The prince and the professor: Summary of responses
BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7470.859-b (Published 07 October 2004) Cite this as: BMJ 2004;329:859
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In a sense, David Carvel was right...pop or maybe popgun? "A man
cannot become a competent surgeon without the full knowledge of human
anatomy and physiology, and the physician without physiology and chemistry
flounders along in an aimless fashion, never able to gain any accurate
conception of disease, practicing a sort of popgun pharmacy, hitting now
the malady and again the patient, he himself not knowing which." [Sir
William Osler, 1849–1919]
The modern approach to cancer is a good example of popgun pharmacy
and indeed much of modern medicine follows the same approach. The toolkit
of medicine is a chemical toolkit founded on an exclusively chemical
theory of disease cause. Note well that word: theory. That it so often
fails, and were they genuinely scientific, should encourage its adherents
to question and revise theories and methods in the light of changing
situations. The conceptual toolkit is just as bad. The concepts of disease
cause have been static and set in concrete for a century. No change to
them is anticipated in the coming century, not least from the lowly likes
of CAM. God forbid!
Cancer provides a good example of what is wrong with medicine as a
whole. Modern cancer treatment does "flounder along in an aimless
fashion," and it reflects a profound and dangerous ignorance of "the full
knowledge of human anatomy and physiology," to which Osler alludes. Just
consider what an ideal form of medicine would be like.
The ideal type of treatment would subdue the ferocity of the disease,
push the disease process into reverse, with no unpleasant side-effects,
diminish the tumours to zero and cleanse the entire system without any
nasty chemical drugs and without cutting body parts out. That is precisely
what medicine should be doing with cancer and all diseases. It does not
even attempt such a gentle approach. It should also respect the dynamic
structure of the body and its functional totality. In truth, the repulsive
vivisection of cutting parts out and applying a blitzkrieg of nasty drugs
pays no respect to the patient whatsoever. Such methods seem to be
reliably grounded in profound ignorance of the dynamic structure of the
body.
Disease affects the whole person; it is an interconnected whole, not
a machine made of parts. You cannot destroy the cancer in the breast, so
you remove the breast. You cannot remove the breast without removing the
axillary lymph glands, all with dire consequences. And so on. This doomed
and destructive approach ever fails because it destroys the functional
totality of the organism and blithely blunders on mutilating the patient.
Any fool can see these are the wrong methods, founded as they must be
upon wrong principles. And these really are the "unproven methods" Baum
talks about—as the track record clearly shows. No wonder some good people
would rather die nastily of cancer, but in one piece, than face the
undignified anatomical holocaust of being legally processed into a mutant
possessing considerably less anatomy than they were born with. Where
really is the sense in all this? Where is the justification, the sound
rationale? It is demonstrably a desperate, degrading and failed approach.
Why dress it up as anything else? It is an absolute failure.
While cancer is basically a disease where a cell has learned to
outsmart the system i.e. to become immortal, the aim of proper treatment
should be to reverse that, rather than cutting out parts and irradiating
the system in the full knowledge that the latter will cause future
cancers, although most patients won't have to worry about living long
enough under established treatments. Cancer is a systemic disorder that
requires a systemic treatment.
By contrast, the Gerson approach, for example, is basically a more
extreme form of nature cure, one where fasting, fruit juices and enemas
are common practice. Yet, it is well-suited to a pretty extreme disease.
The obvious objective is to purify the whole body—the functional
totality—in every possible way and this comes close to the purging methods
of old and to things like hydrotherapy, saunas and 'sweating things out.'
All such approaches are purificatory therapies, designed to purify the
body of toxins, which are imputed as the deeper causes of sickness, and to
enhance the natural recuperative powers of the organism.
Anyone who has observed or employed such methods knows full well that
far from being way-out whacky stuff, their underlying rationale is amply
justified by the results. A statistical comparison of treatment outcomes
between Gerson and the methods of modern medicine might convince Baum of
its value.
Along with hydrotherapy, saunas, abdominal massage, reflexology,
spinal manipulation and vitality enhancing therapies like acupuncture and
homeopathy, such approaches can indeed push the disease process into
reverse, reduce tumours and cleanse the entire system. The same methods,
used for many less destructive ailments, refresh and tone up the body,
improve sleep and the mind - they enhance wellness and a sense of well-
being as well as subduing sickness naturally, gently and with no ill-
effects. They do indeed conform to the above concept of an ideal medical
system.
