expertise treating Covid sufferers with the filter, to assist administer the remedy. Firm officers had instructed Ms. Mobbs that she could be helping with a most cancers examine. However when she arrived at Dr. John’s clinic, she noticed no indicators of the guardrails that may usually accompany a scientific trial, three folks with data of the matter mentioned. There was no therapy plan, no oversight from a medical board to make sure the supposed examine was performed safely and ethically. There wasn’t even an oncologist on web site.

Ms. Mobbs later instructed associates that her unease grew when she overheard Dr. Ilic inform most cancers sufferers that the filter would remedy them, the three folks mentioned. She anxious Dr. Ilic was giving them false hope. To extricate herself from the state of affairs, she made up a narrative that her mom and daughter had been in a automotive accident and left the island in a rush.

Dr. Ilic mentioned she shared a few of Dr. Chow’s and Ms. Mobbs’s misgivings. However she denied telling any sufferers that the filter remedies would remedy them.

Dr. Chow voiced his considerations to Erin Borger, ExThera’s chief govt, and others on a number of video calls, based on somebody with data of the conversations. He then despatched Mr. Borger and Robert Ward, certainly one of ExThera’s founders who was additionally chairman of its board, a letter outlining his worries. Within the absence of knowledge supporting the usage of the filter to deal with most cancers, the corporate was taking “undue dangers” with sufferers and subjecting them to “human experimentation,” he wrote. Referring to the Antigua clinic as a “doubtful international operation,” he urged ExThera to finish its affiliation with it.

However ExThera continued offering Quadrant with filters and the remedies in Antigua continued. Pissed off that his warnings had been ignored, Dr. Chow resigned from ExThera in June.

Requested about Dr. Chow’s letter, Mr. Borger mentioned: “We take issues of security and office conduct very critically. When these points come up, we instantly examine the matter and take acceptable motion.” He declined to say what, if any, actions had been taken. Dr. Ward declined to remark.

The Most cancers Wives Membership

Practically a month after Dr. Chow started airing his complaints inside ExThera, Mr. Preston, the board member who had launched the corporate to Mr. Quasha, spoke by cellphone with Mr. and Ms. Hudlow and Jaime Baskin.

Ms. Hudlow, who lives in Panama Metropolis, Fla., and Ms. Baskin, an elementary college particular ed trainer in Chicago, had met 18 months earlier by way of a standard pal. Ms. Baskin’s husband, Brian Withey, was eight years youthful than the 55-year-old Mr. Hudlow, however they each had metastatic most cancers. Mr. Withey’s had began in his rectum and unfold to his liver.

Together with the wives of three different most cancers sufferers, Ms. Hudlow and Ms. Baskin had shaped what they jokingly known as “The Most cancers Wives Membership,” texting and calling each other day by day to lend emotional help and share new medical insights.

One member of their group had heard about ExThera and its blood filter by way of a pal who had breast most cancers and had been handled — unsuccessfully, it might end up — in Antigua. Intrigued, Ms. Baskin organized a name with Mr. Preston. The Hudlows dialed in from Florida.

It’s unlawful in the US to advertise a medical system or a drug for a use that has not been authorized by the F.D.A. But that’s exactly what Mr. Preston did, based on a recording of the decision.

Mr. Preston started by explaining the filter’s origin and the science behind it. By eliminating circulating tumor cells from sufferers’ blood, he mentioned, the filter freed up the immune system to assault the tumor itself. (There isn’t a printed scientific knowledge to help this principle.) Mr. Preston then introduced up the Croatian examine and mentioned that 4 of its eight sufferers had been “doing properly” and that one other three appeared “to be totally recovered from their most cancers.”

When Ms. Baskin requested what he meant by “totally recovered,” Mr. Preston replied: “We will’t discover it, I’ll put it that method.”

Mr. Preston additionally talked about three metastatic most cancers sufferers whose blood had been filtered in Antigua the earlier month. He mentioned the change in how these sufferers felt after their remedies was “outstanding.” One affected person — the girl from Oklahoma — was doing so properly that she not wanted her ache drugs, he mentioned.

The decision with Mr. Preston lifted the hopes of the Hudlows and Ms. Baskin. However the actuality was not as promising as Mr. Preston had implied.

In an interview with The Occasions in September, Dr. Premužić, the nephrologist conducting the Croatian examine, mentioned it might be “extremely suspicious” to explain the filter therapy as efficient at such an early stage of analysis with out bigger randomized scientific trials. He mentioned that whereas his examine had produced encouraging outcomes, it was too small to succeed in any agency conclusions.

In November, the journal Blood Purification printed a brief paper in regards to the examine on-line. The paper mentioned that the variety of circulating tumor cells measured in 10 sufferers handled with the filter declined by a median of 71 p.c through the therapy. Nevertheless it mentioned nothing about how the sufferers fared long run and made no point out of three sufferers being cured of their cancers. Dr. Premužić didn’t reply to follow-up questions after the paper was printed. Dr. Ilic, who’s a co-author with Dr. Premužić on the Blood Purification paper, mentioned extra papers based mostly on the Croatian examine are forthcoming.

Mr. Preston mentioned in an e-mail that his communications with the Hudlows and Ms. Baskin had been “true and correct to the perfect of my data” and passed off “on the request of the treating physicians.” However Ms. Baskin mentioned no physician was concerned in organising the decision.

Ms. Hudlow, who had been a nurse earlier than she began a roofing enterprise along with her husband, determined to do a few of her personal analysis. She spoke with Dr. Ilic, who talked in glowing however obscure phrases in regards to the Croatian examine. She additionally realized {that a} Boca Raton, Fla., oncologist named Mark Rosenberg, who had beforehand consulted on her husband’s care, was referring sufferers to Antigua. She reached out to him.

Dr. Rosenberg instructed Ms. Hudlow that he didn’t have a lot knowledge to go on however that sufferers who had undergone a filtering session felt “wonderful” afterward, based on a recording of certainly one of their calls. He additionally instructed her that Dr. Ilic had shared with him scans exhibiting {that a} affected person’s lung tumor had shrunk 80 p.c inside three weeks of being handled with the filter.

“If that is true, what we’re seeing, that is essentially the most thrilling advance in oncology ever,” Dr. Rosenberg instructed Ms. Hudlow.

Dr. Rosenberg has since modified his view. In an interview, he mentioned he stopped referring circumstances to the Antigua clinic months in the past as a result of he didn’t see any optimistic outcomes amongst his sufferers. He mentioned Dr. Ilic by no means shared any knowledge with him past the scans he talked about to Ms. Hudlow. Within the absence of knowledge, “it’s tough to know what’s actual and what’s not actual,” he mentioned.

As an ExThera worker on the time, Dr. Ilic mentioned she was not approved to share scientific knowledge with firm outsiders.

The Occasions reviewed the scans — exhibiting a affected person’s lungs earlier than and after therapy — that Dr. Ilic confirmed Dr. Rosenberg. The post-treatment scan does seem to indicate a smaller tumor, however the angles and scales of the 2 photos are completely different, which makes it tough to inform whether or not the tumor really shrank.

