MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

The use of  so-called alternative medicine (SCAM) for changing the natural history of cancer (rather than for alleviating symptoms) is a dangerous thing. Here is yet another study confirming this statement.

The purpose of this cross-sectional study was to investigate the patterns of SCAM use and its association with time to conventional treatment. The study was performed in Thailand at the Chonburi Cancer Hospital. Chart reviews and interviews were performed for 426 patients with various cancers between May and December 2018.

The results indicated that 45% of all patients reported using SCAMs; herbal products were the most common type. Approximately 34% of these medicines involved unlabelled herbal products with unidentifiable components. The rates of SCAM use were significantly elevated for men and for patients with stage IV cancer. The multivariable linear regression analysis of the relationship between factors and the time until conventional treatment was received revealed that the regression coefficient of the use of SCAM was 56.3 (95% confidence interval [27.9-84.6]). This coefficient corresponded to an additional 56.3 days of time until conventional treatment, relative to patients who did not use SCAM.

The authors concluded that these findings demonstrated that there is a relatively moderate prevalence of CAM use among Thai cancer patients, with most of the CAM treatments involving homemade herbal products. The use of CAM was significantly associated with a prolonged time to conventional treatment. Nevertheless, these findings do not imply that CAM should be banned for all patients, although healthcare providers should recommend that patients aim to use CAM treatments that are considered safe and will not interfere with conventional treatments.

This study would in itself not be very important. Its relevance, in my view, lies in the fact that it is an independent confirmation of many studies published previously showing that cancer patients ought to be cautious about SCAM; for instance:

My recommendation to people who have been diagnosed with cancer is to resist the many temptations and promises of SCAM, discuss the issues with their oncology team, and follow their advice. This may sound a little boring, but it just might save your life.

12 Responses to Yet another study shows the negative effects of SCAM use for cancer patients

  • Sadly, in the prostate cancer world, some oncology departments recommend acupuncture for androgen deprivation therapy caused hot flashes, despite studies that i think confirm it is a placebo. So asking your oncology team may bot always get you good advice either.

    • Sometimes it is useful to harness the placebo effect in order to manage troublesome symptoms such as hot flushes in men due to testosterone deprivation. The danger with something like acupunture (which can be a very strong placebo due to its rituals and invasive techniques) comes when the patient decides to use it as an alternative to the cancer treatment. Personally I used to prescribe short courses of low-dose cyproterone acetate for this problem, which most of my patients seemed to find quite helpful and is a licensed indication for this drug.

      • I know of a case where a very sick man was traveling one hour each way threr tomes a week for thos placebo acupuncture. That is a large part of his limited capability. I think that was a serious harm from fake or paternalistic treatment.

        • DavidP

          Just remember, an equal amount of efficacy from allopathic medicine benefits from placebo effect also, it works both ways.

          • this is precisely why the placebo argument does not work for SCAMs that are pure placebos

          • EE

            It has not been established that acupuncture is pure placebo. There are studies that indicate acupuncture is a valid therapy, regardless if science can explain the why.
            NCBI withheld validating acupuncture for RA, even though only one study out of many studies failed to show efficacy.

            That said, lets assume for a moment it’s no more than a placebo effect. The placebo effect from acupuncture is much greater than any pill. So even if acupuncture is merely a placebo, the effect has more merit than the typical placebo.
            Would I prefer to treat the cause of the disease rather than the symptom…. YES ! However, pills that treat the symptom only effect for a long as you consume the pill also. So what’s the difference ? At least acupuncture studies HAVE concluded that there are NO negative effects.

          • The placebo effect from acupuncture is much greater than any pill.
            EVIDENCE PLEASE!

          • EE

            Are you implying all placebo effects are similar ? Or that the placebo effect from acupuncture can not be greater than a pill ?

            Or you just want to see it in ink ?

