MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Recently, I was sent an interesting press release; here it is in full:

A new study has shed light on how cancer patients’ attitudes and beliefs drive the use of complementary and alternative medicine. Published early online in CANCER, a peer-reviewed journal of the American Cancer Society, the findings may help hospitals develop more effective and accessible integrative oncology services for patients.

Although many cancer patients use complementary and alternative medicine, what drives this usage is unclear. To investigate, a team led by Jun Mao, MD and Joshua Bauml, MD, of the Abramson Cancer Center at the University of Pennsylvania’s Perelman School of Medicine, conducted a survey-based study in their institution’s thoracic, breast, and gastrointestinal medical oncology clinics.

Among 969 participants surveyed between June 2010 and September 2011, patients who were younger, those who were female, and those who had a college education tended to expect greater benefits from complementary and alternative medicine. Nonwhite patients reported more perceived barriers to the use of complementary and alternative medicine compared with white patients, but their expectations concerning the medicine’s benefits were similar. Attitudes and beliefs about complementary and alternative medicine were much more likely to affect patients’ use than clinical and demographic characteristics.

“We found that specific attitudes and beliefs — such as expectation of therapeutic benefits, patient-perceived barriers regarding cost and access, and opinions of patients’ physician and family members — may predict patients’ use of complementary and alternative medicine following cancer diagnoses,” said Dr. Mao. “We also found that these beliefs and attitudes varied by key socio-demographic factors such as sex, race, and education, which highlights the need for a more individualized approach when clinically integrating complementary and alternative medicine into conventional cancer care.”

The researchers noted that as therapies such as acupuncture and yoga continue to demonstrate clinical benefits for reducing pain, fatigue, and psychological distress, the field of integrative oncology is emerging to bring complementary and alternative medicine together with conventional care to improve patient outcomes. “Our findings emphasize the importance of patients’ attitudes and beliefs about complementary and alternative medicine as we seek to develop integrative oncology programs in academic medical centers and community hospitals,” said Dr. Bauml. “By aligning with patients’ expectations, removing unnecessary structural barriers, and engaging patients’ social and support networks, we can develop patient-centered clinical programs that better serve diverse groups of cancer patients regardless of sex, race, and education levels.”

And here is the abstract of the actual article:

BACKGROUND:

Complementary and alternative medicine (CAM) incorporates treatments used by cancer survivors in an attempt to improve their quality of life. Although population studies have identified factors associated with its use, to the best of the authors knowledge, assessment of why patients use CAM or the barriers against its use have not been examined to date.

METHODS:

The authors conducted a cross-sectional survey study in the thoracic, breast, and gastrointestinal medical oncology clinics at an academic cancer center. Clinical and demographic variables were collected by self-report and chart abstraction. Attitudes and beliefs were measured using the validated Attitudes and Beliefs about CAM (ABCAM) instrument. This instrument divides attitudes and beliefs into 3 domains: expected benefits, perceived barriers, and subjective norms.

RESULTS:

Among 969 participants (response rate, 82.7%) surveyed between June 2010 and September 2011, patient age ≤65 years, female sex, and college education were associated with a significantly greater expected benefit from CAM (P<.0001 for all). Nonwhite patients reported more perceived barriers to CAM use compared with white patients (P<.0001), but had a similar degree of expected benefit (P = .76). In a multivariate logistic regression analysis, all domains of the ABCAM instrument were found to be significantly associated with CAM use (P<.01 for all) among patients with cancer. Attitudes and beliefs regarding CAM explained much more variance in CAM use than clinical and demographic variables alone.

CONCLUSIONS:

Attitudes and beliefs varied by key clinical and demographic characteristics, and predicted CAM use. By developing CAM programs based upon attitudes and beliefs, barriers among underserved patient populations may be removed and more patient centered care may be provided.

Why do I find this remarkable?

The article was published in the Journal CANCER, one of the very best publications in oncology. One would therefore expect that it contributes meaningfully to our knowledge. Remarkably, it doesn’t! Virtually every finding from this survey had been known or is so obvious that it does not require research, in my view. The article is an orgy of platitudes, and the press release is even worse.

But this is not what irritates me most with this paper. The aspect that I find seriously bad about it is its general attitude: it seems to accept that alternative therapies are a good thing for cancer patients which we should all welcome with open arms. The press release even states that, as therapies such as acupuncture and yoga continue to demonstrate clinical benefits for reducing pain, fatigue, and psychological distress, the field of integrative oncology is emerging to bring complementary and alternative medicine together with conventional care to improve patient outcomes.

I might be a bit old-fashioned, but I would have thought that, before we accept treatments into clinical routine, we ought to demonstrate that they generate more good than harm. Should we not actually show beyond reasonable doubt that patients’ outcomes are improved before we waffle about the notion? Is it not our ethical duty to analyse and think critically? If we fail to do that, we are, I think, nothing other than charlatans!

This article might be a mere triviality – if it were not symptomatic of what we are currently witnessing on a truly grand scale in this area. Integrative oncology seems fast to deteriorate into a paradise for pseudoscience and quacks.

14 Responses to Integrative oncology = paradise for pseudoscience and quacks?

  • Why the Editor of CANCER allowed such a puff piece to be published without requiring the evidence upon which the claims are made is deeply disturbing.

