When alternative cancer therapy harms patients

After a terribly painful and debilitating illness, Steve died.  He had been treated for Stage 2 Hodgkin’s Disease with a series of intense therapies including German enzymes, American antineoplastins, Mexican naturopathy and Chinese herbs, complemented by focused meditation, innumerable vitamins, extreme diet modification and acupuncture for severe pain.  He fought the cancer with every ounce of his being, doing everything to survive, except the one thing that had an 85% chance of cure: chemotherapy.

I was struck this week by a comment on my website, which bemoaned the highly disorganized state of “alternative medicine” in this country and in particular the “paltry sums” for alternative research funding by the National Institutes of Health (NIH). The writer suggested that not only could the quality of health be improved with alternative medicine studies, but would go a long way towards saving health care dollars.

It seems to me that the idea that we need more complementary and alternative medicine (CAM) research goes right to the core of the confusion between so called “conventional medicine” and CAM.  There is a major difference between the medicine practiced by board certified, classically trained physicians and that of alternative practitioners.  That difference is research and data.

If an MD or DO is treating a cancer patient and that patient asks to see or understand the basic science and clinical studies which support the recommended therapy, that published data is readily available. Standard oncology treatment goes through 10-20 years of research, from the test tube, animal studies and through a series of supervised human multi-phase trials, until it is approved and offered to patients. Each step is refereed by competing and critical PhD and physician scientists and must be published in peer-edited journals for general review and criticism, all of which is public and transparent. Where it is not, and when people attempt to manipulate or falsify the system or data, massive blowback eventually occurs.

Alternative medicine, by its very definition, means that it is an alternative to this system of scientific analysis.  Essentially, anyone can come up with an idea and without any of the above research steps, provide it to patients.  If I decide that sunshine enhanced lemon juice can kill cancer because it is acidic and cancer hates acid, then I can start selling it in pill form tomorrow.  If you look at a long list of CAM therapies, that is what they have in common … the shortcut from idea to bedside.

CAM treatments may have long respected histories. Some, like Chinese traditional medicine, ayurvedic medicine of India, American homeopathy or acupuncture, are hundreds or even thousands of years old and have millions of adherents who believe it has helped or even cured them.  Often the most vocal support comes from individual patients regarding their own experience with an alternative treatment. Scientists believe that individual case reports are poor substitutes for the objective analysis of hundreds of patients in experimental trials.  All CAM therapies have limited or no published research to explain the science of these therapies or to prove they work any better than placebo.

When proper research is performed, certain alternative treatments are found to have value.  Vitamin D (with calcium) seems to improve bone density.  Acupuncture can treat migraines and prevent chemotherapy-induced nausea.  Chiropractic is more likely than orthopedic surgery to return patients with routine back pain to employment.  Exercise helps depression and decreases the likelihood that breast cancer will relapse. On the other hand, randomized trials have shown that laetrile (amygdalin) has no anticancer activity and that Vitamin C does not prevent or blunt upper respiratory infections any better than sugar pills.

A key question is that just because the research supporting CAM therapies is limited, does that make them bad?  Not necessarily, but it does mean that when choosing such a method of care, patients need to understand they are making the decision based not on a step-by-step scientific process, but on unproven theory.  It comes down to trust in the CAM practitioner, because no one, not the person providing the treatment, the patient’s primary physician, nor the patient, has any objective evidence to show that the therapy may help or hurt.

Patients have many reasons to choose alternative treatment instead of or in addition to conventional medical care. The most obvious is the powerful desire to do everything possible to fight the disease, to leave no stone unturned.  The need to control one’s destiny, especially if confronted by doctors or a medical system, which seems impersonal, cold and uncaring, drives many patients to seek a different path.  Many patients distrust conventional medical care, and most Americans believe conventionally trained doctors either deliberately or by ignorance fail to offer reasonable alternative therapies. For some there is deep mistrust in the objectivity of the “physician-medical school-pharmaceutical-government complex.”  Traditional religious, superstitious and pseudoscientific reasoning support the CAM decisions of many patients.

Like most physicians, I have seen many patients hurt by CAM therapies. Some by obvious side effects, such as the woman whose breast fell off after receiving a poultice or the man who had such severe nerve damage that he never walked again.  Others delayed life saving therapy with horrible result.  Many spent their last dollars without benefit.  Finally, other patients undoubtedly experienced side effects and perhaps increased cancer growth because we simply do not have the data on alternative therapies to understand what to expect.

