Focus on Alternative and Complementary Therapies
www.pharmpress.com/fact
Focus Alternat Complement Ther©2005 Pharmaceutical Press
Focus Altern Complement Ther 2004; 9: 274–9
On 24 June, 2004, the Prince of Wales addressed a research symposium on ‘Complementary Therapies and Cancer Care’ in London.1 This conference united the National Cancer Research Institute, four of the UK’s leading cancer charities and the Prince’s own Foundation for Integrated Health with the aim ‘to discuss, explore and develop new ways of integrating complementary therapies into the care of cancer patients’.
The Prince spoke about the effects of offering treatment choice to patients in order to ‘foster a renewed sense of control through integrated approaches to health’ as well as the effects that complementary practitioners have by providing ‘time, empathy, hope and reassurance skill that are referred to as the “human effect”.’
As an example for the many cancer patients who have turned to an integrated approach to manage their health he reported the following case: ‘I know of one patient who turned to Gerson therapy having been told she was suffering from terminal cancer and would not survive another course of chemotherapy. Happily, 7 years later, she is alive and well. So it is vital that, rather than dismissing such experiences, we should further investigate the beneficial nature of these treatments.’ He called for more resources to research integrated approaches to health care, highlighting the discrepancy between the high demand for CAM and the lack of research funding in the area: ‘Above all, we need to realise that the demand for integrated health care is going to increase. Two surveys have indicated that up to 80% of cancer patients try alternative or complementary treatments at some stage following diagnosis and 75% of patients would like to see complementary medicine available on the NHS.… And yet less than 1% of NHS funding is devoted to implementing complementary approaches. It seems to me that we need to devote more time and resources to researching and developing integrated approaches to health care.’ Again he used Gerson therapy as an example to reflect the need for research: ‘For example, many patients use and believe in Gerson therapy, yet more evidence needs to be available as to who might benefit or what adverse effects there might be.’
The Prince concluded that ‘we need to adopt a truly holistic view of health care’ and invited everybody to participate in meeting the challenge and explore different approaches and opportunities when considering the importance of research in tackling cancer care in the 21st century.
The Prince’s speech provoked a critical response from cancer specialist Michael Baum, professor emeritus of surgery and visiting professor of medical humanities at University College London. The BMJ published an open letter2 in which Baum urged the Prince not to misuse his royal power to promote unproven cancer therapies: ‘I do beg you to exercise your power with extreme caution when advising patients with life-threatening diseases to embrace unproven therapies.’ Baum said of himself ‘over the past 20 years I have treated thousands of patients with cancer’ and ‘the power of my authority comes with a knowledge built on 40 years of study and 25 years of active involvement in cancer research.’ In contrast the Prince’s medical expertise has a different background: ‘Your power and authority rest on an accident of birth… There is no General Medical Council for the monarchy.’
He defended the scientific approach: ‘Many lay people have an impressionistic notion of science as a cloak for bigotry. Nothing could be further from the truth. The scientific method is based on the deductive process that starts with the humble assumption that your hypothesis might be wrong and is then subjected to experiments that carry the risk of falsification. This approach works.’
Baum criticised the Prince for promoting the Gerson diet, a truly alternative approach based on coffee enemas and carrot juice ‘whose only support comes from inductive logic – that is, anecdote.’ Baum, an advocate of the scientific method and the scientific evaluation of CAM using controlled trials, said: ‘I have much time for complementary therapy that offers improvements in quality of life or spiritual solace, providing that it is truly integrated with modern medicine, but I have no time at all for “alternative” therapy that places itself above the laws of evidence and practises in a metaphysical domain that harks back to the dark days of Galen.’
Barbara Wider
Baum’s open letter reignited a vigorous debate. Between 9 July and 5 August, a total of 86 rapid responses written by 74 individuals were published on the BMJ website.3 The largest number of responses came from individuals based in a mainstream medical healthcare setting (34 individuals, 42 responses). Thirteen individuals (14 responses) had a scientific but non-medical affiliation. Interestingly, only seven individuals (nine responses) had a CAM-related professional affiliation and only five individuals (seven responses) mentioned explicitly that they worked in cancer care institutions. Most came from the UK (41 individuals) followed by the USA (eight), Canada and Australia (seven each).
