A natural cancer remedy dangerous?

Jeffrey Tobias - 1 May 1991

The Lancet article on survival of patients with breast cancer attending the Bristol Cancer Help Centre (BCHC) has provoked widespread comment and badly shaken the confidence of those who believed that, at the very least, complementary therapies in cancer couldn’t do any harm.

The report confirmed much worse results than expected in BCHC breast cancer patients, who received treatment with dietary measures, relaxation, meditation, and art and music therapy in addition to conventional therapy. Attending the press conference given by the authors and two BCHC representatives, I was just as shocked by the attitude of the speakers from the centre as I was by the *

results themselves.

On the face of it, they were faced with a serious problem over the credibility of their treatment, though you wouldn’t have thought so from the tone of their comments. Dr Michael Wetzler, BCHC medical director, stated We do not believe that anything we do at Bristol could conceivably be harmful to the patients.

Why?

What reasons might there be for the very poor results in patients attending the centre.

Were they different or more unlikely to be cured in the first place? Did they delay conventional treatment believing that their adherence to the centre guidelines rendered them immune from relapse of the cancer? Were they psychologically different from those receiving conventional treatment, and if so, is this important? Or could it be, despite Wetzler’s bold assertion, that they were actually armed by the treatment they received?

Of all these possibilities, I find the last much the most likely, based on a substantial experience of patients who have adopted faddish diets, usually on the advice of well-intentioned but wrong-headed “alternative” practitioners who know little about cancer and its curiously unpredictable behaviour.

I have often been depressed by the degree of weight loss encountered in patients who have stuck rigidly to diets similar to that of the Bristol centre, resulting in discord at family mealtimes and quite frequently resulting in a major marital rift.

Arrogance

What arrogance to insist on the central importance of this thoroughly unproved approach with its profound implications for the patient’s life. No tea, coffee, sugar, salt, and only the very occasional glass of wine.

Many patients cannot maintain their body weight easily, feel unhappy with the restricted nature of the diet, yet also feel, understandably, in a dreadful cleft stick when it comes to the point of soldiering on with no prospect of returning to their former culinary pleasures or, as they see it, risking relapse and death by giving up and tucking into sausage and chips.

Since the Bristol centre does not routinely follow up its patients closely, it knows little of the true effects of its intervention. For many patients with advanced cancer, enjoyment of normal food is one of the few remaining pleasures, to say nothing of the enormous social importance of partaking in a family meal.

Furthermore, there are certain people for whom the Bristol centre diet is positively harmful for other reasons. For example, in patients irradiated for pelvic tumours (and often cured by this apparently monstrous treatment), increased sensitivity of the lower intestine, resulting in more frequent bowel actions, is the price the patient has to pay for the cure. The Bristol diet, with its emphasis on fibre and vegetable protein, is thoroughly unsuitable and makes matters far worse, sometimes to the point of impairing nutrition.

Yet even under those circumstances, so strong is the Bristol mystique that patients in this category, even given an explanation for their worsening symptoms, may be reluctant to give up what they believe to be good for them.

Desperation

I fully understand and sympathise with the point of view of any patient suffering from cancer that there must surely be something he or she can do independently of the doctor’s advice, taking them beyond the appalling loss of control they are faced with. I’d feel the same myself. But simply wishing fervently that something were true does not, regrettably, make it happen.

Those visiting the Bristol centre desperately want to help themselves, to hear about encouraging options which could be valuable. As a group, they are naturally motivated towards believing in what the centre firmly assures them is a series of valuable additions to their conventional treatment.

The very fact of the existence of these centres, with their strong message to patients that there really is a reasonable and realistic alternative to conventional medicine, represents a very real threat to the health of a patient with cancer. Many patients have come to seek advice in our oncology department at a far later stage than they should have done because of an initial visit to a medically unqualified homeopath or “alternative practitioner.”

Uncritical

Cancer sufferers naturally turn with gratitude to those who say they can help them, and do not always pay regard to their qualifications. Indeed, I am constantly astonished at the contrast between the extremely lively critical discussions I often conduct (and enjoy) with my patients and the totally uncritical attitude with which they then travel down to Bristol and take on board the most extraordinary advice, which increasingly I find to be far more invasive of their lifestyle than anything I would dare recommend myself.

For instance, since I (and most other practising oncologists) don’t believe that there is any such thing as “the cancer personality” I don’t expect patients to change their lives by relaxing more, giving up work, meditating for lengthy periods, and so on — unless, of course, they want to do so.

From what I hear from my patients, however, the Bristol centre quite frequently makes firm recommendations which, if acted on, would necessitate major changes.

Getting Better

Over the past 20 years, conventional medicine has, I believe, developed a much greater regard for the needs of patients and paid more respect to the importance of controlled clinical studies. We have rapidly accepted new approaches when old ones have been shown to be inferior — look at how quickly, for example, mastectomy is being discarded in favour of more conservative therapies. By and large, the medical establishment has not cried foul and, far from being overly paternalistic, has shown itself more flexible and less authoritarian than the “holistic” centres.

It occurred to me that the results of the study might possibly have shown the same result, but with the graphs labelled in the opposite direction — that is, with an apparent twofold to threefold advantage for the Bristol group. What would Dr Wetzler and Mrs Penny Brohn have said then? Would it have been a preliminary statistical quirk? Might there have been differences in the patients’ psychological characteristics to account for it? Not a bit of it. They would have been jubilant, convinced that the recommendations of the Bristol Cancer Help Centre had been proved effective. QED, I think.

Jeffrey Tobias Is a consultant radiotherapist in London and this article originally appeared in The Economist, or was it New Scientist…