ECHINACEA FOR COLDS, ginkgo biloba for memory, and glucosamine for arthritis are just some of the herbal remedies taken by millions of people around the world. But they all have something else in common: none of them have been proven to be effective.
In clinical trials funded by the National Centre for Complementary and Alternative Medicine in the US, who spent US$2.5 billion of taxpayers’ money over ten years trying to find out whether certain alternative remedies actually work, the only one with clear evidence of effectiveness was ginger, which was found to be helpful in relieving nausea in patients taking chemotherapy for cancer.
The use of alternative therapies to treat cancer is controversial. Despite absolutely no evidence supporting their use, millions of people still take them. Figures for Ireland are not available, but the market in the UK is worth around £210 million, reports show, with one-in-five adults thought to be consumers. Research has also estimated that up to 60 per cent of cancer patients try unconventional remedies and about 40 per cent take vitamin or dietary supplements.
When it was revealed that the late Steve Jobs deliberately delayed his recommended treatment for pancreatic cancer in order to take alternative medicines, the debate over their use and effectiveness was heightened. Shortly after Jobs’ death, one cancer specialist from Harvard University, Ramzi Amri, wrote: “Mr Jobs allegedly chose to undergo all sorts of alternative treatment options before opting for conventional medicine…given the circumstances, it seems sound to assume that Mr Jobs’ choice for alternative medicine has eventually led to an unnecessarily early death.”
It should be pointed out that there is a difference between alternative therapies and complementary therapies. The latter refers to treatments that are used along with standard or mainstream medical treatment. Examples may include meditation to reduce stress or peppermint or ginger tea for nausea.
Alternative medicine, however, is used instead of mainstream, recommended treatment. Alternative therapies are either unproven because they have not been scientifically tested, or they have been disproved (studied and found not to work).
The Irish Cancer Society says it does not recommend the use of alternative therapies in place of conventional treatments for cancer. A spokesperson said:
There is often little or no medical or scientific evidence to prove the claims of unlicensed practitioners who maintain to have the ‘cure’ for cancer. We recommend the use of conventional therapies under the supervision of licensed medical practitioners for the treatment of cancer. Conventional therapies include surgery, radiotherapy, chemotherapy, hormonal and biological therapies.
According to an article in a 2008 edition of Fortune magazine, for nine months between 2003 and 2004 Steve Jobs (a vegetarian) chose “alternative methods to treat his pancreatic cancer, hoping to avoid [an] operation through a special diet”.
Then in July 2004 he had surgery because his cancer had spread throughout his liver.
The suggestion from Dr Amri and other cancer specialists who commented on his case (but did not treat Mr Jobs) is that he wasted precious time trying alternative therapies.
Along with the Irish Cancer Society, neither professional medical oncologists nor alternative medicine organisations recommend that patients forgo proven medical therapy to go down an alternative route. So why do patients do it?
The placebo effect: “It makes me feel better”
For every person who says that homeopathy, for example (a disproven alternative therapy that claims a disease can be cured by a substance that produces similar symptoms in healthy people) has cured their illness, there are 99 people (probably more) who have seen no benefits – except perhaps psychological ones.
The placebo effect is a well-documented physiological and psychological phenomenon whereby a person’s symptoms disappear when no effective treatment has been taken (a placebo, or ‘sugar pill’, is used in clinical trials to test the efficacy of a drug). Some studies have shown that even after a patient is told they are taking a placebo, it continues to be effective.
Even proponents of herbal medicines acknowledge the placebo effect. Last year Professor Edzard Ernst, professor of complementary medicine at the Peninsula Medical School in the UK, stepped down from the role after 18 years, many of which were spent doing research. According to Professor Ernst, 95 per cent of the treatments he examined are “statistically indistinguishable” from placebo treatments. There was only a clear benefit above and beyond a placebo in 5 per cent of cases (which included the depression remedy St John’s Wort).
But tell this to someone determined a particular alternative therapy will or does work and you will probably get nowhere. Some cancer patients would perhaps understandably rather take something known for its purported healing and soothing properties than something that causes them to get sick and lose their hair.
How does conventional cancer treatment work?
People with cancer now have access to more effective therapies than ever before, and Irish patients are in a unique position with regard to these treatments; in Ireland, at least for the time being, oncologists are not restricted by the HSE and can prescribe cancer drugs as needed and when necessary – one of the only countries in the Western world where this is the case (although this may soon change with ongoing plans by the Health Minister and HSE to save money on drug spending).
Two of the most effective (and expensive) cancer drugs are Avastin and Herceptin, which directly target cancerous cells, as opposed to chemotherapy, which attacks every and any cell that divides in the body, hoping to damage the rapidly dividing cancerous ones. These drugs and others like them changed cancer treatment by changing the way doctors target the disease in their patients.
Other groundbreaking drugs, called tyrosine-kinase inhibitors (such as Tarceva or Iressa, used in lung cancer), target gene mutations that are now known to be linked to cancerous growth in certain patients. The discovery of such gene mutations has led scientists to hope that eventually, and where possible, these mutations will be discovered before they have a chance to cause cancer. The decades of rigorous testing and research that led to such developments do not exist in the world of alternative medicine.
One oncologist who works in a large Dublin teaching hospital and who wished not to be named, in order to protect the anonymity of his cancer patients, is highly critical of alternative and complementary therapies. The oncologist said:
I have seen cancer patients literally waste months of what little life they have left researching herbal treatments, or taking them, or arguing with their family and loved ones about taking them. There are websites and sham specialists in Ireland and abroad who promise cures and tumour shrinkage and it’s understandable that, faced with death, some people cling to this and hope, of course it is.
He continued: “Many patients, especially in pancreatic cancer or oesophageal cancer, present to us so late that they have even less time. The earlier cancer is detected and the earlier treatment begins, the better the chance. Patients can buy anything online and you don’t even know what is in these compounds. I had one patient say he wasn’t going to ‘poison his body’ with chemo anymore because it made him sicker and wasn’t working. He was reading these websites that say cancer treatment is a scheme cooked up by rich companies and doctors; one of those crazy sites that say the moon landing was faked, that sort of thing. This patient was dead in less than a year. We have to stress to patients that cancer treatment is tough and sometimes the best you’ll get is an extra two months of life…but in medicine you treat with what has been proven to work.
“All it takes is one or two patients who have been taking some kind of alternative medicine and whose cancer entered remission or didn’t progress, and they are held up as proof they can work. Which is dangerous. You can have the flu and eat an apple every day; if the flu doesn’t turn into pneumonia you don’t thank the apples.”
As pointed out by this oncologist, a general suspicion of ‘Big Pharma’ can also be the problem. However, a drug is not licensed for use just because a pharmaceutical company spends millions marketing it. Much like the world of law, a drug is assumed to be ineffective until proven to be useful. Doctors only focus on drugs that have spent years going through carefully controlled and monitored clinical studies – they do not prescribe a drug simply because a drug company says it works.
Doctors want to cure cancer and help their patients, probably at any cost. The accepted, conventional cancer drugs are expensive and, as explained above, can be toxic. If specialists believed herbal medicines could cure or diminish someone’s cancer they would be recommending it, and it would be standard therapy. Anyone who holds the view that “poisoning your body” with cancer treatment is not the way to beat the disease should think carefully, and perhaps learn something from Steve Jobs’ case, before ignoring specialist advice. Cancer patients don’t have time to waste.
Sandra Ryan is a medical journalist and clinical editor of the Irish Medical News.
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