Sodium bicarbonate therapy (Simoncini)

1. What it was

Version followed: the sodium-bicarbonate regime promoted by the Italian former physician Tullio Simoncini ("cancer is a fungus"), as described by the Dutch Association against Quackery (2007), Italian and Swiss news reporting of his trials (2015–2018) and later fact-checks. Do-it-yourself and online variants (baking soda with lemon, "cancer cookies") are described separately in sections 2 and 4.

This is a historical harm account. Sodium-bicarbonate "therapy" for cancer has no legitimate implementation for a psychotherapist and is not a treatment for cancer or any other disease. The psychotherapist's role is limited to recognising it, supporting clients and families who are considering, using or recovering from it, coordinating with treating physicians, and reporting.

Who and where. Tullio Simoncini, an Italian doctor, promoted the method from at least the early 2000s. His medical licence was withdrawn in 2003, and in 2006 an Italian court convicted him of wrongful death and swindling [source: Dutch Association against Quackery 2007]. He continued treating patients after this, including in other countries: in the Netherlands at a private clinic in Bilthoven (2007), in Rome, and at a clinic in Tirana, Albania (2012) [source: Dutch Association against Quackery 2007; RSI 2018; ANSA 2015].
Convictions. In January 2018 a court in Rome sentenced Simoncini to 5 years 6 months for manslaughter and illegal practice of medicine, and his collaborator, the radiologist Roberto Gandini, to 2 years for manslaughter, over the 2012 death of a young man with a brain tumour treated in Tirana [source: ANSA 2018; RSI 2018].
Stated rationale. Simoncini held that cancer is essentially a fungal infection caused by Candida albicans, which he said forms colonies that drive abnormal cell growth. He argued that fungi do not tolerate sodium bicarbonate, so bicarbonate delivered as close to the tumour as possible would destroy it. He claimed tumours shrank or disappeared in about half of treated patients; no published data support this [source: Dutch Association against Quackery 2007]. He also framed the treatment as harmless because bicarbonate is used in hospital medicine [source: Dutch Association against Quackery 2007].
How it was sold. Through websites in several languages, a book with a title along the lines of Cancer is a Fungus, Facebook pages run by supporters, and online interviews with alternative-health promoters. He presented himself as a specialist in metabolic disease, a surgeon and a philosopher, and as an unrecognised genius suppressed by official medicine. His own site acknowledged that no research or clinical testing preceded treating patients and mentioned the loss of his licence without mentioning deaths or verdicts [source: Dutch Association against Quackery 2007; Raskrinkavanje]. In a Swiss television investigation (2015), a journalist posing as a liver-cancer patient was told that chemotherapy would be useless and was referred to colleagues at a clinic in Rome for bicarbonate treatment [source: RSI 2018].
Evidence status in one line. No clinical trial or published clinical evidence shows that sodium bicarbonate treats cancer in people; laboratory and animal research on tumour acidity is not evidence for patient use [source: Full Fact 2023].

2. What was actually done

The following is a typical course as reported by regulators, courts and journalists. Amounts, concentrations and schedules are deliberately left out.

Recruitment. People with cancer, often advanced or with poor prognosis (brain, bowel, lung, breast and liver cancers appear in the reports), or their relatives, found Simoncini through his websites, his book, supporter groups on Facebook, online interviews, and onward referral by clinics and other practitioners [source: Raskrinkavanje; RSI 2018].
"Assessment" and consent. The cancer was re-explained as a fungal colony. Conventional treatment was discredited (the undercover patient was told chemotherapy would be useless), which shaped consent around rejecting or abandoning oncology [source: RSI 2018]. Patients were not told that the practitioner had been struck off and convicted, or that patients had died [source: Raskrinkavanje; Dutch Association against Quackery 2007] [uncertain: individual consent conversations are not documented in the sources].
Setting and staff. Treatment took place outside mainstream oncology: private clinics in Italy, a clinic for "preventive medicine" in Bilthoven (Netherlands), and a clinic in Tirana, Albania, with an interventional radiologist placing catheters [source: Dutch Association against Quackery 2007; RSI 2018; ANSA 2015]. Travel abroad meant patients were away from their own doctors.
Component techniques (described qualitatively).
- Intravenous infusions of a bicarbonate solution, given in a series of sessions [source: Dutch Association against Quackery 2007].
- Intra-arterial delivery: a catheter was placed in an artery feeding the tumour so that the solution could be deposited repeatedly in tumour tissue. In the 2012 Tirana case the young man died after two days of intra-arterial administration [source: Dutch Association against Quackery 2007; RSI 2018].
- Direct injection of a baking-soda-and-water mixture into tumours [source: Raskrinkavanje].
- Oral use of bicarbonate as a supplementary route [source: Dutch Association against Quackery 2007].
- Other routes (enemas, local application, inhalation) are described in some secondary accounts [uncertain: secondary, unverified].
Fees. Reports describe payments ranging from a few hundred euros for a single injection to €20,000 asked for a short series of intra-arterial infusions, and tens of thousands of dollars reported by one family [source: RSI 2018; Raskrinkavanje].
How "progress" was judged. By the practitioner's claim that tumours shrink or vanish; no systematic measurement or published outcomes exist [source: Dutch Association against Quackery 2007]. How deterioration was interpreted in individual cases is not documented in the cited sources [uncertain].
Non-response and refusal. Medical warnings were framed as the hostility of official medicine; supporters later circulated claims that "no patient of his died" [source: Raskrinkavanje].

