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

This recently published survey aimed to investigate the use of so-called alternative medicine (SCAM) among long-term cancer survivors and its links with healthy behaviour. Data was used from the VICAN survey, conducted in 2015-2016 on a representative sample of French cancer survivors 5 years after diagnosis.

Among the 4174 participants, 21.4% reported using SCAM at the time of the survey, including 8.4% who reported uses not associated with cancer. The most frequently cited reasons for using SCAM were:

  • to improve their physical well-being (83.0%),
  • to strengthen their body (71.2%),
  • to improve their emotional well-being (65.2%),
  • to relieve the side effects of treatment (50.7%).

The SCAM users who reported using SCAM to cure cancer or prevent relapses (8.5% of the participants) also used SCAM for other reasons. They had more often experienced cancer progression, feared a recurrence, and had a poorer quality of life because of sequelae, pain, and fatigue. They also consulted their general practitioners more frequently and had changed their lifestyle by adopting more healthy practices.

The authors concluded that the use of SCAM is not an alternative but a complementary means of coping with impaired health. Further research is now required to determine whether the use of SCAM reflects a lifestyle change or whether it assists survivors rather to make behavioural changes.

The 2012 data from the same survey had previously reported that, among the participants, 16.4% claimed to have used SCAM, and 45.3% of this group had not used SCAM before cancer diagnosis (new SCAM users). Commonly, SCAMs used were:

  • homeopathy (64.0%),
  • acupuncture (22.1%),
  • osteopathy (15.1%),
  • herbal medicine (8.1%),
  • diets (7.3%),
  • energy therapies (5.8%).

SCAM use was found to be significantly associated with younger age, female gender and a higher education level. Previous SCAM use was significantly associated with having a managerial occupation and an expected 5-year survival rate ≥80% at diagnosis; recent SCAM use was associated with cancer progression since diagnosis, impaired quality of life and higher pain reports.

In nearly half of the SCAM users, cancer diagnosis was one of the main factors which incited patients to use SCAM. Opting for SCAM was a pragmatic response to needs which conventional medicine failed to meet during the course of the disease.

These surveys mostly confirm what has been shown over and over again in other countries. What I find remarkable with these results, however, is the increase in SCAM use over time and the extraordinary high use of homeopathy by French cancer patients (more recently, the reimbursement of homeopathy in France has changed, of course). As homeopathy has no effects beyond placebo, this suggests that SCAM use by French cancer patients is far from being driven by evidence.

So, what then does determine it?

My best answer I can give to this question is this: relentless promotion through pharmacies, advertisements and journalists. These have all been very powerful in France in relation to homeopathy (hardly surprising, as the world’s largest homeopathic producer, Boiron, is based in France).

This leads me to the conclusion that SCAM is far more commercially driven than its enthusiasts would ever admit. They think of the pharmaceutical industry as the evil exploiter of the sick. It is now time to realise that the SCAM industry is, to a large extent, part of the pharmaceutical industry and often behaves just as badly or even worse: because what could be more unethical that selling placebos to desperate and vulnerable cancer patients?

29 Responses to Use of so-called alternative medicine (SCAM) by French cancer patients – it’s all about money

  • It makes one reflect on the sad case, mentioned in another thread here, of young musician Sean Walsh, who died of cancer after pursuing SCAM treatments involving thermographic scans, coffee enemas and a visit to Mexico. He was persuaded to call NHS medics “pill salesmen” in one of his videos. Yet it wasn’t NHS medics, but all the SCAM practitioners, who took Sean’s money in return for ‘treatment’.

  • It may become unethical not to give a placebo, at least for some symptoms, if one is patient centered.

    “Ted Kaptchuk, study co-author and director of the Harvard-wide Program in Placebo Studies, has previously shown that open-label placebos can bring relief to patients with irritable bowel syndrome, chronic low-back pain and migraine headache. This is the first study to test the effects of open-label placebos with cancer survivors.”

    https://www.sciencedaily.com/releases/2018/02/180209114554.htm

    • “It may become unethical not to give a placebo”
      Are you trying to surpass yourself in posting BS?

      • “What did the doctors actually tell their patients? Over two-thirds of those who prescribed placebos told patients they were getting “medicine not typically used for your condition but which might benefit you.”

        Is it “appropriate” to fool patients this way? Yes, 62% of the doctors said.”

        AMA…

        “Physicians may use placebos for diagnosis or treatment only if the patient is informed of and agrees to its use.”

        https://www.webmd.com/pain-management/news/20081023/50percent-of-doctors-give-fake-prescriptions

        • In what way does this back up your stupidity in claiming: “It may become unethical not to give a placebo”

          • May…to express a possibility.

            “Since open-label placebos do not require deception, their existence and effectiveness undermine the ethical objections to placebo use. The blooming research in this area warrants an investigation and perhaps revision of ethical standards surrounding placebo use.”

