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

Cancer

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I was asked by the ‘Science Media Centre’ (SMC) to provide a short comment on the following press release (which was embargoed until today):

Daily use of cannabidiol (‘CBD’) oil may be linked to lung cancer regression 

… The report authors describe the case of a woman in her 80s, diagnosed with non-small cell lung cancer. She also had mild chronic obstructive pulmonary disease (COPD), osteoarthritis, and high blood pressure, for which she was taking various drugs.

She was a smoker, getting through around a pack plus of cigarettes every week (68 packs/year).

Her tumour was 41 mm in size at diagnosis, with no evidence of local or further spread, so was suitable for conventional treatment of surgery, chemotherapy, and radiotherapy. But the woman refused treatment, so was placed under ‘watch and wait’ monitoring, which included regular CT scans every 3-6 months.

These showed that the tumour was progressively shrinking, reducing in size from 41 mm in June 2018 to 10 mm by February 2021, equal to an overall 76% reduction in maximum diameter, averaging 2.4% a month, say the report authors.

When contacted in 2019 to discuss her progress, the woman revealed that she had been taking CBD oil as an alternative self-treatment for her lung cancer since August 2018, shortly after her original diagnosis.

She had done so on the advice of a relative, after witnessing her husband struggle with the side effects of radiotherapy. She said she consistently took 0.5 ml of the oil, usually three times a day, but sometimes twice.

The supplier had advised that the main active ingredients were Δ9-­tetrahydrocannabinol (THC) at 19.5%, cannabidiol at around 20%, and tetrahydrocannabinolic acid (THCA) at around 24%.

The supplier also advised that hot food or drinks should be avoided when taking the oil as she might otherwise feel stoned. The woman said she had reduced appetite since taking the oil but had no other obvious ‘side effects’. There were no other changes to her prescribed meds, diet, or lifestyle. And she continued to smoke throughout.

This is just one case report, with only one other similar case reported, caution the authors. And it’s not clear which of the CBD oil ingredients might have been helpful.

“We are unable to confirm the full ingredients of the CBD oil that the patient was taking or to provide information on which of the ingredient(s) may be contributing to the observed tumour regression,” they point out.

And they emphasise: “Although there appears to be a relationship between the intake of CBD oil and the observed tumour regression, we are unable to conclusively confirm that the tumour regression is due to the patient taking CBD oil.”

Cannabis has a long ‘medicinal’ history in modern medicine, having been first introduced in 1842 for its analgesic, sedative, anti-inflammatory, antispasmodic and anticonvulsant effects. And it is widely believed that cannabinoids can help people with chronic pain, anxiety and sleep disorders; cannabinoids are also used in palliative care, the authors add.

“More research is needed to identify the actual mechanism of action, administration pathways, safe dosages, its effects on different types of cancer and any potential adverse side effects when using cannabinoids,” they conclude.

The SMC published three invited comments:

Prof David Nutt, The Edmond J Safra Chair in Neuropsychopharmacology, Imperial College London, said: 

“This is one of many such promising single case reports of medical cannabis self-treatment for various cancers.  Such case reports are biologically credible given the adaptogenic nature of the endocannabinoid system.  A case report itself is not sufficient to give any form of proof that one thing caused the other – we need trials for that.  There are some controlled trials already started and more are required to properly explore the potential of medical cannabis in a range of cancers.”

Prof Edzard Ernst, Emeritus Professor of Complementary Medicine, University of Exeter, said: 

“Cannabinoids have been shown to reduce the size of prostate cancer tumours in animal models.  Previous case reports have yielded encouraging findings also in human cancers.  However, case reports cannot be considered to be reliable evidence, and there are currently no data from rigorous clinical trials to suggest that cannabis products will alter the natural history of any cancer.” 

Dr Tom Freeman, Senior Lecturer and Director of the Addiction and Mental Health Group, University of Bath, said: 

“These results are exciting and very encouraging for this patient.  However as a single case study the quality of scientific evidence is low and should not be used to change clinical practice.  People with lung cancer should always seek guidance from a healthcare professional when deciding on an appropriate treatment. 

