Choice in Unconventional Cancer Therapies
A Framework for Evaluating Unconventional Cancer Therapies
In the course of my investigations of unconventional cancer treatments, I have reached several conclusions that seem to have stood the test of time:
To date, I have seen no decisive and scientifically documented cure for any type of cancer among the complementary cancer therapies.1
Relatively little scientific evidence exists for most therapies on which to evaluate questions of whether these therapies sometimes result in survival advantage, life extension, or improved quality of life.
However, significant anecdotal or case evidence indicates that some people have recovered from life-threatening cancers or lived for an unexpectedly long time while using many of these therapies, and that some of these therapies do enhance quality of life.
The old stereotypes that describe unconventional cancer therapies as the domain of cynical “quack” practitioners catering to ignorant, credulous patients are largely (but not entirely) erroneous.
While the hostilities between the most vocal proponents and opponents of some of the alternative cancer therapies continues unabated, there is also cautious movement by thoughtful people on both sides of the “war over cancer therapies” toward a middle ground with respect to ethical, spiritual, psychological, nutritional, herbal, traditional, and immunosupportive approaches to cancer.
The following sections discuss these findings in more detail.
No Scientifically Documented Cure
I have seen no systematic cure for any form of cancer among the therapies currently described as “unconventional.” This is an important finding. Conventional therapies, for all their real shortcomings, are capable of curing a number of cancers reliably. When I say I have seen no systematic cure for cancer among the unconventional therapies, this does not mean that I have seen no individual cures among people who have used unconventional therapies. In fact, there are well-documented examples of people who have recovered from “terminal” cancers using various unconventional cancer therapies. But these examples of individual recoveries from terminal cancers are not frequent enough to form a pattern that would allow me to say that there is a cure for any cancer among the unconventional therapies. There are therapies, as we shall see, which appear possibly to extend survival with specific cancers–such as hydrazine sulfate for non-small cell lung cancer, or psychosocial support for metastatic breast cancer and malignant melanoma. And there are many complementary therapies which definitely contribute to enhanced quality of life. These therapies that enhance quality of life may, I propose, confer some survival advantage by enhancing physical and psychological general health.
I emphasize the absence of any decisive cure as my first finding about these therapies because some of the alternative cancer literature suggests that there are cures for cancer among unconventional cancer therapies which are being suppressed by a medical-industrial conspiracy because these “cures” would cut into its profits. Certainly, the medical establishment disapproves of many unconventional cancer therapies, and certainly there are powerful structural forces at work to delegitimize them and sometimes punish their practitioners. But there is no documented cure for cancer among the unconventional cancer therapies known to me.
Relatively Little Scientific Evidence
Relatively few scientific studies have been made of most unconventional cancer therapies, although some therapies do have significant scientific documentation. Scientific studies are urgently needed to determine if some of these therapies might extend survival or enhance quality of life for patients who integrate them with the judicious use of conventional therapies.
For a few therapies, notably psychological treatments, scientific studies do document quality of life and some possible survival advantage for patients using them. Moreover, unconventional cancer therapies do occasionally cross the line into mainstream medical practice. It is more than a rhetorical point made by proponents of unconventional cancer treatments that chemotherapy, radiotherapy, and hyperthermia (raising a patient’s body temperature to abnormally high levels) all started out as unconventional cancer therapies, with hyperthermia being the most recent therapy to cross the line. It is equally important to note, as opponents of unconventional therapies do, that such cases of the subsequent legitimization of unconventional cancer treatments represent the rare exceptions, not the rule.
Psychological treatments for possible survival advantage, as well as demonstrated quality-of-life benefits, appear to be the most plausible candidates to cross over next into mainstream medicine. I anticipate that medically supervised nutritional support–drawing extensively on some of the tenets of the unconventional nutritional therapies–may follow psychological treatments across the line in the next few decades.
At present, the possibilities that Stanislaw Burzynski in Texas is getting is getting good results with some brain tumors (see chapter 21) and that hydrazine sulfate may extend life with some lung cancers (see chapter 22) are based on preliminary, though intriguing, findings. Thus, the field of unconventional cancer therapies is, by definition, continuously stripped of the most notable examples of scientifically and clinically demonstrated treatments.