Named variants.

Lemon and baking soda at home. Promoted widely in Balkan online outlets (2014–2022). In Croatia in 2015 a boy with lymph-node cancer died after his parents took him out of hospital and treated him at home with baking soda and lemon; the parents were later reported to have been sentenced to prison [source: Raskrinkavanje].
"Cancer-killing cookies". A 2022–23 social-media claim that baking soda baked with molasses after a period of fasting is a "lethal poison to all cancers"; rated false [source: Full Fact 2023].
Candida reframing. Later articles recast the claim as a link between Candida and cancer treated by alkalising [source: Raskrinkavanje].

3. How it caused harm

Metabolic alkalosis and electrolyte disturbance. Large, rapid bicarbonate loads disturb the body's acid-base and mineral balance and can cause serious or fatal complications; in hospital, bicarbonate is used only for specific disorders with close monitoring [source: Dutch Association against Quackery 2007]. The court record in the Tirana case gave the cause of death as metabolic alkalosis [source: ANSA 2015; RSI 2018]. Albanian forensic experts concluded the death resulted from negligent medical practice and that the tumour had not been treated according to modern protocols [source: Top Channel 2013]. Clinical literature on bicarbonate excess lists metabolic alkalosis, high sodium, low potassium and chloride, high blood pressure, volume depletion and (with oral ingestion) gastric rupture [source: Thomas & Stone 1994]. Physicians quoted in the press warned of cramps, arrhythmias and heart failure, with particular risk for people with heart disease [source: Raskrinkavanje]; people with kidney problems are also at particular risk [source: Full Fact 2023].
Procedure-related injury. Invasive catheterisation and injections outside a regulated oncology setting. In one Italian case from 2002 a patient with a bowel tumour died the day after an injection, from bowel perforation (his lawyer argued the tumour may have caused it) [source: Raskrinkavanje].
Documented deaths (as reported). Three patients in the Milan area in 2002 [source: Raskrinkavanje]; a woman with breast cancer in the Netherlands in 2007, who died days after emergency admission following a series of infusions at the Bilthoven clinic; the attending doctor would not certify a natural death [source: Dutch Association against Quackery 2007]; a woman in the UK in 2012 after about two months of the treatment [source: Raskrinkavanje] [uncertain: secondary]; a 27-year-old man in Tirana in 2012 (basis of the 2018 convictions) [source: ANSA 2015; ANSA 2018]; and a child in Croatia in 2015 after home treatment with baking soda and lemon [source: Raskrinkavanje].
Lost treatment time. Abandoning or delaying effective treatment is the largest harm. In a US cancer-registry study of curable (non-metastatic) breast, prostate, lung and colorectal cancers, people who chose alternative medicine alone had about two and a half times the risk of death of matched patients given conventional treatment, and over five times for breast cancer [source: Johnson et al. 2018].
Financial harm. Payments of thousands to tens of thousands, often made by desperate families, plus travel abroad [source: RSI 2018; Raskrinkavanje]. Cancer Research UK describes patients and families being "exploited by sellers of bogus cures" [source: CRUK 2016].
Psychological sequelae [synthesis]. False hope followed by rapid deterioration; dying away from home and usual care; bereaved relatives' guilt for having found, funded or encouraged the treatment; conflict between relatives who supported and opposed it; anger and shame on discovering the practitioner's record; complicated grief, particularly where legal proceedings follow.
Who was most at risk. People with advanced or frightening diagnoses (for example brain tumours), those distrustful of medicine, people with heart or kidney disease, children whose parents chose for them, and families with money to spend. Those choosing alternative medicine alone in the US study were more often younger, female, with higher income and education [source: Johnson et al. 2018].