“The product used by this patient reportedly contained high levels of THC (the intoxicating component of cannabis), and was sourced from outside the UK.  This type of product is very different to most CBD oils which predominantly contain CBD.  Unlike prescribed medicines, CBD wellness products lack assurance of quality, safety or efficacy and should not be used for medicinal purposes.”

The original paper has now been published and can be found here.

Last week, a naturopath who has been practicing naturopathy for more than three years, appeared in the Paris High Court. He is accused of “illegal practice of medicine” and of “usurpation of the title of doctor” after two of his cancer patients died.

Charles B. was diagnosed with testicular cancer in 2016 but wanted to avoid traditional medicine. In March 2017, he consulted the naturopath, Miguel B., who studied for fourteen years in the United States and has a degree in biochemistry and a doctorate in molecular medicine. He knew that his qualifications did not allow him to practice in France and presented himself as a naturopath. Knowing about his client’s cancer, Miguel B. drew up a health plan for him that included numerous fasts and purges to detox his body.

In the following months, the cancer spreads to the lungs and brain. Charles B. wrote to his naturopath in early February: “Great pain, don’t know what to do”. The naturopath continued his advice: “You should go on a diet, rest and purge in the evening. In court, Charles B.’s father recalled a conversation between his son and Miguel B. during which the latter had said to Charles B.: “It would be a pity if you were to undergo this chemotherapy.” On 22 February 2018, now weighing only 59 kg, Charles B. finally decided to start chemotherapy. But it was already too late, and he died on 18 December 2018, at the age of 41, of a cancer from which more than 98% of patients usually recover. Charles B.’s wife stated that the naturopath had told her husband that he would not need chemotherapy. She believes that the defendant is “responsible and even guilty” of her husband’s death.

The family of another patient of Miguel B. has also joined the case. Catherine F., who had been suffering from cervical cancer, died at the age of 39. She had followed, among other treatments, a fast recommended by the naturopath and was one of 149 further patients whose list was found on a USB stick belonging to the defendant.

 

 

They say, one has to try everything at least once – except line-dancing and incest. So, when I was invited to co-organize a petition, I considered it and thought: WHY NOT?

Here is the text (as translated by myself) of our petition to the German Medical Association:

 

 

Dear President Dr Reinhardt,

Dear Ms Lundershausen,

Mrs Held,

Dear Ms Johna,

We, the undersigned doctors, would like to draw your attention to the insistence of individual state medical associations on preserving “homeopathy” as a component of continuing medical education. We hope that you, by virtue of your office, will ensure a nationwide regulation so that this form of sham treatment [1], as has already happened in other European countries, can no longer call itself part of medicine.

We justify our request by the following facts:

  1. After the landmark vote in Bremen in September 2019 to remove “homeopathy” from the medical training regulations, 10 other state medical associations have so far followed Bremen’s example. For reasons of credibility and transparency, it would be desirable if the main features of the training content taught were not coordinated locally in the future, but centrally and uniformly across the country so that there is no “training tourism”. Because changes to a state’s own regulations of postgraduate training are only binding for the examination committee of the respective state, this does not affect national regulations but is reduced to only a symbolic character without sufficient effects on the portfolio of medical education nationwide.
  2. Medicine always works through the combination of a specifically effective part and non-specific placebo effects. By insisting on a pseudo-medical methodology – as is “homeopathy” represents in our opinion – patients are deprived of the specific effective part and often unnecessarily deprived of therapy appropriate to the indication. Tragically, it happens again and again that the “therapeutic window of opportunity” for an appropriate therapy is missed, tumors can grow to inoperable size, etc.
  3. Due to the insistence of individual state medical associations on the “homeopathic doctrine of healing” as part of the medical profession, we are increasingly exposed to the blanket accusation that, by tolerating this doctrine, we are supporting and promoting ways of thinking and world views that are detached from science. This is a dangerous situation, which in times of a pandemic manifests itself in misguided aggression reflected not just in vaccination skepticism and vaccination refusal, but also in unacceptable personal attacks and assaults on vaccinating colleagues in private practice.
[1] Homöopathie – die Fakten [unverdünnt] eBook : Ernst, Edzard, Bretthauer, Jutta: Amazon.de: Kindle-Shop

Responsible:

Dr. med. Dent. Hans-Werner Bertelsen

Prof. Dr. med. Edzard Ernst

George A. Rausche

You can sign the petition here:

Petition an die Bundesärztekammer › Sachverständiger kriminalistische Forensik, Foto- Videoforensik, digitale Forensik und der Identifikation lebender Personen nach Bildern (rauscher.xyz)

 

The authors of this review start their paper with the following statement:

Acupuncture has demonstrated effectiveness for symptom management among breast cancer survivors.