CAM therapies are an alternative to conventional medicine.  As we do research on each concept, it will not longer be alternative medicine, but proven or not will fall under studied medical science.  I absolutely agree with the comment on my blog that we need to do more experimentation on any therapeutic concept for which there is a reasonable scientific base.  Every hypothesis, every dream, every hope must be considered. Nevertheless, until ideas are subjected to the light of scientific scrutiny, each patient and family must understand that by alternative we do not mean a therapy which is proven, but out of the mainstream; by alternative we simply mean unknown.

James C. Salwitz is an oncologist who blogs at Sunrise Rounds.

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  • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

    Dr. Salwitz,
    What a very eye-opening piece. This also serves as a good reminder to the rest of society that wants to use a lot of this to treat other types of illnesses. Thank you for sharing it with us.

  • Dave

    Dr. S, I always love your writing and this article is no exception. I supposed your speciality is really where the rubber meets the road in terms of CAM potentially hurting patients. If a person with a cold takes lots of vitamin C and herbs, they might end up with a wallet abscess, but probably nothing worse. The stories of CAM in your field though can be heartbreaking – Steve Jobs comes to mind as a very public example.

    You strike a nice balance here between respect for evidence and respect for those who are CAM-believers. I’d love to see you write a piece in the future about how you deal with patients who want CAM therapies vs. evidence-supported therapy. How did you treat the patients you mentioned in this article? In retrospect, are there things you said/didn’t say along the way you would change that might have altered their choices? Do you ever recommend CAM for patients for whom all other therapies and trials have failed simply for its placebo effect? I’d love to hear your thoughts on this in a future piece.
    Isn’t it ironic that CAM has grown into a multi-billion dollar industry largely by marketing that decries mainstream medicine and pharma as being huge multi-billion dollar industries?

    • Kris

      “Isn’t it ironic that CAM has grown into a multi-billion dollar industry largely by marketing that decries mainstream medicine and pharma as being huge multi-billion dollar industries?”

      Hahaha. Spot on!

      • http://www.facebook.com/obinna.akunna Obinna Akunna

        Or maybe it is that conventional medicine has taken such a parochial approach to healing that patients are fed up and voting with their wallets.

        • Mike

          “…and voting with their wallets.”

          And their lives.

          • Molly_Rn

            And dying because of their stupidity.

  • Mandy

    Bullsh*t. Dangerous, irresponsible bullsh*t.

  • http://www.facebook.com/obinna.akunna Obinna Akunna

    “When proper research is performed, certain alternative treatments are found to have value”

    That is the problem. Everyone knows that big pharma and subsequently doctors will not research/market potential CAM therapies because there is no money to be made ie they can’t patent it for 10 years.

    If doctors would do their jobs and stop being beholden to the drug companies, patients will stop looking at alternatives.

    • Molly_Rn

      Are the manufacturers of “alternative” medications giving them away? I think not. Practitioners of alternative medicine make money and so do those who make all of their accoutrements.Doctors are not beholden to the drug companies. This is the same old, same old BS arguement about how holier than thou the alternative medicine and their products are than real medicine. it simply isn’t true no matter how loudly or how long you say it.

      • http://www.facebook.com/obinna.akunna Obinna Akunna

        You are making straw arguments here….

        1) I never said CAM drugs are being given away but if you want my opinion, they 1000x cheaper than many conventional drugs….and yes, some like vitamins (fruits) can picked up at your local grocery without a prescription.
        2) I also never said practitioners of alternative medicine are altruistic but clearly people don’t trust what their doctors are saying these days so are rushing to alternatives.

        • Molly_Rn

          But your
          implication is that doctors are tools of big pharma and they are both just in
          it to make the big bucks. CAM drugs are a huge and amazingly profitable
          business with absolutely no actual proof that they do anything let alone work.
          I don’t think people are rushing to alternatives, but the advertising by the
          fake doctors is all over the place with quick cures as the lure. I think the
          people in fake medicine are in it for the money just as much if not more than
          those in medicine. They really don’t want their so called drugs actually
          scientifically studied because they will fail and then they won’t make the big
          bucks. And homeopathy is pure silliness and would be laughable if people’s health wasn’t being affected. If it were true than you would need only one bottle of gin for perpetual gin and tonics because you could just dilute it
          down to nothing and still feel the effects of the alcohol in the gin. Now if
          that doesn’t sound ridiculous to you I don’t know what would.

          • http://www.facebook.com/obinna.akunna Obinna Akunna

            People are rushing to alternatives because conventional medicine has failed in so many ways. Conventional medicine is great for lowering blood pressures (take this pharma pill), great for lowering blood sugar (take that pharma injection) but is that good health? People want to be healthy and conventional medicine is just giving more pills.

