Sunday, October 30, 2011

Alternative Medicine in the Adelaide Advertiser

One of the fundamental principles of medical therapy in Australia and most other western nations is that an adult of sound mind should be able to chose their own therapy, or choose to forgo therapy completely. To make these choices, people need access to the best available information. However, when it comes to complementary/alternative medicine this information often gives a false sense of the effectiveness of CAM therapies.

Nowhere is this more true than in cancer therapy. Cancer and it's treatment is a very emotive issue. Having lost several family members to cancer, including my greatly loved mother-in-law, I've experienced some of this first hand. Unfortunately, an article in this Saturdays Advertiser, "Why a brave mum said no to chemotherapy", gives a very misleading idea of the effectiveness of alternative cancer therapies, which could potentially endanger lives.

I don't want to denigrate the experience of the author and her mother, but in trying to explain why her mother chose alternative medicine, a lot of factually incorrect or misleading information is presented by the author.

It starts early on with this piece:
It's interesting to note that when an alternative cancer treatment fails, the practitioner is denounced as a charlatan. But when conventional treatment fails and research shows it fails 75 per cent of the time, we assume "it was their time" and that the doctors "did their best".
What research is this that shows conventional treatment fails 75 percent of the time? For which cancers? For uterine cancer, 81% of patients will survive 5 or more years, for ovarian cancer it's a more sobering 40% survival. As the authors mother had ovarian/uterine cancer presumably she was talking about ovarian cancer (which as a much better survival rate than the 25% stated), but the way this piece is written it suggests that this is true for all cancers. For cervical cancer the survival rate is 65%, for breast cancer the survival rates on average are around 88%, you can get a good overview of cancer survival in Australia here.

On the other hand the success of alternative medicine in treating cancer is the same as if you had been treating cancer with sugar pills. This is why alternative medicine practitioners are called charlatans, because they provide treatments that have either been shown not to work, or have no good evidence that they work.

An example is the Gerson Therapy, lauded in this article. A punishing regime of strict diet, vitamin supplementation and coffee enemas, it doesn't work, and has significant risks of side effects (some more information on how shonky it is here). The Gonzalez protocol, based on the Gerson therapy doesn't work either. Oh, you can certainly get testimonials, but these are subject to selection bias, recall bias and without adequate controls on diagnosis and follow up, you have no idea what is happening. And of course the alternative medicine people never publish testimonials like this.

Coffee enemas are part of the protocol:
There were plenty of jokes about Mum going upstairs to have a "crappuccino", but the aim of the coffee enema is to detoxify the liver, which many believe is the most important organ for cancer recovery.
Except this is absolute rubbish, the enemas do nothing what so ever to the liver (which contrary to alt-med belief are not massive stores of toxins). Pumping coffee into your intestine might stimulate the intestine to contact a bit more, but this will do nothing to affect the mutant, out-of-control rapidly growing cells that are cancer (or "cleanse" the blood). The bowel seems to be a fixation for alt-med, but the whole idea that the colon needs to be "cleansed" is a myth.

Then there is the vitamin C infusions: .
..up to 75,000mg intravenously every week. To give you some idea of how much vitamin C we're talking, the RDA is 80mg. The treatment may sound crazy, but it's hard to argue with the evidence.
And the evidence is that it doesn't work. Proper controlled trials of vitamin C therapy have shown no benefit (as opposed to Linus Paulings shambolic attempts which didn't include proper controls). Sure if you put enormous quantities of vitamin C on cancer cells in culture dishes you will kill them, so will extract of old boots (in my day job I do experiments with cancer cells, so I am aware of the pitfalls of this kind of experiment). These tissue culture experiments don't reflect what would happen in a real clinical situation.

So the author's mum is taking potentially dangerous treatment with no proven benefit. Wait, you are saying, surely vitamins aren't harmful. At that level they are, with the potential to cause renal disease. Supplemental vitamins, above what is necessary to prevent vitamin defficenacy, have been linked to adverse our comes (see here and here).

Oh yes, and Black Salve is not a cancer specific curing agent, it's a generalised corrosive agent.

The author reminds us that cancer treatment is big business for pharmaceutical companies, giving the impression that alternative medicine is all warm and fuzzy. Make no mistake, alternative medicine itself is big business, in 2004 Australians spent 4 times the public expenditure on the PBS on alternative therapies.

"Why poison yourself with something you don't believe in?" was Mum's answer to the inevitable chemo question. But some people really do believe in the power of chemotherapy, and for those people having chemo is the right thing to do.
This, I think cuts to the heart of everything, it's all about belief. So instead of poisoning themselves with things they don't believe in they will poison themselves with things they do believe in. Yet cancer doesn't care what you believe in, and neither does chemotherapy, it works or it doesn't regardless of your belief in it.

The author has claimed to have used her journalistic experience to study cancer therapy, but it doesn't take much to discover that the therapies portrayed in the article are not only useless, but potentially harmful. As such this is grave disservice to those cancer sufferers and their families considering treatment options.

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