Islon Woolf MD
Is Alternative Medicine helpful when fighting cancer?
Updated: Mar 16, 2019
If one considers lifestyle medicine such as exercise (Yoga), nutrition, and stress reduction as “alternative“, up to eighty percent of patients use Alternative Medicine to treat their cancer. With 6 months to live, having failed all Science-based Medicine treatments (surgery, radiation, and chemotherapy), it’s hard to fault anyone for trying.
But what about early stage cancer? Some, fearing the invasiveness and pain involved with Science-based Medicine treatments, use Alternative Medicine alone to treat their early stage cancer. Others hedge their bets and combine Alternative Medicine with Science-based Medicine in an approach called Integrative Medicine. Are either of these approaches, Alternative Medicine alone or Integrative Medicine, helpful when fighting early stage cancer?
The case of Steve Jobs
As documented in his official biography, Steve Jobs was diagnosed with pancreatic cancer in 2003. It was found incidentally on a CT scan of the abdomen. All of his doctors recommended he have it removed immediately with surgery. Unfortunately, the removal of a pancreatic tumor is not quite so simple. Sometimes it requires the removal and shifting around of several organs in the GI tract. A difficult decision for anyone to make. Instead, he turned to his acupuncturist and nutritionist. They offered him a way out without surgery. A pain-free treatment without side effects - the vegan diet. They believe meat, toxins, and GMO’s are the “one true cause” of cancer, and a diet high in phytonutrients can cure it. If cancer were only so simple. Regrettably he listened, and a year later a repeat CT scan demonstrated the mass had metastasized to his liver. We know the rest.
How did this happen to Steve Jobs? How did a man of science with all the resources in the world end up dead because of his refusal of Science-based Medicine? It is an important question to answer, but without knowing his thoughts we may only speculate. For someone who fearlessly faced problems in his life, his evasion of reality in this circumstance seems almost uncharacteristic. Perhaps his successful iconoclasm in the tech world led him to a false sense of confidence, or perhaps he was completely misled by his charismatic Alternative Medicine practitioners. One thing we do know is that he regretted his decisions in retrospect. According to his official biographer Walter Isaacson, "We talked about this a lot, he wanted to talk about it, how he regretted it. I think he felt he should have been operated on sooner."
Even Josephine Briggs, the director of the Alternative Medicine branch of the NIH (the NCCIH), was shocked with this news. Steve Jobs did not have the kind of pancreatic cancer most of us are familiar with, the kind that kills in months. Rather, he had a neuroendocrine tumor - a rare type of slow growing pancreatic cancer potentially curable when found early. He should not have been offered alternative treatments instead of treatments known to work. As she stated in a letter to the public, “Simply put, the evidence [for Alternative Medicine] is not there”.
Why the NCCIH says, “The evidence is not there.”
To be more precise, there is evidence that Alternative Medicine can treat cancer, just not good evidence. Science-based Medicine doctors have painfully learned over time that most forms of evidence produce false positives. Anecdotal evidence, observational evidence, ancient wisdom, authority, and laboratory evidence all produce false positives. These forms of evidence make treatments look like they work when in reality they do not. For this reason, Science-based Medicine doctors insist on the clinical trial - a direct and controlled form of evidence less likely to fool us. In fact, treatments once supported by other forms of evidence are often proven not to work when subjected to clinical trials. Some classic examples: angioplasty does not prevent heart attacks in stable patients, hormone replacement therapy does not prevent heart disease in women, and anti-oxidant vitamins do not prevent heart disease or cancer.
The NCCIH branch of the NIH was formed in the 1990’s by Alternative Medicine proponents to prove that Alternative Medicine works; they were willing to put Alternative Medicine to the test with well-conducted clinical trials. It was the brainchild of a very pro-Alternative Medicine Senator from Iowa, Tom Harkin. He claimed his allergies were cured with Bee Pollen and his friend’s prostate cancer cured with Naessens Serum. He wanted to bring Alternative Medicine into the mainstream directing billions of NIH dollars to his cause. The NCCIH was staffed with Alternative Medicine doctors (including Deepak Chopra) and offered large grants to institutions and hospitals willing to open departments of Alternative Medicine. Well designed clinical trials controlling for placebo effects were, once and for all, going to prove the claims of Alternative Medicine. Almost 30 years and billions of taxpayer dollars later, not a single treatment was validated by the NCCIH. Harkin was annoyed and in disbelief. When high standards of evidence were applied to Alternative Medicine the treatments did not work. That’s what Josephine Briggs meant by, “Simply put, the evidence is not there”.
As for Science-based Medicine cancer therapies, the evidence is there. That’s what defines a Science-based Medicine therapy - it must have passed clinical trials.
A new observational study
It is difficult to study Alternative Medicine for early stage cancers with a clinical trial. It would involve at least one group of subjects that would not get Science-based therapies. Consequently this kind of trial would never pass an ethical review committee; it is unethical to withhold therapy that works. (We don’t want to repeat the infamous Tuskegee experiments.)
However, we can observe the course of patients that have chosen Alternative Medicine for themselves. Such an observational study was recently published in the Journal of the National Cancer Institute using data from the national cancer registry. It followed the survival of 280 patients that decided to use Alternative Medicine alone to treat their early stage cancers and compared them with a matched control group of 560 patients that used Science-based Medicine alone.