            As for suggesting that they do not want to their drugs to undergo scientific study, what a joke. Who is the biggest culprit in this area? How many drugs are FDA approved for nebulous without showing a true benefit over placebo.

            I will say this over and over again. The great thing about CAM is that it has been here for centuries. When conventional medicine has no answers, which is increasingly the case, CAM is a great alternative.

          • Molly_Rn

            As PT Barnum said there’s a sucker born every minute and there have always been suckers. Snake oil salesmen will always be around when there are suckers with too much money and not enough sense.

  • DISQ_user9801

    As recently as the 1960s, children with acute lymphoblastic leukemia (ALL) had about a 10% survival rate. Today the survival rate is over 90%.

    Thank goodness for the “physician-medical school-pharmaceutical-government complex.” They saved our daughter’s life. Eschewing science and going with faith-based “alternative” “medicine” like homeopathy or herbs instead would almost certainly have been a death sentence for our child.

    • adh1729

      Why did your daughter get leukemia in the first place? Might our high-tech world be causing problems (e.g. ALL), that later require solutions (e.g. chemotherapy) ridden with morbidity and side-effects?

      • Guest

        You’re actually a creep. Take your conspiracy theories about traditional science-based medicine elsewhere, but don’t try them out on me. If our daughter had got ALL in 1960, she almost certainly would have died within 5 years. The fact that she lived, and that 90% of children with that cancer do today, is 100% thanks to real doctors and real science. FACT.

        • adh1729

          Hats off to the professionals who saved your child’s life, and a hangman’s noose for the money-grubbers who have polluted our world. We shouldn’t be getting cancer at the rate that we are. E.g. Are all of the millions of interacting chemicals in our air/water/food/lawns/personal products truly safe? Should we make innocent humans into guinea pigs? Should every 9 year old start chattering all the time on a cell phone? Do those phones have a 70 year track record of safety? Does genuine concern for human life and health, make me a “creep”? I happen to be the father of 4 children; I believe in protecting them as much as reasonably possible.

          • Guest

            You’re not a creep at all. As a parent the Monsanto produced GMOs my kids eat, the chemicals they are exposed to and the general state of our earth scares the crap out of me.

  • Maggie Beaumont

    I agree with much of what you say here, but left out of your piece is the very real possibility that some scientific studies have been treated to biased reporting, some have been later found to be actually fraudulent, and many have been significantly limited but over-generalized in treatment.

    I’m thinking of the recently-retracted Lancet article about vaccines and autism, that is now seen as financially motivated and falsified. I’m thinking of the original studies that justified hormone replacement therapy in menopausal women, that have lately been shown to be incomplete, while HRT has been implicated in increased cancer risk. And I’m thinking of all those FDA-approved drug studies using male subjects 18-34, which are then generalized for the treatment of women, children, and the very old.

    As long as the medical-scientific community is relying on studies of such quality, it’s not surprising if the patient community looks for other sources of different treatments.

    • DISQ_user9801

      Any patient whose standards and expectations are so high that they are going to reject an entire mode of medicine because of a few incomplete or fraudulent studies is going to reject alternative medicine, where that sort of thing is an everyday occurrence, before they reject conventional medicine, where such things are rare enough that they make headlines.

      Don’t let the perfect become the enemy of the good. If you want perfection, give up now. If you want rigorous scientific studies and meticulous peer review to the point where mistake and fraud where it happens gets called out and corrected, it’s conventional medicine that wins hands down.

  • Mandy

    There is no science behind homeopathy. None. It is quackery in its purest form, nothing more than magical thinking.

    Magic water does not cure cancer. Full stop.

  • Molly_Rn

    There is a difference between cause and coincidence. Just because you were taking lots of Vitamin C when you got a cold and it only lasted 2 days does not mean the Viamin C was the reason for the mildness of the cold. It could only be coincidental and hence antidotal. Cause goes back to Koch’s Law where you prove repeatedly that x causes y every time.

    • http://www.facebook.com/obinna.akunna Obinna Akunna

      And that does not happen with conventional medicine. How many times is one drug or therapy hot today and no longer recommended tomorrow. Conventional medicine is beholden to drug companies and their share holders.

      • Molly_Rn

        When you are critically ill do not use real medicine, just die or put a crystal on your chest or try your magical thinking fake medicine. Please, please do not let them CPR you or defibrillate you or god forbid give you medication to save your life because that would just benefit those companies and their share holders. Think about what you are saying. Fortunately for all of us who believe in medicine science keeps testing and trying to do better and to find the best therapy possible so yes, we find better medications and sometimes after a long period of time we find side effects that could not be known about until enough time had elapsed. Did you ever take any science?

