Unorthodox Cancer Medicine
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Unorthodox Cancer Medicine Barrie R. Cassileth, PhD Helene Brown Introduction popularityinrecentyears,as wellas the The use of unorthodox, alternative, or un toxicities often associated with them. It in cludes research-based suggestions for the proven treatments by cancer patients rep resents an important social, economic, and clinician who must deal with a patient using or considering an alternative treatment reg clinical problem. The public spends ap imen, and it attempts to place the contem proximately four billion dollars on un porary zeal for unorthodox practices in so proven cancer cures each year.' Contrary cial and historical perspective. to the stereotype, however, patients who seek. unproven methods include the edu cated, the middle to upper class, and thq@se who are not necessarily terminal or even From Herbal Medicine to beyond hope of cure or remission by con High Colonics ventional treatments.2 Also contrary to many people's impressions, today's prac The most commonly used alternative treat titioners of unproven remedies are often ment for cancer today is so-called meta licensed MDs or scientists engaged in re bolic therapy, a practitioner-specific com search. They typically work within a ho bination. of special diet, detoxification by meopathic or naturopathic framework in internal cleansing, spiritual or emotional treating patients with cancer and other ma restoration, and high-dose vitamins and jor illnesses. They also often claim to be minerals.2Maintenanceoftheseregimens ahead of their time or misbranded by the requires a full-time commitment of activity “¿medicalestablishment.― andtimeby thepatientand typicallyalsoa closefamilymember. This article reviews the types of un proven cancer remedies that have achieved Metabolic therapy and other variant treatments are based on a philosophy of health and illness that views disease not as Dr. Cassileth is Director of Psychosocial Pro a localized or system-specific disorder, but grams at the University of Pennsylvania Cancer rather as an expression of systemic pathol CenterinPhiladelphia,Pennsylvania. ogy.Cancer,forexample,isthereforeper Ms. Brown is Director of Community Applica ceivedasoneofmany possibleexpressions tions, Division of Cancer Control, at the Ionsson ofunderlyingdysfunction.Itistheunder Comprehensive Cancer Center, at the Univer sity of California, Los Angeles, in Los Angeles. lying dysfunction, not the symptom—can California. cer—thatis treated. SupportedinpartbyNIH GrantCA 31147. This philosophy and its implicit self This is an edited version of an article that ap carecomponentsareabsolutelycentralto peared in Cancer Investigation 4:591—598, contemporary unorthodox cancer medi 1986.Reprintedwithpermission. cine. It is precisely this ideology, rather 176 CA-A CANCER JOURNAL FOR CLINICIANS than the particulars of the treatment regi far removed from conventional medicine's men per se, that patients acknowledge as a concerns with diet, lifestyle, environmen verity when they elect unproven methods. tal carcinogens, and the reciprocal relation Proponents of unproven therapies reject the ship between many emotional and physio concept that optimal treatment for cancer logic responses. At times, alternative varies with the specific diagnosis and the remedies also appear to be related to theo site, type, stage, and other particulars of ries that are presently under aggressive the disease. The underlying success of conventional investigation'. This is now the many proponents hinges on acceptance by case with the currently unproven immune patients of often unfounded messages con system therapies that claim to pursue an cerning the etiology of cancer. People re immunologic approach using the body's spond positively to oversimplified notions own biologics. of causality, especially concerning the Despite these important differences be complex and multifactorial causes of can tween unorthodox and conventional ap cer. proaches, it is perhaps both surprising and Every decade seems to bring its own reassuring to note that precedents exist for type of alternative cancer therapies. In the both the scope and the particular emphasis past, these were cancer-targeted quasi of contemporary unorthodox therapies. medicines in pill or liquid form.3 The early The 19th century, known as the golden age years of this century saw liquid cures such of quackery, produced an abundance of as Radol, Chamlee's Cancer Specific Puri self-care cults and the following statement fies-the-Blood Cure, and a host of others.4 from an anonymous physician, published Koch's.glyoxylide (distilled water) cure of in 1861: “¿Quackerykills a larger number the l940s was followed by the Hoxsey annually of the citizens of the United States treatment in extract and pill' form in the than all the diseases it pretends to cure.