Patients treated with Alternative Medicine alone faired much worse
The Alternative Medicine group was 2.5 times more likely to die; a 250% increase in death (see graph below tracking percentage survival over the year; the dashed line is the Science-based Medicine group and the solid line is the Alternative Medicine group).
Looking at specific cancers, breast cancer patients suffered the highest mortality when treated with Alternative Medicine; a 6 times greater chance of death. These observations are not surprising given “there is no evidence” Alternative Medicine works for cancer in the first place.
Even patients treated with Integrative Medicine did worse
A similar study compared patients that chose Integrative Medicine (Science-based Medicine + Alternative Medicine) with patients that chose Science-based Medicine alone to treat their early stage cancers. The results: the Integrative Medicine group had double the chance of death. This is surprising. The Integrative Medicine approach, offering “the best of both worlds”, would be expected to yield at least as good, if not better, results than Science-based Medicine alone. With the addition of Lifestyle Medicine, Integrative Medicine patients should experience less side effects, and be more compliant with effective Science-based Medicine therapies. In actuality, Integrative Medicine patients in the study delayed or refused Science-based Medicine treatments. Opportunities to use treatments that work were missed. Instead of Integrative Medicine helping, Integrative Medicine seemed to create an environment of doubt and procrastination for therapies that work.
The message: if you are going to use any form of Alternative Medicine in early stage cancers, don’t delay or refuse treatments that work.
In the next sections, I would like to address the role the Alternative Medicine practitioner plays. They can hold the lives of their patients in the balance as they are often brought into their patient’s decision making process. Although, it may be next to impossible to know what they are thinking, it is helpful to speculate.
The Alternative Medicine Purists
Some practitioners of Alternative Medicine refuse to acknowledge the lack of evidence and poor outcomes. They are digging their heals in, insisting they know “the one true cause” of cancer. These are the Alternative Medicine Purists. Although it is possible that some are insincere Charlatan’s fooling their patients, I believe the opposite. They are so motivated to bring hope and answers to their patients they are willing to fool themselves instead. Not through stupidity but through smarts. In fact, the smarter they are, the better they are at justifying beliefs they arrived at for non-smart reasons. They can cleverly manipulate human physiology, search for truth in powerful anecdotes, and scour the scientific journals to cherry pick evidence that supports their beliefs. As the famous physicist Richard Feynman said “The first principle is that you must not fool yourself — and you are the easiest person to fool”.
Ironically, it’s the sincere motivation of the Alternative Medicine purist to help their patients that necessitates they harm their patients. Let me explain. If they truly believe they have the cure for cancer that is painless and without side effects (a vegan diet for example), it is their moral imperative to stop patients from harmful treatments. They are obliged to recommend against Science-based Medicine cancer therapies. This is necessitated by the ethical principle, “first, do no harm”. Taking their worldview into account, advising against Science-based Medicine treatments is not only justified, but ethical.
The Alternative Medicine Compromisers
The other group of Alternative Medicine practitioners are the Compromisers; they seem to acknowledge the limitations of Alternative Medicine. They have entered mainstream medicine rebranding themselves as Integrative Medicine - providing “the best of both worlds”. On close inspection, they appear to practice a watered-down version of Alternative Medicine. No bold claims of knowing the “one true cause of cancer” are made. The heavy lifting of treating the cancer is provided by Science-based Medicine treatments while Alternative Medicine treatments are relegated to help deal with the side effects; for example, acupuncture for nausea or lifestyle medicine. Integrative Medicine is now quite widespread in the US and can be found in most prestigious universities and cancer centers. It wouldn’t be surprising to hear in the halls of Sloan Kettering, “After your proton therapy, you will be offered energy healing to rebalance your Chi, followed by aromatherapy”.
The problem with the Compromisers is that you never truly know what opinions lurk inside; sometimes Integrative Medicine is a Trojan Horse for the Purists. Recently, the Cleveland Clinic got quite a shock. Daniel Neides, the head of Integrative Medicine, aired an anti-vaccine rant in a public forum that even Jenny McCarthy would be proud of. He was subsequently fired; but alas, it was too late. There are many more from whence he came. Thanks to Tom Harkin, the halls of academia are now filled with Alternative Medicine Purists.
There is no evidence that Alternative Medicine works for cancer. If there was evidence, we wouldn’t call it Alternative Medicine, we would call it... Medicine. Recent observational studies have confirmed that patients choosing Alternative Medicine over Science-based Medicine for early stage cancer die at a much higher rate. This is not surprising. What is surprising, however, is that Integrative Medicine patient (Science-based Medicine+Alternative Medicine) do worse as well. Adding Alternative Medicine only seems to cast doubt on Science-based Medicine treatments leading to refusal and delay of treatments that work.
As for the practitioners of Alternative Medicine, they can be truly dangerous. The Purists have convinced themselves they know the “one true cause” of cancer, obliging them to recommend against Science-based Medicine therapies. Patients are approached with compassion, conviction, and confidence, and offered a simple way out of a hard problem.
When considering the treatment of early stage cancer, don’t get distracted, stay rational, and go with what has been proven to work. Make sure you team up with a trusted primary care provider to help you navigate through difficult decisions. Someone with a broad range of knowledge that can present all of your options. Someone with analytical skills that can discriminate between options likely to work from those unlikely to work. And finally, someone without a conflict of interest, an ax to grind, or a theory to prove.
#vegan #alternativemedicine #hierarchyofevidence #integrativemedicine #cancer