My last blog post was about alternative medicine in cancer treatment. That piece was about patients who refuse all other treatment, and thankfully that is still a relatively rare occurrence. Usually, patients use alternative medicine alongside their regular treatment. As a result, studying patients who refuse all regular treatment isn't necessarily the most informative thing.Because of this distinction, researchers from Yale decided to have a look at patients who do this, and they published their results this month. It is not encouraging reading.The research showed that if patients used alternative medicine at the same time as conventional medicine, they were twice as likely to die in the 5 years after diagnosis. I will get into the details and the numbers below, but first I want to repeat that statement. If patients used alternative medicine at the same time as conventional medicine, they were twice as likely to die in the 5 years after diagnosis. That is a shocking toll.Before I get into the study itself, I want to briefly explain this result. Essentially, if someone uses alternative medicine, they are more likely to refuse other parts of the treatment. So this terrible loss of life is probably not because a specific alternative medicine was causing a problem, but because the belief in pseudoscience has corroded and undercut the public’s trust in medicine. People believe that their alternative treatment is viable replacement for conventional therapy.This belief has not sprung out of nowhere; an entire industry has been built on the idea that medicine is “toxic”, and that if something is “natural” it is automatically better for you.I know so many people who use alternative medicine, from acupuncture, to supplements, to homeopathy, and they often say “what’s the harm?”. Well, this is the harm. Because of the normalisation of this kind of thinking, patients are making bad medical decisions, and are dying as a result. I will say it again: patients who used alternative medicine at the same time as conventional medicine were twice as likely to die in the 5 years after diagnosis.So what does the science actually tell us? Research from a few years ago showed that if someone uses alternative medicine, they are more likely to skip certain parts of their treatment. However, that study didn’t look at how this impacted their survival. This new paper takes that finding and looked at a larger population of patients to see if the use of alternative medicine alongside conventional treatment had any affect (good or bad) on cancer.Firstly, the authors confirmed that in their population of patients, those who used alternative medicine were far more likely to refuse or skip part of their treatment. This included surgery, radiotherapy, chemotherapy and hormone therapy.For example, 7% of patients who used alternative medicine refused surgery, while only 0.1% of other patients did. 34% of alternative medicine using patients refused part of their chemotherapy, while only 3% of other patients did. In a way, this is understandable: these treatments are hard, and make people feel awful. If you already believe that your side effect free alternative medicine is a viable replacement for your chemo, then skipping a round of chemo doesn’t seem like that big a deal.Just to be clear, interventions like surgery, radiotherapy or chemotherapy are not used because we think they improve survival; they are used because we know it. Huge numbers of clinical trials have been done to figure out what allows patients to live longer, and these treatments do that. And refusing some of these seems to be what is doing the damage in patients taking alternative medicine.There is not much more I can really say about this study, apart from the usual caveats. A lot of patients lie to their doctors about their use of alternative medicine, so that could be a confounding factor. The authors were very strict with their criteria, so as a result, the study was relative small, with only 258 alternative medicine-using patients. That being said, it is the biggest study we have on the topic, and the analysis was very rigorous.What this study really shows is the harm that the “natural” industry is doing. Vaccination rates are falling all around the western world. Species are being wiped out because of the popularity of traditional Chinese medicine. But perhaps most damagingly, a third of the American population regularly use alternative medicine without any evidence that is has any effect, spending nearly $200 billion in the process. With such a huge number of people using it, and with the credulous treatment it receives in Hollywood and other media, it is no wonder that people assume it works. It has been marketed and accepted by a large number of people as a true alternative to medicine, and as a result, people are dying for no reason.This is why it is so important to call out pseudoscience when it comes up. We live in a world where medicine is advancing on a daily basis. We can live longer, healthier lives, but people are increasingly taking that for granted and turning towards pseudoscientific ideas, because they are more "natural". The reality is that the more people who understand that alternative medicine does nothing, the better.
Alternative medicine and cancer survival
I often wonder just how much I annoy people when the topic of alternative medicine (alt med) comes up. In general, if someone says something I don’t agree with, I let it slide. When it comes to alt med, however, I don’t seem to have the same restraint. It’s unfortunate really, as it comes up surprisingly often, and my position comes across as pretty extreme.People ask “What’s the harm?”, and point out that “Even if it doesn’t do anything, people feel better having tried it”. I empathise with this position, but completely disagree. The point I try to make is that if we accept the use of alt med, we legitimize it, making people more likely to choose it over conventional medicine.
