Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Ignorance-based cancer treatment
- Caroline Richmond (24 November 2006)
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Why alternative medicine for cancer therapy?
- Bill Sardi (25 November 2006)
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Just who can a cancer patient trust?
- Damien Downing (25 November 2006)
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One size does not fit all
- Simon IR Noble (25 November 2006)
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Cancer quackery - effective legislation is already in place but is not being properly used
- Charles B Shepherd (25 November 2006)
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Incredible Ideas
- Jeremy D Budd (25 November 2006)
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Shark cartilage in the water: does it do any harm?
- Michael Holmes (26 November 2006)
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cancer research/industry
- Marlene A. Thompson (26 November 2006)
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Is the good professor being as objective as he might think he is?
- Robert Verkerk (27 November 2006)
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Re: Ignorance-based cancer treatment
- Jonathan Waxman, w12 onn (27 November 2006)
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Re: Why alternative medicine for cancer therapy?
- jonathan waxman (28 November 2006)
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Making Complementary and Alternative Medicine Safe
- Robert M Pittilo, Michael McIntyre (28 November 2006)
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Re: Just who can a cancer patient trust?
- jonathan waxman (28 November 2006)
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Re: One size does not fit all
- jonathan waxman (28 November 2006)
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Re: Cancer quackery - effective legislation is already in place but is not being properly used
- jonathan waxman (28 November 2006)
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Re: Incredible Ideas
- jonathan waxman (28 November 2006)
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Re: Shark cartilage in the water: does it do any harm?
- jonathan waxman (28 November 2006)
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Re: Re: Shark cartilage in the water: does it do any harm?
- jonathan waxman (28 November 2006)
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Re: Is the good professor being as objective as he might think he is?
- Jonathan waxman (28 November 2006)
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Re: Making Complementary and Alternative Medicine Safe
- jonathan waxman (28 November 2006)
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Sharks in Alternative Medicine.
- Alexander SD Spiers (28 November 2006)
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Shark cartilage in the water
- Croft Woodruff (28 November 2006)
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Snake oil and evidence based medicine?
- Michael Bending (28 November 2006)
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Re: Snake oil and evidence based medicine?
- jonathan waxman (28 November 2006)
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Re: Making Complementary and Alternative Medicine Safe
- Leslie B Rose (28 November 2006)
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There are no magic answers.
- Leslie B Rose (28 November 2006)
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Shark Bait
- Kate Nurse (28 November 2006)
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Anecdotal Evidence
- Stephen Kane (30 November 2006)
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Re: Re: Is the good professor as objective as he thinks he is?
- Robert Verkerk (30 November 2006)
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Re: There are no magic answers.
- Pat Rattigan (30 November 2006)
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Throwing the baby out with the bathwater
- Krystyna Krzyzak, Alix Rodwell (30 November 2006)
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Confront New Age Snake Oil Peddlers
- Alex Avery (2 December 2006)
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Re: Re: Just who can a cancer patient trust?
- Raymond G Holder (2 December 2006)
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Shark Cartilage in the Water
- Gail Easterbrook (2 December 2006)
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Re: Re: Just who can a cancer patient trust?
- Damien Downing (2 December 2006)
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Priceless Advice?
- Michael W Nield (3 December 2006)
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It’s either a proven therapy or an unproven therapy.
- S Sundar (3 December 2006)
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Re: Re: Shark cartilage in the water: does it do any harm?
- Oscar U. Cadogan (4 December 2006)
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Re: Re: There are no magic answers.
- Peter J Flegg (5 December 2006)
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Re: Re: Re: There are no magic answers.
- Stephen Gascoigne (6 December 2006)
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Methinks the Prof. should take at look at the pharma model he advocates
- Alyssa Burns-Hill, MSc, FRSH, MIHPE (6 December 2006)
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Shark cartilage in the water
- Pippa. R. Lovell (11 December 2006)
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Re: Re: Re: There are no magic answers.
- Pat Rattigan (15 December 2006)
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Why is it that science is disregarded?
- Steve Hickey (16 December 2006)
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Dr Waxman has misunderstood what I wrote
- Caroline Richmond (21 December 2006)
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Re: Re: There are no magic answers.
- John M Davis, Townsville, Qld. 4814. Australia (25 December 2006)
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Caroline Richmond, Obituary writer SW3 5AQ
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A reflexologist believes that the organs of the body reappear symbolically on the soles of the feet, and disease of these organs can be treated by massaging that part of the foot. Anyone who believes that is either woefully ignorant of human biology and seriously misinformed, or barking mad I spend most of a year, from November 2002 to October 2003, in a cancer ward, being treated for the complications of two different types of lymphoma. During that time the nurses repeatedly offered me the services of a reflexologist. After two months in bed with septicaemia, my toenails had grown too long for me to wear my slippers comfortably. I could not cut them myself and a nurse told me that she could not, as it was against some kind of rule. I am all for hospitals offering non-medical treatments to improved the happiness and well-being of patients. Hairdressing – for those of us with hair – and skin and nail care would be welcome. The same hospital trust now offers cancer patients the services of Reiki therapists, and has a homeopathy hospital in its group. It is unsurprising that a high proportion of cancer patients use improbable, potentially hazardous, non-evidence-based therapies. They come with the apparent endorsement of their NHS doctors. Competing interests: Sometime cancer patient |
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Bill Sardi, Journalist San Dimas, California 91773