This, I think, begs the following question: if they already know that, why do they conduct a systematic review of the subject?

The answer becomes clear as we read thier article: they want to add another paper to the literature that shows they are correct in their assumption.

So, they do the searches and found 26 trials (2055 patients), of which 20 (1709 patients) could be included in the meta-analysis. Unsurprisingly, their results show that acupuncture was more effective than control groups in improving pain intensity [standardized mean difference (SMD) = -0.60, 95% confidence intervals (CI) -1.06 to -0.15], fatigue [SMD = -0.62, 95% CI -1.03 to -0.20], and hot flash severity [SMD = -0.52, 95% CI -0.82 to -0.22].  Compared with waitlist control and usual care groups, the acupuncture groups showed significant reductions in pain intensity, fatigue, depression, hot flash severity, and neuropathy. No serious adverse events were reported related to acupuncture intervention. Mild adverse events (i.e., bruising, pain, swelling, skin infection, hematoma, headache, menstrual bleeding) were reported in 11 studies.

The authors concluded that this systematic review and meta-analysis suggest that acupuncture significantly reduces multiple treatment-related symptoms compared with the usual care or waitlist control group among breast cancer survivors. The safety of acupuncture was inadequately reported in the included studies. Based on the available data, acupuncture seems to be generally a safe treatment with some mild adverse events. These findings provide evidence-based recommendations for incorporating acupuncture into clinical breast cancer symptom management. Due to the high risk of bias and blinding issues in some RCTs, more rigorous trials are needed to confirm the efficacy of acupuncture in reducing multiple treatment-related symptoms among breast cancer survivors.

Yes, I agree: this is an uncritical white-wash of the evidence. So, why do I bother to discuss this paper? After all, the acupuncture literature is littered with such nonsense.

Well, to my surprise, the results did contain a little gem after all.

A subgroup analysis of the data indicated that acupuncture showed no significant effects on any of the treatment-related symptoms compared with the sham acupuncture groups.

In other words, this paper confirms what has been discussed repeatedly on this blog (see for instance here, here, and here):

Acupuncture seems to be a placebo therapy!

Research on glucosamine, one of the most popular dietary supplements, shows anti-inflammatory and anti-cancer benefits with minimal adverse effects. An international team of researchers aimed to explore the relationship between the use of glucosamine and the risk of lung cancer and lung cancer mortality based on data from the large-scale nationwide prospective UK Biobank cohort study.

Participants were enrolled between the years 2006 and 2010 and followed up to 2020. The Cox proportion hazards model was used to assess the relationship between glucosamine use and the risk of lung cancer and lung cancer mortality. Subgroup analyses and sensitivity analyses were performed to explore the potential effect modifications and the robustness of the main findings.

A total of 439,393 participants (mean age: 56 years; 53% females) with a mean follow-up of 11 years were included for analyses. There were 82,603 (18.80%) participants reporting regular use of glucosamine at baseline. During follow-up, there were 1,971 (0.45%) lung cancer events documented. Glucosamine use was significantly associated with a decreased risk of lung cancer (hazard ratio=0.84, 95% CI: 0.75-0.92, p<0.001) and lung cancer mortality (hazard ratio=0.88, 95% CI: 0.81-0.96, p=0.002) in fully adjusted models. A stronger association between glucosamine use and decreased lung cancer risk was observed in participants with a family history of lung cancer when compared to those without a family history.

The authors concluded that regular use of glucosamine was significantly related with decreased risk of lung cancer and lung cancer mortality, based on data from this nationwide prospective cohort study.

A previous analysis of the same data concluded that regular glucosamine supplementation was associated with lower mortality due to all causes, cancer, CVD, respiratory and digestive diseases. The new analysis shows a strong association with lung cancer.

This is certainly interesting, but does it prove a causal relationship?

The answer is no.

Correlation is not causation!

What would be helpful in testing whether we are dealing with a cause-effect relationship?