Reliable Case Evidence
Case evidence and anecdotal evidence have demonstrated that some cancer patients have recovered from life-threatening cancers while using current unconventional cancer therapies, whether or not one chooses to attribute the recoveries to the use of the unconventional treatment. Rarely, however, are there reliable data on how common these recoveries are. The number of patients who have undertaken the same unconventional therapy that were associated with the well-publicized recoveries without achieving exceptional recovery is simply not known. More important, given the high probability that most unconventional cancer therapies–like most conventional cancer therapies–will at best usually extend survival rather than “cure” cancer, we do not have reliable data for most unconventional cancer therapies that enable us to assess their contributions to life extension rather than cure.
Evidence of individual cases of recoveries from metastatic (or other life-threatening) cancers, and of the correlation between the use of unconventional treatments and length of life, could be gathered by practitioners of these therapies at relatively low cost. Unfortunately, few practitioners of unconventional therapies are committed to careful record keeping, or even rudimentary assessment of outcomes. This is a serious shortcoming in the field.
The work of people with AIDS and the physicians and researchers supporting them in organizing community clinical trials of unconventional AIDS therapies provide a fine example of what is possible in terms of evaluating unconventional cancer therapies. Such initial studies need not be either extremely expensive or extremely difficult to design and execute. For those concerned with unconventional cancer therapies, collaborative work to design and initiate such clinical studies is critically important. Until this happens, most of what even the best-informed clinicians and researchers can tell patients about these therapies is highly subjective and of relatively little value for facilitating informed choice.
Old Stereotypes of Patients and Practitioners
For almost 50 years, mainstream opponents of unconventional cancer therapies successfully portrayed unconventional therapies to the American public as practiced largely by unethical “quack” practitioners, cynically exploiting the fears of patients for personal profit. The patients who used these therapies were portrayed as desperate and credulous people too ignorant to make informed choices. These stereotypes have proved to be highly inaccurate.
The studies of Barrie Cassileth, Ph.D., and my own more journalistic surveys, suggest that, for the most part, unconventional therapies in the United States are offered by licensed physicians or other credentialed health care practitioners who believe in the therapies they offer, who are not charging excessive fees for treatment, and who are treating patients of above-average education. These patients are likely to be more deeply engaged than the average patient in their fight for recovery. In the large majority of cases, these patients also, significantly, choose to remain under the care of a mainstream physician.2
In my experience, patients generally leave mainstream medicine completely only because their doctors told them they had “nothing more to offer them,” or because they had shockingly poor experience with mainstream medicine, or because they weighed the risks and benefits of what mainstream medicine offered and decided to explore other options.
The vast majority of cancer patients do not see conventional and unconventional therapies as an either-or proposition. Rather, they seek to make informed, personal choices about how to integrate what conventional therapies offer them and what unconventional therapies offer them. It is also important to recognize that the problem of impaired physicians is as real in conventional medicine as the problem of quack practitioners is in unconventional medicine. It is my opinion, based entirely on my own personal experience, that unethical and impaired practitioners probably represent a somewhat larger proportion of unconventional than of conventional practitioners, largely because the field of unconventional therapies is unregulated and, given its socially marginalized position, probably attracts disproportionate numbers of both highly committed ethical practitioners and unethical quack practitioners.
Unconventional cancer therapies also have the problem, which conventional medicine does not have, of attracting well-intentioned but poorly informed “true believer” practitioners who may do cancer patients as much harm as the unethical quacks, out of ignorance and incompetence. It is true that many mainstream oncologists are also true believers in conventional treatments and are poorly informed about ethical, legitimate complementary approaches to cancer care. But at least they have extensive training in cancer treatment, which some of the most dangerous unconventional practitioners lack entirely. Legalization and intelligent regulation of ethical complementary cancer therapies, on the German model, for example, could help to minimize the serious problems presented by quacks and true believer practitioners.