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Dowsing and flower therapy are certainly an affront to oncologists. But criticism of alternative cancer therapies fails to address why patients resort to these poorly if not totally unfounded treatments. Isn't it because modern medicine has failed to cure cancer and operates under the guise that it holds scientific high ground? Much cancer treatment has been disproven, but oncologists attack the unproven. Which has a better chance of effecting a cure? On the day cancer is diagnosed 30-50% of cancer patients have metastatic cancer, for which there is no effective treatment. Among the remaining percentage of cancer patients, most have solid tumors which cannot be penetrated by radiation or chemotherapy and the latter only works for a time till drug resistance sets in. Modern medicine has obviously failed to sell cancer patients on the idea that chemo, radiation or surgical treatment are of much benefit. We now have expensive gene-targeted drugs that add only a few months of life to a cancer patient's prognosis. Is it any wonder cancer patients look elsewhere? Bill Sardi, President Knowledge of Health, Inc. San Dimas, CA Competing interests: Author of books on dietary supplements |
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Damien Downing, Doctor Harley St W1
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Prof Waxman employs and perpetuates a crucial medical myth — that, in contrast to complementary therapies, conventional therapies are all evidence- based, on sound science. But the BMJ’s website Clinical Evidence reports that, of the 2404 treatments they have surveyed, only 15% are rated as beneficial, while 47% are of unknown effectiveness[1]. In his own speciality, indeed, chemotherapy for cancer was found in a 2004 systematic review of studies in the USA and Australia[2] to improve overall 5-year survival chances by less than 2.5%. Interestingly, the review of dietary interventions he cites[3] derived an odds ratio for the effect of a healthy diet, with or without dietary supplements, of 0.90 — which appears to make them probably 4 times as effective as chemotherapy. Different end-points, granted, and a big confidence interval, but nevertheless “absence of evidence is not evidence of absence”. Talk of “vile and cynical exploitation” could with equal justification be applied to the cancer industry, into which billions has been poured in recent decades, to very little effect. Surely Prof Waxman should be careful not to become, as discussed in the same issue of BMJ, “a lapdog to drug firms”? 1 http://www.clinicalevidence.com/ceweb/about/knowledge.jsp 2 Morgan G, Ward R, Barton M. The contribution of cytotoxic chemotherapy to 5-year survival in adult malignancies. Clin Oncol (R Coll Radiol), 2004; 16(8): 549-60. 3 Davies AA, Davey Smith G, et al.. Nutritional interventions and outcome in patients with cancer or preinvasive lesions: systematic review. J Natl Cancer Inst 2006; 14: 961-73. Competing interests: I practice, inter alia, nutritional medicine, which everybody, including Prof Waxman, appears to have decided is complementary |
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Simon IR Noble, Senior Lecturer in Palliative Medicine Cardiff University and Royal Gwent Hospital NP20 2UB
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Whilst I agree with many of Waxman’s points on the marketing of complementary therapies, one size does not fit all in his argument. The efficacy and potential physical harm of someone self administering coffee enemas is clearly different to that of someone receiving aromatherapy for improvement of general well being. There needs to be a distinction between “complementary” and “alternative therapies”. Whilst the latter is often marketed as an “all natural remedy” that will kill cancer cells, most complementary therapies are used alongside accepted current oncology therapies. Their intention is not to cure but to support other aspects than just the physical. The psychological and spiritual domains are as important to many patients as their objective response to treatments. Indeed many of my patients consider the concurrent use of complementary therapies being the key to them being able to face further chemotherapy regimes. Rather than being a “battle”, so often described in personal accounts, the patient experience of cancer treatment for many is a helplessly passive one. Accessing complementary therapies can be an empowering experience regardless of the anticipated benefits. If 80% of patients are seeking out additional or alternative therapies, we need to equip ourselves with a knowledge and evidence base from which to advise patients. The web sites often warn patients that doctors will disparage the use of their product and we have a responsibility not to push our patients towards seeking alternatives by giving reflex responses when other therapies are brought up in clinic. The use of complementary therapies and alternative cures is commonplace in the palliative care population. Many view they have “nothing to lose” and it is here where the patient may be most vulnerable to therapies that claim a cure. Such claims can inhibit realistic goal setting and future planning. In addition complex bereavement is often worsened by unrealistic goals that were set by the use of alternative cures. The internet can be an anarchic library when it comes to cancer cures and regardless of what legislation is developed locally, this will not stop people accessing information and medicines from elsewhere. We need to be able to advise patients with credibility and empathy and not “throw the baby out with the bathwater” when it comes to therapies that are there purely to support and edify the individual. Competing interests: None declared |
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Charles B Shepherd, physician Friars Cottage, Queens Square, Chalford Hill, Stroud, Glos GL6 8EH
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EDITOR - Jonathan Waxman has correctly identified the need for effective legislation to protect vulnerable cancer patients from unproven and/or harmful cancer remedies. So it was surprising to see no mention of the 1939 Cancer Act - an important piece of legislation that in section 4.1 prohibits '..the publication of any advertisement containing an offer to treat any person for cancer, or to prescribe any remedy therefor, or to give any advice in connection with the treatment thereof;' I have now made successful use of this legislation in relation to patients who have used cancer therapies that have been advertised in both the complementary health sector (1) and by registered medical practitioners associated with a registered pharmacy (2). If doctors identify complementary practitioners, commercial companies, or even registered health professionals who are advertising cancer remedies they should contact their local trading standards department, who have a responsibility to enforce the act. In the case of registered medical practitioners, the General Medical Council should also be notified. Charles Shepherd charlesbshepherd@lineone.net 1 Dyer O. British company fined for falling foul of Cancer Act. BMJ 1994; 308: 158. 2 Campbell D. "Quackery" outlawed in registered pharmacy. BMJ 1997; 315: 625. Competing interests: None declared |
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Jeremy D Budd, GP Principal Somerset TA6 4GP
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It is interesting to compare this article with the following one by Kevin Barraclough. Personally, I am with Waxman and Dawkins, and hope that Dr Barraclough will be better than his word, and read some of Dawkins' work with an open mind rather than the closed one he describes. If you look more closely at both articles, the difference is that Professor Waxman is railing at the continued existence of foolish ideas. Dr Barraclough's arguments are entirely ad hominem, and reflects the fact that doctors care for a individuals. This needs a working relationship; it is difficult to rubbish your patient's irrational beliefs especially when you cannot offer the hope of cure yourself. As I think the Catholic Church says, it is possible to love the sinner but to hate the sin. So let Dr Barraclough continue to admire the scruffy, mad looking hippy, and to like religious people, but stand up against snake oil and shark cartilage in the water! Competing interests: None declared |
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Michael Holmes, SHO Hepatology Royal Free Hospital, NW3 2QG