  1. We need data from other studies. Several other epidemiological investigations indicated that glucosamine use might play a role in the prevention of cancer.
  2. We require to know the strength of the association. The new analysis suggests that it is indeed strong.
  3. We need a mode of action. Might the anti-inflammatory action of glucosamine explain the effect?
  4. We should ask whether there is a dose-response relationship. As far as I know, this has not been addressed as yet.
  5. Ideally, we would require a randomized trial to test the hypothesis. But I fear that such a study might be too difficult to conduct and will thus not be forthcoming.

And what if glucosamine should one day be proven to reduce the cancer risk? Would it become the first ALTERNATIVE measure to prevent cancer?

Certainly not!

It would automatically become a conventional method of cancer prevention. All the research into the subject has been entirely conventional and is unrelated to the alternative medicine movement. Or, to put it bluntly, alternative cancer prevention is a contradiction in terms. Either it works in which case it is conventional medicine, or it doesn’t in which case it is not even an alternative but at best so-called alternative medicine.

 

Bromelain, papain and chymotrypsin are proteolytic enzymes. They can be found in fruits such as pineapple or papaya, but also in the human body, namely in the pancreas. Besides their enzymatic functions, they have long been said to have a wide range of positive health effects. For instance, it is claimed that they reduce side effects and even improve the outcome of cancer therapies. This systematic review examined the existing evidence on the role that these enzymes which are available as food supplements might play in cancer treatment.

A total of 15 studies with 3,008 patients could be included in this systematic review. Patients treated with enzymes were diagnosed with various entities of gastrointestinal, gynecologic, head and neck, and lung cancer as well as hematological malignancies. The therapy concepts included mainly oral intake of enzymes in addition to conventional therapies. Investigated outcomes were:

  • side-effects of anticancer therapy,
  • quality of life,
  • anticancer effects,
  • survival rates.

Due to conflicting results and moderate quality of the included studies, the evidence is insufficient to attribute positive effects to enzymes in terms of better tolerability of the various antineoplastic therapies or even improvement in treatment efficacy. In most cases, enzyme therapy was well tolerated; side-effects were mainly gastrointestinal complaints such as diarrhea or meteorism.

The authors concluded that there is no clear therapeutic benefit of enzymes neither as supportive therapy nor as part of antineoplastic therapy.

I fully agree with this conclusion. In fact, in my new book that is just being published, I summarised the evidence for enzyme therapy (and many more alternative cancer therapies) in very similar terms: the evidence to suggest that enzyme therapy might be an effective treatment for any type of cancer is less than convincing.

I find it highly irresponsible to claim otherwise. Cancer patients are vulnerable and can easily be tempted to opt for one of the many quack treatments that are said to be both effective and free of nasty adverse effects. If they do try such options, they usually pay dearly, and not just in monetary terms.

Guest post by Norbert Aust and Viktor Weisshäupl

Imagine you recently published an excellent and rigorous trial providing solid evidence that a certain therapy is able to help patients suffering from some inevitably fatal condition. You proved that your therapy is able to significantly prolong the patients’ lifetime, much longer than with the current state-of-the-art therapeutic approach. But the patients not only live considerably longer, but they also do so with a much better quality of life (QoL) and subjective well-being. In short: this therapy marks some progress that would otherwise take years or decades of scientific effort.

And then someone comes forward and points out your data apparently were manipulated. Essential parameters of this trial were modified sometime after data collection was completed, with the patients’ outcome and first analyses available. Thus the results were biased in a certain direction and the critics show that the results as published in your study show characteristics that such manipulations would evoke. After all, this holds an implication of scientific misconduct that could, if verified, ruin your academic reputation more or less completely.

What would you do?

Ignore the preposterous concerns because you know your methods and performance were rigorous and solid? After all, anytime some real academic criticism arises you are ready to prove your findings are well-founded results of accepted scientific methods. Or would you publish data or documents that your critics were too ignorant to find or to understand, and thus to stop such rumours once and for all? Maybe you could even clarify some of the issues raised by those critics, maybe add some follow-up information or data to ensure no more misunderstandings occur. Or would you try to find some clues for a libel lawsuit?

