Alternative Medicine and Cancer

 

 

Can it be rational to use alternative cancer treatments, and if so, when? 

Cancer is a very personal thing.  Even as a critic of alternative methods I think that cancer patients often use them reasonably rationally,  when looked at from their rather unique viewpoint.   

We sceptics have the interests of the cancer patient at heart, too,  but with  a broader, longer-term and  more detached overview..   Our focus is on the ethical and scientific responsibilities of those who offer medical treatments to seriously ill patients,  and how we can know when such treatments really do work  (see Footnote  for a summary of our position).  Cancer patients, on the other hand,   just want anything that might help them over a serious problem.  They are not making scientific statements or even investing great belief when they try out dubious treatments.

Each case should be considered on its own merits, but the two commonest modes of use of dubious treatments cannot, in my view,  be regarded as completely irrational: (1) when used alongside conventional measures in the hope of improving the chances of cure or remission, and (2) when used for  advanced cancers where conventional measures have failed or have little chance of helping (including when chemotherapy is the only conventional option available, but is very unlikely to help much) .   I will go into my reasons a little later.

"As well as", or "instead" ?

Essentially  complementary uses like these should be clearly distinguished from truly alternative usage, where conventional care is never considered at any stage.    Conventional methods certainly often fail, and alternative circles like to make great play of that,  but if you happen to have one of the types and stages of cancer that are  regularly cured by conventional methods, why on earth choose to rely on methods that have never been definitely shown to cure any at all,  or hardly any,  should you be impressed by the very few testimonials of any quality?    

Why do some people  do this?  Is it not being made clear enough that well over fifty per cent of all new invasive cancers can be cured these days,  and in some types and stages close to 100% (and I am not just talking about five year survival, I am talking about cure in every sense).  Or is the "information superhighway" now completely gridlocked with doomsayers?  

Is it that conventional treatment programs can be unpleasant and have later ill effects?   Yet what matches the brutality of inadequately treated cancer?   Do some have difficulty in taking in and  dispassionately assessing the truly enormous amount of information that is now available about the results of both conventional and alternative treatments?    Or,  is the "inner child" responsive only to the  nice-if-it-were-true, like Santa Claus, or the tooth fairy, or "cancer is easy to cure when you know how"?   

Some are undoubtedly drawn into a paranoid and delusional belief system, where lies look like truth, truth looks like lies, and scraps of truth become the whole cloth.   Being privy to "the truth about cancer" and a member of this elite offers considerable support and self validation,  even while the inadequately treated cancers can continue to gnaw away .  Any little change in the cancer is interpreted as a treatment success, even when the bleeding gets worse or the cancer starts to fungate through the skin (the body is expelling it!).   It is as though centuries of medical experience and research never existed.   An arrogant amateurishness and ignorance rules both theory and practice.  

My concern is not merely the as yet rather small number of lives lost unnecessarily,  it is the forgoing of the very substantial palliative benefits  that conventional methods often offer  for both primary and metastatic cancer,  even when not curative.   It is appalling to me, for example,  that in the year 2006 some breast cancers are being allowed to progress to cancer-en-cuirasse and other miserable states scarcely otherwise seen for nearly a century.      I regularly come across cancer patients who suffer terribly through being persuaded not to accept conventional treatments, even as palliation.    Some even proclaim, with extraordinarily misplaced pride, how they refuse to even use  morphine for the  pain of terminal cancer.

The simple fact is that patients who refuse all conventional care, even simple surgery,  for potentially curable cancers  almost invariably do poorly.   We oncologists and surgeons have considerable personal experience of this in our own practices.   A recent study on breast cancer patients who refused conventional treatment in favour of alternatives shows what usually happens  [1].   

