The arrogance of science and the pitfalls of hope.

When passion edges into zeal and frustration becomes arrogance, scientists lose credibility and risk depriving us of their considerable and unique understanding of the intricacies of biology and the nuances of meaningful research. Alternative medicine has more than its share of snake-oil merchants and other zealots, and there is little doubt that patients are wasting money on much of what they have to offer. Watching scarce research dollars and journal space being spent on the evaluation and discussion of unlikely remedies is frustrating to scientists. Yet Drs. Ian Tannock and David Warr (page 801) go too far in their outright dismissal of all unconventional therapies for cancer. Cancer brings with it both fear and hope and it is the latter that leads many to try alternative and complementary approaches. We need to construct bridges, not moats, between thoughtful and careful science and unconventional therapy. Patients have always sought and always will seek help from practitioners outside of conventional medicine. In the US more visits are made to alternative practitioners than to primary care physicians. In Europe and Australia up to 50% of the population use alternative therapies. Some of the more scientifically minded among us may be surprised to know that people who use such therapies tend to have a higher level of education than those who do not use them. If the scientific message that alternative therapies don’t work is so “loud and clear,” why do so many people, physicians included, use them? A commonly cited factor is the presence of a chronic condition. Any illness that we label “chronic” can be viewed at least in part as one of conventional medicine’s failures. When I practised medicine in Nigeria years ago, I often saw the botched results of the witch doctor’s remedies. A common therapy for any illness in newborns was to rub cow dung on the umbilical stump, the result being neonatal tetanus and death. On the other hand, Western-trained physicians had little to offer for most chronic conditions. Many patients came to the university centre for care, but an equal and perhaps greater number went into the bush to seek the advice of traditional healers — some of which, no doubt, was helpful. Patients seek alternative care when mainstream medicine doesn’t get results. The management of cancer is a case in point: despite a decades-long “war” against cancer, age-adjusted cancer mortality in the US increased by 6% from 1970 to 1994. Encouragingly, oncologists have recognized this failure and are beginning to shift the objective of chemotherapy, particularly of solid tumours, from prolonging life to improving its quality. Many patients being treated for cancer seek symptomatic relief — and, more fundamentally, hope — from alternative therapies. This is the reality. It was to give physicians and patients reliable information about what some of these therapies are all about that we published the 6-part series, “Unconventional therapies for cancer.” Tannock and Warr’s claim that this is tantamount to publishing a guide to “Canadian witch doctors” disregards the care that was taken to provide a cautious and balanced account. Moreover, their dismissive rhetoric appears, reductively, to tar “unconventional” and “traditional” medicine with the same brush. Western medicine has had many occasions to be reminded that it is well to approach traditional practices with a certain humility. Amid misconception and ignorance — cow dung on umbilical stumps — it is sometimes possible to glean insight into the cultural contexts of healing and (as pharmaceutical companies know) a potential gold mine for research. Editorial