  • Abstract
    Numerous randomized controlled trials (RCTs) of acupuncture have been conducted in recent years. The results of several studies implied that acupuncture was only a powerful placebo; however, certain studies demonstrated that verum acupuncture had a greater effect than placebo and the mechanisms between a verum acupuncture group and a placebo/sham group were different. Researchers attempted to investigate the inherent factors that may potentially influence the results of trials. Certain problems observed in acupuncture RCTs also occurred in RCTs in other fields, including insufficient sample size, high dropout rates, inadequate follow-up and randomization. The study of acupuncture is so complex that specific methodological challenges are raised, which are frequently overlooked, including sham interventions, blinding, powerful placebo effects (even stronger than an inert pill) and variations in acupuncture administration. The aforementioned problems may contribute to bias, and researchers systematically attempt to solve these problems. The present review aimed to suggest techniques to design high-quality studies, minimize the placebo effect and optimize acupuncture administration in acupuncture studies. If these problems are addressed, then the results of acupuncture studies may be different.

    Specific elements was considered to be responsible for the specific therapeutic actions, and other aspects that influenced the effects were placebo elements, such as the patient expectations and the communication between therapists and subjects (43). A previous study considered that the placebo effect was derived from factors included in a social, cultural and clinical context, rather than from the sham interventions per se (44). Other studies (42,45,46) demonstrated that a placebo effect was a complexity resulting from psychological, social and cultural background factors, as well as real physiological responses. Notably, one study (47) demonstrated that the placebo effect had a ‘dose-dependent response’: Although the intervention was sham, if people received more care, their outcome would be improved.
    The psychological mechanisms (42) of the placebo effect include many aspects associated with the procedure of acupuncture, including expectations, memory, motivation, cognitive and conditioning mechanisms.

    Although the placebo effect is complex, research demonstrated that the placebo effect from sham acupuncture was stronger compared with the effect from a placebo pill (50). These results may be due to more complex medical interventions having a higher placebo effect than medication (51).

    Given the potential physiological effects of sham interventions and the powerful placebo effects, the results of acupuncture RCTs may be undervalued in numerous studies (52). Although sham acupuncture exerted a powerful placebo response and uncertain physiological mechanisms, evidence also demonstrated a specific effect from acupuncture which was better than the ‘placebo effect’

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4578107/

    • Better yet, just for you EE

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6000751/

      Abstract
      Because acupuncture treatment is defined by the process of needles penetrating the body, placebo needles were originally developed with non-penetrating mechanisms. However, whether placebo needles are valid controls in acupuncture research is subject of an ongoing debate. The present review provides an overview of the characteristics of placebo needles and how they differ from placebo pills in two aspects: (1) physiological response and (2) blinding efficacy. We argue that placebo needles elicit physiological responses similar to real acupuncture and therefore provide similar clinical efficacy. We also demonstrate that this efficacy is further supported by ineffective blinding (even in acupuncture-naïve patients) which may lead to opposite guesses that will further enhances efficacy, as compared to no-treatment, e.g., with waiting list controls. Additionally, the manner in which placebo needles can exhibit therapeutic effects relative to placebo pills include enhanced touch sensations, direct stimulation of the somatosensory system and activation of multiple brain systems. We finally discuss alternative control strategies for the placebo effects in acupuncture therapy.

      A clinical trial revealed that placebo needles have greater effects than placebo pills on self-reported pain and severity of symptoms in patients with persistent arm pain (20). Expectations on the potential benefit induced in the recipient, influenced by the magnitude of the invasiveness of the intervention, leads to therapeutic effects following a placebo treatment (21). The greater effect of placebo devices compared with placebo pills may be due to the additional physical contact or the tactile component of the intervention, which is minimally present with the use of pharmaceutical pills. Therefore, the contextual effects associated with the preparation of acupuncture treatment devices are multisensory and have a broader impact on the patient. The tactile context of treatment devices such as during acupuncture is essential for the establishment of therapeutic effects (22). In contrast to the use of oral placebo pills, this context has two components: physiological action and ineffective blinding, which initially takes effect once the treatment is applied, and which, therefore, is different from the gradual unblinding due to experiences of adverse events during the drug applications.

  • acupuncture studies HAVE concluded that there are NO negative effects.

    You are quite adept at demonstrating how little you know about the subjects you comment on.

    https://edzardernst.com/2013/02/how-many-fatalities-has-acupuncture-caused-and-are-acupuncturists-in-denial/#comment-88309

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