Ms. Hudlow doesn’t begrudge Dr. Rosenberg for his change of coronary heart. However on the time, his enthusiasm helped promote her on the therapy. After speaking issues over along with her husband, she contacted Tom Pontzius, the president of Quadrant Medical Care, to make an appointment and wired $45,000 to the corporate. On Feb. 27, she and Mr. Hudlow flew to Antigua.

After they bought to Dr. John’s clinic, Ms. Hudlow’s educated nurse’s eye picked up on issues that bothered her. The nurses weren’t washing their palms. The surgical scissors they had been utilizing to chop away the dressings round sufferers’ catheter wounds weren’t sterilized. And one of many affected person rooms didn’t have a machine to watch very important indicators. However, she mentioned, she tried to stay upbeat for her husband’s sake.

Over the subsequent seven days, Mr. Hudlow underwent three filtering classes. Afterward, Ms. Hudlow mentioned, he felt weaker, and his ache elevated.

Quickly after the Hudlows returned to Florida, there have been indicators that his most cancers was rising extra aggressively. A check referred to as Signatera confirmed that the quantity of mobile tumor DNA in his blood rose practically sixfold. As she was slicing his hair in the future, Ms. Hudlow seen an ugly-looking development on his again. Quickly, one other one appeared on his ear, adopted by one on his scalp. They had been pores and skin tumors.

Mr. Hudlow was additionally having problem respiratory. Ms. Hudlow took him to the emergency room, the place he was recognized with a pleural effusion — a buildup of fluid within the lining of the lungs. Medical doctors tapped his lungs and drained a liter of reddish-brown liquid.

Ms. Hudlow puzzled whether or not her husband ought to get again on chemotherapy, however Mr. Preston, the ExThera board member, had suggested towards it on their name. He had mentioned that chemotherapy labored at cross functions with the filter by weakening the immune system.

She referred to as ExThera’s Dr. Ilic for recommendation. Dr. Ilic mentioned that if Mr. Hudlow felt worse after the filter remedies, it was a superb signal, based on a recording of the decision. It meant that he “had robust immune activation,” Dr. Ilic mentioned.

Dr. Ilic dismissed the Signatera check as a result of she mentioned it didn’t differentiate between dwell and lifeless most cancers cells. Quadrant had mentioned it might ship samples of Mr. Hudlow’s blood to a lab in Germany to measure the change in his circulating tumor cells. That C.T.C. check was the one to concentrate to, Dr. Ilic mentioned.

Ms. Hudlow was nonetheless on the lookout for extra proof that the therapy labored, so she inquired once more in regards to the Croatian examine. Dr. Ilic mentioned its knowledge was “wonderful,” and she or he repeated one thing she’d talked about as soon as earlier than: The tumor a great deal of the sufferers within the examine had shrunk by a minimal of 49 p.c six to eight weeks after their remedies. Ms. Hudlow was in awe. “Wow, that’s simply, that’s simply unbelievable,” she mentioned. (There isn’t a proof of this within the Blood Purification paper.)

Even so, Ms. Hudlow sensed that there have been simmering tensions between Dr. Ilic and Quadrant. After three weeks of ready for outcomes of the C.T.C. check, Ms. Hudlow had contacted the German lab straight and realized that Quadrant had bungled the blood cargo. Her husband’s samples had arrived there coagulated and ineffective. When Ms. Hudlow instructed Dr. Ilic in regards to the mishap throughout one other name, Dr. Ilic referred to as Mr. Pontzius, the Quadrant Medical Care president, a “whole fool” who didn’t perceive drugs.

However within the subsequent breath, she gave Ms. Hudlow new hope, the recording of that decision reveals. She had beforehand talked about a “Affected person No. 4” from the Croatian examine with inoperable colon most cancers whose situation was just like Mr. Hudlow’s. That morning, Dr. Ilic mentioned, she had realized that 60 p.c of Affected person No. 4’s tumors had disappeared. In truth, the affected person was doing so properly that he was coaching for a marathon, she mentioned. (There isn’t a point out of this within the Blood Purification paper.)

Dr. Ilic then confided to Ms. Hudlow one thing that she requested her to not repeat to anybody: British medical doctors had contacted her to debate the filter in reference to the care of Catherine, Princess of Wales, who, Dr. Ilic instructed, had colon most cancers.

An individual with data of the princess’s medical care mentioned that was not true.

Three Husbands within the I.C.U.

Listening to about Affected person No. 4’s restoration satisfied the Hudlows to return to Antigua for one more spherical of remedies. They flew there on April 3. Mr. Hudlow’s well being had declined sharply, however he was nonetheless capable of stroll on his personal.

Ms. Baskin and Mr. Withey had been to fly in from Chicago 4 days later, on April 7. They might be joined by one other member of the Most cancers Wives Membership, Stacey Bowen, and her husband, John, who had colon most cancers.

Ms. Baskin had been involved with Dr. Ilic, too, however what had actually offered her on the therapy was the decision with Mr. Preston and his description of the three Croatian sufferers’ full recoveries. The identical was true of the Bowens.

By the point the 2 different {couples} arrived on the island, Mr. Hudlow was in unhealthy form. In the course of the second of his three scheduled filtering classes, his pulse had quickened and he had begun gasping for air. The nurses transferred him to a small intensive care unit on the opposite aspect of the constructing.

Checks confirmed that his blood counts had been dangerously low, so Dr. John ordered a blood transfusion. However that didn’t assist together with his respiratory. Mr. Hudlow spent three nights within the I.C.U. on intermittent oxygen.

On April 8, Dr. John provided a grim prognosis: He instructed Ms. Hudlow that her husband was dying. Dr. John was touring to Miami for a convention the subsequent day and really useful that they get on the identical business flight. If Mr. Hudlow struggled to breathe onboard, Dr. John mentioned he would declare a well being emergency and pull down the oxygen masks from the panel above his seat.

That appeared like a horrible concept to Ms. Hudlow. On their final name earlier than leaving Florida, Dr. Ilic had referred to as Dr. John “a cowboy” and his clinic “the Wild West.” Ms. Hudlow now wished she had taken her phrases extra critically.

Ms. Hudlow tried as an alternative to rearrange an air ambulance to the Mayo Clinic in Jacksonville, the place her husband had been handled earlier than. However Mayo instructed her it couldn’t settle for a world switch. Working out of choices, she pleaded with Dr. John to promote her oxygen tanks after which began dialing constitution jet corporations. Three pilots turned her down earlier than she discovered one who agreed to fly with the oxygen tanks aboard.

Within the meantime, John Bowen and Brian Withey had begun their very own filtering remedies. After his first session on April 8, the incision Dr. John had made in Mr. Bowen’s groin to insert his dialysis catheter started oozing blood. Within the subsequent room, Mr. Withey’s blood clogged three filters earlier than a fourth one lastly appeared to work.