Types of Unconventional Approaches
Because relatively few scientific studies have been made of many of the unconventional cancer therapies, some system for analyzing these divergent approaches to cancer treatment is necessary. The typology I present here–which was adapted in part by the Office of Technology Assessment in framing its report on unconventional cancer therapies–is entirely flexible, and other people may wish to add or subtract elements from the typology. However, in my experience, this typology represents a useful map with which to explore the otherwise confusing terrain of unconventional, alternative, adjunctive, and complementary cancer therapies. Many unconventional cancer therapies combine several of the following 12 elements. The 12 elements in my typology of unconventional cancer therapies are:
1. Spiritual approaches
2. Psychological approaches
3. Nutritional and dietary approaches
4. Physical and psychophysiological approaches
5. Traditional medicines
6. Pharmacological approaches
7. Herbal approaches
8. Electromagnetic approaches
9. Unconventional uses of conventional therapies
10. Esoteric and psychic approaches
11. Unconventional instruments, apparatuses, and diagnostic tests
12. Humane approaches
A spiritual response is undoubtedly one of the most common human reactions to cancer. The fact that spiritual support in the treatment and care of people with cancer is considered unconventional today, or at best the marginal province of the hospital chaplain, is a testament to how alienated from core human needs the conventional medical system has become. Spiritual approaches to cancer, some going back to the dawn of human history, include prayer, laying on of hands, and many forms of spiritual imagery or inner dialogue designed to help align the patient with higher forces in himself or the guiding spirit of nature or the universe, however he defines it.
Prayer and Therapeutic Touch are two of the areas in which exciting early research suggests that extraordinary fields may open up for both physical and psychospiritual healing. The growing scientific literature on “near death experiences” is another area in which research tends to corroborate–although it has not and perhaps cannot “prove”–some of the most ancient human teachings about the immortality of the human soul.
Spiritual approaches to cancer partially overlap religious approaches, but should be clearly differentiated from them. Many cancer patients with negative religious experiences or associations from childhood find to their surprise that they are drawn toward a spiritual response to the “spiritual emergency” of cancer that is authentic and very different from the religious experiences that disappointed them earlier in life. Conversely, many cancer patients access powerful spiritual experiences directly through their fulfilling religious traditions. My own view is that, in future scientific studies, spiritual approaches will be shown both to enhance quality of life–a fairly obvious proposition–and also to extend life for some patients with some cancers. However, spiritually based “cures” will remain the rare exception rather than the rule.
But neither physical recovery nor life extension is the test of the value of spiritual approaches to cancer. The test is in the effect they have on the living experience of the person involved.
Numerous psychological approaches to cancer–both ancient and modern–are now available, and many of these approaches have crossed the line into mainstream respectability. The approaches that are now widely respectable within the medical mainstream–although relatively rarely practiced–include individual psychotherapy, group therapy, support groups, imagery, psychoeducational programs, guided self-exploration, biofeedback, and hypnosis. They are used variously for:
Support in recovering from the shock of diagnosis.
Reducing the anxiety and stress of having cancer.
Reducing the stress of cancer treatment.
Minimizing side effects and enhancing recovery from surgery, chemotherapy, and radiotherapy.
Controlling pain, nausea, sleeplessness, and appetite loss.
Facing and grieving over losses associated with cancer.
Exploring possible areas of life enhancement.
Learning to live a full life with cancer or the threat of recurrence.
Facing the shock of diagnosis of a cancer recurrence.
Learning to live with a cancer for which cure is unlikely or for which there is no known cure.
Facing death and dying from one’s own perspective and that of one’s family.
The only major hypothesis about psychological approaches to cancer on this list that remains genuinely controversial is the hypothesis that psychological interventions may extend survival with cancer. Several well-designed studies support the life extension hypothesis, as we shall see in chapter 10, but the scientific jury will not reach a definitive conclusion for another 10 years. My own estimate is that well-designed future studies will show that psychological approaches to cancer–in addition to enhancing quality of life, protecting against the side effects and enhancing the effects of treatment–will, indeed, prove to extend life for some patients with some cancers, and prevent recurrence of cancer for other patients, often to a degree sufficient to make these interventions an important adjunctive treatment option. I believe equally firmly that “cures” of metastatic cancer using psychological approaches will remain rare, individual exceptions rather than the rule.
Nutritional and Dietary Approaches
The dietary and nutritional approaches to cancer therapy are as numerous as the psychological approaches. Diet is now well recognized by scientists to play a major role in lowering the risk of some types of cancer, including some of the most common cancers, such as colon, prostate, and breast cancer. The possibility that a diet known to prevent a specific cancer could play a role in slowing, stopping, or reversing the development of an established cancer of that type, or indeed in preventing or slowing the recurrence of such a cancer, remains highly controversial, with plausible arguments on both sides. Some unconventional practitioners believe that one or another of these unconventional therapies can offer full or partial cures for some cancers. Among the best known of the nutritional and dietary approaches are the macrobiotic diet, the Gerson diet, the Hippocrates wheat-grass diet, the Kelley-Gonzalez nutritional program, and the Livingston-Wheeler nutritional program.