Well, we thought some of the above would happen after we contacted the authors of the recent study on adjunct homeopathy in non-small cell lung cancer. On that date, we forwarded our detailed analysis to the lead author and all the co-authors.

Of course, we even considered the possibility, not very likely though, that we would receive some explanation for the numerous exclusion criteria while other serious conditions that coincide with advanced age did not preclude enrollment. Or an updated CONSORT diagram accounting for the patients excluded. Or some explanation just why the numerous amendments to the protocol were necessary but not important enough to mention them in the published paper.

But nothing of this happened as yet (July 2021). Instead on June 14 and 16, 2021, not two weeks after our messages to the authors, the registration data at ClinicalTrials were updated once again and a new version of the protocol was uploaded [3]. And this update looks pretty much like it is meant to cover up and blur the former data that we based our analysis on. Of course, these data and the former version of the protocol are available still – just one layer further down, and you have to scroll to the bottom of the page to find the small link “history of changes”. Maybe not many visitors will do that.

In contrast to the versions before, now the uploaded data are in line with the study as published, namely, they include a full list of the exclusion criteria and the reduced observation time for QoL, which was the primary outcome. Note: throughout the trial until the end of data assessment those parameters were set with pregnancy as the only exclusion criterion and two years follow up time, only to be amended in the protocol uploaded two months after data collection was complete and analysis presumably was well underway.

In addition, there is a new version of the study protocol, this one dated Feb. 6, 2014. Of course, this protocol is fairly new, in spite of the date it carries. Why would the older version allegedly from January 2011 be uploaded to the register in September 2019, if this more actual version already had existed and was available?

Contrary to the prior version all the clues are removed that would indicate that this document was finished at a much later point in time than given in its date: References to some future software versions that were released years after the protocol was allegedly compiled are dropped. And this strange literature reference “25” that corresponds to the reference list in the final study as published but is pointless in the protocol without any reference list, is removed too. And of course, again contrary to the prior version, the exclusion criteria are identical with the final study as is the shortened follow-up time for QoL.

New to the protocol is a section “Bringing in the patient’s voice”, where the authors disclose how they want to “systematically research the ethical, legal, socio-political, and science theoretical dimensions of homeopathy as in the case of lung cancer (non-small-cell lung carcinoma) exemplified” in some “integral social scientific study”, where some “focus groups” of 4 to 10 participants together with their relatives, friends and caregivers included should be used to study “interactions between individuals, collectively shared and uncontested assumptions, and the emergence of collective meaning”.

But from all of this more or less meaningless but very sciency sounding socio-speak, not a single word found its way into the study. Nothing. So it is pointless to try to figure out what the content of this part of the investigation is all about.

Why then was this chapter added? This “integral social scientific study” was to start after the “third or fourth homeopathic treatment” (But why should patients not be included in this “research” from the very first beginning?). Is it perhaps to give some rationale why the follow-up time for QoL was to end after the third homeopathic treatment?

So what we see, when we look up the study at ClinicalTrials now, is a perfectly matching set of data and a protocol that corresponds to the study as published and looks as if it was published at a time where the trial was underway and the patients were still blinded. If you do not look very closely everything now appears to be perfect.

And here we would like to forward some critique to the register: The purpose of the study register is to prevent not only publication bias but misleading manipulation from happening as well. They do quite a good job in preserving former versions of data and documents and keeping them available to the public. Many national study registers do not offer this service. But you must be of a suspicious mind and of some persistence to actively search and find and check the history of modifications. Thus, a cover-up like the one we are witnessing here might well prove successful. We, therefore, propose to improve the presentation of the registration: If vital amendments occurred that may affect the outcomes – such as protocol changes, extensions of exclusion criteria, modifications of follow-up time – this should be indicated upfront in the study’s record instead of some small hint to “history of changes” at the very bottom of the page.

In conclusion, there appears to be no proof that the results of the study were produced using rigorous scientific methods. And the issues we raised in our report to the authors remain unresolved.

So-called alternative medicine (SCAM) for cancer is the title of my new book. I was informed that it has been published but, in reality, the hard copy might still take a few days until it is available (there were major problems at the proof-reading stage which caused a considerable delay). To give you a flavor of the book, allow me to show you my introduction; here it is:

 

In February 2013, my wife and I were in good spirits. I had recently retired from my post at Exeter University, and we were heading off to celebrate Danielle’s round birthday with her family in Brittany. There was just one thing that bothered us: Danielle had recurring abdominal pains. She had seen our GP in England several times about it. The last time, she had received a prescription for some antibiotics. I knew they would not help; her symptoms were not due to an infection.