Two days later, throughout his second filtering session, Mr. Withey clogged one other 5 filters. In response to Quadrant, if a filter turned clogged, it was as a result of it captured a big amount of circulating tumor cells and different pathogens. However there was one other potential clarification the corporate didn’t talk about: Blood might coagulate contained in the filter if the dialysis machine’s movement charge was set too low. Movies taken by Ms. Hudlow throughout her husband’s first spherical of remedies confirmed the movement charge set at 80 milliliters per minute, lower than half of what ExThera thought of the optimum vary.

Ms. Baskin turned anxious, as a result of every time a filter bought clogged, the nurses would simply throw it away with Mr. Withey’s blood inside. Together with the blood within the connecting tubes, 335 milliliters of blood had been being discarded every time. After 5 filter modifications that day, Mr. Withey had misplaced practically one-third of his blood.

When Mr. Withey was lastly disconnected from his sixth filter round midnight, he seemed white as a sheet. He stood up and walked over to his spouse however then slumped to the ground unconscious and started shaking. Ms. Baskin turned hysterical. A nurse rushed in and spent 10 minutes attempting to resuscitate Mr. Withey earlier than a health care provider arrived and transferred him to the I.C.U.

The subsequent day, Dr. John referred to as Ms. Baskin from Miami and instructed her it seemed like her husband had come down with heparin-induced thrombocytopenia, a situation the place platelets within the blood turn into dangerously low. Ms. Baskin was doubtful as a result of she knew H.I.T. was a uncommon situation, and she or he suspected the actual drawback was less complicated: Her husband had misplaced an excessive amount of blood. However Dr. John assured her that Mr. Withey’s blood loss was manageable. When lab exams later confirmed her husband’s platelets rebounding — indicating that H.I.T. was not the perpetrator — Dr. John agreed to order a blood transfusion.

Whereas Mr. Withey recovered within the I.C.U., Mr. Bowen had his third filtering session. His spouse seemed on anxiously as his blood strain stored dropping. She mentioned that she referred to as Dr. John, who assured her that all the things was underneath management.

However Ms. Bowen was starting to panic. When the filtering session was over and the nurse pulled the dialysis catheter out of her husband’s groin, he wouldn’t cease bleeding. Ms. Bowen frantically tried to succeed in Quadrant’s Mr. Pontzius, however he was on a flight to Asia. One other physician on name ultimately decided that Mr. Bowen, too, wanted a blood transfusion.

Citing affected person confidentiality, Dr. John mentioned he couldn’t touch upon Mr. Hudlow’s, Mr. Withey’s and Mr. Bowen’s circumstances. “I’m assured within the top quality of care offered on the clinic,” he mentioned.

In a press release, Mr. Pontzius mentioned that Dr. John is “a revered U.S. board-certified surgeon with greater than 30 years of medical expertise” and that he leads “a protected and thriving clinic.”

Mr. Pontzius mentioned that lots of the points raised by The Occasions had been “not factually correct,” however he, too, declined to handle particular affected person circumstances.

Mr. Hudlow’s Remaining Hours

The jet carrying the Hudlows touched down on a non-public touchdown strip in Jacksonville round 2 a.m. on April 10. Ms. Hudlow rented a automotive close to the airport and rushed her husband to the Mayo Clinic’s Florida campus. She knew that if she wheeled him into the emergency room, the hospital wouldn’t be capable to flip him away. She was proper. Mayo admitted him inside 5 minutes of their arrival.

As she had suspected, Mr. Hudlow suffered from pleural effusions. Medical doctors drained the fluid from his lungs, which helped him breathe. The unhealthy information was that tumors in his liver, adrenal glands, bones and mushy tissue had multiplied and grown. Apart from providing hospice care, there was nothing the Mayo medical doctors might do. On April 16, Ms. Hudlow drove him dwelling to Panama Metropolis so he might spend his remaining hours together with his household. He died two days later.

Ms. Hudlow introduced her husband’s demise on a Fb group she had created to share details about the filter remedies. In her submit, she wrote that she didn’t blame the remedies for Mr. Hudlow’s demise and that she remained hopeful that “there could also be some magic there.”

Wanting again, although, she thinks the remedies accelerated his most cancers’s development. She says the ordeal additionally unnecessarily worsened the tip of his life. As an alternative of placing him by way of exhausting journey and ineffective filtering classes that elevated his ache, she says, she might have offered him palliative care at dwelling and stored him comfy.

The Bowens flew again to Chicago from Antigua on April 15. Mr. Bowen vomited on the aircraft. The subsequent morning, Ms. Bowen rushed him to Northwestern Memorial Hospital. Medical doctors there discovered a clot in the identical vein during which Dr. John had positioned the dialysis catheter. Additionally they recognized Mr. Bowen with tumor lysis syndrome, a situation during which most cancers cells disintegrate and flood the bloodstream with chemical substances and toxins quicker than the physique can eliminate them.

Upon seeing Mr. Bowen’s blood work, one of many Northwestern Memorial medical doctors predicted he wouldn’t survive greater than 48 hours. In the long run, he lasted every week. He died on April 24, six days after Mr. Hudlow.

Ms. Bowen mentioned she and her husband had hoped the filter remedies would “be the miracle that may give him extra time.” That didn’t occur.

“I’m offended,” Ms. Bowen mentioned. “They preyed on our desperation.”

Lab exams initially instructed that the most cancers of Mr. Withey, the lone survivor among the many three husbands, regressed barely within the first few weeks after coming back from Antigua. However his tumor cell counts quickly soared to as a lot as 5 occasions their ranges earlier than the journey. Scans additionally confirmed development within the tumors in his liver. He went again on high-dose chemotherapy.

Like Ms. Hudlow and Ms. Bowden, Ms. Baskin believes that the filter therapy supercharged her husband’s most cancers. That could be partly as a result of it led him to cease present process chemotherapy, however it’s not possible to know for positive.

Mr. Pontzius mentioned Quadrant “has no motive to consider that the remedy had a unfavourable affect on any affected person’s well being” and identified that lots of the sufferers Quadrant handled “had been terminally sick and had exhausted different therapy choices.”

Mr. Quasha mentioned the perceptions of grieving relations “are merely not dependable when in comparison with sound medical evaluate and judgment of their care.” He inspired The Occasions to ask Dr. Rosenberg, the Boca Raton oncologist who consulted on each Mr. Hudlow’s and Mr. Bowen’s care, for his scientific perspective.

Dr. Rosenberg mentioned that Ms. Hudlow and Ms. Bowen could also be proper to suppose that the filter remedies accelerated their husbands’ cancers — and subsequently their deaths. “Did it trigger hyper development? I requested myself that,” he mentioned. Dr. Rosenberg mentioned it was potential that the blood filtering brought on Mr. Bowen’s tumor lysis by sparking “an awesome immune response,” although he mentioned such a state of affairs could be “uncommon.”

Along with Mr. Hudlow and Mr. Bowen, The Occasions has realized of 4 different sufferers who died following their remedies in Antigua.

