With depressing regularity, we hear that this or that VIP has decided to travel to Germany to get her/his cancer cured. As long as I can remember, cancer quackery has been wide-spread in Germany. More recently, dozens of private clinics have sprung up that seem to specialise in treating rich, foreign cancer patients. The message they like to send out is that, in Germany, one gets more advanced and effective treatments.
Having looked at some of the clinics’ websites, I do, however, not get the impression that this is true. For instance, one clinic that is often mentioned offers amongst other treatments the following (the descriptions are quotes from the clinic’s website):
- Orthomolecular medicine aims to restore the ideal and beneficial environment of the body by correcting molecular imbalances, and this approach is used in cancer, infections, depression and atherosclerosis, among others.
- Here at the Hallwang Private Oncology Clinic every patient receives a well-balanced supportive infusion program consisting of anti-inflammatory, potent anti-oxidant and detoxifying substances, which help you recover from previous treatments, minimize side effects from current treatments and strengthen your immune system to enhance treatment effects. Substances used are for example vitamin C, selenium, zinc, L-ornithine aspartate, glutathione, alpha lipoic acid, among many others.
- Vitamin C, also known as ascorbic acid, is an essential vitamin. It is a potent antioxidant which helps to protect against free radical damage to our proteins, fats, carbohydrates, DNA and RNA. Vitamin C is used to boost the immune system.
- Ozone is a powerful oxidizing agent. While high concentrations can be toxic, small ozone doses may increase naturally occurring antioxidants in the body. Antioxidants help to eliminate malignant calles and are needed to keep the body healthy. Ozone used for treatment is known for its bactericidal, fungicidal and virostatic properties. It also stimulates circulation and immune functions, and revitalizes the body.
- Hyperbaric oxygen therapy is used to treat several medical conditions. It is a well-established treatment for decompression sickness, a hazard of scuba diving. Other conditions treated with hyperbaric oxygen therapy include serious infections, skin lesions or radiation injury. Wounds for example need oxygen to heal properly, and exposing a wound to 100 percent oxygen can improve and speed the healing process. This has been shown in a number of studies. The goal of this treatment is to increase the amount of oxygen your blood can carry in order to restore normal levels of blood gases and tissue function to promote healing and cure infection.
- Whole body hyperthermia can be applied in a number of different diseases, including malignant, immunological, viral and other diseases. The aim of WBH is the destruction of malignant cells by induction of apoptosis via hyperthermia along with elimination of malignant cells that have become resistant to chemotherapy. With the help pf WBH, effects of other treatments, including chemotherapy and immunotherapy, can be enhanced.
END OF QUOTES
This does not look like cutting edge cancer therapy at all; in fact, none of these treatments are new and none have been shown to cure cancer or any other condition. Thus they are all examples of cancer quackery.
But, to be fair, the clinic in question (and most similar institutions in Germany) also employs a range of conventional cancer therapies. I am not an oncologist and therefore not competent to comment on these treatments; I leave this to someone who is competent; this is what David Gorski writes about them: Hallwang uses very experimental treatments in a “blunderbuss” fashion, basically throwing everything but the kitchen sink together with no sophistication. We can’t even know if these doctors know what the hell they are doing. Patients are treated, and, as far as we can tell, no systematic record of how well these patients do and how long they survive is kept, or, if such records are kept, they are kept secret.
One might, of course, argue that many patients are suffering from terminal cancers. They are desperate and have a right to try anything. As good physicians, we must not take their hope away. I would not dispute that; on the contrary, these patients deserve the best care we can muster. But I would still warn them to be cautious, and again I concur with David Gorski: People will often say of a terminal illness: How could things get any worse? The lesson of Hallwang tells us. Things can get worse if you’re induced into chasing false hope. Things can get worse if you are enticed into eschewing effective palliative treatment and suffer more than is necessary—or even die prematurely from the treatment. Things can get worse if you drain your life’s savings, leave nothing behind for your family, and spend the rest of your life chasing ever more money. Things can get worse if your family joins you in draining their life’s savings to pay for your treatments. Things can always get worse, and quack cancer clinics virtually guarantee that they will.
In view of all this, I feel strongly that it is high time the German regulators have a close look at the plethora of cancer quackery and find a way of stopping this unethical, despicable exploitation.
All those forms of quackery are on sale in the UK too. See, for example, http://www.dcscience.net/2013/03/25/the-exploitation-of-cancer-patients-is-wicked-carrot-juice-for-lunch-then-die-destitute/
Have you got any idea of how much more prevalent they are in Germany?