After our arrival in France, things got worse, and Danielle consulted a gynaecologist at the out-patient clinic of the local hospital. More tests were ordered; an ultrasound showed an abnormality; a subsequent MRI revealed a tumour of the uterus. The gynaecologist advised to operate as soon as possible, and Danielle agreed.

The operation went well, but the gynaecologist, Dr Matthieu Jacquot, was concerned and said he had to be more radical than he had anticipated. The diagnosis was still uncertain until the results from the histology lab were in. A few days later, when we saw Dr Jacquot again, our hopes that all was fine were thoroughly dashed. He explained that Danielle had cancer of the endometrium and laid out the treatment plan which an entire team of oncologists had designed after an in-depth review of her case: a second, much more extensive operation, followed by six sessions of chemotherapy, followed by months of daily radiotherapy, followed by two sessions of brachytherapy.

Dr Jacquot could not have been more empathetic. He explained in detail what consequences all this would have. Danielle’s life would be dominated for the next year by a long series of treatments that were unpleasant to say the least. We were both shocked and close to tears.

Before arriving at a decision, we talked to friends and experts in this area. Opinions differed marginally. Two days later, we had made up her mind: we would stay in Brittany for the entire year and get Danielle treated exactly as Dr Jacquot suggested.

The second operation was much tougher than the first, but Danielle recovered well. Ten days later, she was back in our home and looked after by a nurse who came daily to change the bandages and give injections. On her third visit, the nurse broached the subject of chemotherapy which was scheduled to start soon. She explained how unpleasant it would be and what horrendous side effects Danielle was facing. Then she said: ‘You know, you don’t need to go through all this. They only pump you full with poison. There is a much better approach. Just follow the anti-cancer diet of Dr Schwartz.[1] It is natural and has no side effects. It would surely cure your cancer.’ When Danielle told me about this conversation, I informed the nurse that from now on I would myself take charge of the post-operative care of my wife and that her services were no longer required.

Today, Danielle is cancer-free. Had she listened to the nurse, she would almost certainly no longer be with us. But the lure of a ‘natural’ cancer cure with no side effects is almost irresistible. Faced with a serious diagnosis like cancer, most patients would consider any therapy that promises help without harm. Inevitably, they encounter a myriad of so-called alternative medicines (SCAMs), and many patients give SCAM a try.

In addition to Dr Schwartz’s cancer diet, there are hundreds of SCAMs that specifically target vulnerable cancer patients like Danielle. How can patients not be confused, and who might give them responsible advice? Conventional doctors rarely do. A recent summary of 29 relevant papers concluded that physicians will discuss complementary therapies only when a patient him/herself raises this issue within a consultation.[2] But cancer patients are often too embarrassed to ask about SCAM. Those who are courageous enough usually get short shrift. Many conventional doctors are not just critical about SCAM, but also know very little about the subject.[3]

Patients deserve evidence-based information, instead they often get unhelpful blanket statements from their GPs such as:

  • ‘there is no evidence’;
  • ‘that’s all rubbish, best to stay well clear of it’;
  • ‘if you want to try it, go ahead, it cannot do much harm’.

All of these are untrue. Frustrated by such erroneous platitudes, patients might go on the Internet for help where they are bombarded with uncritical promotion. We investigated the information on SCAM for cancer provided by popular websites and found that they offer information of extremely variable quality. Many endorse unproven therapies and some are outright dangerous.[4] Sadly, the advice patients might glean from newspapers[5] or health-food stores[6] tends to be equally misleading and potentially harmful.