 A more rational approach might be for such patients to negotiate with their doctors with a view to accepting any elements of conventional care that offer a chance of cure, or remission,  or even just control of the primary cancer,  while not clashing too much with whatever concerns are dictating their choices.    Adequate surgical removal, for example,  is the foundation for the cure or local control of most common solid cancers.   The addition of other treatments such as radiotherapy, hormonal agents,  chemotherapy, or immunotherapy  is clearly demonstrated  to reduce the risk of some kinds of cancer coming back either locally or as metastases,   but they can undoubtedly sometimes also introduce significant ill effects.  Fully informed consent should  always prevail so that the patient can weigh up the various risks/benefits and make their own choices. 

Elements of  the alternative cancer industry are quick to seek justification in this right of the patient to choose, while never producing the kind of information that might enable the rational exercise of that right in relation to their own offerings.  The strategy is to keep  the focus upon  real and alleged failings of the mainstream  and especially on the easy target of chemotherapy, the least useful treatment for most kinds of common solid cancers  (It has a major curative role with lymphoma and leukemia).   The relative usefulness of the "alternatives" can be left to be moulded by the hopes and imaginings of frightened people and shabby testimonial  that as often as not is consistent with the known effectiveness of the conventional care also received as any alternatives used (e.g. see A Deceptive Breast Cancer Testimonial and How to Read a Cancer Testimonial)..  

It is also too easy to misrepresent truly numerous options as a single "either/or" choice -- conventional vs "alternative".   Mostly the decision to use or not to use any method is not tied to the use of any other.   There is a "whether" in each case, sometimes depending upon the specific state of the cancer.   In a better world decisions about alternatives would be based upon a similar availability of information as to benefits and risk and with the same standards of informed consent.             .  

Pascal's Wager

The complete abandonment of conventional methods  has to involve one of the above kinds of blindness to the realities of cancer.  

 The more usual complementary  (ras well as") use of dubious methods can, however,  be looked upon as a kind of  "Pascal's wager".    Blaise  Pascal (1623-1662) suggested that it was wise to believe in God, even when doubtful, because there was little downside if He did not exist  but a huge payoff later if He did.   Pascal's proposition was debatable on both logical and theological grounds, but the possible outcomes for the cancer patient are surely sufficiently  extreme as to justify gambling against considerable odds.    Contract bridge players apply similar logic when a difficult contract can only be made if the  cards lie in one improbable  way.     

I sense that despite the rather "rah-rah" atmosphere of alternative newsgroups and mailing lists, dominated as they are by vocal extremists,   most alternative users don't need to be told that the chances of them working are rather small.   Even very sympathetic and thorough  alternative cancer investigators such as Michael Lerner, author of "Choices in Healing", and Ralph Moss,  a constant critic of conventional medicine's dealings with alternatives,  have been unable to offer very optimistic estimates as to how often they work,  or even, after all their researches,  firm data as to whether any work consistently at all.    It is also revealing that the staunchest supporters of alternative methods always react to criticism, not by producing any body of cured patients, but by dwelling on those areas where conventional methods  are (also?) rather ineffective!   

Yet, when the stakes are so high, why not go against the odds?

"Science doesn't know everything"

Reinforcing this kind of reasoning, everyone knows that science can sometimes get things wrong.  The use of "alternatives",  could, at a stretch,  be viewed as a quite sophisticated application of the principle that  all scientific knowledge is provisional  to varying degrees.   The customary, knee-jerk,  sceptical opinion  may wrong in disregarding  some of the methods.  The cancer sufferer might be lucky enough to hit upon some good ones if they try enough of them.   

That is true, I suppose.  Unfortunately it doesn't improve the odds much.     "Science doesn't know everything" is no answer to the only question that really matters, and that is: "how do the promoters of the treatment know/show that it does what they claim?"     This is invariably where the true deficiency lies and where  cancer patients should be demanding more detailed information and learning to ask more penetrating questions..   As explained on other pages, it should be easy to show that a cancer cure works, if it worked as well as the promoters of alternative treatments usually imply [see here].   