I am not aware of good stats on this.
the fact that UK citizens are regularly reported to travel to Germany to have their cancer ‘cured’, is telling.
alt med in general is considerably more prevalent in the German compared to the UK general population – about 70% vs 25%.
It is not true to say that none of these treatments have any place in cancer therapy. Most tumours are very susceptible to hyperthermia. However, clinical trials with local hyperthermia have had limited success, partly due to the difficulty in raising the temperature of a structure deep within the body (microwave radiation has been used for skin metastases from breast cancer) and parly because the heat is rapidly conducted away by the blood. Whole-body hyperthermia is difficult to achieve and is extremely unpleasant for the patient, though there have been some interesting results (I’m sorry I don’t have any references to hand). Interestingly an early approach to treating cancer by William Coley in the late 19th century innvolved the use of a mixture of bacterial toxins to induce pyrexia (“Coley’s toxins”). He described some remarkable responses (anecdotal, of course), though as far as I understand subsequent trials have had mixed results and as far as I know there has not been any recent research, nor is this treatment used in conventional medicine.
With regard to hyperbaric oxygen, it has been used as a radiosensitiser in conjunction with radiotherapy (most tumour cells are quite hypoxic, making them very resistent to radiotherapy which works by generating oxygen free-radicals). The conclusion of trials conducted at St. Bartholomew’s Hospital in London was that it was effective as a radiosensitiser, but so difficult that the benefits were more-or-less balanced by the problems in delivering the radiotherapy accurately. In any case, different cells are hypoxic on different days, so fractionating the radiotherapy (which is standard practice) is an effective way round the problem. Nevertheless, research into radiosensitisers continues; theoretically, taking antioxidants might reduce the effectiveness of radiotherapy, though I am not aware of any data to back this up. We do know, of course, from large randomised trials that antioxidants can be carcinogenic (for instance the recent SELECT trial looking at prostate cancer prevention).
I have always been worried by German clinics where treatment approaches currently being researched elsewhere are offered as though they have been proven, often with different protocols from the ones in clinical trials. I have had a number of patients spend a lot of money on dendritic cell therapy, for instance, which is promising in some trials but needs a lot more research before it can be considered as a treatment outside the trial setting.
If a cancer patient has run out of traditional options and wants further therapy, my recommendation is that they should volunteer for a clinical trial, in the knowledge that it is unlikely to help them (though it may), but that the information gleaned will be of benefit to future patients. Indeed, I am overwhelmed by the number of people who selflessly enter such trials at significant invonvenience to themselves.
this is a strange comment; you say that “It is not true to say that none of these treatments have any place in cancer therapy.”
and then continue explaining why they do not work.
of course, you can kill a cancer cell with heat, but if you try that in vivo, you harm the patient more than the cancer.
I was summarising what I know of some of the mainstream research which has been done in those areas and where it has got us so far. As far as I know these lines of enquiry continue to be pursued, to to say that they have no place in cancer treatment is to pre-empt the findings of further studies.
There is a lot of interest in the use of hyperbaric oxygen to treat (relatively rare) complications of radiotherapy, and indeed I have referred patients for trials, and also for treatment in the absence of good trial evidence (after detailed discussion with colleagues) where there have not been good alternatives. On the whole they have shown improvements, some of them marked (particularly late-onset rectal bleeding after prostate radiotherapy), but of course this is anecdotal. Concerns about the late effects of conventional cancer treatment does set limits on their use. Oncologists tend to err on the side of caution – if you undertreat a patient and fail to cure the cancer you are a hero for having done you best, but if you overtreat them, cure them and cause long-term problems then you are the villain. Anything which widens the grey area in between is a step forwards, and there is hope that HBO may have something to contribute here.
“… to say that they have no place in cancer treatment is to pre-empt the findings of further studies.”
even if I said that, it does not pre-empt research.
RESEARCH AND TREATMENT ARE DIIFERENT!
Of course a lot of medical research is lab-based, but most of the research that I have been involved in has been to compare the safety and efficacy of different treatments, so I am not quite sure what you mean here.
Does this also apply to the German tests for Lyme disease that have been promoted so widely recently? That found all members of a millionaire’s family had Lyme disease whereas the British tests were negative? I’d wonder if they were taking advantage of someone.
Not just German tests.
Unfortunately the predictive value of a test depends on the prevalence of what is being tested for in the population in question. Suppose there is a test for Buggins disease which has proven to be 98% accurate when given to a population of patients known to have the disease. If we now apply it to a different population in which Buggins disease is rare (e.g. the general public, where, say, 1 in 1,000 are affected, then we will find that of 100,000 tested, there will be 98 cases which the test has correctly identified, and 2 cases which it has missed. There will also be 2,000 cases that have tested positive but which do not have Buggins disease, giving the test a positive predictive value of 98 / 2000, which is about 5%.