4. Recognising it today

Phrases and rationales that signal the regime or its descendants

"Cancer is a fungus" / "cancer is Candida"; tumours described as fungal colonies or cysts [source: Dutch Association against Quackery 2007; Raskrinkavanje].
"Baking soda kills cancer", "alkalise the tumour", "cancer cannot survive in an alkaline body" [source: Raskrinkavanje; Full Fact 2023].
"Lemon and baking soda: a marvellous combination"; "cancer-killing cookies" (baking soda with molasses, sometimes after fasting) [source: Raskrinkavanje; Full Fact 2023].
"The biggest pharmaceutical lie", "cheap cure they don't want you to know", "chemotherapy is useless" [source: Raskrinkavanje; RSI 2018].
"No patient of his died", or presenting the practitioner as a persecuted genius or a former oncologist [source: Raskrinkavanje; Dutch Association against Quackery 2007].
Reframing toward "Candida and cancer are connected" without naming the originator [source: Raskrinkavanje].

Red flags in a referral, clinic, colleague or programme [synthesis, drawing on the cases above]

Invasive procedures (infusions, catheters, injections into tumours) offered by a clinic that is not part of an oncology service, or abroad, paid in advance.
A practitioner who has been struck off, is not registered where they practise, or works through "colleagues" (in the Netherlands the inspectorate could not discipline a practitioner who was not registered there) [source: Raskrinkavanje].
Discouraging, delaying or replacing surgery, chemotherapy, radiotherapy or palliative care.
Testimonials instead of outcome data; suppression narratives; pressure to decide quickly.
Online groups or influencers sharing home "protocols" and asking members to keep oncologists out of the loop.
In the UK, advertising that offers to treat cancer to the general public is generally unlawful under section 4 of the Cancer Act 1939 (enforced by Trading Standards); a 2012 cancer conference in Totnes that had billed Simoncini dropped him after a Trading Standards investigation was opened [source: CRUK 2016; Quackometer 2012].

How legitimate practices differ

Hospital use of bicarbonate: given only for specific acid-base or mineral disorders with laboratory monitoring by a medical team, not as an anti-cancer agent [source: Dutch Association against Quackery 2007].
Research on tumour acidity ("buffer therapy"): laboratory and animal studies exist; a 2020 review found insufficient clinical evidence to replace routine treatment, and Cancer Research UK knows of no published clinical trials of bicarbonate as a cancer treatment [source: Full Fact 2023]. A client who reads about this research is reading early science, not an approved therapy.
Integrative oncology (see 172): complementary supportive care delivered alongside standard treatment and coordinated with the oncology team, never instead of it [synthesis; cross-reference].
Fungi and cancer research: emerging research on the microbiome is not evidence that cancer is a fungus [uncertain: secondary, unverified].

5. What to do instead and how to help those harmed

Recommended alternatives (by name). Standard oncology care decided with the treating team (surgery, systemic therapy, radiotherapy as indicated); a second opinion from another oncology centre where trust has broken down; specialist palliative care, which can run alongside active treatment; psycho-oncology and psychological support for the person and family; integrative-oncology supportive care alongside standard treatment (see 172) [synthesis; cross-reference]. The psychotherapist never performs, sells, prescribes or recommends bicarbonate or any other remedy, and never advises on medicines or treatment choices: those go to the oncologist, GP or pharmacist [synthesis].

The psychotherapist's work below is general psycho-oncology and ethical practice applied to this harm; unless a source is cited it is [synthesis].

5.1 Asking about alternative treatments without judgement

Purpose / when: At intake and at each major point in the cancer course (diagnosis, recurrence, end of a treatment line), because clients often do not volunteer alternative use and judgement drives it underground.
Steps: (1) Ask routinely, as you would about sleep or alcohol. (2) Ask what, from whom, by what route (swallowed, infused, injected), where (home, clinic, abroad), cost, and whether the oncology team knows. (3) Record it factually in the notes, including any invasive procedure or travel plans. (4) Thank the client for telling you.
Example language (illustrative): "Many people with cancer look into other treatments as well. Is there anything you're using, or thinking about, that your oncology team might not know about?"
Watch for: Defensiveness or vagueness about where treatment happens; mention of injections or catheters outside a hospital; a plan to travel. It is working if the client keeps you informed over time rather than hiding plans.