Medical bigots like Baum seem to despise CAM because they don't
believe in it and because it falls outside the hallowed realm of 'orthodox
science,' to which they seem fanatically welded as the only respectable
medical belief system. Either through sheer bigotry or arrogance, or a
mixture of both, they just cannot stomach the fact that so many patients
would rather try empirical systems like CAM, than face the legalised
mutilation these orthodox practitioners inflexibly showcase as the only
possible approach. It proceeds in the blind name of dead-end reductionist
chemistry, which continues to offer no alternative and which does not even
have a proven track record of success.
People would clearly rather die naturally of cancer or use CAM, than
be mutilated beyond recognition and then have to die in disgrace and
indignity anyway, first of their disease and second, from the evil effects
of its iatrogenic mis-management. These are the main reasons people will
try CAM alongside or instead of the standard radiological and chemotherapy
approach. Is it really any wonder?
O'Donnell jokingly says the patients are the real paupers. I don’t
think it was the cheap point he was scoring, but unwittingly he is right
in the sense that they get a very raw deal. Cancer treatment is like some
anachronistic failed industry long overdue for demolition. What other
industry in the world would tolerate blinkered adherence to one failed
approach, dominant for over fifty years and responsible for 159,302 deaths
a year = 436 people per day, [1; 2002] in the UK, yet still hailed by
orthodox bigots as the only approach? And like some repulsive cuckoo in
the nest, it takes all the research money and prevents any other views
from even getting a hearing.
This was precisely the point Prince Charles was making - at least
give the alternatives more of a chance to show their potential worth. What
is really so outrageous, so abhorrent and so unthinkable about such a
modest and sensible proposal? How could they do much worse than the
present track record? To dogmatically rule out all other approaches, in a
situation of long-standing and unmitigated failure, beggar's belief. The
paupers actually deserve better, a lot better; give CAM a chance.
Competing interests:
None declared
Competing interests: No competing interests
Why the confusion?
The pauper is clearly the patient.
Even your most eager rapid responders must know there many more more
painful forms of impoverishment than shortage of cash
Competing interests:
Like David Carvel I fear this debate is disapearing up is own fundament
Competing interests: No competing interests
Perhaps "Pauper" was a typo for "popper". My tatty dictionary gives
numerous definitions which may shed some light.
Popper (Karl Popper 1902-1994) Philosopher known for his
contributions to scientific reasoning and his attacks on historicism.
Author of "The logic of Scientific Discovery" 1931 & "The Open Society
and its Enemies" 1945. (mm..maybe)
An ampoule of amyl nitrate. (probably not)
A container for popcorn (doubtful)
A dagger (after Chaucer) (certainly could be seen as one in the back)
One who takes a "pop" at another. (ah that's the one!)
Competing interests:
A realisation that my contribution does not take this debate forward but then, where else can it go?
Competing interests: No competing interests
Indeed, who is the Pauper - the bmj perhaps?
Competing interests:
None declared
Competing interests: No competing interests
There appears to be an ambiguity in the title of Dr Baum's letter.
This concerns his use of the word 'pauper.' I take a pauper to mean a
person who is *very poor* and thus a person who is eking out some meagre
kind of living on *a fraction* of the average wage.
The average UK wage is roughly £25,000 per annum. Thus, a real pauper
might be construed as a person living, or rather existing, on
significantly less than this, for example, £10,000 per year or possibly
much less?
In which case, who is the pauper Dr Baum is referring to? The title
of his letter clearly implies that it is not Prince Charles, but Dr Baum
himself who is the pauper. Well, there lies the problem. Is he suggesting
that he himself is eking out some perilous kind of living on less than
£10,000 per annum? One hardly thinks so.
The average London salary is approx £600 per week or £31,200 per
annum, some 25% higher than the UK average. The salary of an average UK
medical consultant is £82,000 to £90,000 per annum. A man of Baum's
experience is probably earning significantly more than that. Indeed, if
you apply the equivalent London weighting of 25% to a UK consultant salary
of £90,000 then you get a salary of £112,500 per annum.
Therefore, on the basis of such calculations, one feels entitled to
say that Baum's use of the term 'pauper' is certainly ambiguous and
misleading. It might also be construed as cynical considering that he
probably earns ten times what most modern day paupers actually earn.
One wonders therefore why he chose that title and that word, for he
clearly is not a modern day pauper, and not by any stretch of the
imagination.
As Dr Nerhlich has already hinted, it might have helped Dr Baum's
case if he had not sent a further letter in to BMJ at all.