This is one situation where  "absence of evidence IS evidence of absence", once we ask how such important medical claims as the ability to cure cancer could ever be made with no more than a smattering  of highly selected, poor quality testimonials.   Either the  more usual, overall  results are not very pretty to look at and best kept quiet, or  the claimants are so cancer-naive as to not understand what a good cancer treatment should look like.   In either case, buyer beware.   

 Tipping the balance

Lastly,  it could be argued that even when lacking obvious effects on its own against established human cancer, an "alternative"  may sometimes help keep patients in remission, or improve ultimate cure rates when used alongside other methods i.e. "adjuvant" use..   Or it may simply slow cancer progress.        

These possibilities cannot be discounted on the available evidence.    Some cancers remain dormant for long periods after initial treatment, and it is often not clear why they can suddenly and aggressively flare up after many years.   Might a little tweaking of the immune  system or other weak anti-cancer influence sometimes tip the balance in favour of the patient rather than the cancer in such cases? 

The mainstream has considerable experience of such adjuvant use of  various physical, hormonal, immunological and chemotherapeutic agents,  but has so far achieved only modest improvements in results even from agents that can have quite powerful activity against the same cancers in other settings.   So it is not clear how a method that has little activity against cancer  in its own right would have significant activity in these other roles..   

And again, the problem arises as to how it could be known that a treatment possessed such activity,  without quite sophisticated  trials involving large numbers of patients.    The natural variability of outcomes with many kinds of cancer would  otherwise swamp the weak effect.   Testimonial would merely show one end of the normal range of possible outcomes without the treatment.         

Still, such minor effects can also not be entirely discounted without the appropriate studies         

Conclusions

 For the above reasons I can mostly sympathise with cancer patients using alternative treatments, when at their own expense and risk.   

 I cannot bring myself to actively encourage it.   The medical profession  (and that should include alternative medicine) has obligations with respect to the  expansion of medical knowledge and the interests of ALL  cancer patients, even those yet to come,  that go well beyond the world-view of the individual patient.   

Also, the  above is a defence of some of the cancer patient's choices  without in any way justifying the other side of the deal.    It remains immoral to offer seriously ill patients a treatment without being able to show that  it regularly has the claimed benefits, and I fail to see how any person can defend this.   

This is also no defence of cancer patients who claim they have been cured by these methods without considering everything that might bear upon such a claim.   Are their moral obligations any less?   After all, their testimonials sustain the entire alternative cancer industry.   It is disheartening that the most well-intended of testimonials typically do not show what they supposed to --- yet they can be seen to be influencing others in life and death decisions.  

 

Footnote: Reasons for NOT using "alternatives"

Considerable research into many once very popular methods  has never produced any clear  evidence of  effectiveness  <2,3>.    Many look frankly fraudulent.  Others make no sense on  well-trodden paths of science.  

The serious use of "alternatives" can nevertheless require enormous commitments of time, money and energy..   

Using unproven. or  disproved alternative methods encourages quackery and fraud.  

Cancer patients should not be compelled to choose between  methods having so little evidential support.  Those with overt cancer have the right to know how similar patients usually fare with any new treatment that is offered to them.   Such information would be readily available if only average standards of patient documentation and follow-up were being applied within alternative medicine, yet it is being routinely withheld in what looks like an industry-wide  collusion of the many parties not to compete with each other on cure rates, as would occur in any ethical and rational medical marketplace  

The alternative cancer marketplace will not improve until cancer patients and those who care about them withdraw their support from those who refuse to engage in  the  transparent and honest gathering and  publishing of results.    Back

 References

[1]  Am J Surg. 2006 Oct;192(4):471-3. Links
Outcomes of breast cancer in patients who use alternative therapies as primary treatment.Chang EY, Glissmeyer M, Tonnes S, Hudson T, Johnson N.   Medline     http://tinyurl.com/yhl7zx

[2] See What DO alternative methods really do? --- The inside story

[3] Alternative Cancer Cures: "Unproven" or "Disproven"? Andrew Vickers, PhD. CA Cancer J Clin 2004; 54:110-118 http://caonline.amcancersoc.org/cgi/content/full/54/2/110