Considered one of them was Kyle Chupp, who was recognized with metastatic stomach most cancers in December 2023. Throughout a name the next month, Mr. Preston satisfied Mr. Chupp and his spouse, Vanessa, to delay Mr. Chupp’s scheduled chemotherapy and radiation by telling them that the three sufferers who had fared the perfect within the Croatian examine and had been now cancer-free hadn’t had chemotherapy or radiation beforehand, Ms. Chupp mentioned. Mr. Chupp’s blood was filtered in Antigua in February. His well being declined precipitously afterward, and he died on April 19.

Two of the opposite deaths concerned sufferers that Mr. Preston had described as feeling remarkably higher throughout his cellphone name with the Hudlows and Ms. Baskin, based on folks with data of the sufferers’ remedies.

Considered one of them was Ashley Sullivan, who had metastatic breast most cancers. Her husband, Edmund Mudge, mentioned she did really feel higher after her first two filter remedies. However not lengthy after the second therapy in March, she realized of a big new tumor between her ribs and lungs. Ms. Sullivan, 42, texted Dr. Ilic and requested her why the filter had labored so properly for the Croatian sufferers however not for her, based on copies of the messages reviewed by The Occasions.

“Have NO concept who instructed you just isn’t working for you,” Dr. Ilic texted again. “We bought your CTCs right down to zero.”

Three months later, Ms. Sullivan was lifeless.

The non-public jet took off from the Caribbean island of Antigua in April carrying three extremely flammable tanks of compressed oxygen and a terminally sick most cancers affected person.

Kim Hudlow had chartered the aircraft for her husband, David. She crouched by his aspect on the five-hour journey to Florida, frantically adjusting the valve on one of many oxygen tanks as he struggled to breathe. A physician had simply instructed her he was dying. She was terrified he wouldn’t survive the flight.

It was an abrupt turnaround. Six days earlier, Ms. Hudlow and her husband, who had late-stage esophageal most cancers, had arrived on the tropical island filled with hope {that a} novel blood-filtering therapy provided there would save Mr. Hudlow’s life — or not less than extend it.

They had been amongst about two dozen households lured to Antigua by a California start-up referred to as ExThera Medical and its secretive billionaire companion, Alan Quasha.

ExThera, which has about 50 staff, makes a single product: a filter that it says can be utilized to take away the tumor cells that flow into in sufferers’ blood and allow most cancers to metastasize. Early final 12 months, the corporate offered hundreds of the gadgets to Mr. Quasha’s non-public fairness agency, Quadrant Administration, which started utilizing them on late-stage most cancers sufferers at a small clinic in Antigua.

Quadrant, which invests on behalf of Mr. Quasha and his household and doesn’t have exterior traders, charged $45,000 for every course of therapy and suggested sufferers to return to the clinic for normal classes. It additionally urged them to abstain from chemotherapy between remedies.

ExThera and Quadrant promoted the blood filtering to the Hudlows and different {couples} by citing a Croatian examine of sufferers with metastatic most cancers that they mentioned had yielded extraordinary outcomes, based on cellphone recordings obtained by The New York Occasions.

In a single name with the Hudlows, John Preston, an ExThera board member and longtime enterprise companion of Mr. Quasha, claimed that three sufferers within the examine had been cured of their cancers. Throughout one other name, Dr. Sanja Ilic, ExThera’s chief regulatory officer, instructed Ms. Hudlow that one of many examine’s sufferers had recovered from inoperable colon most cancers to such an extent that he was coaching for a marathon.

“I don’t know of another therapy out there on this planet, on this planet, that may do higher stuff,” Dr. Ilic instructed Ms. Hudlow.

However these statements have but to be backed up by any printed knowledge, and the Croatian examine — with solely 12 individuals — was too small to attract any dependable conclusions, based on the physician who performed it. There isn’t a knowledge from a human scientific trial exhibiting the system slows or reverses most cancers.

In the US, the Meals and Drug Administration has approved ExThera’s blood filter to be used solely in emergency Covid-19 circumstances. The filter seems to work properly for that function, having been administered efficiently to tons of of severely sick sufferers contaminated with the coronavirus.

Final summer time, the F.D.A. allowed ExThera to check the filter on 5 pancreatic most cancers sufferers in Oklahoma — the primary part of what’s prone to be years of scientific trials to hunt the company’s approval to make use of the filter to deal with most cancers.

By finishing up the remedies in Antigua, the place the F.D.A. has no jurisdiction, ExThera and Quadrant circumvented that lengthy, drawn-out regulatory course of. However Mr. Preston and Dr. Ilic might have nonetheless violated federal legislation by selling ExThera’s filter to American most cancers sufferers on U.S. soil.

In February, two months earlier than the Hudlows’ ill-fated journey to Antigua, Jonathan Chow, ExThera’s director of medical affairs, warned the corporate’s high executives in a letter that the Antigua operation amounted to an unethical and unsafe experiment on sufferers and urged them to close it down, based on three folks accustomed to the matter. Throughout a short go to to the island, Dr. Chow had witnessed sufferers bleeding from catheter wounds and screaming in ache. ExThera didn’t act on his pleas.

Greater than 600,000 People die of most cancers every year. For all of the medical advances achieved in latest a long time, the variety of therapies provided to sufferers whose most cancers has unfold to a number of organs stays restricted. Typically, the usual of care continues to be chemotherapy and radiation, which might purchase sufferers time however not often cures them.

Sufferers with grim prognoses are sometimes prepared to strive something which may provide hope. And loads of suppliers — a lot of them working in international locations with rules much less stringent than these in the US — are prepared to grab on that desperation.

Some sufferers have sought therapy from a health care provider in Austria who says he’ll remedy them with a machine he constructed underground that supposedly restores “steadiness” to cells. Others have gone to Mexico for injections of immunotherapy medicine straight into their tumors. Just like the blood-filtering classes in Antigua, these remedies are costly and never lined by insurance coverage, saddling sufferers and their households with monumental out-of-pocket prices.

However ExThera and Quadrant appeared to supply extra credibility than the same old offshore clinic. ExThera is a U.S. firm with an F.D.A.-approved system, albeit not for the aim it was being touted. Quadrant, too, is an American company, run by a rich investor with a profitable observe report. The therapy the businesses had been advertising and marketing was experimental, however its promoters had the veneer of legitimacy.

In hindsight, Ms. Hudlow mentioned, the potential of a miracle remedy acted on her “like a drug.” She added, “I really feel so duped by all these folks. The way in which this was spun up and the best way it was defined, they bought me.”

Mr. Quasha mentioned in an e-mail that Quadrant “made no suggestions for what therapies sufferers ought to obtain.” Sufferers opted for the filter remedies on their very own in session with their medical doctors, and the corporate took care to remind them “at a number of steps within the course of” that the remedy was experimental, he mentioned. He and Quadrant declined to handle the specifics of Mr. Hudlow’s or another affected person’s case.

Of the greater than 20 sufferers handled in Antigua, The Occasions has recognized not less than six who’ve died since their remedies. Nonetheless, one affected person, a lady from Oklahoma, did seem to learn from the blood filtering. Her husband mentioned that the remedies offered her important reduction from her pancreatic most cancers ache and that she not requires any ache medicine.