        • http://www.facebook.com/obinna.akunna Obinna Akunna

          Took science and history. In the past, medicine was truly revolutionary. Insulin, penicillin etc etc. The medicine frontier was led by people with a true interest in curing sick people.

          That is no longer the case. The only drugs being pushed or discovered today are those that can return a good profit (billions at minimum). Look at our nightly commercials. You would think our #1 health concern is sex and sleep.

          Medicine, so long as it is in the hands of wall street, will never have the same revolutionary position like it once it did. This is why CAM is taking off.

          • Molly_Rn

            If you are judging medicine and science by the commercials you see on TV no wonder you like quackery. Come work as a nurse in ICU and then have an opinion about how well medicine works.

          • http://www.facebook.com/obinna.akunna Obinna Akunna

            Spend some time outside an ICU and see what the real world is like.

          • Molly_Rn

            I do and what you call CAM; is in reality snake oil or crap. Sorry, but it is bogus.

  • Noni

    Relying solely on homeopathic treatment accelerated the death of my aunt from breast cancer. I think there may be a role for homeopathy in cancer but NOT as a replacement for chemo/radiation/surgery.

    Now if we could just get some transparency with regards to cost for conventional medical treatment we might make some progress. No one should have to deal with cancer and worry about going bankrupt in the process.

  • SBornfeld

    Dr. Salwitz–
    I figure you’re either quite young; otherwise you have a much greater capacity to endure the alt.med. crowd than I. As a dentist, I decided long ago that arguing about amalgam, fluoride, x-rays, etc. was not good for my blood pressure (an anecdote, but there you have it).
    Here you’re largely preaching to the choir (with the few notable exceptions, hopefully not physicians).

    The bigger question is why charlatanism posing as medicine has such traction to so many people.
    As an oncologist, you know part of the reason–people want to have hope, even where none exists. This I understand.
    But there is another dimension–and that is that health care has very much dropped the ball when it comes to trust. There are more than enough fingers to point, and I’d be the last to single out physicians and other medical personnel.

    I’m not telling you anything most physicians and medical personnel don’t know well.

    There has to be leadership, and it has to come from somewhere. It’s probably not coming from Kathy Sebelius, Andrew Weil, or Dr. Oz. Will it come from the FDA, the AMA, the Surgeon General?
    People have to start demanding better, and they have to be ready to pay. They may has well, because I figure we’re going to pay one way or another.

    • adh1729

      “with the few notable exceptions, hopefully not physicians”: I am an MD, and am smart enough to avoid drinking in Salwitz’ position hook, line, and sinker. He mentions a (hopefully real) case of Hodgkin’s with a poor outcome. He fails to mention that Hodgkin’s is one of the rare malignancies where chemotherapy makes a major difference at all.
      “Why do they lock caskets at funerals? To keep the oncologist out.” When I was a general surgeon newly out of residency, I used to try to hint to patients (politely) that the metastatic adenocarcinoma would not respond significantly to chemo; I learned, before long, just to place the blasted port.
      If there is one specialty that should keep their mouth shut regarding quacks, it would be oncology. They have given chemo in so many situations where it wasn’t going to help at all, and they knew it, and $$$ was the main motive involved.

      • ReallyGoodMedicine

        I have to agree! When my father developed lymphoma his choice was not to use chemo or radiation. He was talked into using them both and was told that he would die a horrible death if he didn’t use them. He died a horrible death after using them and suffered additional pain and trauma from the treatments themselves.

        I understand that in many cases 80% of doctors would not accept these treatments for themselves or their families.

      • SBornfeld

        That’s a pretty broad scalpel–er, brush you’re wielding. Most of the mouths I’ve seen are attached to individuals, not specialties. I’m more than willing to say that the majority of oncologists I’ve known do their very best in what is usually a very bad situation. I doubt very much that you could demonstrate that they are any more motivated by money than any other specialty–surgery, for example.
        And I have had the pleasure to know some very fine surgeons.

        • adh1729

          You speak of broad brushes/scalpels – have you noticed the broad brushes wielded on this website, aimed against the alternative medicine “charlatans”? Of course CAM is a big hodge-podge of good and bad, but so unfortunately is conventional medicine, and I don’t share Salwitz’ optimism that “evidence” will clean up either mess significantly. “Evidence” comes from money, and anyone who thinks that money is clean and pure needs a cranial reboot.

  • Caitlin

    That video is brilliant! It should be mandatory viewing on any comment thread where anyone starts showing signs of taking homeopathy seriously :-D

    • Molly_Rn

      Homeopathy for people with more money than sense!

  • Molly_Rn

    Bull $hit