Considering the alternatives

I’m pretty sceptical when it comes to unconventional medical treatments. I take the approach best expressed by Tim Minchin – “Do you know what they call alternative medicine that’s been proved to work? Medicine.”

When it comes to cancer, alternative medicine abounds. A range of concoctions purport to offer an easy pathway to greater longevity and better health. Charlatan Belle Gibson made outrageous claims about beating cancer merely through “nutrition, patience, determination and love – as well as vitamin and Ayurvedic treatments, craniosacral therapy, and a whole lot of other treatments”. The US-based Cancer Tutor website claims that purple grape juice and carrot-and-beet juice are both “excellent cancer treatments with very high cure rates”. Advocates of Gerson Therapy say that cancer can be cured with 13 glasses of juice a day, a range of supplements and coffee enemas. Really.

Cancer patients are particularly vulnerable to the lure of such quackery. I think part of the reason lies in the fact the conventional medical treatment is so toxic and arduous. To learn that the path to better health mapped out by conventional medicine involves rounds of chemotherapy and radiotherapy, with cells both innocuous and malicious coming under attack as the body becomes a battleground, is confronting. It is daunting to know that debilitating side-effects lie ahead. Another route to the same destination that avoids the side-effects is understandably tempting.

The existential threat posed by cancer adds to the allure of alternatives. After all, if your life it at stake, it seems foolish to not explore all the options. Many people diagnosed with cancer will ultimately die from the disease even with the best in conventional medicine, leading to the false and naïve assumption that they might have been saved had they embraced the alternatives.

Much of the support among patients for alternative medicines comes from people who have an ingrained cynicism towards the medical establishment and who view following its edicts as acts of conformity. For them, embracing alternative medicine is a statement of identity; they choose their cancer treatment in the same way they might buy their groceries. With chemotherapy drugs expensive and major pharmaceutical companies driving development, opting for an unscientific alternative to chemo becomes a political statement of rebellion.

The formula most medical experts adopt is that patients can try alternative treatments if they want, but they should continue with conventional medicine and tell their treating doctor to make sure the alternative treatment doesn’t interfere. If the alternative is doing no harm, then why discourage a patient from trying? That approach makes a lot of sense.

For all their failings, alternative treatments can have some benefit, though not in the way their advocates say. If you’re like me and you are doubtful of the power of alternative treatments, they will do no good. But if you’re someone who believes strongly in the power of those treatments, they might provide some marginal benefit thanks to the placebo effect. The sense of hope that treatment might give the patient could, in and of itself, benefit the patient if it lifts their mood, gives them comfort or in some other way improves their disposition.

There’s plenty of conjecture about the extent to which psychological factors can impact on the progress of physical ailments. While scientifically testing the impact is notoriously difficult, lived experience suggests there is some physical benefit at the margins from a more positive psychological outlook.

(This also reflects my thinking on the power of prayer. Since I was diagnosed, some people have told me they are praying for me. I don’t believe in a higher power, and so I do not think those prayers per se will have any impact on my health. But it is comforting to hear from various people that I am in their thoughts, and the kindness of these people lifts my mood. But my mood is also lifted from other people that get in touch to send good wishes rather than prayers. That improvement in mood has some incremental positive impact on my health, but of course it is not the “praying” that brings the benefit but the “telling me”. As for patients themselves praying, there’s no benefit for a non-believer like me, but there may well be for a person of faith.)

The greatest problem is among patients who discard conventional medicine altogether and rely exclusively on alternative medicine for treatment. Too many people in that position have lost their lives relying on alternative medicine while cancer, or other diseases, ravaged their bodies. While you can never say for sure that conventional medicine could have helped, it seems likely in many cases.

Tasty, but not a cure for cancer. (Image courtesy of Pixabay)
Why do people turn away from conventional medicine? Cancer Australia notes on its website: “One large study has found there is a significant association between the use of complementary and alternative therapies by cancer patients and needs unmet by conventional medicine, helplessness and lower scores on emotional and social functioning scales.” The Skeptic’s Dictionary also has an excellent list of 11 reasons why alternative health care is so popular. So there are things that doctors can do to encourage patients to embrace conventional rather than alternative medicine.

For starters, give patients the information they need in a format they can understand. The early period after diagnosis is one in which the patient is given great volumes of information, but much of it is technical and laden in jargon. The material can be intimidating for a patient and prompt them to fear that they will receive a treatment that may do them harm. In my case, an excellent hour-long session with a cancer nurse early on gave me a no-nonsense guide to what was coming up and a chance to ask questions. For some later clinical decisions, though, I was left in the dark or given information that was difficult to understand. Informed consent is impossible in these conditions, and a patient is more likely to consider alternatives.

Which gets to the matter of choice. Many people with cancer have a feeling of helplessness because of the disease harming their body. But I suspect many also feel helpless that they have little agency over the treatment they receive. The path of chemotherapy and radiotherapy can be presented as the only option rather than the best option, leaving the patient feeling they have no choice but to proceed. While this may lead to early patient compliance, it may also lead to later rebellion and a search for alternatives. Better for the patient to choose to go down the path rather than feel forced onto it.

Doctors might also benefit from being frank with their patients about their outlook in the absence of treatment, which is essentially what relying exclusively on alternative treatments amounts to. To hear the prospects of death or a low quality of life in the absence of treatment makes conventional treatment, even with its side-effects, more palatable. Remaining naïve to the consequences of inaction can leave a person more willing to let their desire for a treatment that reflects their identity overwhelm their survival instinct.

Ultimately, of course, patients should be free to choose the path they think is right for them, including alternative medicine if they wish. But they should be able to do so in full possession of the facts about the success rates and the side-effects. Unless advocates of alternative medicine are willing to subject their treatments to scientific rigour – which, following the Tim Minchin line, would allow successful treatments to enter conventional medicine – they should be treated with scepticism. 

Advocates who hide painful truths from those they are seeking to lure are doing themselves and patients no favours.

Comments

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