No matter what the prognosis, experts say alternative medicine is never a replacement for conventional cancer treatment.
By Jo Cavallo
America’s fascination with alternative medicine took root
during colonial times when patients longing
to escape such torturous—and largely ineffective—medical
practices as bloodletting and purging, turned to steam baths of
botanical herbs to find a cure for what ailed them. An uneasy alliance
with conventional medicine has existed ever since.
The popularity of mainstream medicine surged in the 1940s
when antibiotics were used successfully to control infectious diseases,
but by the ’60s and ’70s, patients rebelled against
modern medicine in favor of a more holistic approach that treated
the body, mind and spirit. The concept of holistic medicine morphed
into two general practices: alternative and complementary.
Although often identified by the acronym CAM (complementary
and alternative medicine), leaders in the field say the term is
problematic based on their distinct differences. Alternative therapy
refers to unproven or disproven treatments that are used instead
of standard or proven therapy, and complementary therapy is used
in addition to standard medicine to help improve quality of life
and relieve chemotherapy and radiation side effects. The term “integrative” is
now used to more accurately describe CAM therapies that complement
conventional cancer therapy.
Despite the unproven claims of many integrative and alternative
medicine practices, its popularity finds Americans spending up to
$47 billion a year on various therapies for different illnesses—$5
billion on herbal products alone. According to the National Health
Interview Survey conducted by the National Center for Health Statistics,
62 percent of Americans use some form of unconventional therapy,
including a vast array of approaches, such as taking biologically
based products like herbs and megavitamins; special diets; chiropractic
care, acupuncture and massage; and relaxation techniques like Reiki,
yoga and guided imagery.
The study of alternative medicine gained legitimacy in 1992
when the National Institutes of Health launched the Office of Alternative
Medicine, now called the National Center for Complementary and Alternative
Medicine, to investigate alternative and complementary medicine
with the same scientific rigor as conventional therapies. Currently,
NCCAM has funded more than 1,500 clinical trials, including 83 that
involved cancer.
Besides determining the efficacy of alternative and integrative
medicine, the NCCAM studies have the added benefit of independently
proving whether they are safe. “Companies [who manufacture
dietary supplements] have no incentive to pay for clinical trials
themselves because they don’t have to,” says Sidney
Wolfe, MD, director of the Health Research Group for Public Citizen,
a consumer watchdog group in Washington, D.C. “And one after
another, these studies are turning out to show these things don’t
work.”
The onus to prove the efficacy and safety of herbal medicines
was taken off the shoulders of the dietary supplement industry in
1994 with the passage of the Dietary Supplement Health and Education
Act, which restricts the authority of the Food and Drug Administration
to regulate dietary supplements, which includes vitamins, minerals,
herbs or other botanicals and amino acids, among others. “There’s
the pretense that because something is ‘natural’ there
is no legal requirement to prove it is safe or to prove it works,
and once you have a law forbidding the FDA from requiring any evidence
on that, everything out there is a fraud until proven otherwise.
And worse than just being a fraud, a number of these things are
dangerous,” Dr. Wolfe says.
Contrary to public perception, many alternative cancer cure claims
thought to be unproven have actually been disproven in clinical
studies.
Just how dangerous was made clear in 2002 when the FDA removed
from the market a patented herbal product called PC-SPES (PC: prostate
cancer; spes: Latin word for hope), which was touted to promote
prostate function and taken as an alternative treatment for prostate
cancer.
“PC-SPES was shown in phase I and phase II studies to be
effective in reducing PSAs in men with prostate cancer,” says
David Rosenthal, MD, past president of the Society of Integrative
Oncology and professor of medicine at Harvard Medical School. “But
an NCI-funded randomized trial of the product found there were impurities
within the product. For example, there was an anticoagulant, so
people were having bleeding problems. And other batches of the product
contained hormones, and we know that estrogen and estrogen-like
hormones treat prostate cancer,” which likely explains the
misleading effectiveness of the product in early-phase trials.
Buyer Beware
Contrary to public perception, many alternative cancer cure
claims thought to be unproven have actually been disproven in clinical
studies. As far back as 1955, the American Cancer Society launched
a Committee on Quackery to review cancer cure claims. In the 1980s
the organization investigated alternative cancer cures, such as
Laetrile, high-dose vitamin C and detoxification, all of which were
proven useless or harmful.