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It is easy to sympathise with Professor Waxman’s disdain for the so- called ‘complementary therapies’ (just what are they meant to compliment?) in the treatment of cancer [1]. It is paradoxical that despite current medical practice never being as ‘evidence-based’ as it presently is, with the advent of patient autonomy and the doctor acting as patient’s advocate (rather than being the dictating paternalist of yester-year), patients regard their doctor’s opinion less and are thus less inclined to act on it than previously. With the current healthcare framework in which patient treatment depends on the utilitarian NICE, frustrations arise and no more so than in the setting of cancer, with new and appallingly expensive biological agents being enticed to the sick. It is human nature to seek our own answers, and a diagnosis of cancer must be one of the most fundamentally questioning events that can occur to us - the loss of trust of one’s own biological state. Victims of cancer look for the answer in everything they do, from wake to sleep, and so it is unsurprising that changes in diet and other daily habits occur. Even in the complete absence of evidence base, if these treatments do not alter or delay conventional treatment and do no harm (primum non nocere), are they worthy of the vilification received in Waxman’s article? The absence of statistics means that the stark truth of the efficacy (or lack of) cannot be made known to the patient. Although this may seem to provide patients with hope that seems unfounded, who are we to force the bleak truth upon them and deny them of hope that they may desperately need? References 1. Waxman, J. Shark cartilage in the water. BMJ 2006; 333: 1129 Competing interests: None declared |
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Marlene A. Thompson, Housewife NG15 6DN
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The ICRF(Imperial Cancer Research Fund) was founded in 1902, and the CRC(Cancer Research Campaign)in 1925, which equals a staggering 185 years research. Include other countries and this amounts to an amazing hundreds of years research in all. In 2003 ICRF and CRC merged to become Cancer Research UK. When their research began cancer was quite rare. Today despite all the billions of pounds and dollars poured into research, increased knowledge and skills, sophisticated screening and diagnostic techniques, hundreds of cancer specialists and hospitals, and countless new drugs, cancer has reached epidemic proportions, and remains incurable! It's hardly surprising people are looking elswhere considering this dismal track record. Dozens of people, including a friend, have been successfully treated by unconventional therapies, yet this is dismissed without any proper research into the methods. My mother and brother (and thousands more)have died from conventional treatments they believed would 'cure' them. It seems cancer today is big business. I read of drug companies forcasting the billions of pounds they will make from new cancer drugs. Cynics claim if cancer was curable some drug companies would become bankrupt, thousands would be jobless and the government would lose millions in revenue. As Dr Joe Collier wrote in his book The Health Conspiracy, 'They weave dreams that cures are within our grasp courtesy of their industry. Reality says otherwise, but whilst the public remain hooked upon that dream their commercial future is guaranteed". Having researched cancer treaments, the immune system, and prevention through a healthy diet and avoidance of chemicals, if I had cancer I know which route I would take, and it wouldn't be the conventional one. Competing interests: None declared |
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Robert Verkerk, Scientific Director Alliance for Natural Health, The Atrium, Curtis Road, Dorking RH4 1XA, UK
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As someone who honed his scientific skills at the same university in which Prof Waxman works (MSc, PhD and a number years as a postdoctoral research fellow), I am left somewhat aghast by many of the statements made in Waxman's 'Personal View'. Prof Waxman has fallen into the trap of being overtly biased, by criticising a minor element of an industry (eg. "snake oil salesmen") and confusing this with the scientific platform on which this very small minority thrive (eg. clinical nutrition, nutrigenomics, etc.). Prof Waxman would no doubt have some difficulty trying to justify the high level of efficacy of chemotherapy in cancer treatment, when it has been shown to contribute less than 5% to the 5-year survival rates for cancer in Australia and the USA (Clin Oncol (R Coll Radiol) 2004; 16(8): 549-60). Does Prof Waxman honestly believe that chemotherapy and radiotherapy are the sole contributors to improvements in cancer survival rates which can be an order of magnitude greater than this chemotherapy contribution? How can any good scientist rule out the role of altered lifestyles and dietary regimes as potential 'confounding factors' in clinical trials, given the sheer power of the human survival instinct? Ignoring the role of nutrition as a means of increasing survival rates and reducing side effects from chemo- or radio-therapy is also irresponsible (e.g. Cancer 2004; 100: 1967-77). There are no legitimate food supplements in the UK or Europe sold on the basis of their ability to treat or prevent disease. Such claims for any unlicensed medicine amount to a criminal offence and a very small number of 'snake oil salesman' have been and continue to be prosecuted for this. It seems laws exist for snake oil salesmen, but not for misleading or biased scientists or doctors. Competing interests: Chair of Scientific Advisory Board, Ultralife (UK) Ltd (a UK-based supplement/functional food company); Director, Alliance for Natural Health, a non-profit campaign organisation working to protect and promote natural health using good science and good law. |
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Jonathan Waxman, Professor hammersmith, w12 onn
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Ms Richmond presses for supportive non-medical treatments such as hair, skin and nail care to be available on the NHS for cancer patients. Great! We too believe this and supply similar services such as aromatherapy and massage. These services are paid for from our own non-NHS resources in our own hospital. And this funding oddity is a source of some chagrin for us clinicians. These benefits were supplied directly by the NHS and have been shut down as an 'economy measure'. We cannot though support services for any treatment without known benefit ... except to those who would profit from misery. Competing interests: None declared |
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jonathan waxman, professor W12 ONN
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Mr Sardi concludes that patients resort to alternative treatent because of the limited benefit of conventional treatment. Well now ... 'limited benefit'? Let's examine that phrase shall we? We have come a long way from nowhere in the discovery of cancer treatments. Now cure is the expectation for many cancers and there have been major benefits in the treatments of so many other incurable tumours. Let Mr S talk about 'Limited benefit' with the men and women cured of lymphoma and leukaemia, the children cured of cancer, the women with breast cancer saved by adjuvant treatment, the patients with metastatic colorectal cancer whose life expectancy has been doubled in the last five years thanks to the real benefits of molecular medical research. It is a puzzle for us straight docs that patients resort to alternative treatments with absolutely no known benefit. But we forget that there is some benefit ... the financial gain to those traders in fools gold and pieces of the real cross. It is a puzzle, a puzzle explained by the death of hope in the hospitals and the gain of false hope in the market place of hair restorer and the elixir of life. Competing interests: None declared |
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Robert M Pittilo, Principal and Vice-Chancellor Robert Gordon, University Aberdeen AB10 1FR, Michael McIntyre