After The Occasions despatched ExThera a listing of detailed questions, the corporate mentioned it requested Mr. Preston to depart its board and instructed its staff it had parted methods with Dr. Ilic. It additionally mentioned it terminated its partnership with Quadrant. ExThera didn’t elaborate on the explanations, however Mr. Quasha mentioned it was a mutual enterprise resolution and “had nothing to do with our perception within the efficacy of the filter therapy.”

Regardless of the cut up, Quadrant says it continues to deal with most cancers sufferers in Antigua with ExThera’s gadgets. Quadrant has a number of thousand filters saved at a warehouse on the island.

A Navy Origin

ExThera’s blood filter got here out of a navy contest. In 2012, the Protection Superior Analysis Initiatives Company, the Pentagon division behind early variations of the web, solicited proposals for a brand new medical system that may take away pathogens from blood. The objective was to deploy it within the area to deal with troopers uncovered to infections or organic brokers.

ExThera, based within the San Francisco Bay Space by two chemical engineers, received the competition with a three-by-nine-inch clear cylinder containing greater than 20 million tiny beads. The beads are lined in heparin, a substance just like a molecule discovered inside blood vessels that pathogens bind to. When blood flows by way of the system, the beads mimic the interior partitions of blood vessels and seize viruses, micro organism and fungi. The system works in tandem with a dialysis machine, which pumps blood out of a affected person’s physique and into the system earlier than returning it, filtered of pathogens, to the affected person.

The European Union authorized ExThera’s filter, which the corporate christened the Seraph 100 Microbind Affinity Blood Filter, to deal with bloodstream infections in August 2019. When the pandemic reached U.S. shores six months later, Military medical doctors tried it on two critically sick Covid-19 sufferers. The sufferers’ viral counts plummeted, and each recovered. The F.D.A. subsequently authorized the system to be used on Covid sufferers on the cusp of respiratory failure. ExThera says its Seraph filter has since been used on hundreds of U.S. and European sufferers with Covid or bloodstream infections.

However because the pandemic ebbed, ExThera’s gross sales to hospitals peaked at a couple of million {dollars} after which started to say no. The corporate started on the lookout for new makes use of for its filter. One concept was to see if the heparin beads might additionally seize the tumor cells that float in most cancers sufferers’ blood. Often called circulating tumor cells, or C.T.C.s, they play an essential function in enabling most cancers to metastasize.

The preliminary indicators had been encouraging: A small German laboratory examine confirmed that, not less than in check tubes, C.T.C.s connected to the heparin beads.

ExThera took the analysis a step additional within the spring of 2023. Dr. Ilic, who had labored at main medical system corporations earlier than changing into ExThera’s chief regulatory officer, met a Croatian physician named Vedran Premužić at a convention in Zagreb, and over dinner at a seafood restaurant, they determined to check the filter on most cancers sufferers, based on an individual accustomed to the matter.

The examine started with eight sufferers in September 2023 and later expanded to 10 after which to 12 sufferers. Usually a examine to gauge a tool’s effectiveness at treating most cancers could be run by an oncologist, however Dr. Premužić wasn’t a most cancers skilled. He specialised in kidney ailments.

In December 2023, Dr. Ilic mentioned promising early findings from the examine with ExThera’s high executives, together with outcomes for a lung most cancers affected person whose tumor appeared to have shrunk and a number of other sufferers whose biopsies had come again unfavourable, based on an individual with data of the matter.

Just a few days later, Mr. Preston, the ExThera board member, knowledgeable the corporate that he knew somebody who was all in favour of changing into its companion within the Caribbean. It was Mr. Quasha, with whom Mr. Preston had labored on non-public fairness offers for 15 years.

Mr. Quasha had deep pockets. Over 4 and a half a long time, he had quietly constructed a fortune shopping for up corporations and restructuring them. Considered one of his early acquisitions was a Texas oil agency whose chairman was the long run president, George W. Bush.

Following Mr. Preston’s introduction, ExThera shared the Croatian most cancers knowledge with Mr. Quasha. Impressed, he invested $3 million within the firm.

He additionally created a subsidiary of his funding agency referred to as Quadrant Medical Care and appointed his daughter, Dr. Devon Quasha, a doctor at Mass Basic Hospital in Boston, as certainly one of its executives. Quadrant Medical Care paid ExThera a further $10 million — a number of occasions what ExThera was producing in annual income — to turn into its Caribbean distributor.

A ‘Doubtful International Operation’

In early January 2024, Dr. Ilic and one other ExThera official loaded a dialysis machine and tons of of filters onto Mr. Quasha’s non-public jet at an airport in San Diego and flew them to Antigua. On the best way, the jet made a refueling cease within the Bahamas, the place it picked up Mr. Quasha. Dr. Chow, ExThera’s director of medical affairs, adopted on a business flight two days later.

Quadrant had contracted with an area clinic to start administering the therapy. The ExThera workforce was touring to the island to show the clinic workers learn how to use the filter. In contrast to the F.D.A., the federal government in Antigua had approved Mr. Quasha’s agency to make use of the system on most cancers sufferers.

The operation had the potential to be profitable. Quadrant was paying ExThera round $1,000 per filter, based on an individual with data of their contract, and three filters could be used per therapy routine in Antigua. With a $45,000 price ticket for sufferers, the revenue margins for Quadrant may very well be large.

However when the ExThera staff arrived in Antigua, a few of them shortly grew anxious.

The clinic Quadrant had employed lacked fashionable medical gear, and the physician in cost, a surgeon named Joey John, was making incisions underneath some sufferers’ collarbones to put in dialysis catheters with out utilizing any medical imaging or ample anesthesia, based on two folks accustomed to what the ExThera workforce encountered. Dr. Chow witnessed sufferers bleeding profusely and, in a single case, screaming in ache. He was additionally alarmed to study {that a} affected person was forgoing chemotherapy, a pillar of most cancers care, for an experimental therapy.

ExThera had flown in Sarah Mobbs, a nurse who had expertise treating Covid sufferers with the filter, to assist administer the remedy. Firm officers had instructed Ms. Mobbs that she could be helping with a most cancers examine. However when she arrived at Dr. John’s clinic, she noticed no indicators of the guardrails that may usually accompany a scientific trial, three folks with data of the matter mentioned. There was no therapy plan, no oversight from a medical board to make sure the supposed examine was performed safely and ethically. There wasn’t even an oncologist on web site.

Ms. Mobbs later instructed associates that her unease grew when she overheard Dr. Ilic inform most cancers sufferers that the filter would remedy them, the three folks mentioned. She anxious Dr. Ilic was giving them false hope. To extricate herself from the state of affairs, she made up a narrative that her mom and daughter had been in a automotive accident and left the island in a rush.

Dr. Ilic mentioned she shared a few of Dr. Chow’s and Ms. Mobbs’s misgivings. However she denied telling any sufferers that the filter remedies would remedy them.