The first spontaneous responses posted on the BMJ website contained congratulations to Baum:
It required someone of Professor Baum’s stature to come out courageously in open to put the things straight.… Thank you professor for standing firmly for medical scientific community. (Thorat, 9 July)
… for having the courage to say what most of us believe, but usually feel to [sic] cowardly to express in the presence of the Royals. (Fallowfield, 9 July)
(see also Varman, 9 July; Devey, 9 July; Eeckels, 9 July; Gorodezky, 9 July; Bamji, 10 July; Thompson, 10 July; Meltzer, 11 July; Beuchelt, 13 July)
The ensuing debate centred around the following four main topics:
The responses addressing these topics are summarised below.
The largest part of the debate, 21 out of 86 responses, focused on the benefits and risks of both conventional medicine and CAM. Many respondents accused conventional medicine of having failed patients, particularly in cancer care:
Taken together with blunders, errors and happenstance, doctors are the number one cause of death. (Walker, 9 July)
When you talk about SCIENCE and MEDICINE you may not be thinking about your track record concerning cancer but, as you must know, I am not alone in the conviction that there is little difference in cancer outcomes between 1974 and 2004; in fact the record is dismal! (Nehrlich, 10 July)
A strong subtext in Professor Baum’s letter is the notion that conventional cancer treatments are based on sound scientific ground. But is this really so?… These bald statistics mean that the great majority of individuals diagnosed with cancer will die from it. This is hardly a ringing endorsement of conventional cancer therapy. (Briffa, 10 July)
Conventional medicine has nothing to offer for cancer except surgery, radiation, and chemotherapy – otherwise known as slash, burn, and poison – and more and more people are catching on that the mutilation, burning, and toxic chemicals are completely unnecessary. (Lipsman, 9 July)
(see also Anderson, 16 July; Ellner, 10 July; Straus, 12 & 29 July & 1 August; Grant, 12 July; Gath, 15 July; Jones, 15 July; Anderson, 16 July; Carlos, 23 July; Molassiotis, 27 July)
Several responses alleged a conspiracy, accusing the ‘pharma industry’ and ‘orthodox establishment’ of trying to cover up the failures of conventional medicine and of preventing the promotion of CAM:
Desperate patients in the United States and around the world are turning increasingly to alternative therapies because of the manifest failure of conventional approaches to cancer that produce benefit mostly to pharmaceutical giants and the oncologists. (Straus, 12 July)
In the atmosphere of blatant data manipulation by drug companies for corporate gain, falsification or bias of results for personal glory, and the proven inability to discern truth from the morass of unluckily applied statistics, I would far rather question the results of current pseudo-research than the documented successes of ethical and caring observers of facts. (Walker, 9 July)
I proffer therefore that some science is not considered politically correct, and that our healthcare systems and scientific establishments are therefore clearly in need of a radical overhaul. (Taylor, 10 July)
Our repeated failures still do not lead us to ask if the underlying reasoning is not fatally, fundamentally, flawed. Why not?… This is revolution; therefore nobody wants it.… The oncological establishment excels at suppression. (Jones, 15 July)
Dr Nicholas Gonzales of New York recently received a grant from the US National Institutes of Health (NIH) to fund a large clinical trial using nutritional therapy to treat cancer. The grant was given in light of the fact that Dr Gonzales has a demonstrably successful track record in the nutritional management of cancer. Of course the old boy network (or is it nitwits?) in the cancer establishment attacked the NIH for giving the grant. What are they afraid of? They are always demanding proof until there is the likelihood of a study – then they try anything to shut it down. (Woodruff, 10 July)
(see also Hawkins, 10 July; Briffa, 13 July; Gath, 15 July; Potter, 9 July)
Others, particularly those with personal experience of CAM, pointed out that patients’ dissatisfaction with conventional treatments and doctors is an important reason why people turn to CAM:
After all, if all was great with orthodox medicine, would patients need to turn to CAM? (Molassiotis, 23 July)
The research agenda has been dominated for too long by clinical scientists, academia and industry.… The most urgent need is to listen to the patient’s voice if care, as well as cure, is to be researched and provided. (Thornton, 20 July)
It is strongly hoped that CAM will flourish in future and take the major, leading role in alleviating the pains of those patients with (in)curable diseases without developing any untoward complications, which are most common with modern medicines. (Qureshi, 10 July)
The good news is that millions of people around the world are waking up and smelling the herbal teas; many are doing their own research, firing their doctors and taking charge of their lives and health.… It is obviously long past time to hold the practice of medicine to the same scientific standards that Professor Baum insists are lacking for alternative health care. (Ellner, 10 July)