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Editor-Waxman (1) alerts us to the risks associated with complementary and alternative medicine and the paucity of the evidence base regarding effectiveness. He does however fail to acknowledge what the government has done to ensure that the public are protected from poor practice including denial of access to effective orthodox care. Osteopathy and chiropractic are now statutorily regulated and plans are well advanced to extend this to herbal medicine, acupuncture and traditional Chinese medicine practitioners. The Prince’s Foundation for Integrated Health, with support from the Department of Health, is also working with other therapies to implement effective voluntary regulation and encourage effective research for complementary and alternative medicine. These measures will help ensure that the public is protected from bogus claims and not subjected to treatment of no benefit. A new EU Traditional Herbal Medicinal Products Directive will shortly require all herbal medicines sold over-the-counter to be licensed and to carry indications for their use confined to minor self-limiting conditions. The UK Medicines and Healthcare Regulatory Agency is also reforming the part of the 1968 Medicines Act which sets the rules for prescribing by professional herbalists who are trained to know the limits of their competence and when to refer. The public access complementary and alternative medicine not just, as Waxman (1) asserts, hoping for a cure but because of the comfort and relief offered. Sometimes this is in situations where all orthodox approaches have been exhausted. There will always be those seeking to exploit vulnerable members of society with expensive treatments promising hope where there can be none. The above measures will help eradicate this ensuring that no one is denied the benefits of conventional medicine and that false claims are not made for unproven therapies. R Michael Pittilo, principal and vice-chancellor,
Robert Gordon University, Aberdeen AB10 1FR
Michael McIntyre, medical herbalist,
Chipping Norton OX7 6SF
1 Waxman J. Shark Cartilage in the Water. BMJ 2006; 333:1129 (25 November) Competing interests: RMP is chair of the Department of Health (England) for the statutory regulation of herbal medicine, acupuncture and traditional Chinese medicine and a trustee of the Prince’s Foundation for Integrated Health MM is Chair of the European Herbal Practitioners Association and a member of the Department of Health (England) for the statutory regulation of herbal medicine, acupuncture and traditional Chinese medicine and a trustee of the Prince’s Foundation for Integrated Health |
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jonathan waxman, professor HAMMERSMITH W12 ONN
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Dr Downey is critical of Big Pharma. But we know, don't we just know, know if we examine the matter critically, that without the Drug Companies, we would not be able to cure leukaemia, lymphoma, testicular cancer, nor childhood malignancy. Nor would we be at a wonderful point in the history of cancer treatments. We are at this point because of the miracle of molecular biology, because of the profit motive, driving Industry. We can promise so much now and we will be able to give so much more soon, to those women with breast cancer who struggle for treatment with herceptin and to those men and women with colorectal cancer whose life expectancy and been doubled in the last five years. Dr Downing, there is no conspiracy. Be thankful for the profit motive that has driven so much change for the good. Competing interests: None declared |
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jonathan waxman, professor w12 0nn
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Dr Nobel in his letter makes the reasonable points that there is a distiction between Complementary and Alternative Therapies and on matter this we agree. He also points to the difficulty in regulating the Internet and this is a major problem for those people with cancer who seek help from the Net. May I recommend to BMJ readers that they view some of the patients' websites available on the Internet where the pathos of such exeriences are heartrending described. Competing interests: None declared |
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jonathan waxman, professor Hammersmith w12 onn
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Dr Shepherd argues that there is legislation in place to guide and protect the consumer from the hair restorer salesmen who ravage the hearts and pockets of cancer patients. I would argue that although the legislation is there, it is too passive a piece of legislation to be effective. The onus is on the law enforcers to prosecute, and not on the tradesmen to be honest. Such a prosecution is a difficult journey, a journey that I have travelled with the law, in prosecutions made through the agencies of the Prostate Cancer Charity which I founded. Competing interests: None declared |
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jonathan waxman, professor hammersmith w12 onn
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Dr Budd recommends that Kevin Barraclough reads Richard Dawkins' work ... I know that he has and so the recommendation is not needed! He also comments that patients' irrational beliefs should not be 'rubbished'. Certainly, as doctors, we cannot take away hope. Of course not: it is our duty as physicians to inspire some hope. But we cannot provide confident support that transmutes the false claims of charlatans. Competing interests: None declared |
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jonathan waxman, professor hammersmith w12 onn
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Dr Holmes wonders wether there is any harm to complementary therapy. Certainly there is, and just this month in my clinic there have been patients with deranged liver and renal function tests, heart failure and thromboses from such patent 'cures'. First do no harm? Indeed. Competing interests: None declared |
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jonathan waxman, professor hammersmith w12 onn
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Ms Thompson has one view of cancer research and treatment. but many of us have another view that encompases the reality of the last 40 years. May I take this opportunity to remind Ms T that in the 1960's it was the expectation that most patients with cancer would die, and indeed my own most impossible childhood memomory is of a young boy who was a patient of my father, who died in 1964 from leukaemia. He would have survived in this current decade where the majority of patients with lymphoma, almost all children with solid tumours and haematological malignancies, and most adults with testicular cancer and leukaemia are fortunate to be cured. And what about the death rates from other more common cancers? Well, deaths from breast cancer have fallen by 30% and from cervical cancer by 50% in the last decade. 'Research' has shown that cigarettes do cause cancer and the decline in smoking that has followed this observation has led to a drop in lung cancer deaths by 40% over the last 15 years. Let us look at the common metastatic cancers and note that the median survival of patients with colorectal cancer has doubled in the last five years as has that for women with breast cancer. So!! How come this has happened? Has the air supply changed, do we have the Martains to thank for these advances? I don't think so. We have the Pharmaceutical Industry and Charity to be grateful to. And what about the Universities? Yes of course, there are the academic researchers many of whom, were, and are sponsored, as I was and am, in my own training and work, by the Cancer Charities. Competing interests: None declared |
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Jonathan waxman, professor w12 onn
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Yes, there is objectivity in the evidence backing my view that cancer patients are being cynically exploited. I note the relevance of the 'competing interests' cited by Dr Verkerk in correspondence with the BMJ, competing interests that devalue the currency of his own comments. Competing interests: None declared |