Dr. Chow voiced his considerations to Erin Borger, ExThera’s chief govt, and others on a number of video calls, based on somebody with data of the conversations. He then despatched Mr. Borger and Robert Ward, certainly one of ExThera’s founders who was additionally chairman of its board, a letter outlining his worries. Within the absence of knowledge supporting the usage of the filter to deal with most cancers, the corporate was taking “undue dangers” with sufferers and subjecting them to “human experimentation,” he wrote. Referring to the Antigua clinic as a “doubtful international operation,” he urged ExThera to finish its affiliation with it.

However ExThera continued offering Quadrant with filters and the remedies in Antigua continued. Pissed off that his warnings had been ignored, Dr. Chow resigned from ExThera in June.

Requested about Dr. Chow’s letter, Mr. Borger mentioned: “We take issues of security and office conduct very critically. When these points come up, we instantly examine the matter and take acceptable motion.” He declined to say what, if any, actions had been taken. Dr. Ward declined to remark.

The Most cancers Wives Membership

Practically a month after Dr. Chow started airing his complaints inside ExThera, Mr. Preston, the board member who had launched the corporate to Mr. Quasha, spoke by cellphone with Mr. and Ms. Hudlow and Jaime Baskin.

Ms. Hudlow, who lives in Panama Metropolis, Fla., and Ms. Baskin, an elementary college particular ed trainer in Chicago, had met 18 months earlier by way of a standard pal. Ms. Baskin’s husband, Brian Withey, was eight years youthful than the 55-year-old Mr. Hudlow, however they each had metastatic most cancers. Mr. Withey’s had began in his rectum and unfold to his liver.

Together with the wives of three different most cancers sufferers, Ms. Hudlow and Ms. Baskin had shaped what they jokingly known as “The Most cancers Wives Membership,” texting and calling each other day by day to lend emotional help and share new medical insights.

One member of their group had heard about ExThera and its blood filter by way of a pal who had breast most cancers and had been handled — unsuccessfully, it might end up — in Antigua. Intrigued, Ms. Baskin organized a name with Mr. Preston. The Hudlows dialed in from Florida.

It’s unlawful in the US to advertise a medical system or a drug for a use that has not been authorized by the F.D.A. But that’s exactly what Mr. Preston did, based on a recording of the decision.

Mr. Preston started by explaining the filter’s origin and the science behind it. By eliminating circulating tumor cells from sufferers’ blood, he mentioned, the filter freed up the immune system to assault the tumor itself. (There isn’t a printed scientific knowledge to help this principle.) Mr. Preston then introduced up the Croatian examine and mentioned that 4 of its eight sufferers had been “doing properly” and that one other three appeared “to be totally recovered from their most cancers.”

When Ms. Baskin requested what he meant by “totally recovered,” Mr. Preston replied: “We will’t discover it, I’ll put it that method.”

Mr. Preston additionally talked about three metastatic most cancers sufferers whose blood had been filtered in Antigua the earlier month. He mentioned the change in how these sufferers felt after their remedies was “outstanding.” One affected person — the girl from Oklahoma — was doing so properly that she not wanted her ache drugs, he mentioned.

The decision with Mr. Preston lifted the hopes of the Hudlows and Ms. Baskin. However the actuality was not as promising as Mr. Preston had implied.

In an interview with The Occasions in September, Dr. Premužić, the nephrologist conducting the Croatian examine, mentioned it might be “extremely suspicious” to explain the filter therapy as efficient at such an early stage of analysis with out bigger randomized scientific trials. He mentioned that whereas his examine had produced encouraging outcomes, it was too small to succeed in any agency conclusions.

In November, the journal Blood Purification printed a brief paper in regards to the examine on-line. The paper mentioned that the variety of circulating tumor cells measured in 10 sufferers handled with the filter declined by a median of 71 p.c through the therapy. Nevertheless it mentioned nothing about how the sufferers fared long run and made no point out of three sufferers being cured of their cancers. Dr. Premužić didn’t reply to follow-up questions after the paper was printed. Dr. Ilic, who’s a co-author with Dr. Premužić on the Blood Purification paper, mentioned extra papers based mostly on the Croatian examine are forthcoming.

Mr. Preston mentioned in an e-mail that his communications with the Hudlows and Ms. Baskin had been “true and correct to the perfect of my data” and passed off “on the request of the treating physicians.” However Ms. Baskin mentioned no physician was concerned in organising the decision.

Ms. Hudlow, who had been a nurse earlier than she began a roofing enterprise along with her husband, determined to do a few of her personal analysis. She spoke with Dr. Ilic, who talked in glowing however obscure phrases in regards to the Croatian examine. She additionally realized {that a} Boca Raton, Fla., oncologist named Mark Rosenberg, who had beforehand consulted on her husband’s care, was referring sufferers to Antigua. She reached out to him.

Dr. Rosenberg instructed Ms. Hudlow that he didn’t have a lot knowledge to go on however that sufferers who had undergone a filtering session felt “wonderful” afterward, based on a recording of certainly one of their calls. He additionally instructed her that Dr. Ilic had shared with him scans exhibiting {that a} affected person’s lung tumor had shrunk 80 p.c inside three weeks of being handled with the filter.

“If that is true, what we’re seeing, that is essentially the most thrilling advance in oncology ever,” Dr. Rosenberg instructed Ms. Hudlow.

Dr. Rosenberg has since modified his view. In an interview, he mentioned he stopped referring circumstances to the Antigua clinic months in the past as a result of he didn’t see any optimistic outcomes amongst his sufferers. He mentioned Dr. Ilic by no means shared any knowledge with him past the scans he talked about to Ms. Hudlow. Within the absence of knowledge, “it’s tough to know what’s actual and what’s not actual,” he mentioned.

As an ExThera worker on the time, Dr. Ilic mentioned she was not approved to share scientific knowledge with firm outsiders.

The Occasions reviewed the scans — exhibiting a affected person’s lungs earlier than and after therapy — that Dr. Ilic confirmed Dr. Rosenberg. The post-treatment scan does seem to indicate a smaller tumor, however the angles and scales of the 2 photos are completely different, which makes it tough to inform whether or not the tumor really shrank.

Ms. Hudlow doesn’t begrudge Dr. Rosenberg for his change of coronary heart. However on the time, his enthusiasm helped promote her on the therapy. After speaking issues over along with her husband, she contacted Tom Pontzius, the president of Quadrant Medical Care, to make an appointment and wired $45,000 to the corporate. On Feb. 27, she and Mr. Hudlow flew to Antigua.

After they bought to Dr. John’s clinic, Ms. Hudlow’s educated nurse’s eye picked up on issues that bothered her. The nurses weren’t washing their palms. The surgical scissors they had been utilizing to chop away the dressings round sufferers’ catheter wounds weren’t sterilized. And one of many affected person rooms didn’t have a machine to watch very important indicators. However, she mentioned, she tried to stay upbeat for her husband’s sake.

Over the subsequent seven days, Mr. Hudlow underwent three filtering classes. Afterward, Ms. Hudlow mentioned, he felt weaker, and his ache elevated.