Competing interests:
None declared
Competing interests: No competing interests
Once again Michael Baum’response shows very little humility.
He is pleased that in “his own subject” breast cancer, the last 20
years have shown remarkable progress. During this time we have also
witnessed the most appalling increases in breast cancer the world has ever
seen.1,2
These increases are mostly due to the increasing use of hormones for
contraception and/or as menopausal hormone replacement therapy (HRT) and
to the false claims of safety and benefit of such use based on "evidence"
from epidemiological trials. Even the celebrated Women’s Health Initiative
Study, which eventually gave lie to many of the false claims of safety and
benefit, still underestimated the harmful effects of hormone use. Most of
the women, randomised to take placebos or HRT in this trial, had taken
hormones before. How many women in the WHI studies had never ever taken
hormones remains a mystery to me. They would form the only scientifically
valid control group.3
I repeat, it is not clever to have to give women anti-hormones to
treat cancers which have been caused by unnecessary exposures to hormones
in the first place.
I also repeat that enemas can help clear toxic metals from the gut,
which otherwise can re-enter the blood stream. Toxic metals are
potentially carcinogenic by forming DNA adducts. The number of DNA adducts
can be reduced by use of nutritional supplements.4 John Briffa is right
that coffee induces enzymes and therefore speeds up liver clearance. This
allows a more rapid metabolism of carcinogens like benzpyrenes.5
Michael Baum appears to be out of touch with some of the most
important discoveries in evidence-based Scientific Medicine.
1 Grant ECG. Increases in breast cancer incidence
http://bmj.com/cgi/eletters/328/7445/921#55298, 1 Apr 2004
2 Grant ECG. Re: Rapid Responses; Authors' reply.
http://bmj.com/cgi/eletters/328/7445/921#55843, 6 Apr 2004
3 Grant EC. Estrogen plus progestin and colorectal cancer in
postmenopausal women.
N Engl J Med. 2004; 350: 2417-8.
4 McLaren Howard J. The Detection of DNA Adducts (Risk Factors for
DNA Damage). A Method for Genomic DNA, the Results and Some Effects of
Nutritional Intervention. J. Nutr. & Env. Medicine. 2002; 12: 19-31.
5 Capel ID, Grant ECG, Dorrell HM, et al. Disturbed liver function in
migraine patients. Headache 1979;19:270-272
Competing interests:
None declared
Competing interests: No competing interests
I welcome Professor Baum’s attempts to draw a line in the sand
regarding the brouhaha he sparked with his open letter to the Prince of
Wales (1). Having read his response, however, I wonder whether what he
has done is not to draw a line in the sand, but redraw the battle lines.
Baum says he believes there is a role for interventions such as
therapeutic massage, acupuncture and counselling to "help the patient feel
better", but resists "the claims that these approaches alone can cure
cancer". I have been absorbed in the field of natural medicine for more
than a decade, and have never heard or heard of anyone involved in these
disciplines making such a claim. And even if such a claim were made, on
what basis does Baum dispute this? Baum clearly believes wholeheartedly
in the scientific process. I’m assuming therefore he has a stack (or at
least a couple) of studies that show these treatments are ineffective as
cures for cancer. I invite the Professor to produce the science on which
he bases his judgement.
If the science is not there, then are we to conclude that Baum’s
views on natural medicine are based on prejudice? My suspicion is that he
would dispute this, in which case perhaps his judgement is founded on his
clinical experience of what seems to work, and what doesn’t. Which often,
by the way, is precisely the same approach taken by the naturally-oriented
practitioners he seems to have such as low opinion of.
Throughout his response, as he did in his original letter, Baum gives
the impression that modern medicine is evidence-based. One responder to
his original letter attempted to enlighten the Professor as to the rather
unscientific and unproven nature of much of medical practice (2). Such
conclusions have come not just from sceptics, but also from members of the
conventional medical establishment. But Baum seems unmoved by such
things, and doggedly bangs the drum for conventional medicine despite the
fact that the vast majority of people diagnosed with cancer end up dying
from it, and that conventional cancer treatments can contribute
significantly to both morbidity and mortality.
In his response, Baum likens natural therapies to ancient medical
practices that he says "didn’t work and increased the patient’s
suffering". Again, where’s the ‘evidence’ for any of this? And, while
we’re on the subject of things that often fail to work and can increase
the patient’s suffering, Baum need look no further than the conventional
cancer treatments he appears to have so much faith in.