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jonathan waxman, Professor hammersmith w12 onn
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I am aware of the EU legislation concerning traditional herbal medicines. This will regulate a small part of an enormous market. It is clear that further legislation is required to limit the exploitation of the sick. Competing interests: None declared |
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Alexander SD Spiers, Professor of Medicine (Retired) N/A
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As a medical oncologist I applaud Professor Waxman's condemnation of alternative medicine. I wish his contribution were printed on the front page of every national daily, because few patients or their families read the BMJ. I practised for some years in the United States, where worthless alternative therapies are an even bigger problem than they are in the United Kingdom. Eccentric diets, herbal remedies, ineffective and often toxic medicines, spurious "immunotherapy", coffee enemas, faith healing, acupuncture, organic foods and dietary supplements are a billion dollar per year industry. A supposed anticancer drug named laetrile became extremely popular and caused many cancer patients to discontinue orthodox therapy. There is no acceptable evidence that laetrile ever cured anyone of cancer. The Food and Drug Administration rightly refused to license laetrile, despite great political pressure. It was then promoted as a "vitamin" and marketed as a dietary supplement. As in the United Kingdom, this removed it from the regulatory powers that apply to drugs. Organic diets are undeservedly popular because they are marketed as "natural" and therefore must be good. As the New England Journal of Medicine pointed out, tuberculosis, syphilis and cancer are all natural but certainly not beneficial. In one celebrated instance in Boston, the parents of a child with lymphoblastic leukaemia removed him from effective chemotherapy and treated him with an organic diet. He succumbed to leukaemia a few weeks later. It is bad enough that business sharks can make millions selling worthless remedies. Much worse is that many patients die because they are seduced away from orthodox treatment that might cure them. Some proponents of alternative therapies are honest but deluded individuals, usually with an inadequate scientific background, but one must suspect that the majority are cynical sharks who want to make money. The promise of cure is a powerful inducement to embrace a quack remedy, because of the patient's intense desire to be cured. Some alternative practitioners are much better salesmen than orthodox doctors - and of course honest practitioners are handicapped because their ethics will not permit them to promise a cure. I strongly agree that unlicensed substances, dietary supplements and organic diets should be reclassified as drugs and scrutinised as thoroughly as the products of the pharmaceutical industry. Few or none of these so-called remedies would survive that process, and more cancer patients would survive because they adhered to scientifically established treatments. Competing interests: None declared |
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Croft Woodruff, retired health researcher Vancouver V5W 3A6
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Ancient and modern medical history is replete with broken and abandoned ideas. In the 20th century alone many medical concepts to which nearly all doctors once subscribed have collapsed, such as bacterial theories of scurvy, beriberi, and pellagra, and more recently, the viral theories of cancer causation - for which billions of dollars funded thousands of convincing research papers during the "War on Cancer." The 1976 swine flu fiasco saw President Gerald Ford solemnly urging all Americans to get vaccinated against an imminent deadly influenza epidemic. 50 million Americans were panicked into being immunized with useless or harmful vaccines rushed onto the market. Adverse reaction damage claims reached $2.7 billion. Not a single case of swine flu appeared subsequent to the death of one sick recruit undergoing basic training in a US army base. Aside from current examples of ongoing medical mistakes - that space does not allow to list - what makes establishment medicine so arrogant that it can never be wrong?
Competing interests: None declared |
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Michael Bending, Dip Massage & undergraduate of Chinese Herbal Medicine at the University of Western Sydney 10 Camera St, Manly, Sydney NSW 2095, Australia
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Dr Waxman shows a very one sided if not ignorant approach to research, medicine, cancer and now it seems also the law. Firstly let’s take a look at the history of snake oil. “Snake oil originally came from China, where it was used to alleviate inflammation and pain in rheumatoid arthritis, bursitis, and similar conditions. Chinese labourers on section gangs doing the work involved in building the railroad tracks to link North America coast to coast gave it to Europeans with joint pain (bursitis, arthritis). When rubbed on the skin above the pain, snake oil brought relief, so the story goes. Patent medicine men ridiculed the claim. Recent scientific analysis shows it contains 75% unidentified carrier material, presumably for emulsifying the snake oil and helping to transport it through the skin. It also contains camphor. The remaining 25% of the product is oil from Chinese water snakes, which contains 20% of the important omega 3 derivative eicosapentaenoic acid (EPA) as well as 48% myristic acid (14:0), 10% stearic acid (18:0), 14% oleic acid (18:lw9), and 7% linoleic (18:2w6) plus arachidonic (20:4w6) acids. At 20% EPA, Chinese water snake is the richest known natural source of the parent of series 3 prostaglandins, which inhibit the production of pro-inflammatory series 2 prostaglandins. Like essential fatty acids and their other derivatives, EPA can be absorbed through our skin. Salmon oil, the next- best source of EPA, contains a maximum of only 18% EPA. Other fish oils contain less. But the bottom line is that traditional snake oil is natural and therapeutic. The snake oil salesman is vindicated. The patent medicine salesman can expect a dimmer future.”[1] Like many people Dr Waxman seems to be mechanically repeating this derogatory medical, mythical mantra about snake oil without consciously researching its origins or without looking at the current scientific evidence for alternative and complementary medicine… Let’s have a look at this evidence based medicine that Dr Waxman espouses upon. The BUJ’s website Clinical Evidence reports that, of the 2404 treatments they have surveyed, only 15% are rated as beneficial, while 47% are of unknown effectiveness[2] Chemotherapy for cancer was found in a 2004 systematic review of studies in the USA and Australia to improve overall 5-year survival chances by less than 2.5%.[3] According to Don Benjamin, past Australian Commonwealth Scientific and Research Organization (CSIRO) researcher and spokesman for the Australian Cancer Information & Support Society (CISS) "it would be a good idea if orthodox health practitioners supply much of what they claim to provide. About 15% of orthodox medical interventions are proven to be beneficial, meaning that 85% are not." In the cancer field, where Don Benjamin has the most expertise on the statistical front, he says "less than 6% are proven to be beneficial. meaning that about 94% are unproven using the standard levels of proof that orthodox medicine requires of alternative practitioners, such as randomised controlled trials." The evidence for Don Benjamin's claims is in Part 1 of the submission by the CISS to the Australian Senate inquiry into services and treatment options for persons with cancer in March 2005, accessible as submission #15[4] A new study by the Breast Cancer Research Foundation (BCRF) -funded researcher Dr. Patricia Ganz and her colleagues at the University of California, Los Angeles (UCLA) shows a stunning correlation between chemotherapy and disrupted brain function known as "chemo-brain". The UCLA study reveals chemotherapy changes the brain's metabolism and blood flow -- changes that can last at least 10 years after treatment.