Quickly after the Hudlows returned to Florida, there have been indicators that his most cancers was rising extra aggressively. A check referred to as Signatera confirmed that the quantity of mobile tumor DNA in his blood rose practically sixfold. As she was slicing his hair in the future, Ms. Hudlow seen an ugly-looking development on his again. Quickly, one other one appeared on his ear, adopted by one on his scalp. They had been pores and skin tumors.

Mr. Hudlow was additionally having problem respiratory. Ms. Hudlow took him to the emergency room, the place he was recognized with a pleural effusion — a buildup of fluid within the lining of the lungs. Medical doctors tapped his lungs and drained a liter of reddish-brown liquid.

Ms. Hudlow puzzled whether or not her husband ought to get again on chemotherapy, however Mr. Preston, the ExThera board member, had suggested towards it on their name. He had mentioned that chemotherapy labored at cross functions with the filter by weakening the immune system.

She referred to as ExThera’s Dr. Ilic for recommendation. Dr. Ilic mentioned that if Mr. Hudlow felt worse after the filter remedies, it was a superb signal, based on a recording of the decision. It meant that he “had robust immune activation,” Dr. Ilic mentioned.

Dr. Ilic dismissed the Signatera check as a result of she mentioned it didn’t differentiate between dwell and lifeless most cancers cells. Quadrant had mentioned it might ship samples of Mr. Hudlow’s blood to a lab in Germany to measure the change in his circulating tumor cells. That C.T.C. check was the one to concentrate to, Dr. Ilic mentioned.

Ms. Hudlow was nonetheless on the lookout for extra proof that the therapy labored, so she inquired once more in regards to the Croatian examine. Dr. Ilic mentioned its knowledge was “wonderful,” and she or he repeated one thing she’d talked about as soon as earlier than: The tumor a great deal of the sufferers within the examine had shrunk by a minimal of 49 p.c six to eight weeks after their remedies. Ms. Hudlow was in awe. “Wow, that’s simply, that’s simply unbelievable,” she mentioned. (There isn’t a proof of this within the Blood Purification paper.)

Even so, Ms. Hudlow sensed that there have been simmering tensions between Dr. Ilic and Quadrant. After three weeks of ready for outcomes of the C.T.C. check, Ms. Hudlow had contacted the German lab straight and realized that Quadrant had bungled the blood cargo. Her husband’s samples had arrived there coagulated and ineffective. When Ms. Hudlow instructed Dr. Ilic in regards to the mishap throughout one other name, Dr. Ilic referred to as Mr. Pontzius, the Quadrant Medical Care president, a “whole fool” who didn’t perceive drugs.

However within the subsequent breath, she gave Ms. Hudlow new hope, the recording of that decision reveals. She had beforehand talked about a “Affected person No. 4” from the Croatian examine with inoperable colon most cancers whose situation was just like Mr. Hudlow’s. That morning, Dr. Ilic mentioned, she had realized that 60 p.c of Affected person No. 4’s tumors had disappeared. In truth, the affected person was doing so properly that he was coaching for a marathon, she mentioned. (There isn’t a point out of this within the Blood Purification paper.)

Dr. Ilic then confided to Ms. Hudlow one thing that she requested her to not repeat to anybody: British medical doctors had contacted her to debate the filter in reference to the care of Catherine, Princess of Wales, who, Dr. Ilic instructed, had colon most cancers.

An individual with data of the princess’s medical care mentioned that was not true.

Three Husbands within the I.C.U.

Listening to about Affected person No. 4’s restoration satisfied the Hudlows to return to Antigua for one more spherical of remedies. They flew there on April 3. Mr. Hudlow’s well being had declined sharply, however he was nonetheless capable of stroll on his personal.

Ms. Baskin and Mr. Withey had been to fly in from Chicago 4 days later, on April 7. They might be joined by one other member of the Most cancers Wives Membership, Stacey Bowen, and her husband, John, who had colon most cancers.

Ms. Baskin had been involved with Dr. Ilic, too, however what had actually offered her on the therapy was the decision with Mr. Preston and his description of the three Croatian sufferers’ full recoveries. The identical was true of the Bowens.

By the point the 2 different {couples} arrived on the island, Mr. Hudlow was in unhealthy form. In the course of the second of his three scheduled filtering classes, his pulse had quickened and he had begun gasping for air. The nurses transferred him to a small intensive care unit on the opposite aspect of the constructing.

Checks confirmed that his blood counts had been dangerously low, so Dr. John ordered a blood transfusion. However that didn’t assist together with his respiratory. Mr. Hudlow spent three nights within the I.C.U. on intermittent oxygen.

On April 8, Dr. John provided a grim prognosis: He instructed Ms. Hudlow that her husband was dying. Dr. John was touring to Miami for a convention the subsequent day and really useful that they get on the identical business flight. If Mr. Hudlow struggled to breathe onboard, Dr. John mentioned he would declare a well being emergency and pull down the oxygen masks from the panel above his seat.

That appeared like a horrible concept to Ms. Hudlow. On their final name earlier than leaving Florida, Dr. Ilic had referred to as Dr. John “a cowboy” and his clinic “the Wild West.” Ms. Hudlow now wished she had taken her phrases extra critically.

Ms. Hudlow tried as an alternative to rearrange an air ambulance to the Mayo Clinic in Jacksonville, the place her husband had been handled earlier than. However Mayo instructed her it couldn’t settle for a world switch. Working out of choices, she pleaded with Dr. John to promote her oxygen tanks after which began dialing constitution jet corporations. Three pilots turned her down earlier than she discovered one who agreed to fly with the oxygen tanks aboard.

Within the meantime, John Bowen and Brian Withey had begun their very own filtering remedies. After his first session on April 8, the incision Dr. John had made in Mr. Bowen’s groin to insert his dialysis catheter started oozing blood. Within the subsequent room, Mr. Withey’s blood clogged three filters earlier than a fourth one lastly appeared to work.

Two days later, throughout his second filtering session, Mr. Withey clogged one other 5 filters. In response to Quadrant, if a filter turned clogged, it was as a result of it captured a big amount of circulating tumor cells and different pathogens. However there was one other potential clarification the corporate didn’t talk about: Blood might coagulate contained in the filter if the dialysis machine’s movement charge was set too low. Movies taken by Ms. Hudlow throughout her husband’s first spherical of remedies confirmed the movement charge set at 80 milliliters per minute, lower than half of what ExThera thought of the optimum vary.

Ms. Baskin turned anxious, as a result of every time a filter bought clogged, the nurses would simply throw it away with Mr. Withey’s blood inside. Together with the blood within the connecting tubes, 335 milliliters of blood had been being discarded every time. After 5 filter modifications that day, Mr. Withey had misplaced practically one-third of his blood.

When Mr. Withey was lastly disconnected from his sixth filter round midnight, he seemed white as a sheet. He stood up and walked over to his spouse however then slumped to the ground unconscious and started shaking. Ms. Baskin turned hysterical. A nurse rushed in and spent 10 minutes attempting to resuscitate Mr. Withey earlier than a health care provider arrived and transferred him to the I.C.U.