The focus of this post is cancer patients who put all their trust in alt med. While it's true that most people use alt med alongside real medicine, the popularity of, and belief in, the alt med movement means that it is inevitable that some people will ignore mainstream medicine in favour of alternatives.Unfortunately this does happen, and it happens regularly enough for us to study it. A few months ago, researchers from Yale published a paper looking into the outcomes for cancer patients who chose alt med over conventional treatment.The authors chose four types of cancer to look at: breast, prostate, lung and bowel. Additionally, they chose patients who had early stage disease, so had a good chance of surviving their cancer.Before I get on to the results of their study, one interesting thing to note is that the researchers show that the patients who rejected conventional treatment were more likely to be younger, healthier, more highly educated, and female. These are the patients who would be expected to have better outcomes than other cancer patients, to survive longer and to have fewer complications. However, that is not what the researchers found.Unsurprisingly, the patients who chose alternative medicine were far more likely to die from their cancer than those who didn’t. In the case of breast cancer, alt med users were nearly 6-times as likely to die. In colorectal cancer they were 5-times as likely. In lung cancer they were twice as likely. To put it simply, choosing alternative medicine above conventional therapy kills cancer patients.So, if 100 women with breast cancer were on conventional therapy, 13 would be expected to be killed by their cancer in the 5 years after diagnosis. If the same women were on alternative medicine instead, 41 of them would be expected to be killed over the same time. It is a damning example of the damage alt med can do.
As always, there are a few caveats with this study. One is that these patients completely rejected conventional therapy. Patients who combined it with conventional therapy were included in the conventional arm, so this study can't say anything about the benefits/damage of that situation.It is also likely that these numbers quoted above are an underestimation. Patients who started using alternative medicine, but switched to conventional therapy (when they realise it was not working) will have been counted in the conventional therapy group, meaning that in reality the use of alt med is probably doing even more damage than described in this paper.This all brings me back to my original point. When people give alt med a sheen of validity by claiming it works, it starts to be seen as a true alternative to our tried and tested treatments. The reality is that it simply isn't. As long as it has some legitimacy, a proportion of the population will use it instead of real medicine, at best wasting money, and at worst seriously damaging their own health. I argue with people about alt med because if I don’t, I feel like I am tacitly agreeing that it has some clinical use, when I know it is not true.To paraphrase an old saying, you know what they call alternative medicine that has been shown to work? MEDICINE. And real medicine saves lives.
Have we explained how acupuncture works?
Acupuncture is a topic that divides people. It is seen by some as a little understood branch of medicine, by others simply as pseudoscience. The theory states that inserting needles at specific points can have effects on almost every ailment, from chronic pain and allergies to irritable bowel syndrome and even stroke. At present, however, there is little reliable evidence that acupuncture works any more than placebo, which makes this article from The Guardian quite unexpected:
Rats help scientists get closer to solving the mystery of acupunctureThe Guardian - 21/07/2015
The title is surprising because this was not a report on acupuncture. The scientists applied an electric current through the acupuncture needles. This technique is called transdermal electrical stimulation and is already used in the clinic to treat chronic pain. The authors, however, call it “electroacupuncture“, and equate it to acupuncture. They are not the same thing, and the conclusions are hence not about acupuncture at all.Scientifically there are many other problems with this study. This was a tiny experiment, with only 7 animals being tested with the “electroacupuncture”. It was not blinded, meaning that the experimenters knew what treatment they were giving to each animal. You may not think that this is an important issue, but consider this: studies on acupuncture in the West yield very mixed results, leading us to believe that the effects are either tiny or non-existent. In China, Japan and Taiwan, where there is a culture of belief, almost every single study shows a positive result. The belief of the experimenter can drastically influence the result of an experiment. Blinding is essential in such studies to overcome this.It is also worth drawing attention to the controls used in this study. The experimenters compare “electroacupuncture” to two controls: sham-acupuncture and no acupuncture. Sham-acupuncture is specifically in place to test for the presence of the placebo effect. Depending on the study, sham-acupuncture can be one of a few things, from inserting the needle at a random point in the body to the use of needles that retract into the sheath, so there is no penetration of the skin at all. In this study, the authors used the insertion of their electric needle at a non-acupuncture point as the sham.Tellingly, the authors did not report any difference between sham-acupuncture and acupuncture. The fact that this isn’t reported, and a look at the data presented in the paper, suggests that there is no difference between their “electroacupuncture” and sham. They only report that “electroacupuncture” seems to be slightly better than the no treatment control. So not only their results are unspectacular, but can be entirely explained by placebo effects. It is worth pointing out that the placebo effect can be extremely powerful, and people can see vast improvements when using any therapy that may not be due to the therapy themselves, but down to the placebo effect. This is why we control for it in trials.This control issue with the study is one that is common with other acupuncture research. It is regular these kinds of studies to see no difference between acupuncture and sham-acupuncture, and rather than conclude that acupuncture doesn’t work, they conclude that both acupuncture and sham-acupuncture work, and this is just not true! If a drug had the same level of effect as a sugar pill, we wouldn’t conclude that both are working. Unfortunately, it is rare for studies into pseudoscience to hold themselves to the same standards.Put simply, this is a badly designed study, from which the authors conclude that acupuncture works, seemingly without actually looking at acupuncture at all. At present, we cannot even say that there is a “mystery of acupuncture”, as described in the headline of this article. There is no mechanism in science or medicine through which sticking needles into particular points around the body can have very specific effects on other parts, so to claim acupuncture works would require convincing evidence (extraordinary claims require extraordinary evidence). This is certainly not that.