[5] So after all this, just what evidence based medicine is Dr Waxman talking about? And which snake oil is he referring too? With regards to the law, the UK 1939 Cancer Act - section 4.1 prohibits '..the publication of any advertisement containing an offer to treat any person for cancer, or to prescribe any remedy therefore, or to give any advice in connection with the treatment thereof;’. What new laws does Dr Waxman suggest be enacted that this previous 1939 act does not already cover? [1] Erasmus, U. Fats that heal, Fats that Kill. P268. Burnaby, Canada. Alive Books. 1993 [2] http://www.clinicalevidence.com/ceweb/about/knowledge.jsp [3] Morgan G, Ward R, Barton M. The contribution of cytotoxic chemotherapy to 5-year survival in adult malignancies. Clin Oncol (R Coll Radiol), 2004; 16(8): 549-60. [4]http://www.aph.gov.au/Senate/committee/clac_ctte/cancer/submissions/sublist.htm or through the homepage of the Society at www.ciss.org.au [5] Breast Cancer Research and Treatment, published online Oct. 5, 2006 Competing interests: Facilitator of the non-profit Alliance for Health Freedom Australia. |
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jonathan waxman, professor hammersmith w12 0nn
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So the respondent is most welcome to treat himself with snake oil ... His question concerning legislation is important. The problem with the 1939 act is that it is a piece of legislation that is not active enough in its framing. For example if a cancer charity takes action against a company or individual in breach of the act, there is a need to pursue that company or individual in a lengthy action through the courts, an action that when complete often sees the individual in breach getting down to business again. I know this from my own experiences. Legislation needs to be brought up to date with an emphasis on the accurate description of the effect of the patent medicine or foodstuff. Competing interests: None declared |
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Leslie B Rose, Clinical Science Consultant Pharmavision Consulting Ltd, Salisbury, SP2 8NJ, UK
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I am perplexed by Robert Pitillo's statements about the regulation of various complementary therapies. Chiropractic and osteopathy may have statutory regulation, but this says absolutely nothing at all about whether they work. The proposed regulation of herbal medicine etc is exactly the same - nothing to do with efficacy. It will be no better than ensuring that people can tell fairy stories with conviction. The role of the Prince's Foundation for Integrated Health in this enterprise is entirely consistent with its other activities. For example, its Patient Guide to Complementary and Alternative Medicine, published last year partly with government funding, excluded any consideration of evidence for efficacy, despite this being a requirement specified by the Department of Health. Indeed expert advice in this regard was ignored. Yet Pitillo says that "These measures will help ensure that the public is protected from bogus claims and not subjected to treatment of no benefit". The EU Directive to which Pitillo refers actually allows claims of efficacy in the total absence of evidence by all generally accepted scientific standards. Is this sending the right message to consumers? Competing interests: None declared |
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Leslie B Rose, Clinical Science Consultant Pharmavision Consulting Ltd, Salisbury, SP2 8NJ, UK
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Much of what I had intended to say here has been covered by other respondents, so I will just make a few brief points. It is a major benefit of the electronic age that learned journals now reach out to a much broader range of readership. But it's important that we still adhere to rational principles, and to the truth. It is not true that cancer was rare 100 years ago (see Marlene Thompson's response). Until the 1960s it was only talked about in lay circles in hushed tones, if at all. King George VI's death was announced without mentioning any cause, although it is now generally taken to have been lung cancer. Neither Waxman nor anyone else to my knowledge claims that conventional therapies are 100% evidence-based. But it is quite misleading to imply that most of them are not. Those who cite the Clinical Evidence analysis misunderstand the data. They are counting sheep when they should be counting goats. Uncertainty may be embedded in science, but does that allow us to ignore evidence? Finally, I am in a strong position to comment on Marlene Thompson's last sentence. I do have cancer, and I am absolutely convinced as to which route I will take. It will be the one based on the evidence, and not on magic. Competing interests: I was diagnosed with myeloma 9 months ago. |
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Kate Nurse, chiropractic student home
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I was diagnosed with cancer 12 years ago. Within the space of a few minutes all the control of my life was handed over to the medical profession. Maybe I was lucky that they treated me with the utmost respect and kept me informed of everything that they were doing and why. Even so I still turned to alternative medicine, not as a a means of curing the cancer but as a way of supporting the treatment that I was receiving. My belief was that if I could make myself as healthy a being ( mental, physical and spiritual) for the duration of the treatment then I would be aiding the recovery from it and Yes, I suppose gain hope also. Perhaps it was just to regain some form of control back. If I had just sat there and done nothing, would my recovery have been so quick and definite or would it have taken longer and taken an even greater toll on my body than it did. Statistics show that there are people who have recoverd from all types of cancers but there is always a % of people who will not recover from a cancer, no matter how common as well as those who recover against the odds from cancers that have a very small % of recovery. Is it hope that makes the difference? If so, then it should be readily available and places like the Bristol centre are invaluable in helping to provide this. Competing interests: None declared |
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Stephen Kane, writer Ivybridge, PL21 0DF
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Having experienced the benefits of underfunded, "non-scientific" medicine, I was amused by Jonathan Waxman's polemic on the subject. After being diagnosed with tuberculosis of the spine, I was prescribed four antibiotics for 21/2 years. When this "scientific" treatment failed, I was diagnosed with SAPHO and started on two more antibiotics. When this treatment started failing, I gave up on "scientific" MRIs, CT-scans, scintigraphies, x-rays, biopsies, antibiotics and painkillers - and started on a homeopathic medicine. The disabling symptoms I'd been enduring for six years by then were largely gone in 48 hours. And a subsequent scan demonstrated the medicine's effectiveness. I subsequently experienced the same success with crystal therapy for the colitis and bladder irritation caused by the antibiotics - the "scientific" treatments for this also having failed to help. A treatment with magnesium chloride sorted out the spinal damage for which, I had been advised, there was no alternative to surgery. My wife then cured her ankylosing spondylosis with some nutritional supplements after the non- effects and side-effects of her specialist's treatments became intolerable. I don't recall relatives ever persuading us to try these or similar forms of treatment - we just invested some time in researching the available data, anecdotal or otherwise. Now we use them as our first-line response to problems - simply because they usually work. It's unfortunate that Jonathon Waxman and so many of his peers believe that double-blind standards are alternatives to real-world, clinical experiences - I know, for example, of one doctor who routinely cures "terminal" cancer cases with homeopathic and other such medicines - until, at least, patients start keeling over from "side-effects." Waxman may believe that legislating often more effective treatments out of existence will be a good way to keep a populace, increasingly disgruntled with "scientific" arguments in favour of poor practices, under control - it has been ever-thus with all coercive religions. But I suspect that suppressing the competition too forcefully will ultimately result in the usual backlash to such repression. Then Waxman might find himself having to explain his lack of knowledge or interest in methods of treating cancer that so often cure people who have been failed by his "scientific" beliefs and so much more profitable patent medicines. Competing interests: None declared |
