Questionable Cancer Therapies

Posted by: Bruce Paine on February 26, 1999

Stephen Barrett, M.D. Victor Herbert, M.D., J.D

The American Cancer Society (ACS) defines questionable methods as lifestyle practices, clinical tests, or therapeutic modalities that are promoted for general use for the prevention, diagnosis, or treatment of cancer and which are, on the basis of careful review by scientists and/or clinicians, deemed to have no real evidence of value. Under the rules of science (and federal law), proponents who make health claims bear the burden of proof. It is their responsibility to conduct suitable studies and report them in sufficient detail to permit evaluation and confirmation by others. ACS's Committee on Questionable Methods of Cancer Management evaluates methods by asking three questions: (a) Has the method been objectively demonstrated in the peer-reviewed scientific literature to be effective? (b) Has the method shown potential for benefit that clearly exceeds the potential for harm? and (c) Have objective studies been correctly conducted under appropriate peer review to answer these questions?

FDA Historian Wallace F. Janssen has noted that in every decade since 1940, a questionable cancer remedy has attracted a large following and become a national issue. It was Koch Antitoxins in the 1940s, Hoxsey treatment in the 1950s, Krebiozen in the 1960s laetrile in the 1970s, and immuno-augmentative therapy in the 1980s. Today's questionable methods include corrosive agents, plant products, special diets and "dietary supplements," drugs, correction of "imbalances," biologic methods, devices, miscellaneous concoctions, psychological approaches, and worthless diagnostic tests. Many promoters combine methods to make themselves more marketable. A 1987 ACS investigation found that 452 (9%) of 5,047 cancer patients identified through a telephone survey had used questionable treatments. Of these, 49% had used "mind therapies" (mental imagery, hypnosis, or psychic therapy) and 38% had used diets. The dangers of using questionable treatments include delay in getting appropriate treatment, decreased quality of life, direct physical harm, interference with proven treatment, waste of valuable time, financial harm, and psychological damage.

Typical Misrepresentations

Proponents of questionable methods typically claim that marketplace demand and testimonials from satisfied customers are proof that their remedies work. However, proponents almost never keep score or reveal what percentage of their cases end in failure. Cancer cures attributed to questionable methods usually fall into one or more of five categories: (1) the patient never had cancer; (2) a cancer was cured or put into remission by proven therapy, but questionable therapy was also used and erroneously credited for the beneficial result; (3) the cancer is progressing but is erroneously represented as slowed or cured. the patient has died as a result of the cancer (or is lost to follow-up) but is represented as cured; or (5) the patient had a spontaneous remission (very rare) or slow-growing cancer that is publicized as a cure.

Promoters of questionable methods often misrepresent their methods as "alternatives." Genuine alternatives are comparable methods that have met the criteria for safety and effectiveness. Experimental alternatives are unproven but have a plausible rationale and are undergoing responsible investigation. Questionable "alternatives" are unproven and lack a scientifically plausible rationale. When referring to the latter, we use quotation marks because they are not true alternatives. Some promoters of "alternative" methods are physicians or other highly educated scientists who have strayed from scientific thought. The factors that motivate them can include delusional thinking, misinterpretation of personal experience, financial considerations, and pleasure derived from notoriety and/or patient adulation.

Misinformation about questionable cancer therapies is spread through books, articles, audiotapes, videotapes, talk shows, news reports, lectures, health expositions, "alternative" practitioners, information and referral services, and word of mouth. Promoters typically explain their approach in commonsense terms and appear to offer patients an active role in their care: (a) cancer is a symptom, not a disease; (b) symptoms are caused by diet, stress, or environment; (c) proper fitness, nutrition, and mental attitude allow biologic and mental defense against cancer; and (d) conventional therapy weakens the body's reserves, treats the symptoms rather than the disease. Questionable therapies are portrayed as natural and nontoxic, while standard (responsible) therapies are portrayed as highly dangerous. The figure below comes from a misleading comic book designed to undermine public trust in conventional methods.