One heavily neglected area of mainstream research is in the role of nutritional interventions in enhancing outcomes for patients who have had chemotherapy, surgery, or radiotherapy. The scientific reports that vitamin E may prevent hair loss for patients treated with doxorubicin (Adriamicin), and possibly protect against cardiac damage as well, are one example of a promising nontoxic use of nutritional supplements as an adjunct to conventional therapy.3 I expect that adjunctive programs of intensive nutritional support will follow the adjunctive psychosocial approaches into medical mainstream respectability in cancer treatment. I think that in the future diet and nutrition will play a significant role in enhancing the response to and controlling the side effects of conventional therapies. I further believe that well-designed future studies will show that, in addition to improving quality of life, diet and nutrition may extend life for some patients with some cancers, and that diet and nutrition work best when used synergistically with other currently unconventional approaches to healing, including spiritual, psychological, and physical approaches.
Physical and Psychophysiological Approaches
The wide range of physical and psychophysiological approaches to cancer includes exercise, movement therapies, massage therapies, chiropractic and osteopathic treatments, progressive relaxation, breathing practices, yoga, and an element of traditional Chinese medicine called qi gong. These therapies are occasionally recommended as potentially curative in themselves, but far more frequently are offered as adjuncts to conventional treatment or to other complementary treatments. Just as mainstream medicine ignores spiritual, psychological, and nutritional adjuncts to conventional treatments, so, to a lesser degree, even mainstream physical therapies are often overlooked or underemphasized as key elements in recovery from common cancer treatments, particularly mastectomies. Thus conventional physical therapy must paradoxically be included as “unconventional” because it is so frequently ignored in mainstream protocols, although its role in recovery from mastectomy and other cancer treatments is well documented. I feel quite certain that physical and physiological approaches to cancer will join nutritional approaches in following the psychological approaches into the medical mainstream. I believe they will be found to contribute to quality of life, symptom control, minimizing side effects of treatment, enhancing effects of treatment, and life extension for some patients with some cancers. Definitive “cures” attributable to them will remain the rare exception rather than the rule.
The Vital Quartet
At this point, I pause in the discussion of the 12 common elements in unconventional cancer therapies to make a crucial point about the first four common elements described above. Spiritual, psychological, nutritional, and physical approaches to cancer represent a quartet of ethical approaches to improving health that have benefited many cancer patients. When a cancer patient takes the time to undertake a system of intensive multimodal health promotion that includes these four elements–and which makes sense to him–the general result is that he becomes a healthier cancer patient. The effects of such a regimen on quality of life, symptom control, and controlling side effects of treatment are fairly obvious. But it is also reasonable that becoming a healthy cancer patient may help extend life. I believe the effect on life extension of intensive multimodal efforts to improve quality of life by becoming a healthier person with cancer will someday be demonstrated to significantly extend life or prevent recurrence for some patients with some cancers. I believe it will also prove true that sometimes, but not always, integrating these four approaches will have a synergistic effect on life extension that exceeds the effect of using only one approach. Therefore, these four intrinsically health-promoting therapies could be described as categorically distinct from the other eight elements I describe below. Without any question, research on the effects of intensive spiritual, psychological, nutritional, and physical health promotion in cancer treatment should become an integral part of the mainstream agenda.
The World Health Organization (WHO) designates “traditional medicine”–as opposed to “conventional” or “allopathic” medicine–as those practices which come from the great medical traditions of the world, such as traditional Chinese medicine, Tibetan medicine, Ayurvedic medicine from India, naturopathic and homeopathic medicine from Europe, and the eclectic modern folk medicines practiced in many countries. WHO recognizes traditional medicines as the legitimate and often efficacious providers of medical care to a large part of the world’s people.
The traditional medicine most commonly used by American cancer patients is Chinese medicine, which includes acupuncture, herbal therapies, moxibustion (the burning of a herbal paste over key acupuncture points), and often recommendations on diet and changes in mental state. Western patients widely report that traditional Chinese medicine offers considerable relief from the side effects of chemotherapy and radiation, as well as being a nonpharmacological method of pain control. Ayurvedic medicine from India, Tibetan medicine, and homeopathic medicine also have their adherents among American cancer patients and health practitioners.