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Robert Verkerk, Executive Director Dorking, Surrey RH4 1XA
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I wasn't for a moment suggesting that there is no cynical exploitation of cancer patients - and this I am sure we all condemn. However, I pointed out to you that there is a legal mechanism available for dealing with such offenders - and this instrument finds itself used from time to time. Any of us, you included, are able to report suspected offenders to the MHRA who often respond swiftly to breaches of law. I am surprised that you point the finger at my declared competing interests, given that you have declared none and that I would be very surprised if you or other members of your department have not received funding or support from pharmaceutical companies or any other element within the private sector. You may have noted a pertinent comment about disclosure in a recent edition of Nature Medicine (Nat Med. 2006; 12(9): 979) which states: "Researchers' disclosures of competing financial interests are undergoing a dangerous transformation from instruments of transparency to evidence of wrongdoing." Prof Waxman - you have used an honestly declared competing interest in an attempt to invalidate scientific opinion - and this is hardly cricket. If others in your profession were to follow your example, you would have to devalue the significance of virtually all the drugs and treatments you and your colleagues use in your daily practice. You leave me wondering if those of you working in senior medical positions in universities and hospitals are being as transparent as you might be when you choose not to declare competing interests. Competing interests: Chair of Scientific Advisory Board, Ultralife (UK) Ltd (a UK-based supplement/functional food company); Director, Alliance for Natural Health, a non-profit campaign organisation working to protect and promote natural health using good science and good law. |
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Pat Rattigan, Truth Campaigner S41 0HH
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"It is utter nonsense to claim that catching cancer symptoms early enough will increase the patient's chances of survival. Not one scientist or study has proven that in any way. My studies have proved conclusively that untreated cancer victims live up to four times loger than treated individuals. If one has cancer and opts to do nothing at all, he will live longer and feel better than if he undergoes radiation, chemotherapy or surgery ; other than when used in immediate life-threatening situation. ... .. it is not the cancer that kills the victim. It’s the breakdown of the defence mechanism ... With every cancer patient who keeps in excellent physical shape .. to build up his natural resistance, theres a high chance that the body will find its own defence against the cancer. He may have many good years left in good health. He shouldn’t squander them by being made into a hopeless invalid through radical medical intervention which has zero chance of extending his life.” Leading US cancer statistician, Prof H B Jones, Dept. of Physics and Physiology, Univ. CA., Berkeley. 1975. Comments on the above WITH particular reference to the peer-reviewed, scientifically-valid refutation of THIS - "Not one scientist or study has proven that in any way." Competing interests: Truth Campaigner |
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Krystyna Krzyzak, medical herbalist National Institute of Medical Herbalists, Elm House, 54 Mary Arches Street, Exeter, Devon EX4 3BA, Alix Rodwell
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Professor Waxman’s article raises several points that the National Institute of Medical Herbalists would challenge. We are in agreement with his comments on self-prescription of OTC products for which unsubstantiated claims are made. We ourselves receive many enquiries from the general public concerning efficacy and safety of such products. However, this is just one of many ways in which cancer patients seek to retain some element of control over their disease, and their lives, during a critical period. Professor Waxman suggests that pursuing unorthodox methods of treatment “may” delay the institution of “conventional therapy”. In our experience this is not so. Many patients who have been diagnosed with cancer come to a medical herbalist for help and professional advice, and find that herbal medicine can alleviate symptoms such as anxiety, and some of the side effects from conventional treatments such as chemotherapy and radiotherapy. In these instances we aim to integrate our approach with those of the patients' GPs and oncologists. Our assistance in improving the patient’s general wellbeing is appreciated by patient and orthodox practitioner alike. Contrary to Professor Waxman’s suggestion that “complementary” practitioners will claim to cure cancer, both legislation and our strict Code Of Ethics preclude us from making any such claims. We are not ashamed to admit that we offer hope, but it is hope of an improved quality of life, not necessarily its prolongation. We are also intrigued by Professor Waxman’s assertion that the quality of a patient’s diet makes little difference to the outcome of their disease. It is common sense that an improved, healthy diet will enhance a patient’s health status, and thus potentiate the benefits that orthodox therapy can provide. It is a pity that Professor Waxman has chosen to tar all "complementary" practitioners with the same disdainful brush. Research into the qualifications of healthcare professionals such as medical herbalists – who are trained to university degree level, and combine conventional medical skills with a science-based understanding of phytomedicines – and a more measured approach, would have lent balance and credibility to his findings. nimh@ukexeter.freeserve.co.uk Competing interests: KK and AR are medical herbalists and council members of the National Institute of Medical Herbalists |
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Alex Avery, Director of Research Hudson Institute, Center for Global Food Issues
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I applaud Dr. Waxman’s clarion call to confront the new age global snake oil industry. One of the most egregious actors in this sad tale is the organic food industry, which despite 70+ years of trying has yet to demonstrate a single health benefit from consuming a diet of organic food – even from birth. Isn’t it about time that we demand that the organic food industry provide solid evidence for its claims or shut up? Why does the press continue to parrot the self-serving propaganda of the organic food marketers as gospel truth? Why has the organic food industry been allowed to lead the rest of the ag sector by the nose into oblivion? Why has the self-serving organic industry been allowed a virtual veto on superior genetic engineering and biotechnology in crop improvement? The consequences of the modern snake oils industry are far and wide. Modern snake oils are a serious and malignant growth in our public health system and it’s about time we cut them out or expose them to the tumor-killing light of reason. Cheers, Alex Avery Director of Research Center for Global Food Issues, Hudson Institute PO Box 202, Churchville, VA 24421 Competing interests: None declared |
