Alternative Cancer Treatment and the Problems it Presents

Peter Dady - 1 February 1988

Peter Dady, MD, MRCP, Director, Oncology Department, Wellington Hospital.

When 464 patients being treated for cancer in New Zealand oncology departments were questioned about alternative medicine, virtually all of them had heard of this and one third had been advised about alternative treatment for cancer1. Cancer patients and their relatives often ask their doctors about alternative treatment, so the profession should be aware of the problems such treatment and the ideas that go with it present.

Dangerous Disinformation

Americans are more scared of cancer than any other kind of disease2; the same is probably true for New Zealanders. Politicians and advertisers know that any claim, however implausible, will be believed if repeated often enough. Frequent items in the mass media and a mass of publications have reached a scared, receptive public and advanced the cause of alternative cancer treatment far more effectively than logical argument could ever have done. Responsible but less sensational advice on. smoking, sunburn, sensible eating and early detection, which would decrease cancer mortality, does not appear to be having the same impact.

One very dangerous fallacy, supported by alternative wisdom, is that cancer is a hopeless disease, synonymous with terminal illness. Unfortunately, many people and some doctors do not need much convincing. If the terrified woman who presents with fungating breast cancer had not believed that the breast lump she discovered two years earlier was a death sentence, it might not have been. Derogatory description of conventional treatment by alternative practitioners does not encourage patients to seek early treatment, or accept it when offered. Few patients reject curative treatment in favour of alternative medicine’ but these few are too many.

In a recent newspaper interview a ”natural therapeutist” claimed that he successfully treated cancer patients, who were “‘often people who had been written off by traditional medicine”. To be charitable, one must assume that he is ignorant of what is. being done in general practices, hospitals and hospices for those patients who cannot be cured, but the idea that orthodox medicine writes people off can only be good for the alternativists.

Treatment Worse than Disease

In treating patients rather than writing them off we are sometimes as much “damned if we do as damned if we don’t’. The idea that oncologists are preoccupied with aggressive treatment for its own sake, irrespective of unpleasant side effects, is particularly offensive to those who must weigh the potential benefits of active treatment against possible harm, a judgement outside the competence of any lay therapist. For example, palliative radiotherapy for bone Pain :s quick, effective and virtually free of side effects. This contrasts with an alternative regimen, that has patients self-administering fresh ground coffee enemas several times a day, which may not do much for the quality of life of a patient more used to taking coffee by mouth but prohibited from doing so. The infamous grape diet restricts patients to grapes and water for several weeks.

In a recent radio phone-in a woman told how her father was still alive, having had ”terminal”’ cancer diagnosed 20 years earlier. For all this time the patient had had his diet and pleasures rigorously controlled, backsliding constantly corrected by his ever vigilant daughter. The 20 years must have seemed like 40. This man was not terminally ill, but for those who are, it is particularly unkind to forbid simple pleasures such as meat and wine for no purpose.

It is strange that patients submitting to the lifelong restrictions of alternative therapy are somehow assuming control of their treatment, whereas patients Raving conventional treatment, which aims to return them to a normal life and requires their informed consent, are not.

The medical profession has been getting more than its share of bad publicity. Politicians find it convenient io have the public believe that their doctors are greedy and obsessed with expensive high technology either for its own sake, or for “personal aggrandisement”. Even though New Zealand spends a smaller percent at gross domestic product on health than virtually any other “western” country, this is believed. It seems as if doctors no longer care about people.

Who Cares?

The Great Medical Conspiracy Theory states that doctors have conspired to suppress information about effective non-toxic alternative treatment for cancer. It is difficult to get doctors to agree about anything, but were the Conspiracy Theory correct, the medical profession would need the organisational ability of the Mafia and ethical standards to match. We may not be perfect, but neither are we that bad.

Cancer research is highly competitive. Any researcher who published a completely new way of treating cancer would have a good chance of a Nobel Prize. If patients being treated by conventional and alternative methods (and about 20% are ’) were better than those being treated only by conventional means, this would soon be obvious to oncologists. If any new approach seemed beneficial, it is highly improbable that a controlled study by doctors interested in improving the care of cancer patients would not follow.

A theological debate between the Pope and Ayatollah Khomeini in their respective languages would generate a lot of sound and heat, but not much light and understanding. Few, however, would doubt their sincerity. Most exponents of alternative medicine are sincere. Because they are profoundly ignorant about the complexities of cancer, they easily assimilate simplistic ideas which they reproduce with conviction. In public, doctors are generally careful to avoid oversimplification, broad generalisations and exaggerated claims. They also maintain some degree of professional detachment. Unfettered by such constraints, alternativists put across a message which the lay public often find convincing, sympathetic and, above ail, caring.

Alternative or Complementary? ;

Meetings between orthodox and alternative practitioners are as unlikely to develop any more of a consensus than would a debate between opposed religious leaders. Many alternativists (at least in public) take the line that alternative treatment “need not conflict in any way with orthodox medical treatment”5, but they may tell patients something different. Of 148 patients who had received advice about alternative treatment 26% thought that this would be instead of conventional treatment.