            Int Rev Neurobiol. 2018; 138: 219–240

          • PERHAPS!

          • may…to express a possibility (Cambridge)

            perhaps…used to show that something is possible (Cambridge)

            Maybe try reading what I wrote or you may risk looking stupid.

          • thank you so much fro being my patient English teacher [and just as patronising as the one I had all that time ago]!

          • @DC
            No, you are mistaken.
            If you had really studied Kaptcuk’s efforts on “open-label placebo” instead of just parroting something you read, you might have found his work on this area quite underwhelming and unconvincing. He simply set the experiments up in such a way that he could not fail to get the result he hoped for. He then hyped it up to satisfy his image as the great expert in placebo who proved its worth, an image this upbeat acupuncturist revels in.
            By definition placebo does not have any intrinsic effect. Mr Kaptchuk’s experiments have not changed that Suggestion and expectation however, makes it appear to have an effect, something that is not useful in clinical practice.
            The fact that some doctors prescribe wrong or useless drugs in lieu of telling the truth or making a better effort, does not justify such unethical practice.

          • Regarding modal verbs, I can’t help recalling the story of the well-to-do socialite lady holding a dinner-party.

            Making introductions, she asks an eligible young bachelor “Do you know my daughter May?” To which he replies “No I didn’t, but thanks for the tip”……

            I’m sorry. I’ll get my coat….

          • “If placebos can have effects even when patients are told they are placebos, then placebos do not require deception and ethical objections to placebo use lose their force.”
            Int Rev Neurobiol. 2018; 138: 219–240.

            Again, note I used the word….may

          • “The proportion of physicians who reported having used placebo (ever used or used with a minimum frequency of once a year) varied between: 17% and 80% for pure placebos (six studies); between 54% and 57% for impure placebos (two studies); and between 41% and 99% if both pure and impure placebos were addressed (five groups of physicians in three studies;…)

            Fässler, M., Meissner, K., Schneider, A. et al. Frequency and circumstances of placebo use in clinical practice – a systematic review of empirical studies. BMC Med 8, 15 (2010).

          • “We did not find that placebo interventions have important clinical effects in general. However, in certain settings placebo interventions can influence patient‐reported outcomes, especially pain and nausea, though it is difficult to distinguish patient‐reported effects of placebo from biased reporting. The effect on pain varied, even among trials with low risk of bias, from negligible to clinically important. Variations in the effect of placebo were partly explained by variations in how trials were conducted and how patients were informed.”

            Cochrane Database of Systematic Reviews
            Placebo interventions for all clinical conditions
            Cochrane Systematic Review – Intervention Version published: 20 January 2010

          • “It is interesting to note that
            these traits, as previously described, are also associated
            with low placebo response, suggesting that overall
            negative attitudes towards medication might have a
            moderating influence on the placebo effect. Future
            studies need to examine these potential relations, which could promote the idea of prescribing placebo inter-
            ventions without deception in daily clinical practice
            (Colloca & Miller 2011), at least to ‘pharmacophobic’
            patients.”

            Psychiatria Danubina, 2013; Vol. 25, No. 1, pp 17-23

          • “Ninety-six percent of the respondents believed that placebos can have therapeutic effects, and up to 40% of the physicians reported that placebos could benefit patients physiologically for certain health problems. Only 12% of the respondents said that placebo use in routine medical care should be categorically prohibited.”

            Academic Physicians Use Placebos in Clinical Practice and Believe in the Mind–Body Connection

            J Gen Intern Med. 2008 Jan; 23(1): 7–10.

          • I think you can stop copying stuff; I have long accepted that you do not understand the issue.

          • Oh i know. It deals with the medical field so it’s not your “issue”. Yet it’s an issue.

          • Another one?

            “research to identify optimal ways of harnessing placebo effects in clinical practice is needed.”

            PLoS One. 2014; 9(7): e101822

      • Edzard on Friday 31 July 2020 at 13:28 said:

        “Are you trying to surpass yourself in posting BS?”

        The personal attack is irrational – use reason instead.

        • thank you; you should try it too

          • Edzard on Friday 31 July 2020 at 15:34 said:
            “…you should try it too.”

            Still with the personal, that should read “…one should try it too.” or, to better, “…one should.”

          • I fail to see how justified responses to obtuse comments by anonymous hecklers can be construed as “personal”.

          • hear, hear!

          • Björn Geir on Friday 31 July 2020 at 18:47 said:
            “I fail to see how justified responses to obtuse comments by anonymous hecklers can be construed as “personal”.”

            Again with the personal – remove those to leave “I fail to see how responses to comments can be personal.”

  • If I ever need a treatment, I will want one with robust evidence that it works better than placebo.

  • Has anyone reproduced Kaptchuk’s work?

    Even by Kaptchuck?

    Minimal attention should be paid to it until more evidence is available.

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