Subsequently, some patients might visit a library and read one of the many books on the subject. If anything, they are even worse. We have repeatedly analysed the contents of consumer guides on SCAM and always concluded that following their recommendations would shorten the life of the reader.[7] To give you a flavour, here are a few titles currently on sale:

  • Cancer Medicine from Nature
  • Outsmart Your Cancer: Alternative Non-Toxic Treatments That Work
  • Cancer Medicine from Nature
  • Perfect Guide on How to Cure Breast Cancer Through Curative Approved Alkaline Diets & Herbs
  • How to Starve Cancer
  • Healing the Prostate: The Best Holistic Methods to Treat the Prostate and Other Common Male-Related Conditions
  • Outsmart Cancer: Defeat Cancer With Vitamin B17, Healthy Nutrition and Alternative Medicine

Cancer patients would, of course, all like to ‘outsmart cancer’; they are desperate and vulnerable. In this state of mind, they easily fall victim to anyone who sells false hope at inflated prices. The consequences can be tragic.

In 2016, the actress English Leah Bracknell, for example, raised ~£50 000 to treat her lung cancer in the German ‘Hallwang Private Oncology Clinic’. The SCAMs used there included homeopathy, micronutrients, natural supplements, whole-body hyperthermia, and ozone therapy, none of which cures cancer. If cancer patients fall for bogus treatments, they not just lose their money but also their lives. Leah Bracknell died of her cancer in 2019.[8]

Three basic facts are indisputably clear:

  • a high percentage of cancer patients use SCAM,
  • misinformation about SCAM is rife,
  • misinformation endangers the lives of cancer patients.

It follows that there is an obvious and urgent need for an evidence-based text naming the SCAMs that are potentially harmful and discussing those that might be helpful.

My book is aimed at doing just that.

[1] Dr Laurent Schwartz cancérologue iconoclaste — Guérir du Cancer (guerir-du-cancer.fr)

[2] Stub T, Quandt SA, Arcury TA, et al. Perception of risk and communication among conventional and complementary health care providers involving cancer patients’ use of complementary therapies: a literature review. BMC Complement Altern Med. 2016;16(1):353. Published 2016 Sep 8. doi:10.1186/s12906-016-1326-3

[3] Ziodeen KA, Misra SM. Complementary and integrative medicine attitudes and perceived knowledge in a large pediatric residency program. Complement Ther Med. 2018;37:133-135. doi:10.1016/j.ctim.2018.02.004

[4] Schmidt K, Ernst E. Assessing websites on complementary and alternative medicine for cancer. Ann Oncol. 2004;15(5):733-742. doi:10.1093/annonc/mdh174

[5] Milazzo S, Ernst E. Newspaper coverage of complementary and alternative therapies for cancer–UK 2002-2004. Support Care Cancer. 2006;14(9):885-889. doi:10.1007/s00520-006-0068-z

[6] Mills E, Ernst E, Singh R, Ross C, Wilson K. Health food store recommendations: implications for breast cancer patients. Breast Cancer Res. 2003;5(6):R170-R174. doi:10.1186/bcr636

[7] https://edzardernst.com/2013/09/drowning-in-a-sea-of-misinformation-part-8-books-on-alternative-medicine/

[8] https://edzardernst.com/2019/10/leah-blacknell-1964-2019-another-victim-of-cancer-quackery/

____________________________________________

The publication of this book is perhaps the right occasion to publicly thank two regular and one occasional contributor to this blog. I am grateful to

  • Prof. Michael Baum, emeritus professor, for writing the foreword,
  • Dr. Julian Money-Kyrle, retired consultant oncologist, for his constructive comments on chapter 1.4,
  • Richard Rasker for his corrections and advice on the entire text.

Thank you all.

Acupuncture is a veritable panacea; it cures everything! At least this is what many of its advocates want us to believe. Does it also have a role in supportive cancer care?

Let’s find out.

This systematic review evaluated the effects of acupuncture in women with breast cancer (BC), focusing on patient-reported outcomes (PROs).

A comprehensive literature search was carried out for randomized controlled trials (RCTs) reporting PROs in BC patients with treatment-related symptoms after undergoing acupuncture for at least four weeks. Literature screening, data extraction, and risk bias assessment were independently carried out by two researchers. The authors stated that they followed the ‘Preferred Reporting Items for Systematic Review and Meta-Analyses’ (PRISMA) guidelines.

Out of the 2, 524 identified studies, 29 studies representing 33 articles were included in this meta-analysis. The RCTs employed various acupuncture techniques with a needle, such as hand-acupuncture and electroacupuncture. Sham/placebo acupuncture, pharmacotherapy, no intervention, or usual care were the control interventions. About half of the studies lacked adequate blinding.