Relatively few of the traditional medicines claim to be able to cure cancer on a regular basis. But some have treatments that seem to help with symptom control, the side effects of mainstream treatments, and quality of life. In some instances, the potential for achieving unexpected recoveries is also recognized. The great traditional medicines tend to concur with the informed consensus regarding the possible benefits of an integrated therapy using spiritual, psychological, nutritional, and physical approaches to cancer–all of which are often incorporated in their treatments. They also often use specific herbal remedies, which in in vitro research tests have been found to have anticancer effects.
A vast range of pharmacological approaches to cancer includes pharmacological use of nutritional supplementation, herbs, and hundreds of other unconventional pharmaceutical agents, new and old. Laetrile, vitamin C, the mistletoe extract Iscador, and hydrazine sulfate are examples of a few of these pharmacological treatments. Pharmacological approaches are among the most common unconventional cancer treatments.
Herbal therapies for cancer are largely derived from traditional ethnomedicines from hundreds of different medical traditions. Pau D’Arco tea from South America, the Hoxsey herbs from the United States and Mexico, the Canadian treatment Essiac, and the herbal remedies used in traditional Chinese medicine are a few of the best-known herbal treatments. Fortunately, a respected scientific literature is available on laboratory tests of the anticancer effects of herbal remedies that patients, physicians, and researchers can consult. However, there are few rigorous studies for most of these remedies as actual treatments for human cancer. This category of herbal approaches overlaps significantly with the pharmacological category above.
Electromagnetic approaches to the diagnosis and treatment of cancer are now making significant claims on scientific attention–most notably the work of Bjorn Nordenstrom at the Karolinska Institute in Sweden.4 There is also a growing scientific literature on electromagnetic hazards in everyday life associated with increased incidence of some cancers.5
Unconventional Uses of Conventional Treatments
Unconventional uses of conventional treatment modalities go beyond the normal range of “variations in medical practice” that are found within mainstream medical research and treatment facilities. Wolfgang Scheef, Dr. med., at the Janker Klinik in Bonn, Germany, is a clinician offering unconventional use of conventional or experimental cancer treatments which have attracted many American cancer patients. In Canada, Rudy Falk, M.D., former Chief of Surgical Oncology at the Toronto General Hospital, also uses conventional and experimental agents in unconventional ways.
Esoteric and Psychic Approaches
Esoteric approaches to the prevention, diagnosis, and treatment of cancer often overlap the spiritual approaches and those of the various systems of traditional medicine. Psychic diagnosis of cancer, psychic surgery as practiced by some healers from the Philippines, and the use of crystals in healing are examples of esoteric approaches.
Psychic diagnosis and psychic recommendations for treatment seem extraordinarily far-fetched to most people in the medical mainstream. Yet, as research in psychic phenomena has become more scientific, more researchers and clinicians have become interested in the possible continuum between psychic phenomena–such as clairvoyance and “remote viewing” capacities with respect to diagnosis and treatment–and the common intuitive experiences of many clinicians and patients in which one or the other “knows” when the cancer is active, or in remission, before diagnostic tests confirm this intuitive knowledge. The role of intuition in diagnosis and treatment and its relationship to increasingly well-studied psychic phenomena are certainly likely to attract more attention in coming decades.
Unconventional Instruments, Apparatuses, and Diagnostic Tests
Some unconventional instruments and diagnostic tests are blatantly and cynically fraudulent, others intriguing. Special microscopes for the diagnosis of cancerous and precancerous conditions are some of the most intriguing diagnostic tools. Virginia Livingston-Wheeler, M.D., in San Diego, made unconventional use of mainstream dark-field microscopes for the study of live blood for the purposes of refined cancer diagnosis. Gaston Naessens in Quebec has an unconventional microscope that he designed and built himself–but will not allow others to replicate–with very high magnification powers that he uses to study live blood for refined diagnosis of cancer and other conditions. Royal Rife also developed a microscope in the 1930s in San Diego for which unusual diagnostic potential has been claimed. Many clinicians involved in unconventional cancer treatments who have used dark-field microscopes have confirmed that intriguing phenomena seem to show up in live blood that seem well correlated to cancerous conditions. These diagnostic tools, according to these practitioners’ theories, allow the clinician to track the response of the blood to unconventional cancer treatments and so guide their progress.
