In a recent series of essays, I focused on the interpersonal relationship between physician and patient – especially, but not exclusively cancer-related. Perhaps I’ll come back to that at a future date – it’s a bottomless trove of issues – and at that time, I’ll review what we have previously discussed, so as to make it easy to pick up where we left off. In a search for literary diversity, today I’ll change gears and talk about certain influences on the attitudes and receptiveness of patients undergoing the cancer experience; there are a number of potential extraneous matters available, but for starters, I ask the reader to consider the seductive appeal of alternative medicine and methods that have not been vetted by the appropriate scientific community.
The temptation to avoid harsh conventional methods can be extraordinary – the word surgery is, in itself, intimidating to many; a long course of radiation can be brutal; and for reasons not quite understandable, the superstitions related to chemotherapy can constitutes a psychobiological bête noire. Given the current state of information technology, it’s understandable that an intelligent person who possesses even modest computer skills would do homework on their problem, and in that capacity, they often come into contact with the alternative medicine network; hence, intellectual vistas about different methods of combating a variety of diseases are opened. I believe that this desperate personal search, while not unique to cancer victims, is keenest in this group. No surprise, since it may be the most frightening of diseases – The Emperor of all Maladies, to borrow the title of Mukerjee’s Pulitzer Prize winning book! Not infrequently, for example, patients or their families ask about such unconventional options as dietary supplements, macrobiotics, or herbal remedies, to site the most common queries. In my opinion, it’s important for the physician not to dismiss these possibilities out of hand, even though most oncologists have no real interest in incorporating them. This doesn’t reflect a closed mindset, but instead an appropriate delay until a method has proven its worth. On the other hand, we in the world of conventional cancer medicine should invite the patient’s questions regarding the treatment plan to be used, and, while doing this, be willing to listen and explain the rationale for sticking with conventional methods. Often patients seek to be involved in the battle, so to speak, and at a minimum, this can be psychologically therapeutic. It’s time consuming to listen to and even sometimes read about what the patient is presenting an alternative, and a doctor’s perceived or real impatience can often lead to an air of dismissiviness that essentially demeans a frightened person. This said, I confess that with my patients, I have deflected many of the alternative treatment questions to the medical oncologist on the cancer team because internists are generally more knowledgeable and more fluent with this dialogue.
Regardless of who is “answering the questions,” and despite the need to always stay open to new ideas, it’s important to keep in mind the fact that faddism and untested alternative methods not only can do direct harm but can also delay the employment of proven methods. In educating patients and in an effort to discourage them from chasing fantasies, the oncologist should make it clear that just because alternative or non-science-based methods work occasionally—or conversely, just because standard, science-based methods can and do sometimes fail— abandoning the discipline imposed by translational and clinical research methods is not justified. Almost every aspect of cancer-related research and drug development is controlled by federal and state regulations that have been developed over the past several decades to protect the public from harm due to financial conflicts of interest in the research and pharmaceutical communities, inadequate patient protection in research studies, invasions of privacy, unsafe drugs and ill conceived devices. Granted, even though founded on the best of intentions, many of the regulations have the unintended consequence of impeding the pace of new treatments, and let’s not forget the financial avarice to which corporations are susceptible – little wonder why frightened cancer patients who are somewhat cynical seek to avoid the presumed misery of standard cancer care and thus are vulnerable to the allure of alternative methods. Despite the shortcomings of the system, however, it is far better than the unregulated cancer care conducted in many other countries.
To use one specific alternative methodology as an example, I point to traditional Chinese medicine. In urban areas with large Chinese populations – New York City, San Francisco, and others – this is much more than faddism, and a significant number of physicians practice this ancient craft. While this should not be casually dismissed, it should not replace data- based standard cancer care. Lest we be arrogant about this matter, however, we should keep in mind that the Chinese have relied on such herbal methods for thousands of years, and undoubtedly standard Western medicine can gain much useful information from this ancient cultural methodology. In the genre of cancer management, however, there is little room for variance, and we should adhere to data-driven standard methods.
Other alternatives that have sometimes been used in cancer management are strictly fads, totally lacking a scientific or even a logical basis. During the course of my career, I have encountered cancer patients who, in addition to rejecting standard methods, have sought a variety of advisors and helpers who employed holistic methods, macro-vitamin treatments, and many other unproven alternate treatments. I am reminded of the use of human interferon in cancer treatment. This was developed in Scandinavia in the 1970s by using pooled human blood. The development of recombinant technology in the 1980s as a source of interferon eliminated the dangers associated with viral contamination of human serum. However, one is left to speculate how often HIV and hepatitis viruses were spread by the administration of human interferon prior to that breakthrough. Interferon was first directed to combat certain viruses, but within short order was randomly used in the United States on cancers that had proven resistance to conventional methods and even in some yet untreated malignancies. This was amateurish at best, and given the dangers of infecting patients with ominous viruses prior to the days of recombinant methods, was an extraordinary breech of standards.
Another example of whimsical cancer therapy was seen in a number of patients who traveled to Mexico during the 1970s to receive a certain drug derived from cactus juice, despite a total lack of scientific evidence to support its use. The movie icon, Steve McQueen, pursued this unsuccessful pathway to treat a mesothelioma. The list goes on and on. Fortunately, the Federal Drug Administration has since followed a course designed to avoid the pharmacological frivolity that characterized those less-regulated times. More effective controls are now in place, and generally, there is a much more formalized approach to cancer management throughout the United States.
All this being said, I believe that study and research into alternative methods should be pursued. In fact, the American medical profession has given credence to this area of investigation by creating an entire program of study of Alternative Medicine at the National Institutes of Health (NIH) in Bethesda, Md. I believe this to be a justified investment of taxpayer’s money. Analogous to my point in a previous blog about the influence of spirituality on biology, objective scientific study into these alternative treatment measures should be pursued. To consider our present state of knowledge to be the apogee would be shortsighted, indeed, and perhaps even arrogant. We must stay open to new investigations and results. It is important for the reader to realize that use of standard methods and the study of unconventional alternative (outlying methods) need not be mutually exclusive; however, it is unethical to venture outside of conventional therapy, unless conducted in a research capacity. The cancer centers accredited by the NCI are happy to furnish for any individual information on clinical trials that are part of an authentic scientific approach. The reader is referred back to a summer blog last year entitled The Contemporary Cancer Team Approach, in which I included the names and contact information of the NCI accredited centers in America. Click here to download a printable version of National Cancer Institute Designated Centers in the USA: National Cancer Institute Designated Centers in the USA
Roy B. Sessions, MD, FACS
Mukerjee, S.; The Emperor of all Maladies: a Biography of Cancer; Publ Scribner; 2010