How to be rational about “alternative” medicine in cancer care
It’s easy to feel helpless in the face of cancer, a disease that turns our body’s very own cells into a reckless and mutinous army, destroying normal cell architecture and function. Learning about cancer as a medical student was even more vexing because it gave me a concrete sense of what we still don’t know about cancer and its overwhelming diversity of presentations.
Here’s an increasingly common scenario: a patient is faced with a terminal diagnosis, and after months or years of treatments, her doctor tells her that there’s nothing more medicine can offer. Instead of abandoning hope, many patients are turning to so-called alternative therapies. As far back as 1997, Americans spent the same amount of money out of pocket on alternative treatments as they did on conventional medicine.
So what is alternative medicine, and why are people using it in greater numbers? It’s rather tautologically defined as anything outside of conventional medicine. And that’s dynamic, as some treatments previously considered alternative, such as chiropractic care for back pain, are now supported by enough evidence that they’re largely accepted in mainstream medicine -- even covered by health insurance companies.
Western medicine excels at treating and preventing acute, life-threatening illness. Antibiotics and vaccines, in particular, have saved millions of lives over the last hundred years and dramatically increased our lifespan. But just like every modality of medicine, this new scientific brand is limited. What we, especially in the developed world, are left with in our longer lives is, inconveniently, exactly what Western medicine hasn’t really nailed down yet: chronic disease. Instead of dying within weeks of a smallpox infection, we succumb to years-long battles with coronary artery disease, autoimmune conditions, diabetes, hypertension, cancer, and their many complications. Most pharmaceutical drugs are band-aids that treat symptoms yet don’t resolve the underlying cause of someone’s chronic illness.
Patients turn to alternative medicine because when faced with our own mortality, many of us will exhaust every option available. Unlike Western medicine’s traditionally one-size-fits-all approach, alternative medicine examines each patient holistically, looking at every aspect of someone’s body and life to determine how best to manage their unique manifestation of illness. It encompasses a broad range of treatments, including mind-body therapies, massage, acupuncture, nutrition, yoga, and natural herbal therapies. And unlike the traditionally hierarchical physician-patient model of Western medicine, alternative practitioners see their patients as partners who hold equal responsibility in managing their care. This active engagement and the breadth of options in alternative medicine are what many patients crave when Western practitioners tell them there’s nothing more that can be done.
While pharmaceutical companies are unlikely to invest in research on naturally occurring and therefore un-patentable substances to determine their medicinal value, the National Institutes of Health saw the growing demand for alternative treatments and founded the National Center for Complementary and Integrative Health (NCCIH) to fund scientific research in this historically underfunded and understudied area. Researchers ought to look also to healers in ancient systems such as Traditional Chinese Medicine and Ayurveda who have honed treatments over thousands of years of empiric observation to find anti-inflammatory effects in turmeric or anti-cancer properties in the bark of a local tree. Case in point: Neanderthals didn’t need molecular biology or double-blind randomized clinical trials to tell them that the poppy seeds found in their graves contained opiates that would alleviate their pain.
A particularly fascinating area of alternative medicine is its embrace of the placebo effect. In scientific research, it’s the noise in your data that you try to quiet to see the “real” effects of whatever treatment you’re testing. The marker of success for a new drug is if it’s more effective than a placebo. This means that for some conditions, the placebo is one of the most effective treatments that exists. So while researchers view the placebo effect as a nuisance, patients love it because it works. Our mind’s effects are incredibly powerful. Plus, they’re side effect-free, unlike every pharmaceutical drug. Health care providers should support their patient’s use of an herb, for example, as long as it’s not harmful, to help treat her cancer whether there’s scientific data supporting its efficacy or not. Simply put, if she feels like it will help her, then it necessarily will. Science usually dismisses these individual cases as anecdotal; instead, we ought to study the placebo effect and figure out how to harness this tremendous intrinsic power to heal our own bodies.
The real shame for cancer patients is when Western and alternative practitioners refuse to work together due to ideological differences. No modality of medicine has every answer, but we can use our clinical knowledge and each patient’s preferences to determine an optimal plan utilizing the most effective treatments from all modalities to give her the best fighting chance. For example, a patient with estrogen receptor positive breast cancer could adjust her diet and lifestyle, practice mindfulness meditation to lessen her anxiety and bolster her immune system, and take her tamoxifen treatments with ginger to minimize nausea, plus omega-3 to reduce the risk of blood clots associated with the drug. Another patient with inoperable tumors might forgo chemotherapy and radiation entirely and opt instead for gentle alternative treatments to prolong her life and ameliorate her symptoms. This synergy between Western and alternative medicine is practiced at top academic medical institutions, such as Harvard’s and UCSF’s Osher Centers for Integrative Medicine.
But when practitioners can’t work together, patients have to choose one system or the other and miss out on many options that might work together to save their lives. Or they face dangerous drug-drug interactions between their Western and alternative treatments because they’re afraid their oncologist will be angry if they admit that they’re taking Chinese herbs. For the sake of patients, we must abandon the false dichotomy of conventional versus alternative, and communicate with each other to find what works best, when, and for whom — whether it comes from a high-tech pharmaceutical lab in the U.S. or a hunter-gatherer tribe in Africa.
Cancer is one of the leading causes of death in the United States. We’re more prone to it as we age because it’s a disease of our DNA, which accumulates small mutations over time that can lead to unregulated cell proliferation. Unfortunately, cancer will never go away, and there is no single cure from either Western or alternative medicine. Each cancer is different. This is not simply to say that lung cancer is different from prostate cancer. People with the same type of cancer often have very different outcomes because one has more virulent cells or the other has a genetic type that responds better to a certain treatment. And we’re not very good yet at predicting who has the kind that will progress. Even within a single tumor, cancer cells are heterogeneous. A treatment that kills half of a tumor’s cells might leave the other half to grow and metastasize to other organs. Adding even more complexity, from birth, we all have distinctive genetic predispositions to certain cancers. Genetic breakthroughs are only just beginning to sort this out, but indications are that they will usher in a new era of personalized cancer medicine; we’ll diagnose and treat patients based on the genetic make-up of their particular tumor.
I see this as the perfect opportunity for Western medicine to align and integrate with alternative medicine and its broadest goal: to treat each patient as an individual with her own unique disease process and experience. We’ll need the tools of both of these systems to be truly competent and compassionate healers and give future cancer patients the best possible care — and a fighting chance.
A version of this article was originally published on Surviving Mesothelioma in 2010.