Maybe in an effort to counter the notion that he is ‘cold-hearted’
and prove he really does care, Baum sets out his ‘manifesto’ for cancer
patients’ needs. Symptom suppression and access to potentially curative
treatments (should a patient want these) are clearly important, but I
reckon Baum has missed a few things. My experience is that individuals
suffering illness usually desire that they are heard and have their views
and wishes respected. They also may possibly like to engage in the
decision-making process (and not just be told what they ‘need’), and to be
their own advocates. Apart from talk of negotiating with patients over
risk/benefit balance, I note Professor Baum makes no mention of such
healing arts.
His seemingly dismissive attitude to the importance of emotional well
-being is clear elsewhere in his response when he accuses certain "new
age" spiritual practices of being dressed up as "cure by magic". Surely
even the Professor will recognise that spiritual practice (such as
meditation or prayer) has the potential to influence emotional or
psychological well-being, which in turn may reflect on the function of the
immune system. Perhaps Baum should spend a little time delving into the
established branch of science known as psychoneuroimmunology. To suggest
that spiritual practices dress themselves up as some sort of "magic" not
only denigrates such practices, but also exposes Baum’s rather mechanistic
view of the body.
Baum seizes on the recent publication of a study in which
antioxidants were shown not to reduce risk of gastrointestinal cancer and
might possibly actually increase mortality to strengthen his case (3).
However, as was pointed out in an accompanying editorial (4), when
appropriate statistical tests were used, the apparent significant increase
in mortality associated with antioxidant use disappeared. It is also
worthy of note that the increased mortality appeared to be the result of
one anomalous study that was out of keeping with the other studies
assessed in the meta-analysis. The authors of the editorial concluded
that the study provided no convincing evidence of hazard. And while the
meta-analysis appeared to show no statistically significant reduction in
risk of gastrointestinal cancer, this may have been due many reasons which
include length of study (cancer is believed to have a long latency) and
the fact that the meta-analysis pooled together several studies that had
heterogenous methodologies regarding antioxidant dose and type and length
of study. The study did find, however, that supplementation with one
nutrient at least (selenium) was associated with a significantly reduced
risk of cancer.
This study was the only ‘evidence’ that Baum cited in his efforts to
demonise naturally-oriented medicine. I wonder whether Baum actually read
this study, and its accompanying editorial. If he did, perhaps he found
that there was devil to be found in the detail. For someone who seemingly
puts so much store in science, it does seem rather odd that Baum should
not have bothered to analyse this study with more intellectual rigour.
Baum refers to BBC’s Watchdog programme in which a nutritional
advisor recommended that an individual stop taking tamoxifen. I, like
Baum, also have my issues with this. I freely admit this episode was not
a good advert for natural medicine. But I also wonder what similar
horrors we might find should we ever come to take a long, hard, objective
look at our own medical practices. It might interest Baum to know that
the futility of what much of what we do as doctors becomes evident when
doctors go out on strike and death rates go down (5). And besides the
rather toxic and hazardous nature of conventional medicine, we doctors
should readily admit that we can sometimes unwittingly ill-advise
patients, make mistakes and suffer from errors of judgement.
Baum used his time on BBC’s Watchdog to dismiss in no uncertain terms
the idea that coffee enemas have potential to help cancer sufferers.
However, animal studies show that caffeine can stimulate enzyme induction
including enzymes of the cytochrome P450 class (6) and other constituents
in coffee (such as kahweol and cafestol) have been found to induce
glutathione S-transferase (7). It is therefore possible that that
absorption of the constituents of coffee from the colon may, via the
circulation, induce detoxifying and anti-carcinogenic enzymes in the
liver. However, Baum’s comment regarding coffee enemas included: "This is
utterly bizarre, a throwback to the dark ages. To say that somehow the
COLON IS JOINED TO THE LIVER (emphasis is mine) and this flushes out
toxins from the liver is again gobbledeegook." I do not think that we
should judge the Professor too harshly for not being up on the intricacies
of liver enzyme induction. But, I do not think it unreasonable for a
Professor of surgery to show an awareness of the anatomical structure
known as the hepatic portal vein (8).
Baum seems keen to come across as someone whose opinions and practice
are based on science and objectivity . Yet, what closer inspection
reveals is opinion that is unscientific and loaded with not only
subjectivity, but prejudice. Maybe Baum does not believe in the
scientific process as much as he likes us to believe. After all, he is on
record for admitting that he has been aware of scientific fraud in his own
department, but chose not to report it (9). It is difficult to reconcile
how an individual who allows such misconduct to go on right under his nose
can at the same time have such faith in the scientific process.