A pervasive theme in many unconventional cancer therapies is the emphasis on humane treatment. Obviously, practitioners of conventional cancer therapies are often equally concerned with humane care. Equally obviously, many complementary practitioners are inhumane in their delivery of unconventional treatments. Nevertheless, an emphasis on the humane, compassionate, and sensitive treatment of the patient is one of the major themes that runs throughout the literature on complementary cancer therapies, and some of the best of these treatment systems–notably the anthroposophical hospitals founded in Germany and central Europe by the followers of Rudolf Steiner–do achieve systematically more humane levels of treatment for cancer patients than mainstream hospitals in the United States and Europe usually do. In their focus on humane treatment, practitioners of unconventional cancer therapies come to conclusions similar to the growing number of advocates of “patient-centered” or “humanistic” medicine in the United States medical mainstream.
Evaluating the Therapy, the Practitioner, and Service Delivery
This completes our brief review of the 12 elements often found in various combinations among the hundreds of unconventional cancer therapies used by cancer patients. But how can we begin to approach the practical evaluation of these therapies? Given that valid scientific evidence for evaluating unconventional cancer therapies is often so sparse, there are three categorical distinctions that have proved useful to me in assessing these therapies. I believe that patients, clinicians, and researchers assessing an unconventional cancer therapyêshould differentiate clearly between (a) the therapy itself, (b) the practitioner offering the therapy, and (c) the quality of the service delivery. (These three categories are, incidentally, equally valuable in assessing a conventional therapy.)
In order to evaluate the therapy, the following questions are useful: Can you assess whether the therapy is probably harmless, possibly dangerous, or plausibly helpful in some significant way? Does it operate according to known or plausible principles? Most important, is there any significant scientific literature that supports the use of this therapy?
A further very crucial distinction in evaluating therapies can be made between “open” and “closed” (or “partially closed”) therapies. An open therapy is one where all the information regarding the therapy is publicly available. This is usually true of the spiritual, psychological, nutritional, and physical therapies, as well as the traditional medicines. A closed therapy is one in which the practitioner, wittingly or unwittingly, acts so that the critical information is unavailable. A closed therapy inevitably raises suspicion about the motives of the practitioner. The most important closed therapies are, significantly, pharmacological.
Important commonalities, as well as important differences, exist between closed unconventional therapies and “proprietary” therapies of major pharmaceutical companies. The commonality is that–particularly during the development stage of a new mainstream pharmacological remedy–the ingredients of the treatment may be kept a secret. The difference is that the mainstream closed or proprietary formulas must be registered with the FDA and undergo extensive scientific evaluation.
One line of defense for closed unconventional therapies is that the use by physicians of secret or mysterious treatments has an ancient history and an undeniable psychological pedigree in terms of its potential to augment a placebo healing power. For some patients, the mystery of a closed therapy contributes to the numinous quality of the remedy. This may help explain why, although 90% of unconventional cancer therapies may be open, some of the closed or partially closed therapies have traditionally attracted the greatest patient interest both in the United States and abroad. Lawrence Burton’s immuno-augmentative therapy in the Bahamas is perhaps the frankest and best-known example of a closed and proprietary unconventional therapy. The Essiac herbal therapy in Canada is a widely used partially closed herbal therapy whose formula the practitioners have not disclosed, although it has been analyzed by herbal research specialists.
An almost mythological quality seems to infuse the story of why closed therapies remain closed. The mythological tale often runs like this: The practitioner discovered a cure for cancer outside the establishment. More and more patients came to be successfully treated. Mainstream authorities approached the practitioner, or the practitioner approached mainstream authorities, to discuss the new therapy. The practitioner offered to share the secret with the world if the mainstream authorities guaranteed that it would be made freely available, or available at low cost. But the mainstream authorities wanted to control the treatment, either in order to make large profits or to suppress it because they are part of a conspiracy to continue the profitable cancer industry. The practitioner resolutely refused this bargain with the forces of darkness and underwent long persecution as a result, only to emerge victorious in the end. This archetypal story of the “hero’s journey” will be familiar to students of mythology. It often appears incredible to the mainstream worldview, but it is highly credible to many patients oriented toward alternative cancer therapies. It is interesting to note that the “hero’s journey” undertaken by the practitioner of a closed therapy is often paralleled by many patients in their own journey, in which they partially or fully break with the mainstream system, undergo many hardships along the way, and arrive to find themselves in a community of believers where they are treated with the precious and mysterious substance. This is a psychologically potent process with significant placebo potential which may arguably enhance prospects for recovery, irrespective of the pharmacological action of the therapy itself.