Scientific medicine cannot be reconciled with a system of wishful thinking.

Science and Pseudoscience

In his paper ”The Whys of Cancer Quackery”6, Lerner suggested that in the 1970s the American public lost confidence in science. A New Zealand Listener article7 implies that a professor of general practice feels that GPs are dissatisfied with exclusive reliance on the answers which high technology provides. He is also quoted as saving, “Specialisation has overtaken medicine to a pathological degree. There is an ideological crisis in medicine which has to be resolved”.

The nature of science is widely misunderstood. The Oxford Dictionary offers the following definition: “a branch of study which is concerned, either with a connected body of demonstrated truths, or with observed facts systematically classified”. William Harvey, who would not have known how to use a sphygmomanometer, was one of the greatest medical scientists; his truths were demonstrable; his observations and conclusions were simple but accurate. A GP who accurately observes signs and symptoms is no less of a medical scientist than a specialist with access to high technology. It was science that dragged medicine out of the dark ages, and scientific validation remains the patient’s safeguard against useless and dangerous treatment. It has not provided instant answers to all mankind’s problems, but that is no reason to abandon it in favour of a system that does not define the problems, yet alone come up with answers.

Electronic gadgets which are perceived to be scientific by those who have no understanding of science have long been charlatans’ stock-in-irade. However often these pseudoscientific toys are shown to be fraudulent, they still fool impressionable patients.

The immune system fascinates alternativists, but in a form that no immunologist could recognise, trivialised to the level of pseudoscience.

Reflexology, iridology, naturopathy and homeopathy all sound like scientific disciplines; some of them award “doctorates”. Anybody may describe his or her home or office as an institute. Alternative institutes are on the increase, as are alternative journals with scientific sounding names. Readers of the New Zealand Medical Journal know that the correspondence columns of legitimate medical journals are open to all. By these means alternative medicine seeks scientific respectability for the scientifically incredible.

What do they Claim?

The Wellington natural therapist who treats cancer patients ”claims a success rate higher than orthodox medicine, although he prefers to talk in terms of “relief” rather than “cure’”. No evidence to support this claim was given3.

In America it is illegal to advertise cancer cures, which has produced some minor masterpieces of legalese. A massive reprint (23 closely-typed foolscap pages) tells the story of a man who had a tumour the size of a grapefruit which was completely resistant to conventional treatment. He started taking herbal tea and “by the morning of the second day, my tumour began to shrink… after three weeks my tumour was so small you could hardly see it”. Three years later he was alive and well. The article was titled: ‘I Beat Terminal Cancer With An Herbal Tea”. There is a footnote: ”my tea is NOT intended for use in the diagnosis, cure, mitigation, treatment or prevention of disease in man or other animals”. In private, alternativists are less cautious.

A Wellington woman with rapidly advancing metastases was told that the cancer had completely left her body. When she expressed surprise that she had not been examined she was reassured that this was unnecessary because of her “good vibes”. Shortly afterwards she was admitted to hospital and died.

They are understandably nervous of sick patients. The Cancer Help Centre in Bristol, U.K., although staffed by ‘experienced medical practitioners”, ‘Should not be regarded as a hospital. It is not suitable for very sick people .. . a certain level of physical fitness is required”.

Alternative practitioners give hope to the incurable by telling them what they want to hear. They spend time with them and build up relationships. All this ends when these patients become sick and are suddenly transferred back to the conventional system of which they have low expectations. The psychological prop is withdrawn when it is most needed. In 1985, consultation with an alternative practitioner cost as much as for one with a GP; treatment was extra1. Euphoria does not come cheaply.

Maybe it Works

Any drug used in the treatment of cancer must be clearly shown to have antitumour activity. Objective measurements are required and the process of introduction takes about 10 years.

The alternative way is to claim that a particular form of treatment works; no objective evidence is required, but non-believers are challenged to disprove its efficacy. For example, Mr Jason Winters’ (I Beat Terminal Cancer With An Herbal Tea) remedy went through singularly rapid evaluation before it was offered to the public. “I decided to mix all the herbs together in the same pot. said to myself ‘If it kills me, it kills me'''; a rugged approach to toxicology, unlikely to find favour with regulatory bodies and medical defence societies. After the first cup: “You might not believe this, but I noticed a reaction almost immediately. As soon as I took it, I had a feeling deep inside that this combination of herbs was just what I needed”.

It would require a vast amount of medical research to evaluate all alternative treatments, as they change so rapidly, but some have been studied.

The rationale for high dose vitamin C in cancer treatment was vaguely plausible and its advocates, a Scottish surgeon called Cameron, and Linus Pauling the double Nobel laureate, eminently respectable. Unfortunately, their clinical data were flimsy and two careful studies at the Mayo Clinic showed no advantage for patients so treated.