    No doubt the attentions of an empathic practitioner in a constructive therapeutic relationship makes many patients ‘feel better’ (type I effects) – but we all know that there is no plausible evidence that homeopathic pillules; acupuncture needles; chiropractic or osteopathic attempts to free ‘innate intellegence’ or improve somatic blood flow by spinal manipulation; the use of ‘vital spirits’ in plants; preternatural powers; ‘healing energies’ generated by hands or crystals have any meaningful (type II) effects on any specific disease. Let alone cancerous processes.
    (Yoga does seems to help psychologically and should not be bundled with the other CAMs unless the practitioner makes unsubstantiated claims about chakras, meridians and the like).

    No paper which fails to distinguish the practice from the practitioner, the therapy from the therapist, the style from the substance should be published in a serious journal.

    Conflating type I and type II effects prevents the benefits of the therapeutic relationship being properly appreciated and introduces pseudo science and metaphysical medicine.
    Which is, of course, what some folks want.
    They are indeed quacks, charlatans and worse – they may be frauds taking financial advantage of gullible and vulnerable patients.
    I do hope the editor of CANCER is not complicit in a fraud.

    • The answer is that the editor of CANCER has recently published a positive electroacupuncture study from the same group of people (see my post below).

  • The readers of this blog should be aware that Jun Mao, one of the two people who led this survey, has previously published several electroacupuncture studies including this, this and this.

  • Subjective self-assessment survey yields positive result, eh? Does that surprise anybody? It is concerning that this sort of thing finds its way into supposedly respectable scientific-medical journals; even publishing papers by homeopaths, following peer-review by… homeopaths.

  • I think that you have highlighted at least two major problems:

    1. the enormous pressure being put on science to produce findings that are “sexy” — a terrible term concocted by, and ever since promulgated by, the mass media for the sole purpose of making money out of sensationalism (because vitally importance scientific truths have been unsellable for at least a decade);

    2. alt-med is frequently castigated by both scientists and skeptics for being, at its very best, pseudoscience, and usually being outright anti-science — based on solid empirical evidence obtained via using the scientific method.

    These factors have enabled alt-med to adapt itself into gaining ever increasing prominence by becoming more and more science-based. No, not medical science; it maximally exploits the findings of social sciences and social engineering.

    In terms of efficacious medicine alt-med is, by definition, the collection of diagnostic and treatment modalities that don’t actually work. In terms of effective social engineering, alt-med is a resoundingly successful business empire.

    Dedicated medical practitioners tend to measure their success by the number of patients that they’ve actually helped. Alt-med practitioners tend to measure their success by the size of their house, swimming pool, yacht, and the number of derogatory comments they’ve managed to get posted on websites that are dedicated to reducing illness and suffering.

  • This double standard in the critical treatment of alt-med in respected journals is becoming pervasive. Peer review breaks down when the Peers of pseudoscientists just happen to be other pseudoscientists (real scientists are not welcome). The target market for alt-med tends to be anti-science so it is a good match. This group of consumers matches well with the anti-vaccination folks. http://scienceblogs.com/insolence/2015/06/04/antivaccine-parents-overwhelmingly-affluent-white-and-suburban/. There is a basic problem with the way “educated” people have come to critically think about the world we live in. Some of these people go into health care. Much of what is taught in the healing professions involves a particular type of problem solving which is not the same skill set that is required to take apart a journal article. For such practitioners and their “educated” patients all that is needed is to have something published supporting their views. Reality becomes a flexible concept.

    • well put!

    • @David Tyler
      You’re spot-on. I suspect it’s a similar group of people well educated in “liberal arts and humanities” who strongly migrate to “green” causes. The underlying intention is to trust nature and mistrust “sciency” stuff (usually because it’s not understood). I’m always fascinated by people who accept the scientific consensus on global warming but reject the scientific consensus on genetically modified crops: like you say, reality becomes a flexible concept.

      • I agree.

        Just before the last Australian election, I had a Greens candidate knock on the door and hand me a pamphlet. I scanned it and saw something about domestic solar power being one of their (generally nutty) causes. I asked her about this and why they thought it is a good idea to put solar panels on houses when the power produced could not be consumed (generally) while it is produced. I explained that feeding into the grid creates significant problems for power generators in trying to provide a stable electricity supply at a consistent voltage.

        She was young (mid to late 20s), spoke well and, I suspect, with an university education in other than a science related discipline. The blank look should have been enough for me to desist but I wanted to see what she actually knew. Her answer, “I’m only handing out pamphlets. Someone else will know about this”. That, I seriously doubt.

        As with people like Brenda on another thread, she has a degree (Brenda has a PhD which makes her super smart, according to her) which entitles her to make judgements about which she has no knowledge. It seems science is, indeed, flexible. It is something you can “disagree” with, even without having any inkling of understanding.

        This diatribe has been triggered by a neighbour who from all outward appearance is a normal, rational, well educated person who works in a branch of IT. This morning, however, she told me that polio was planted in Africa by the USA earlier in the last century. She has now been classed as a “first grade loon”.

  • I find it interesting that the press release only cites acupuncture and yoga as examples for CAM treatments, but does not mention homeopathy.

    I also wonder, whether the article – and the questionaire – contains an actual definition of the term “CAM”, or whether all these questions were open ended and the definition was left to the imagination of the participants.

    • as far as I know, there is no generally accepted definition of CAM.

      • Which makes it even more important to define what exactly is meant when asking people about their acceptance of it. A lack of a definition opens this up to all kinds of bias, but the results are then used to argue for any kind of CAM.

        I know a general practitioner, who has his acupuncture diplomas plastered all over the walls of his practice, but still considers homeopathy to be completely bogus.

        Of course, with the obvious target of the investigation, defining CAM according to Tim Minchin probably did not seem feasible for the authors. 😉

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