The subsequent day, Dr. John referred to as Ms. Baskin from Miami and instructed her it seemed like her husband had come down with heparin-induced thrombocytopenia, a situation the place platelets within the blood turn into dangerously low. Ms. Baskin was doubtful as a result of she knew H.I.T. was a uncommon situation, and she or he suspected the actual drawback was less complicated: Her husband had misplaced an excessive amount of blood. However Dr. John assured her that Mr. Withey’s blood loss was manageable. When lab exams later confirmed her husband’s platelets rebounding — indicating that H.I.T. was not the perpetrator — Dr. John agreed to order a blood transfusion.

Whereas Mr. Withey recovered within the I.C.U., Mr. Bowen had his third filtering session. His spouse seemed on anxiously as his blood strain stored dropping. She mentioned that she referred to as Dr. John, who assured her that all the things was underneath management.

However Ms. Bowen was starting to panic. When the filtering session was over and the nurse pulled the dialysis catheter out of her husband’s groin, he wouldn’t cease bleeding. Ms. Bowen frantically tried to succeed in Quadrant’s Mr. Pontzius, however he was on a flight to Asia. One other physician on name ultimately decided that Mr. Bowen, too, wanted a blood transfusion.

Citing affected person confidentiality, Dr. John mentioned he couldn’t touch upon Mr. Hudlow’s, Mr. Withey’s and Mr. Bowen’s circumstances. “I’m assured within the top quality of care offered on the clinic,” he mentioned.

In a press release, Mr. Pontzius mentioned that Dr. John is “a revered U.S. board-certified surgeon with greater than 30 years of medical expertise” and that he leads “a protected and thriving clinic.”

Mr. Pontzius mentioned that lots of the points raised by The Occasions had been “not factually correct,” however he, too, declined to handle particular affected person circumstances.

Mr. Hudlow’s Remaining Hours

The jet carrying the Hudlows touched down on a non-public touchdown strip in Jacksonville round 2 a.m. on April 10. Ms. Hudlow rented a automotive close to the airport and rushed her husband to the Mayo Clinic’s Florida campus. She knew that if she wheeled him into the emergency room, the hospital wouldn’t be capable to flip him away. She was proper. Mayo admitted him inside 5 minutes of their arrival.

As she had suspected, Mr. Hudlow suffered from pleural effusions. Medical doctors drained the fluid from his lungs, which helped him breathe. The unhealthy information was that tumors in his liver, adrenal glands, bones and mushy tissue had multiplied and grown. Apart from providing hospice care, there was nothing the Mayo medical doctors might do. On April 16, Ms. Hudlow drove him dwelling to Panama Metropolis so he might spend his remaining hours together with his household. He died two days later.

Ms. Hudlow introduced her husband’s demise on a Fb group she had created to share details about the filter remedies. In her submit, she wrote that she didn’t blame the remedies for Mr. Hudlow’s demise and that she remained hopeful that “there could also be some magic there.”

Wanting again, although, she thinks the remedies accelerated his most cancers’s development. She says the ordeal additionally unnecessarily worsened the tip of his life. As an alternative of placing him by way of exhausting journey and ineffective filtering classes that elevated his ache, she says, she might have offered him palliative care at dwelling and stored him comfy.

The Bowens flew again to Chicago from Antigua on April 15. Mr. Bowen vomited on the aircraft. The subsequent morning, Ms. Bowen rushed him to Northwestern Memorial Hospital. Medical doctors there discovered a clot in the identical vein during which Dr. John had positioned the dialysis catheter. Additionally they recognized Mr. Bowen with tumor lysis syndrome, a situation during which most cancers cells disintegrate and flood the bloodstream with chemical substances and toxins quicker than the physique can eliminate them.

Upon seeing Mr. Bowen’s blood work, one of many Northwestern Memorial medical doctors predicted he wouldn’t survive greater than 48 hours. In the long run, he lasted every week. He died on April 24, six days after Mr. Hudlow.

Ms. Bowen mentioned she and her husband had hoped the filter remedies would “be the miracle that may give him extra time.” That didn’t occur.

“I’m offended,” Ms. Bowen mentioned. “They preyed on our desperation.”

Lab exams initially instructed that the most cancers of Mr. Withey, the lone survivor among the many three husbands, regressed barely within the first few weeks after coming back from Antigua. However his tumor cell counts quickly soared to as a lot as 5 occasions their ranges earlier than the journey. Scans additionally confirmed development within the tumors in his liver. He went again on high-dose chemotherapy.

Like Ms. Hudlow and Ms. Bowden, Ms. Baskin believes that the filter therapy supercharged her husband’s most cancers. That could be partly as a result of it led him to cease present process chemotherapy, however it’s not possible to know for positive.

Mr. Pontzius mentioned Quadrant “has no motive to consider that the remedy had a unfavourable affect on any affected person’s well being” and identified that lots of the sufferers Quadrant handled “had been terminally sick and had exhausted different therapy choices.”

Mr. Quasha mentioned the perceptions of grieving relations “are merely not dependable when in comparison with sound medical evaluate and judgment of their care.” He inspired The Occasions to ask Dr. Rosenberg, the Boca Raton oncologist who consulted on each Mr. Hudlow’s and Mr. Bowen’s care, for his scientific perspective.

Dr. Rosenberg mentioned that Ms. Hudlow and Ms. Bowen could also be proper to suppose that the filter remedies accelerated their husbands’ cancers — and subsequently their deaths. “Did it trigger hyper development? I requested myself that,” he mentioned. Dr. Rosenberg mentioned it was potential that the blood filtering brought on Mr. Bowen’s tumor lysis by sparking “an awesome immune response,” although he mentioned such a state of affairs could be “uncommon.”

Along with Mr. Hudlow and Mr. Bowen, The Occasions has realized of 4 different sufferers who died following their remedies in Antigua.

Considered one of them was Kyle Chupp, who was recognized with metastatic stomach most cancers in December 2023. Throughout a name the next month, Mr. Preston satisfied Mr. Chupp and his spouse, Vanessa, to delay Mr. Chupp’s scheduled chemotherapy and radiation by telling them that the three sufferers who had fared the perfect within the Croatian examine and had been now cancer-free hadn’t had chemotherapy or radiation beforehand, Ms. Chupp mentioned. Mr. Chupp’s blood was filtered in Antigua in February. His well being declined precipitously afterward, and he died on April 19.

Two of the opposite deaths concerned sufferers that Mr. Preston had described as feeling remarkably higher throughout his cellphone name with the Hudlows and Ms. Baskin, based on folks with data of the sufferers’ remedies.

Considered one of them was Ashley Sullivan, who had metastatic breast most cancers. Her husband, Edmund Mudge, mentioned she did really feel higher after her first two filter remedies. However not lengthy after the second therapy in March, she realized of a big new tumor between her ribs and lungs. Ms. Sullivan, 42, texted Dr. Ilic and requested her why the filter had labored so properly for the Croatian sufferers however not for her, based on copies of the messages reviewed by The Occasions.

“Have NO concept who instructed you just isn’t working for you,” Dr. Ilic texted again. “We bought your CTCs right down to zero.”

Three months later, Ms. Sullivan was lifeless.