At the end of treatment (EOT), the acupuncture patients’ quality of life (QoL) was measured by the QLQ-C30 QoL subscale, the Functional Assessment of Cancer Therapy-Endocrine Symptoms (FACT-ES), the Functional Assessment of Cancer Therapy–General/Breast (FACT-G/B), and the Menopause-Specific Quality of Life Questionnaire (MENQOL), which depicted a significant improvement. The use of acupuncture in BC patients lead to a considerable reduction in the scores of all subscales of the Brief Pain Inventory-Short Form (BPI-SF) and Visual Analog Scale (VAS) measuring pain. Moreover, patients treated with acupuncture were more likely to experience improvements in hot flashes scores, fatigue, sleep disturbance, and anxiety compared to those in the control group, while the improvements in depression were comparable across both groups. Long-term follow-up results were similar to the EOT results. Eleven RCTs did not report any information on adverse effects.

The authors concluded that current evidence suggests that acupuncture might improve BC treatment-related symptoms measured with PROs including QoL, pain, fatigue, hot flashes, sleep disturbance and anxiety. However, a number of included studies report limited amounts of certain subgroup settings, thus more rigorous, well-designed and larger RCTs are needed to confirm our results.

This review looks rigorous on the surface but has many weaknesses if one digs only a little deeper. To start with, it has no precise research question: is any type of acupuncture better than any type of control? This is not a research question that anyone can answer with just a few studies of mostly poor quality. The authors claim to follow the PRISMA guidelines, yet (as a co-author of these guidelines) I can assure you that this is not true. Many of the included studies are small and lacked blinding. The results are confusing, contradictory and not clearly reported. Many trials fail to mention adverse effects and thus violate research ethics, etc., etc.

The conclusion that acupuncture might improve BC treatment-related symptoms could be true. But does this paper convince me that acupuncture DOES improve these symptoms?

No!

The use of so-called alternative medicine (SCAM) is common among cancer patients and it may reflect the individual and societal beliefs on cancer therapy. This paper aimed to evaluate the trends of CAM use among patients with cancer between 2006 and 2018.

The researchers included 2 Cohorts of patients with cancer seen at the Oncology Department at King Abdulaziz Medical City of Ministry of National Guard Health Affairs, Riyadh, KSA, who were recruited for Cohort 1 between 2006 and 2008 and for Cohort 2 between 2016 and 2018. The study is a cross-sectional study obtaining demographic and clinical information and inquiring about the types of SCAM used, the reasons to use them and the perceived benefits. The researchers compared the changes in the patterns of SCAM use and other variables between the two cohorts.

A total of 1416 patients were included in the study, with 464 patients in Cohort 1 and 952 patients in Cohort 2. Patients in Cohort 2 used less SCAM (78.9%) than Cohort 1 (96.8%). Cohort 1 was more likely to use SCAM to treat cancer compared to Cohort 2 (84.4% vs. 73%, respectively, p < 0.0001,); while Cohort 2 used SCAM for symptom management such as pain control and improving appetite among others. Disclosure of SCAM use did not change significantly over time and remains low (31.6% in Cohort 1 and 35.7% for Cohort 2). However, physicians were more likely to express an opposing opinion against SCAM the use in Cohort 2 compared to Cohort 1 (48.7% vs. 19.1%, p < 0.001, respectively).

The authors concluded that there is a significant change in SCAM use among cancer patients over the decade, which reflects major societal and cultural changes in this population. Further studies and interventions are needed to improve the disclosure to physicians and to improve other aspects of care to these patients.

I think that these are interesting findings. Should both patients and conventional healthcare professionally truly become more sceptical about SCAM? It would be good, in my view, but can we be sure?

The answer is NO!

Firstly, we would need data from other countries (SCAM use is known to show marked national differences). Secondly, we would require more up-to-date evidence. The present paper has suggested that, within one decade, SCAM use can change. Therefore, it is only reasonable to assume that it has changed again since 2016/18.

My hope is that progress continues. And by progress, I mean that those forms of SCAM that are demonstrably useful in palliative and supportive cancer care are employed wisely, while all the many bogus alternative cancer ‘cures’ are rapidly falling by the wayside.

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