5.2 Exploring meaning, hopes and the explanatory model

Purpose / when: When a client is drawn to the idea ("cancer is a fungus", "alkalise"), to understand what it offers them before any information is shared.
Steps: (1) Ask how they understand their cancer and how this treatment would work. (2) Explore what draws them: control, hope when told options are limited, fear of side-effects, distrust after a bad experience with doctors, identity, family or community pressure, an online group. (3) Reflect the underlying need (to fight, to be heard, to avoid suffering). (4) Separate the need from the method: ask what else could meet that need.
Example language (illustrative): "It sounds like what matters most is feeling that you're doing something, not just waiting. Can we look at all the ways you could have that?"
Watch for: Hopelessness hidden behind certainty; distrust rooted in real past harm (take it seriously and consider supporting a complaint or second opinion); signs of high-control online groups. Working: the client can name their needs separately from the treatment.

5.3 Autonomy-respecting decision support

Purpose / when: When the client is weighing the regime, or has started it, and is open to considering information.
Steps: (1) Ask permission before sharing information. (2) Share neutrally what courts and regulators found: the originator was struck off in 2003 and convicted over patient deaths; the Dutch Health Care Inspectorate declared bicarbonate cancer treatment hazardous and ineffective [source: Dutch Association against Quackery 2007; ANSA 2018]; people choosing alternative medicine alone for curable cancers had substantially higher death rates [source: Johnson et al. 2018]. (3) Elicit their reaction and their own priorities. (4) Encourage them to bring the question to their oncologist and, if helpful, offer to help them prepare questions. (5) Accept that adults with capacity may decide against medical advice; keep the relationship open so they can return.
Example language (illustrative): "Would it be all right if I told you what's publicly known about this treatment and the doctor behind it? You can decide what to make of it."
Watch for: Pushing, which tends to entrench the choice; shame after hearing the facts. Working: the client discusses it with their medical team and decides with fuller information, whichever way they decide.

5.4 Coordinating with the oncology, primary-care and palliative teams

Purpose / when: Whenever a client is using, or planning, bicarbonate or any invasive alternative procedure, and when palliative needs arise.
Steps: (1) Seek the client's consent to contact the oncologist or GP. (2) Share the relevant facts (what, route, where, since when). (3) Ask the team how they wish to be alerted to symptoms. (4) Encourage the client to keep oncology appointments even while using alternatives. (5) Support referral to palliative care where the team advises it. (6) Document consent and contacts.
Example language (illustrative): "Your oncologist would want to know about this so they can keep you safe. Would you be willing for me to contact them, or would you rather tell them yourself first?"
Watch for: Refusal of consent (respect it unless an exception to confidentiality applies; revisit later). Working: the medical team knows and the client remains in their care.

5.5 Responding to signs of medical harm

Purpose / when: If a client using bicarbonate in any form (or returning from treatment abroad) reports feeling unwell.
Steps: (1) Do not assess or advise on the substance. (2) Treat new confusion, muscle cramps or twitching, palpitations, breathlessness, severe vomiting or abdominal pain, or rapid deterioration as a medical emergency and help the client contact urgent care or emergency services. (3) Tell them to bring details of what they received. (4) Follow up after.
Example language (illustrative): "I'm worried about what you're describing. This needs a doctor today. Let's call now, and take with you anything that shows what you were given."
Watch for: Symptoms being explained away as "the tumour dying" or a healing reaction. Clinical sources list alkalosis, electrolyte disturbance, raised blood pressure and volume depletion as risks of bicarbonate excess [source: Thomas & Stone 1994; Dutch Association against Quackery 2007]. Working: the client reaches medical care promptly.

5.6 Grief, regret and guilt after choosing it

Purpose / when: With clients who used the regime and now face progression, or with bereaved relatives who found, funded or encouraged it.
Steps: (1) Let the person tell the story in full without correcting it. (2) Name the context: fear, love, and persuasive marketing aimed at desperate people [source: CRUK 2016]. (3) Distinguish responsibility from blame: the practitioner who sold it carried professional responsibility. (4) Work with counterfactual rumination ("if only") and self-blame using standard grief and guilt interventions (cross-reference grief and trauma domains). (5) Screen for complicated grief, depression and suicidal thinking using current risk-assessment practice. (6) Where legal proceedings or media coverage follow, plan for re-exposure to the story.
Example language (illustrative): "You chose it because you wanted them to live. Someone sold you a hope they had no right to sell."
Watch for: Persistent self-punishment, isolation, anger turned inward, or idealisation of the practitioner that blocks grieving. Working: the person can hold regret without collapse and begins to remember the person who died, not only the treatment.

5.7 Family conflict

Purpose / when: When relatives disagree about the regime (one pushing, one opposing), before treatment, during it, or after a death.
Steps: (1) Clarify who the client is and whose decision it is (an adult with capacity decides for themselves). (2) Offer a family meeting with the patient's consent, focused on the patient's values and wishes rather than the method. (3) Help each relative name their fear underneath the position. (4) Agree on how the family will stay connected whatever the decision. (5) After a death, address blame between relatives directly and, where needed, refer for family or couple work.
Example language (illustrative): "Everyone here is frightened of losing her. Can we start with what she wants from the time ahead, before we talk about treatments?"
Watch for: A relative overriding the patient's own wishes; the patient being cut off from relatives who object; estrangement after bereavement. Working: the patient's voice leads and relatives can tolerate disagreement.