During the American Prohibition a benevolent Dr Krebs sought to better the lot of suffering drinkers through the use of a substance to alter the taste of smuggled whisky. In the 1940s he claimed that the substance, christened laetrile, had antitumour activity. In spite of a negative study in 1953, by the 1970s laetrile had attracted powerful support. The American National Cancer Institute (NCI) sent 44,000 letters requesting case histories of laetrile users. Sixty eight complete case histories were obtained. These were reviewed by a panel of oncologists who found five remissions (one complete, four partial) and although these could be explained by factors other than laetrile, they concluded that laetrile possibly had some antitumour activity*. In 1980 there followed a limited toxicological study in which one out of six patients developed signs of cyanide toxicity”. A further study of 178 patients treated with laetrile failed to show tumour response, symptomatic improvement, or improved survival**.

Dr Lawrence Burton, a zoologist, claimed to have cured cancers by immunoaugmentive therapy using isolates from the blood of cancer patients. The NCI obtained ampoules said to contain tumour antibody, alpha-2 macroglobulin and C, complement. What they actually contained were simple blood tractions, mainly albumin with some nasty contaminants. All contained bacteria and hepatitis B. Subsequently, AIDS virus has also been isolated’*. The major observed effects on patients have been abscesses and hepatitis. For obvious reasons, no clinical study has been carried out.

For reasons best known to themselves, the British Medical Association invited Prince Charles, weil known to support alternative medicine, to be their President. At his request, they conducted an extensive investigation into alternative medicine. The findings were negative. These were greeted with predictable derision by the alternativists, who alleged that the doctors’ trade union was looking after its members’ interests. The Great Medical Conspiracy Theory is alive and well in the U.K.

What Can Be Done About It?

Alternative medicine will always be with us, but some response to its present malignant growth is indicated, especially as ‘controversial cancer specialist’ Milan Brych has not, at the time of writing, made his future plans known.

Eighty-five percent of patients who had been advised on alternative medicine were satisfied with their doctor’s advice. This question was not put to 68% of the survey who had not received alternative advice, but it is reasonable to suppose that if it had been, the satisfaction with doctors would have been even higher, since those who were questioned included the hard line alternativist patients’. The public need to be reminded of the huge advances that scientific medicine has made. Good medicine has always been ”holistic” and doctors remain committed to the care of the whole patient. High technology is simply a tool which is sometimes used to cure or alleviate suffering or both. The role of the doctor as a well informed sympathetic advisor is particularly important in dealing with cancer patients. The positive aspects of cancer treatment should be stressed. Ill-informed pessimism and negativity are as unprofessional as a “‘treatment at any cost” attitude and both may drive patients to alternative medicine. Some patients will seek alternative advice, however good their doctors. They should be told of the disadvantages of this and be advised to use the same judgement that they would when buying a used car. Getting upset with these patients is counter productive, and if they elect to abandon treatment, they should be assured that they will be welcome to return if they change their minds.

Those doctors who offer alternative treatment should remember that cancer is rarely a self-limiting disease. The privileges that they enjoy are the result of thorough scientific training and their patients are entitled to receive advice consistent with that.

References

1. Clinical Oncology Group. New Zealand cancer patients and alternative medicine 1986, NZ Med J (in press).

2. Anonymous. Most feared diseases. Parade Magazine USA 1977; Feb 6.

3. Warner H. Wellington Evening Post 1986; Sep 13; 18.

4. Brandt J. The grape cure. New York Harmony Centre 1928.

5. Anonymous. The Cancer Help Centre, Grove House, Cornwallis Grove, Bristol, BS8 4PG, UK.

6. Lerner [J. The whys of cancer quackery. Cancer 1984; 53: 815-19.

7. Swain P. Health alternatives. Listener 1986. Feb 22; 19-21,

8. Creagan ET, Moertel CG, O’Faiion JR, et al. Vitamin C (ascorbic acid) therapy to benefit patients with advanced cancer: a controlled trial. N Engl J Med 1979; 301: 687-90.

9. Moertel CG, Fleming TR, Creagan ET, et al. A randomised double-blind comparison of high-dose vitamin C and placebo in the treatment of advanced cancer patients with no prior chemotherapy. N Engl J Med 1985; 312: 137-41.

10. Ellison NM, Byar DP, Newell GR. Special report on laetrile: the NCI laetrile review. N Engl J Med 1978; 299: 549-52.

11. Moertel CG, Ames MM, Jovach FS, et al. A pharmacologic and toxicological study of amygdalin. JAMA 1978, 255: 591-94.

12. Moertel CG, Fleming TR, Rubim J, et ai. * clinical trial of -amygdalin (laetrile} in the treatment of human cancer. N Eng! J Med 1982; 306: 201-06.

13. Curt GA, Katherhagen G, Mahaney FX. Immunoaugmentive therapy. JAMA 1986; 255: 505-07.