Grace Gawler – how the uncertainty principle influences patient's choices in cancer treatments

Examining the ‘Uncertainty Principle’ and How it Negatively Influences Cancer Treatment Choices

 As a director of an integrated cancer solutions charity in Queensland, in my years working in the cancer industry, I remain shocked at the large numbers of cancer patients abandoning conventional treatment in favour of alternative therapies. Unfortunately I’ve also seen the terrible results of such choices ranging from emaciation, electrolyte depletion, metabolic exhaustion, insidious spread of cancer and associated pain increase and even death. Why?

More troubling is the number of ‘integrative’medicine GPs who are not; for the patient’s benefit; collaborating or communicating with mainstream doctors, oncologists or other therapists involved in the patients care. I’ve witnessed there to be little or no communication between treating doctors who should all be active members of the team devoted to a patient’s survival.  It’s also important that integrative medicine GPs  don’t abandon scientific training in favour of promoting excessive supplements – often via affiliations or network marketing initiatives or by promoting dubious diets like Gerson, vegan diets, coffee enemas, various electrical treatments and many other forms of therapy whose evidence is questionable.

Whether a combination of positive placebo and supplements, one very common issue is the plight of cancer patients who are surviving on will power and positive thinking…it appears that strategy has a use by date – they eventually hit a brick wall and deteriorate rapidly when there is a sudden downturn in their condition; often a condition that could have been avoided had they sought proper medical advice. It is a trap for the unwary patient because their general wellbeing may have increased temporarily; but what we see far too often are patients who are entranced by some therapists into denial of their symptoms. They have soldiered on and used up a lot of energy in their struggle for survival. The question begs – What is it in the psyche that encourages cancer patients to completely abandon conventional medicine and play Russian roulette with their lives?

Last week I heard a medical doctor say …”We give people antibiotics for an infection – they don’t have to believe in them in order to have them work- the just do!” He has a point!

At the time I had been thinking about a young man in his late teens, a friend of a friend whose mum implicitly believed in natural medicines, refusing medical advice – he had developed pnuemonia – Without treatment, he died within 4 days.
People believe that there is a certainty in natural medicines because they are natural…they can also believe the same of conventional medicine. Perhaps the truth lies somewhere in between…

An article in the Guardian newspaper (UK) – We Must Learn to Love Uncertainty and Failure made these points:-

  1. Uncertainty is a central component of what makes science successful.
  2. The idea of something being “scientifically proven” was practically an oxymoron
  3. The very foundation of science is to keep the door open to doubt.
  4. A ‘good scientist’ is never ‘certain’ – adopts different view if better evidence avails.

Perhaps I had discovered an answer to my questions!

  1. Alternative cancer treatments are promoted with compelling certainty and sophistication.
  2. Simultaneously alt/med amplifies the uncertainty of conventional medicines.
  3. Terminology – ‘slash, burn and poison’ – denigrates conventional treatment and sows fear.
  4. Many patients we see in our practice are terrified to stop taking their supplements. It is implied by some natural therapists that if patients stop using alt/med methods they will die or be toxic from their medical treatments—ironic that an industry that claims to promote wellbeing has an emphasis on fear – the negative placebo.
  5. Alt/med has successfully promoted the image of the greedy ‘big pharma’ but little is said about alt/med avarice, pseudo science and deception – illustrated below.

Last week we met a cancer patient undergoing chemotherapy while simultaneously spending $1100.00 a week on ‘secret’ alternative treatment – but afraid to give it up because it ‘seemed to be working’ – he didn’t notice anything or feel any better – but was afraid to change what he was doing and had been doing for the past 2 years. I recommended an oncologist – He is now in hospital for emergency drainage of ascites ( fluid accumulation in the abdomen) – 10 litres of fluid has been removed. His naturaopath missed the warning signs. This patient is typical of many, who driven by the fear of their diagnosis, don’t want uncertainty and thus are easily lured by the certainty, the increasingly sophisticated ‘pseudo’ science and ‘aura’ of alternate therapies.

Conclusion:  There is an important role for complementary (CAM) therapies in cancer medicine, but the role of alt/med is questionable as is usage of the often touted term ‘evidence-based’ medicine. A recent Medical Journal of Australia (MJA) article disclosed significant errors in a high profile cancer patient recovery story that has influenced the course of alternative, complementary and lifestyle medicine in Australasia for 32 years. It has even influenced peak training bodies such as The Australasian Integrative Medicine Association (AIMA). In the light of the MJA disclosures, the question of what is evidence-based integrative medicine must be addressed in the public interest.

Happily excellent working models exist in Singapore and Hong Kong. These set the standard for excellence for integrative, or as I now like to call it, collaborative cancer medicine. The winner is the cancer patient.
References:

http://www.guardian.co.uk/science/2011/jan/15/uncertainty-failure-edge-question

National Cancer Centre, Singapore (NCCS).   Strong Team-Based, Evidence-based Practice  http://www.nccs.com.sg/medprof/04.htm

Grace Gawler MJA article – Cancer patients at risk from inaccurate clinical reporting in a high-profile alternative treatment story: comments and corrections – Sept 20 2010

http://www.mja.com.au/public/issues/193_06_200910/letters_200910_fm-1.html

Dr Linda Calabresi – Australian Doctor article
http://insidewww.australiandoctor.com.au/news/58/0c06d258.asp

Ian Gawler response – Australian Doctor article
http://www.australiandoctor.com.au/news/50/0c06d750.asp