Cancer, Unproven Therapies, and Magic

Dr. Wein addresses two issues: the terminology of unproven methods, and patients’ reasons for using them. He prefers to use a previously popular term, “unproven therapies,” to those in common use today, although his term fails to account for the complementary or adjunctive therapies used by the vast majority of cancer patients who try complementary and alternative medicine. The suggestion that we adopt a different label is consistent with the ever-evolving terminology that characterizes this area of cancer care. Labeling Issues Terms applied to questionable cancer therapies have changed dramatically over the decades. Reflecting varying degrees of disapproval, the labels applied historically have included “unorthodox,” “unconventional,” “questionable,” “unproven,” and the American Cancer Society’s 1914 reproach—“quackery.” More recently, however, the term “complementary” came into use in Europe and elsewhere, while “alternative” prevailed initially in the United States, leading, for example, to the National Institutes of Health (NIH) “Office of Alternative Medicine,” which opened in 1992. Since that time, the European and North American terminology has merged, so that today’s most commonly used label is “complementary and alternative medicine,” as in the new NIH “Center for Complementary and Alternative Medicine.” The American Cancer Society (ACS) changed the name of its “Questionable Methods” Committee to “Complementary and Alternative Methods” a few years ago. Alternative vs Complementary Therapies This language reflects the status of the field internationally. It also enables important distinctions to be made between complementary and alternative remedies. Alternative therapies often are promoted for use instead of mainstream care, whereas complementary therapies are used for symptom management and as adjuncts to mainstream care, to enhance quality of life. This distinction was validated by the NIH and ACS shifts in nomenclature and by the results of the largest survey of public use of unconventional therapies.[1] All but 2% of those surveyed who used such remedies did so to complement, rather than replace, mainstream care. Although research evidence is scant,[2] it appears that approximately 8% to 10% of tissue-biopsy–diagnosed cancer patients refuse mainstream therapy and immediately seek alternative care. The vast majority of complementary and alternative medicine users seek complementary, not alternative, therapies for cancer. A glaring flaw in Dr. Wein’s taxonomic effort appears in his proposed reasons for patients’ use of unproven therapies—explanations that he categorizes as “fundamental mechanisms” and “practical factors.” The latter category includes symptom relief. Remedies applied for symptom relief are not consistent with his definition of unproven remedies as cure-oriented and lacking data. Furthermore, most complementary therapies used for pain and other symptom control are often well supported by data. There are, for example, numerous articles in the medical literature describing the physiologic and psychological benefits of massage therapy, acupuncture, music and art therapies, tai chi, meditation, yoga, relaxation therapies, and so on. Complementary therapies represent an extension of what we used to call “supportive care” in oncology. Moreover, the NIH, including the National Cancer Institute, is now backing several studies designed to evaluate complementary as well as alternative or unproven therapies. Nevertheless, the terminology of complementary and unproven medicine will continue to evolve, and may even revert to past labels such as “unproven.” Of greater import is the second aspect of the article, Dr. Wein’s speculation about what he terms the “fundamental motives” behind patients’ attraction to unproven methods.