Having successfully treated cancers with foods, and seen reversal of widespread bony metastases… I find the arrogance of the medical profession with respect to CAM an unbearable slight on the intelligence of our patients. (Walker, 9 July)
In the House of Lords Select Committee enquiry into CAM, on which I served in 1999–2000, we received evidence on the alarmingly low proportion of patients who tell their doctors what CAM therapies they are using. Would I confide in Professor Baum if I were his patient? I think not. (Earl Baldwin of Bewdley, 19 July)
As one who has cured himself of cancer using holistic methods, without going to a doctor, I know whereof I speak. (Lipsman, 9 July)
Some respondents pointed out that some CAM treatments have a longer history than conventional treatments and are therefore established:
You say you have 40 years of knowledge and research behind your approach, yet many of the therapies you dismiss so critically have been around far longer and are far more grounded than all the drugs our modern society has come to depend on. (Rowles, 13 July)
People were being cured of, and curing themselves of (and will continue to be cured of), all manner of disorders long before ‘molecular biology’ was uttered. Sometimes simple is most effective. (Heptonstall, 12 July)
(see also Quanten, 19 July)
The debate surrounding (‘science-based’) conventional medicine vs. CAM in cancer care was closely linked to issues surrounding science, scientific methods and their value in conventional medicine and in CAM:
How do we generate hypotheses? Often, they start with an anecdote, a story with an unlikely, unusual outcome that gives us an impression that beneath this ‘story of interest’ may lie a truth worth discovering and testing.… Prince Charles may have just had an impression, perhaps after speaking to a cancer patient, that his theory was worth listening to and his hypothesis that his diet might be beneficial worth testing and made his voice heard. (Furste, 13 July)
The term ‘scientific proof’ is used as shorthand for people who claim scientific support but do not understand the scientific process. This term can indeed be used as a ‘cloak for bigotry’ to support unscientific arguments by less-able members of the medical profession.… There may be no royal road to mathematics, but in science we even allow a Prince his opinion, especially if it describes a new idea. A good hypothesis is an idea that could be correct, generally seems reasonable, and often suggests a simple experiment that can show it is wrong. (Hickey, 12 July, Biophysist)
(see also Bates, 10 July; Grant, 12 July; Briffa, 10 July; Butler, 11 July; Pickering, 12 July; Molassiotis, 27 July)
Some correspondents had doubts about the value of the scientific methods used in clinical trials:
The end result only is a comparison between two ineffective treatments, the lesser of two evils, so to speak. What are the researchers afraid of? Is it possible that a placebo, or no treatment at all, would be better than any chemotherapy? (Straus, 12 July)
We should congratulate the Prince for asking us to investigate these claims of other systems to find out the truth. True science is curiosity to know the truth. Commercial science is the one that wants only reductionist methods to prove or disprove any claim. What do controlled studies control? (Hedge, 13 July retired vice chancellor)
Imagine my surprise when I read that apparently there is no scientific rationale for the figure 0.05 whatsoever??!!!!!… Could it be that this standard ‘scientific’ baseline is a load of hogswash decided by an arbitrary standard chosen from the crystal ball from the er.. um… well…‘I don’t know’ domain? (Butler, 11 July)
A few respondents thought that CAM cannot be measured with the same methods as conventional medicine but for completely opposite reasons:
Many of the alternative therapeutic sciences address the psychosomatic, ‘sub-clinical’, or ‘subtle physical’ dimensions of health and disease. Their measures of measurements are different and therefore cannot satisfy the criteria of modern medicine. (Bhalendu, 9 July)
Alternative healing is essentially a branch of New Age spirituality. The New Age movement… [is] well-adapted for modern scientific societies since it focuses on subjective psychological states such as integration, authenticity and self-expression which are ignored by other social systems including medicine.… This subjective evaluation system makes New Age healing immune to challenge by science or medicine.… Individual experience is the ultimate authority, and… there can be no argument from medicine or biology. (Charlton, 12 July)
Today’s reductionist science is tomorrow’s folly, but the holistic science of Ayurveda and Chinese medicine are based on longitudinal observational research for thousands of years. Today we have realised that good observational longitudinal research is as good, if not better, than cross-sectional research. (Hedge, 13 July)
Baum and the ‘medical establishment’ in general were accused of being biased towards CAM and opposing novel methods in several responses:
The words of condemnation for alternative medicine come easy to you. You predict that ‘these bigots will be condemned to practise on the fringe.’ After a good look at the numbers I wouldn’t be so sure about that. (Nehrlich, 10 July)