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Raymond G Holder, Retired engineer BH9 3NF
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Prof Waxman is enthusiastic in the praise of drug companies who fund research, but does not that funding come at a price? Such funding appears to be only given to projects which will improve sales of their present or future products and research on non-patentable materials is not carried out or is even actively discouraged. An example of this is that most essential factor of all life, plant, bacterial, animal or human, Coenzyme Q, needed for energy transfer in all cell action and without which no cell can function. The human form is Coenzyme Q10, discovered in USA, its structure determined by Dr Karl Folkers while working for Merck, and synthesised by him, but Merck decided not to pursue the subject, probably because, as a naturally occurring substance, it had no prospects of generating large profits, and also because the cholesterol lowering money spinner was then showing its golden outlook for them, and CoQ10 could dent that project. The Japanese took the subject up, found a simpler way to make CoQ10, and launched into much research and many trials. It was authorised for heart treatments, for which it has great success and some success in breast cancer treatment and diabetes ensued,( it became one of the 5 best selling medications in Japan), but the Western world seems to have been too beholden to big Pharma to dare to make trials of the substance and it appears to be regarded as being in the same category as snake oil. Nothing could be further from the truth, any medical person holding that view would be in the same category as a computer engineer who thought the transistor was an irrevalent part of the most complicated computer. A product of Pharma funded research ruined my life, the rejected CoQ10 has saved me from the succumbing totally to drug side effects, and is now totally necessary for my continued existence. Competing interests: statin damaged patient |
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Gail Easterbrook, Drug Information Specialist Pharmacist Flinders Medical Centre
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Professor Waxman is right about complementary medicines and exploitation of those facing extraordinary life circumstances. The CAM industry is exploitative in other ways, including providing drug pruducts with known performance defects: The complementary medicines industry uses a range of vitamins for conventional and unconventional purposes. In Australia and the USA, the regulatory authorities became aware of the fact that, many of these products containing folic acid, disintegrated in accordance with the relevant pharmacopoeial standard for the oral solid dose form, but they did not dissolve in a physiologically safe time frame after ingestion (and therefore were not bioavailable). Because folic acid is important as a preventative agent for neural tube defects the agencies have regulated these products (against the industries protests about the extra expense) to at least perform "pharmaceutically" as demonstrated by standardized dissolution tests. They have not so regulated the rest of the CAM inventory. So it is known that without such regulation a significant proportion of the CAM products will not perform. This may of course be protective (against needless toxicities) but it is also very deceptive. Competing interests: None declared |
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Damien Downing, Doctor Harley St W1
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Neither Prof Waxman nor I, nor anyone who practises any form of medicine for a living, is in a good position from which to decry the profit motive in medicine; we’re all like Tom Lehrer’s “...old dope peddler, doing well by doing good”. And yes, we do need a pharmaceutical industry — though preferably one that is effectively regulated, sensitive to public needs and not monopolistic. But I didn’t think, or suggest, there was any conspiracy going on until Prof Waxman brought it up in his response to me - then I started to wonder. A striking parallel emerged between this debate and the circumstances in physics and cosmology, lucidly described by Bryan Appleyard in the BBC’s Today programme debate from the Royal Society on Thursday; for 20 years, Appleyard said, scientists, including Stephen Hawking, have been claiming that we are on the verge of having a workable Theory of Everything (“knowing the Mind of God”) but in fact it’s no nearer now than it was 20 years ago. Oncologists - all of them it seems to me - are currently keen to promise that a new Golden Age of Oncology is just around the corner, in which cancer will be a chronic disease controlled and made non-life-threatening by miraculous new drugs. But 40 years ago we were promised that by throwing dollars at the problem of cancer scientists would soon have it fixed, and they didn’t; what reason to believe the oncologists this time round? Appleyard’s phrase was “the arrogance of the contemporary”, which is how I saw it until now. Isn’t this promise of a cancer cure the real “unsubstantiated claim”? Take the case of herceptin, since Prof Waxman raises it; the media have generally agreed that herceptin increases survival by around 50% — a conclusion based on the two key studies [1, 2]. But this is based on the figures for the relative risk of disease-free survival; the figures for improvement in absolute risk of overall survival are 4.8% and 0.9% respectively (I would be very interested if Prof Waxman can show otherwise). Hardly a “miracle”, indeed the campaign to have trastuzumab approved by NICE, on the grounds that it is a breakthrough in treatment, looks to me like the real “vile and cynical exploitation”. And when Big Pharma consistently seek to manipulate the stream of scientific information (as extensively documented, and discussed further in this issue of BMJ), the general media happily cut and paste their press releases (as we all know they often do), and oncologists campaign against alternative therapies which might pinch a fraction of the massive funding needed for the new wave of cancer treatments — well, doesn’t it start to look like a conspiracy? 1. Romond EH, Perez EA, Bryant J, et al. Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med 2005;353:1673-1684. 2. Piccart-Gebhart MJ, Procter M, Leyland-Jones B, et al. Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. N Engl J Med 2005;353:1659-1672. Competing interests: I practise nutritional medicine |
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Michael W Nield, Charity Volunteer Cambridge CB2 2DT
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I have two points for Prof. Waxman with regard to disease prevention. First: As noted by Bill Sardi in a recent article, Vitamin D is vital to human health and a powerful steroid hormone precursor. Prof. Cedric F. Garland of the University of San Diego published a review of 63 studies on vitamin D in the February 2006 issue of the American Journal of Public Health.(1) It did not reveal anything new, but rather tabulated results from scientific reports conducted over the past 40 years that public health authorities had ignored. >1000 IU of vitamin D3 reduced risk of developing most cancers by 30-50% with few or no adverse effects. Since D3 costs a few pennies per pill, the authors noted this is a pretty good cost/benefit ratio even discounting all the other benefits discovered. An hour of total body exposure to midday summer sun at a southern latitude produces about 10,000 IU of vitamin D in the skin without causing toxicity. How would Prof. Waxman restrict access to vitamin D, such a powerful drug? Will he ask Brussels to regulate sunlight exposure? Will we only be allowed out for 5 minutes a day during summer? Second: With such disdain for nutrition and a penchant for pesticides, I'm sorry to say that Prof. Waxman stands an above average chance of being hoisted on his own petard. A recent life expectancy study in Britain showed that there is now a growing gap between rich and poor, a | |||