During the past few years, the news media have publicized "alternative" methods in ways that are causing great public confusion. Most of these reports have contained no critical evaluation and have featured the views of proponents and their satisfied clients. Many have exaggerated the significance of the National Institutes of Health (NIH)'s recently opened Office of Alternative Medicine (OAM). Creation of this office was spearheaded by promoters of questionable cancer therapies who wanted more attention paid to their methods. Most of the its advisory panel members have been promoters of "alternative" therapies. In 1994, the OAM's first director resigned, charging that political interference had hampered his ability to carry out OAM's mission in a scientific manner. The OAM has funded several dozen studies related to "alternative" methods, including a few related to cancer treatment. However, it remains to be seen whether such research will yield useful results. Even if it does, the benefit is unlikely to outweigh the publicity bonanza given to questionable methods. Some of today's "alternative" methods are described below in alphabetical order.........

Macrobiotics

Macrobiotics is a quasireligious philosophical system that advocates a semivegetarian diet. ("Macrobiotic" means "way of long life.") Macrobiotic diets have been promoted for maintaining general health and for preventing and "relieving" cancer and other diseases. The optimal diet is said to balance "yin" and "yang" foods. It is composed of whole grains (50 to 60% of each meal), vegetables (25 to 30% of each meal), whole beans or soybean-based products (5 to 10% of daily food), nuts and seeds (small amounts as snacks), miso soup, herbal teas, and small amounts of white meat or seafood once or twice weekly. Some macrobiotic diets contain adequate amounts of nutrients, but others do not.

Macrobiotic practitioners may base their recommendations on "pulse diagnosis" and other unscientific procedures related to Chinese medicine. Pulse diagnosis supposedly involves six pulses at each wrist that correspond to twelve internal spheres of bodily function. Other diagnostic methods include "ancestral diagnosis," "astrological diagnosis," "aura and vibrational diagnosis," "environmental diagnosis" (including consideration of celestial influences" and tidal motions), and "spiritual diagnosis" (an evaluation of "atmospheric vibrational conditions" to identify spiritual influences, including "visions of the future").

Today's leading proponent is Michio Kushi, founder and president of the Kushi Institute in Brookline, Massachusetts. According to Institute publications, the macrobiotic way of life should include chewing food at least 50 times per mouthful (or until it becomes liquid), not wearing synthetic or woolen clothing next to the skin, avoiding long hot baths or showers, having large green plants in your house to enrich the oxygen content of the air, and singing a happy song every day. Kushi claims that cancer is largely due to improper diet, thinking, and way of life, and can be influenced by changing these factors. He recommends yin foods for cancers due to excess yang, and yang foods for tumors that are predominantly yin. His books contain case histories of people whose cancers have supposedly disappeared after they adopted macrobiotic eating. However, the only reports of efficacy are testimonials by patients, many of whom received responsible therapy. The diet itself can cause cancer patients to undergo serious weight loss.............

macrobiotics

Macrobiotics is a way of life characterized by a special diet said to optimize the balance of

yin and yang. George Ohsawa (1893-1966) started the macrobiotics movement with the

publication of his Zen Macrobiotics in 1965. Michio Kushi popularized the movement in

the United States.

Ohsawa claims that foods have yinness and yangness, and that a proper diet balances

yin and yang. He makes such claims as that schizophrenia is a yin disease and one who is

so afflicted should drink yang fluids. Kushi makes such claims as that cancer "is the

body's own defense mechanism to protect itself against long-term dietary and

environmental abuse." How he knows this is not mentioned.

If a macrobiotic diet is healthy it is by accident, since foods are selected not for their

physical or nutritional qualities, but for their metaphysical properties.

The macrobiotic diet consists mainly of whole grains, vegetables, and beans.

See related entry on alternative health practices.

Questionable Cancer Therapies

Posted by: Bruce Paine on February 26, 1999

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