Still, a small percentage of cancer patients forego standard
medical treatment in favor of alternative care. Research conducted
by Barrie Cassileth, PhD, more than a decade ago found that up to
10 percent of cancer patients sought alternative treatment, though
more recent research puts that figure at around 6 percent. “At
the time my study was done, alternative cancer therapies were underground,” says
Cassileth, chief of Integrative Medicine Service at Memorial Sloan-Kettering
Cancer Center and author of The Alternative Medicine Handbook. “They
had no aura of acceptance whatsoever and they were secret.”
If alternative cancer cures were underground a decade ago,
the emergence of the Internet has brought them into the daylight.
Thousands of websites are filled with products and testimonials
from patients and doctors touting alternative or so-called “natural” cures
for cancer. Besides spreading false information, the real danger
of these claims, says Dr. Wolfe, is they can cause cancer patients
harm. For example, he says ginkgo biloba, an herb used as a cancer
cure or to reduce cancer risk, may increase bleeding disorders.
Stephen Barrett, MD, founder of Quackwatch, an organization
that investigates questionable health-related claims, compares the
search for alternative cancer cures with a wild goose chase. Instead,
he recommends “patients follow a logic that says my doctor
really wants to help me.”
Although exactly how much money is spent each year on false
cancer cures is unknown, some experts put the figure at $1 billion.
The hallmarks of a cancer cure scam are pretty easy to pinpoint,
says Dr. Barrett, and include advertisements asking for large amounts
of cash up front, testimonial evidence, the notion that the company
has a product or practice that is unique, questionable clinics located
outside the United States and claims that the medical establishment
doesn’t want to find a cancer cure.
Although the Federal Trade Commission is in charge of prosecuting
companies that make false cancer cure claims, their numbers are
so high the agency doesn’t have the resources to track them
all down, says Dr. Wolfe.
Desperate Measures
Cancer patients may shun conventional treatment in favor of
alternative medicine for a number of reasons, from mistrust in Western
medicine to believing no other options are left.
“I have patients who have been told by their oncologists
that they only have a year to live and they can be given chemotherapy
but it will make them sick. If somebody told you that, you would
probably run away seeking something alternative too,” says
Donald Abrams, MD, chief of hematology/oncology at San Francisco
Medical Center and director of clinical programs at UCSF Osher Center
for Integrative Medicine.
“You get one shot with cancer. If people delay treatment
to try things that are promoted as ‘alternatives,’ what’s
going to happen is that their tumors will grow and their chances
of a cure are infinitely less.”
—Barrie
Cassileth, PhD
The emotional impact of such a prognosis can cause distress
for the patient as well as family members, making it difficult to
evaluate the validity of information about unorthodox remedies.
Patients should discuss with their doctor or an integrative medicine
professional anything they are considering that falls outside proven
therapy or that has not been prescribed, particularly since harmful
drug interactions can occur.
For an alternative to alternative medicine, medical experts
suggest patients consider a clinical trial testing a new therapy
to combat cancer. “I’ve seen a lot of progress in our
ability to treat cancer and prolong survival. I am not going to
tell somebody I think you should take shark cartilage or go to Tijuana,” says
Dr. Abrams.
No matter the prognosis, Cassileth says replacing conventional
treatment with alternative medicine is not an option for cancer
patients. “There are no viable literal alternatives to mainstream
cancer care. You get one shot with cancer, and that’s treating
it with surgery, chemotherapy or radiation. If people delay treatment
to try things that are promoted as ‘alternatives,’ what’s
going to happen is that their tumors will grow and their chances
of a cure are infinitely less,” she says.
From Alternative to Integrative
While many alternative cancer therapies, such as Laetrile
and metabolic therapy, have been disproved, a lot of research is
under way to study the effectiveness and safety of various integrative
disciplines. One of the biggest areas of study involves the use
of botanicals and herbs.
Researchers like Cassileth are investigating several botanicals
looking at whether they could boost immune function during standard
cancer treatment. “We’re not looking for a single-molecule
pharmaceutical product,” she says. “We’re looking
for interaction among the various constituents of herbs and other
botanicals that might enhance immune function or that might produce
some other benefit to cancer patients.”
Cassileth cautions nothing currently can replace conventional
cancer treatment. “What we know right now is there’s
absolutely nothing that can be used as a substitute, but as an adjunct
along with mainstream cancer care, [botanicals] may be useful.”
The bottom line, say experts, is alternative medicine alone
should never be considered for cancer patients. A patient’s
best bet: Work with a professional health care team to develop an
integrative treatment plan that incorporates the best cancer care
based on medical evidence and experience. |