Despite Professor Baum’s denials, a loose but highly effective combination of pharmaceutical companies, funding organisations, pernickety regulations, molecular biologists and uninformed oncologists has for far too long been working against the advent of a solution to the terrible scourge of cancer. Throughout this sorry story the basic problem has been the lack of dialogue at all levels. (Jones, 15 July)
But, even before the evidence is in, Professor Baum seems to dismisses nutritional therapy out-of-hand, and describes the experience of cancer sufferers who are apparently cured by it as an ‘urban myth’. I respectfully remind Professor Baum that, as far as the potential benefits of a treatment are concerned, absence of evidence does not necessarily mean evidence of absence. (Briffa, 10 July)
The idea of scientific proof seems to permeate the medical profession but, in addition to being technically inaccurate, it is out of date. The appropriate decision-making technique is cost–benefit analysis from the theory of games. Requiring scientific proof is a means of sidelining alternative treatment and may be used to suppress complimentary [sic] theories. The medical establishment provides funding for experiments and clinical trials and this process is subject to bias. If people in authority withhold resources for trials, the treatment will remain untested. (Hickey, 12 July)
In the preface Gerson writes: ‘The history of medicine reveals that reformers who bring new ideas into the general thinking and practice of physicians have a difficult time.’ (Potterton, 11 July)
(see also Hoffer, 15 July; Bradley, 23 July; Molassiotis, 23 July; Gath, 15 July; Heponstall, 10 July; Hedge, 13 July)
Others, however, strongly supported Baum’s scientific approach to medicine:
Arrogant are those, whoever they are, who discount the lengthy application of powerful scientific brains, because they are unable to understand the complexities of the subject. Facts are facts, however hard to grasp. (Devey, 10 July)
The arguments of some proponents of CAM above seem to miss out one of the most crucial benefits of the deductive method (which has a far longer history of just ‘200 years’): reproducibility. Sound scientific research is based on hypothesis and experiment, which either leads to falsification or (temporary) confirmation as a working hypothesis. (Beuchelt, 13 July)
The fact is millions of people in the UK now use CAM. And so, if the field is now being put under the scrutiny of ‘orthodox’ scientific approaches, such as the randomised controlled trial, I for one am happy! (Roberts, 14 July)
I wholeheartedly agree with Professor Baum that fair scientific scrutiny must indeed be applied to all therapies. This is especially the case when it is paid for by the public purse. Much is made of the willingness to adopt an integrated approach subject to rigorous scientific testing but little revenue for research flows from such statements. (Ottman, 12 July)
(see also Thomson, 10 July)
Most respondents agreed that further research and more funds are required:
If Prince Charles is correctly quoted he and Professor Baum are in perfect agreement that alternative cancer therapies should be properly tested with good controlled clinical trials. Prince Charles did not recommend that patients seek out the Gerson treatment. He said we should further investigate such experiences. (Hoffer, 9 July)
Good research can be conducted on CAM and will hopefully meet the territorial requirements of the most entrenched sceptic, but who will rush to fund THAT kind of research? (Feliciello, 10 July)
It is high time we had proper unbiased studies using all the natural cancer cures, herbal, homoeopathic and nutritional, etc. that are available. (McIean, 12 July)
Many practitioners of CAM would love to be able to conduct the trials that could prove their methods are effective, but often can’t because of the high cost of doing good quality research.… Perhaps His Royal Highness should put his money where his mouth is and fund the research into his favourite CAM treatments out of his own pocket. (Jacobs, 12 July)
Proponents of such therapies [nutritional] do not ‘lack the courage of their convictions’: they do lack research funding, and perhaps new ideas about methodology. (Goodare, 13 July)
Now is the time for increased support; new ideas and initiatives. Professor Baum’s action has the potential to spur vigorous debate on the topic. Now we should all be asking the question ‘could we be doing better?’ (Meltzner, 10 July)
(see also Bento, 15 July; Ottman, 12 July; Roberts, 14 July; Hawkins, 10 July)
Two respondents, however, were opposed to further research into CAM:
My message is that those who think that the present 30 or 40 claimants to useful ‘alternative’ cancer treatments should be being investigated further (despite habitually negative results with similarly promoted treatments in the past) are exerting pressure in quite the wrong direction. If the proponents cannot or will not demonstrate clearly how they know their treatments work, why should limited resources be diverted into investigating them? (Moran, 27 July)
Therefore there is no point in performing ever-more inevitably inconclusive (because inapplicable) randomised trials of New Age therapies. Neither should CAM studies be published in the scientific literature. Nor should non-scientific healing be a part of orthodox medical training or practice. A clear demarcation between the spiritual and the scientific is vital not only to efficient science, but also to effective spirituality. (Charlton, 12 July)