5.8 Financial harm and exploitation

Purpose / when: When large payments, fundraising, loans or travel costs are involved, or after the loss.
Steps: (1) Ask about costs and who is paying. (2) Name pressure tactics if present (urgency, advance payment, discrediting other care) [source: RSI 2018; Raskrinkavanje]. (3) Signpost to consumer-protection, legal or debt advice services. (4) Help the person with shame about having paid. (5) Consider whether the person is an adult at risk of financial abuse.
Example language (illustrative): "Being asked for that much, that fast, while you're this frightened, is a warning sign in itself, whatever the treatment."
Watch for: Crowdfunding that locks a family into a course of action; debt; coercion by a third party. Working: the person makes financial decisions with time and advice.

5.9 Safeguarding children and adults at risk

Purpose / when: When a child with cancer is being given bicarbonate or other unproven treatment, or is being removed from or kept away from medical care; or when an adult lacks capacity or is under coercion.
Steps: (1) Recognise that withdrawing a child from cancer treatment in favour of home remedies has been fatal (Croatia, 2015) [source: Raskrinkavanje]. (2) Follow your local child-protection procedure and consult your safeguarding lead without delay. (3) Contact the child's treating team with consent where possible, or under safeguarding exceptions where not. (4) Involve the child according to age and understanding: seek assent and hear their wishes; consent rests with those with legal authority and, ultimately, the courts. (5) For adults, assess capacity concerns and coercion and use adult-safeguarding routes. (6) Document decisions and reasoning.
Example language (illustrative): "I can see how much you love him and want to protect him from the treatment. I have a duty to make sure his doctors are involved, and I'd like to do that with you."
Watch for: Missed hospital appointments, secrecy, a child appearing unwell. Working: the child is back under medical care and the parents remain engaged.

5.10 Reporting

Purpose / when: When you learn of someone advertising or providing bicarbonate as a cancer treatment, or of injury or death.
Steps: (1) Discuss with the client what they want reported and how their confidentiality will be protected. (2) Choose the route: in the UK, Trading Standards for advertising that offers to treat cancer (Cancer Act 1939), and the Advertising Standards Authority, which can refer on [source: CRUK 2016]; in the Netherlands, the Health Care Inspectorate, which ordered a clinic to stop bicarbonate cancer treatment [source: Dutch Association against Quackery 2007]; the professional regulator of any licensed clinician involved; police or prosecutors where injury or death occurred (as in the Italian and Albanian cases) [source: ANSA 2015; Top Channel 2013]. Medicines or device regulators, consumer-protection agencies and medical boards in other countries [uncertain]. (3) Keep your own records factual.
Example language (illustrative): "What happened to your father may happen to other families. If you want, we can look at who to report this to, and you decide how much you're comfortable sharing."
Watch for: Re-traumatisation through proceedings; clients' fear of reprisal from online groups. Working: the report is made at a pace the client can bear.

5.11 Helping clients appraise online claims

Purpose / when: When a client brings in videos, posts or articles promoting baking soda for cancer.
Steps: (1) Look at the material together with curiosity. (2) Ask who benefits, what evidence is offered, whether testimonials replace data, and whether the practitioner's legal history is mentioned. (3) Point to independent fact-checks (for example the Full Fact review of the baking-soda cookie claim) [source: Full Fact 2023]. (4) Encourage the client to take the material to their oncologist.
Example language (illustrative): "Let's look at this together. What would you want to know about the person making this claim before you trusted it with your life?"
Watch for: Exhaustion from searching; reliance on a single online community. Working: the client questions sources independently.

5.12 The therapist's own conduct

Purpose / when: Throughout.
Steps: Stay within competence; never sell, endorse or refer to alternative cancer practitioners; manage any personal beliefs about alternative medicine through supervision; avoid both collusion and contempt; document consent, risk and coordination. The relevant ethics code's provisions on competence, avoiding harm, and conflicts of interest apply [synthesis; the code itself is not quoted here].
Example language (illustrative): "My job isn't to choose your treatment. It's to help you make the choice that fits what matters to you, with good information and your doctors alongside."
Watch for: Rescuing, arguing, or withdrawing from a client who chooses against advice; your own grief after a client's death. Working: the client stays in therapy and in contact with their medical team.

Sources

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