―5 1950s, by injectable Krebiozen during the At that time, as now, advocates worked 1960s, and by Laetrile in the 1970s. Each, for democratization of medical knowledge, in its own time, created a furor and degree of media exposure at least equal to that aroused recently by Laetrile. The public Typical contemporary unproven thera spends about four billion pies differ in three major ways from the previously popular' unorthodox cures of dollars on this century. First, contemporary cures unproven cancer cures may not be pills or potions, but are life each year; style-oriented remedies. They also have a do-it-yourself quality that speaks to demys tifying medicine and that is trendy in its with “¿everyman his own doctor,―and for approach to health promotion. Exercise, a “¿holistic,―self-care alternative to a dis dietary changes, megadoses of vitamins, ease-oriented, impersonal medical sys and self-management of stress direct pa tem.6 The 19th century movement arose in tients to' ‘¿natural―cures and self-care. For response to the development of modern these reasons, the currently popular treat clinical methods with the then-new empha ments can rarely be regulated by the Food sis on localized pathology. and Drug Administration (FDA). Today's medical counterculture mir Second, contemporary cures are not al rors the 19th century experience. The con ways secret formulae known only to their temporary version stems at least. in part manufacturers, but are activities of daily from an analogous reaction to today's tech living understood and accomplished by pa nologic, heroic medicine—against which tients themselves. the public attempts to protect itself through Finally, the cures carry an aura of re living wills, court battles to achieve the spectability, even a hint of conventional “¿rightto die,― and demands for “¿hu medicine's blessing, because they are not mane―alternatives. Medical specialization VOL. 38, NO.3 MAY/JUNE 1988 177 offers sophisticated and clinically optimal unprecedented.9 To place recent unortho care,but it also createsdissatisfactiondox-medicine events in perspective, how among patientsand families. ever, it is important to note the similarities The following comment written in between them and each example in the ta 1932 isequallyvalidtoday:7The patient ble. As was true of Laetrile and now for feels“¿thatthereisno one who reallysees metabolic regimens, previous unproven him or is interested in him as a whole. The methods attracted many thousands of fol cultshave capitalizedon thisfailureof lowers, raised a great deal of money for modem medicine to view the patient as an practitioners, and were attacked by the entity,and toreplacetheoldfamilyphysi medical establishment, the United States cian with a coordinated specialism.' ‘¿8This Postal Service, and the Bureau of Chemis may be due to sometimes less than optimal try (later the FDA). Reports of the worth communication between physicians, pa lessness of most of these cures, and of tients, and families. Although a patient othersnot listedhere,were publishedat may have a clear understanding of the situ that time by the American Cancer Society ation, the family may be applying pressure and by the Journal of the American Medi to “¿tryeverything,― including unproven cal Association .@ routes. Patients, who are dependent psy The table also illustrates the shifting chologically and physically on their loved cyclesof popularunproven approaches, ones,may eventuallysuccumb and tryan from the “¿natural,―“¿holistic―alterna alternative method in order to please the tives of the 19th century,'° to the quasi family. medicines of the early and mid-2Oth cen Currentalternativecancerapproaches tury, to today's return to natural, holistic, diet-oriented regimens. These shifting preferences are also in keeping with the Contrary to the prevailing conventional-medicine em stereotype, patients who phases of the times. The unorthodox therapies listed in the seek unproven table represent only a sampling of the most remedies include the educated, popularregimensoftheirera.Olson'slist the middle of unproven cancer methods22 includes 59 to upper class, and those who entries for the years 1893 to 1971, and the American Cancer Society'sUnproven are not necessarily Methodslistwas evenmore extensive. terminal. Current Unproven Cancer Therapies represent a rejection of both conventional medicine and the previous unorthodox em The covertnatureof most contemporary phasis on targeted medications, profes unorthodox cures and the widespread dis sional authority, and disease as localized semination of self-care remedies through pathology.Now, as then,the counter books and periodicals preclude precise es culture