Although I have made up Buggins disease, and oversimplified the analysis, we could easily apply this to Lyme disease, HIV or anything else (such as measuring CA125 for ovarian cancer, which is useful for following response to treatment but useless in diagnosis, and has indeed led to women insisting on having their (normal) ovaries removed after a “positive” test because they were worried that they had cancer).
The point I am making is that laboratory tests are only useful if they are applied and interpreted in context. Of course that doesn’t stop private laboratories trying to profit from them.
Thanks for the explanation, although that’s a bread and butter part of my work, and doesn’t answer the question I was trying to ask. Sorry if I put it badly.
My main point was that I am questioning whether this is a fake test which gives the answers the patients ‘want’ and then enables the clinician to ‘sell’ a particular treatment
“Alternative” Cancer Clinics in Germany
Most of these alternative clinics in Germany, if not all, do not have board-certified oncologist taking care of their cancer patients. Obviously, this leads to a conflict of interest between the treating non-oncology physician (i.e. naturopath, general practioner, gynacologist, pathologist etc.) and the cancer patient. The cancer patient is usually looking for the best treatment options, not necessarily for only the guideline approved protocols, but at least for an advice by a specialist who is knowledgable about all treatment options, including the guideline approved protocols and the so-called holistic or alternative therapies. Unfortunately, most of the alternative clinics that claim to provide a comprehensive view are very much limited due to the lack of qualifications, leading to combinations of naturopathic, alternative therapies and/or immunotherapies without beeing qualified as a board-certified oncology clinic. There are plenty of these examples, and cancer patients should be highly advised to look for the qualifications of a board-certfication for oncology in Germany, because it appears that in Germany it seems to be possible that non-board-certified oncologist treat oncology patients.
“Pseudoscience” versus “Personalized/Precision Cancer Therapy” and “ImmunoOncology”
For most of us readers, everything that is not approved by our medical agency appears as some kind of so-called “pseudoscience”, or with other words therapies with “lack of evidence” – and “evidence based medicine” is used as a keyword for the best cancer therapies currently available/approved. Nowadays, one could indeed challenge this view, since personalized/precision based cancer therapies show very promising results for the individual, highly recognized in the field of oncology, including immune-oncology. It appears the the German medical regulations allow the oncologist to certain degree to consider so-called off-label use therapies which might be the reason why so many patients are traveling to Germany for these so-called “personalized” therapy options.
Hallwang Clinic – your article seems to focus and thus narrow things down to a degree that I would like to put water in your wine. In regard to the Hallwang Clinic one needs to at least acknowledge that this clinic is belonging to a group of private oncology clinics that are called board-certified oncology clinics. This is a certificate that has a high value in Germany. That means that they must have board-certified oncology specialist running the clinic – and indeed looking at their website the oncologist are mentioned. I have seen that a lot of articles have been published about the Hallwang Clinic, re-feeding themselves with information that I wanted to check – the most recent literature has cleared the confusion and criticism about the connection to the “Privatklinik Dr. Ursula Jacob”, the “Waldeck Klinik” and the “Hallwang Clinic”. The 3 clinics, although apparently completely different, have used the same medical campus and have been located in the same buildings. The “Waldeck Klinik” was a former rehabilitation center and the “Privatklinik Dr. Ursula Jacob” was a former alternative clinic that was or is currently criticized for its alternative therapies. And the Hallwang Clinic on the same campus seems to be an oncology specialized clinic. A closer look own their website shows that The Hallwang Clinic claims to be unique in the field private oncology clinics, or alternative clinics, since they are navigating in a collaborative university institute and hospital network, being able to evaluate and coordinate personalized cancer therapies – so-called precision cancer therapies. The criticism which I can underline is the cost aspect of private clinics and the the clinic seems to use (still) alternative therapies – although to my judgment in a different context- as so-called supportive/supplementary or complementary integrative therapies. Nevertheless you are right, this sound still quite old. I think everyone needs to make their own picture – myself, I have been extremely critical about the Hallwang Clinic but I think one should have today a more differentiated view, which I’m missing in older articles. Talking to friends who have been at the Hallwang Clinic one rather gets the impression that this clinic is quite conventional but tries to be open-minded, or as they said- nearly unlimited (?) whatever this means – in diagnostic and therapeutics.