Having evaluated the therapy, a second useful set of criteria may be applied to evaluating the practitioner. What is his training? What is his reputation within his own social network? For example, what do other unconventional practitioners, who may have referred patients to him, think of him? Most important, what is the experience of other patients who have gone to see him, especially patients with a type and stage of cancer similar to that of the inquiring patient? What are his claims regarding outcomes? Is he willing to make data available to open-minded investigators, or to provide (with their permission) contact with other cancer patients with the same kind of cancer that the inquiring patient has? Does he encourage patients to reject conventional therapies when these therapies offer scientifically documented evidence of cure or significant life extension at acceptable cost in terms of quality of life? Finally, and very important, does he appear to be a person of psychological balance and integrity worthy of your trust?
The quality of the service delivery is the third important factor in assessing the usefulness of an unconventional therapy. What is the cost and quality of the service? What do other patients say about the service delivery? Do most patients who have completed the treatment program believe (whether or not the treatment was effective) that the service was reasonably related to the cost? I have seen instances where the therapy is probably either harmless or potentially beneficial, and the practitioner ethical and devoted to his work, butêwhere the delivery of the service is severely flawed and potentially dangerous to the patient’s health. Costs also vary widely, from reasonable fees–or even free services–to staggeringly expensive fees. Of course, the same questions regarding service delivery hold for the delivery of conventional cancer therapies.
These three areas–the quality of the therapy, practitioner, and service delivery–are critical both for the patient and for the analyst committed to objective evaluation, since so much of the debate over unconventional cancer therapies indiscriminately mixes analysis on each of these three points. You cannot have a legitimate evaluation process for an unconventional therapy unless you distinguish clearly whether you are evaluating the treatment itself, the practitioner of the treatment, or the service delivery.
Curing, Healing, and Intensive Health Promotion
As I indicated in chapter 2, it is also essential to distinguish between “curing” and “healing” in evaluating unconventional cancer therapies. Recall that a “cure” generally refers to a medical treatment that reliably relieves the patient of the disease. “Healing” is recognized as referring primarily to an internal process of becoming whole, which can take place simultaneously or differentially at the physical, psychological, and spiritual levels.
Obviously, the capacity of either mainstream or unconventional therapies to be curative depends in part on the availability of the patient’s inner resources for physical healing and recovery. But beyond that, it is also entirely possible for someone to be “cured” of breast cancer by a mastectomy, chemotherapy, or radiation, yet never “heal” or feel whole again. It is also possible for conventional therapies to fail in their efforts to “cure,” yet for profound “healing” to take place spiritually and psychologically nonetheless. It is also quite possible–probable in my view–that the psychospiritual “healing process” may augment access to an interior biophysiological potential which will maximize the response to potentially “curative” therapies. In this view, efforts at psychospiritual and physiological healing represent a win-win strategy: the patient wins if he achieves physical recovery, and he also can enhance profoundly the quality of his life if physical recovery is impossible.
The most ancient traditions of medicine understood this point far better than mainstream medicine does today. They placed their primary emphasis on psychospiritual healing–on safeguarding the human soul–rather than on curing. The ancient shamans believed that if deep psychospiritual healing took place, whatever energies were available for physical recovery would be released. “Seek ye first the Kingdom of God, and everything else will be added unto you” is a pithy summary of this psychospiritual truth.
The ancient shamans also often practiced what we have identified as intensive health promotion, integrating spiritual, psychological, nutritional, and physical approaches to enhancing the conditions of healing. This combination of support for the inner and outer “conditions of healing” characterizes, as I have said, some of the best unconventional cancer therapies. Many cancer diagnoses give the patient months, if not years, of opportunity to enhance general health. Many cancer patients routinely succeed in enhancing general health through intensive health promotion while they have cancer.