Twelve respondents (including Dr Gerson’s grandson) focused on the benefits and risks of the Gerson therapy and dietary approaches in general:
Adequate and balanced nutrition is an acknowledged prerequisite of good health, but dietary elements have a role in healing too. (Feliciello, 10 July)
Back to the basics of nutrition first, otherwise the science will never make sense. Bravo Prince. (Vos, 11 July)
I want to know why food is seen as alternative. And although 13 glasses of carrot juice and coffee enemas may be yet scientifically unproven, the link of food as a remedy to chronic disease is not. (Potter, 9 July)
Dr Max Gerson was no quack. Coffee enemas were not his invention, they were part of the‘science of medicine’. Yet you manage to make it sound as if Gerson were a member of the lunatic fringe. (Nehrlich, 10 July)
The Gerson therapy has been published for over 70 years in the world’s leading peer-reviewed medical journals, and confirmed by hundreds of serious medical scientists. This is a perfectly adequate definition of scientific proof, Dr Baum, and ignoring it shows your incompetence as a researcher in the literature. (Straus, 23 July)
(see also Grant, 14 July; Gath, 15 July; Da Prato, 17 July; Hickey, 12 July)
One of Baum’s main concerns about Prince Charles’s speech is the importance the public attributes to statements made by someone of his position and influence although he is not medically qualified. This concern was explicitly shared in 14 out of 86 responses:
I am delighted that Professor Baum has spoken for all of us who object to the excessive exposure given to the ill-informed opinions peddled by our future monarch (Devey, 9 July)
However, the media have their part to play in this, for if they reported responsibly it is you who would get the four pages and the Prince of Wales less than one. (Bamji, 10 July)
In the same issues of many of those newspapers there appeared photographs of Gwyneth Paltrow, freshly sporting evidence of a recent moxibustion session. Just as Prince Charles had more space in the newspapers than did Professor Baum, so Gwyneth Paltrow did also. (Goodman, 10 July)
Many acknowledged the potentially dangerous consequences of such statements:
The raising of false hopes and the debilitating charges levied by many clinics and so-called treatment centres together with the ineffectiveness of their procedures constitute a scandal of international dimensions and border on criminal deception. (Jones, 15 July)
I wish to commend the author, Michael Baum, for his frank, reasoned and polite rebuke to the irresponsible medical advice offered to the public by someone not versed in medicine nor in science.… Flawed advice raises false hopes, adding to human suffering. (Jacobs, 9 July)
The pressure from well-meaning friends to try alternative treatment was quite difficult to resist. I have had patients who have felt similar pressure to which they have, at times, succumbed when effective conventional treatment was available. (Jarman, 9 July)
Personally I would like all columns about ‘alternative’ remedies (that in the Sunday Times supplement particularly incenses me with its hearsay and flim-flam) to have a health warning prominently displayed at the top. (Bharma, 10 July)
(see also Forbes, 9 July; Vetter, 9 July; Rowles, 13 July; Richmond, 12 July; Beuchelt, 13 July; Rivett, 10 July)
A few respondents doubted the value of such a debate as a whole and argued that it should be led in public:
Their amateurish statements should not have been exalted or elevated with great whoopings and shoutings by anyone, much less us professionals. I would hope that the intelligent citizen of each country has been able to recognise the comments for what they were, and has not clutched them to their bosoms as gospel. (Rudolph, 10 July)
The very limited power and authority of the heir to the British throne rests on an accident of birth.… The enormous power of the American president rests on an electoral disaster and a gullible people. Who cares – or should care at all – about the matter? (Struthers, 12 July)
When it comes to interpreting what our voices are saying I would put greater trust in the GP who was running 45 min late today because of the care with which he listened to our stories than in an Honorary Visiting Fellow at the Department of Health Sciences in Leicester … or even the Fourth Earl Baldwin of Bewdley … Doubtless both are motivated by the very best intentions but, at my time of life, I get irritated by people inhabiting places like St James’s Palace, the House of Lords, and the groves of academe who get the urge to speak up in, albeit unwittingly, patronising tones on behalf of me and my friends in lowplaces. (O’Donnell, 21 July)
As a general practitioner I watch people dying of cancer every week. To them much of the debate above would be so much meaningless rhetoric. People always couch these things in terms of power; the power of established medical practice, the challenge posed by alternative medicine, the arrogance of doctors, the ignorance of those who criticise them. (Hopkins, 23 July)
Throughout this sorry story the basic problem has been the lack of dialogue at all levels. The time has come to discard bigotry, ignorance and prejudice and to move on. (Jones, 15 July)
The debate continues – but does it progress?