One of the most important unanswered clinical and research questions is whether these efforts at intensive physical and psychospiritual health promotion in unconventional cancer therapies do more than manifestly improve quality of life with cancer, that is, whether they might actually lead to improved “functional status” for people with cancer. According to William Buchholz, M.D., a Los Altos, California oncologist with a strong interest in working with cancer patients who actively collaborate in their own care, “functional status is an independent predictor of survival in almost all cancers, as well as an independent predictor of response and survival for most chemotherapies.”6 Thus there is good reason to believe that intensive health promotion may extend survival in those cancers where the functional status of the patient is a significant predictor of survival.
Most “healing” therapists also know that psychospiritual healing can take place as the patient is losing physical ground, or even as he enters the dying process, and that such psychospiritual healing can be of enormous importance to the patient, to the family, and to all others involved. From my own experience, I want to add that efforts at physical as well as psychospiritual healing can be extremely helpful to the quality of life in people with advanced progressive cancer. The value of health-promoting activities even for people who are near death is, in my view, often overlooked. In cancer, often a limited number of organs are involved, and the person may still be able to work gently to enhance physical as well as psychospiritual health, sometimes with surprisingly positive quality-of-life results.
Controlling Versus Curing
It is also profoundly important to recognize that practitioners of some unconventional cancer therapies propose that they cannot “cure” but may be able to “control,” or “partially control,” some cancers. They offer the analogy of the use of nutritional, behavioral, or pharmacological approaches to the control of asthma, hypertension, angina, or diabetes, or the use of behavioral and psychospiritual approaches to the control of alcoholism and drug addiction. This is an important point, because many of the unconventional cancer therapies, when they work, do appear to function by controlling rather than curing. The evidence for this is that, on the occasions when an unconventional therapy appears to be working, the control often fails when the treatments or health-promoting practices are discontinued or, more important, when another psychological or physical life stress upsets the delicate balance that previously favored control.
Improved Quality of Life and Control of Symptoms
Many benefits beyond curing, healing, and control of the disease are offered by proponents of unconventional cancer therapies. As suggested above, many practitioners of the spiritual, psychological, nutritional, and physical therapies, who essentially offer a variety of forms of intensive, multimodal health promotion, report that patients achieve higher quality of life, respond better to most conventional cancer therapies, experience fewer side effects of treatment and fewer symptoms of the disease, control pain better with less need for medication, experience more lasting or partial remissions and, if and when they die, experience better deaths. Such reports also come from practitioners of other unconventional cancer therapies, such as practitioners of traditional Chinese medicine. Proponents of many of these therapies also say that their treatments are more humane, although the record on humane delivery of services in unconventional therapies is as mixed as in conventional therapies.
In the chapters that follow, I discuss in detail the five most significant categories of unconventional cancer treatment: spiritual, psychological, nutritional, physical, traditional, and pharmacological therapies.
Notes and References
1 Robert Houston, a leading authority on unconventional cancer therapies, challenges this statement. He says, “This sets up a strawman. Rarely do scientific proponents claim a `cure.’ The question is, are there promising and beneficial therapies among the alternative approaches? There most certainly are.”
2 Barrie R. Cassileth and Helene Brown, “Unorthodox Cancer Medicine,” Cancer Journal for Clinicians 38(3):182-3 (1988).
3 K.N. Prasad et al., “Vitamin E Enhances the Growth Inhibitory and Differentiating Effects of Tumor Therapeutic Agents on Neuroblastoma and Glioma Cells in Culture,” Proceedings of the Society for Experimental Biological Medicine 164(2):158-63 (1980). See also L. Wood, “Possible Prevention of Adriamicin-Induced Alopecia by Tocopherol,” New England Journal of Medicine 312:1060 (1985).
4 Bjorn E.W. Nordenstrom, Biologically Closed Electric Circuits: Clinical, Experimental and Theoretical Evidence for an Additional Circulatory System (Stockholm: Nordic Medical Publications, 1983).
5 D.A. Savitz et al., “Case-Control Study of Childhood Cancer and Exposure to 60-Hz Magnetic Fields,” American Journal of Epidemiology 128(1):21-38 (1988). See also A.êAhlbom, et al. “Biological Affects of Power Line Fields: New York State Power Lines Project Scientific Advisory Panel, Final Report,” New York State Department of Health, Albany, NY. Available from: National Technical Information Service, Springfield, VA (1988).
6 William Buchholz, M.D., personal communication with author, 28 November 1990.