What we essentially have here is a repeat of Baum’s original letter:
again he is utterly dismissive of the notion that natural approaches may
help in the curing of cancer (even though he cites no good evidence to
support this position). Moreover, he yet again appears to show unswerving
belief in science and the concept that conventional medicine is effective
and evidence-based (which, for the most part, it isn’t). And then he
seems somewhat aghast at being perceived as a "bigot of an antiquated
medical establishment". I guess some people never learn. Baum wields
science like a sword, and as before, it has been the undoing of him.
1. Michael Baum An open letter to the Prince of Wales: with respect,
your highness, you've got it wrong. BMJ 2004; 329: 118
2. Alexander Molassiotis. With respect, Professor Baum, you've got
it wrong. BMJ 2004;329:858
3. Bjelakovic G, et al. Antioxidant supplements for prevention of
gastrointestinal cancers: a systematic review and meta-analysis Lancet 364
1219-28
4. Forman D, Altman D. Vitamins to prevent cancer: supplementary
problems. Lancet 2004 364: 1193-4
5. Siegel-Itzkovich J. Doctors’ strike in Israel may be good for
health BMJ 2000;320:1561
6. Berthou F, et al. Caffeine increases its own metabolism through
cytochrome P4501A induction in rats. Life Sci 1995 57(6):541-549
7. Lam LKT, et al. Effects of derivatives of kahweaol and cafestol on
the activity of glutathione S-transferase in mice. J Med Chem 1987
30:1399-1408
8. Grays anatomy
9. Wilmshurst P. Lies, damned lies, and science BMJ 1995;310:747
Competing interests:
None declared
Competing interests: No competing interests
Professor Baum has just written a new comment. He is "distressed by
some of the hostile commentaries" he's received and he thinks "that these
commentaries start with the premise that he is a cold-hearted bigot of an
antiquated medical establishment".
Reading his new comments shows that he clearly is not any of these things.
He makes some excellent points about the needs of cancer patients,
although the order of priorities is not what I would have thought cancer
patients would choose.
Unfortunately though, he then announces that he has been and is
presently drawing lines.
Lines in the sand while visiting Sydney, Australia. Lines of warning to
those who would consider crossing them. And lines to confirm his position
on matters discussed in the previous exchange (as if these needed to be
clarified).
He then reveals the results of someone's clandestine filming of what
the Professor still seems to regard as the enemy: Gerson Cancer Therapy,
done in a cloak and dagger (or should I say coffee enema/carrot) manner.
Apparently, the quacks strongly urged that the patient discontinue
Tamoxifen, the establishment drug. Also, he mentions that the side effects
of the underground treatment were worse than those from any establishment
therapy such as chemotherapy.
I do not really understand why this episode was brought up as many a
reader would be tempted to think about the intriguing idea of someone
doing some secret filming in the camp of 'proven therapies'.
Somehow, Professor Baum is still not really addressing the point of
the original debate. Prince Charles made a very sensible statement and
some people, including the professor, chose to misunderstand it.
Bigot - no, cold-hearted - surely not, antiquated medical establishment -
most definitely yes.
Let us not forget that the statements about tremendous progress in
cancer treatment are mostly hype.
I think that Professor Baum would have been well-advised not to write
another comment.
Tunnel Vision is a bit like the stripes on a zebra. It is difficult
to tell whether zebras have black stripes on white background or white
stripes on black background.
But they tend to be permanent.
Competing interests:
None declared
Competing interests: No competing interests
The Prince and the Pauper:
What are the needs of patients diagnosed with cancer?
I started writing this piece in the lovely winter sunshine in Sydney
where I was attending a cancer congress, having just learnt of the
turbulence I’d created in my open letter to HRH the Prince of Wales in the
BMJ. I’m taking this opportunity to correct many of the misconceptions
I’ve already picked up from the media feeding frenzy that tracked me down,
down-under and the correspondence column in this week’s BMJ. Most of my
friends and professional colleagues have applauded the position I’ve taken
but I am distressed by some of the hostile commentaries I’ve received in
the BMJ that seem to start with the premise that I’m a cold hearted bigot
of an antiquated medical establishment. Below is my “manifesto” where I
have drawn my lines in the sand, feel free to attack me by crossing these
lines but not as a result of any misunderstanding of my position.
The needs of cancer patients.
Patients diagnosed with cancer have many needs. The diagnosis comes
as a shock and maybe for the first time the individual is facing up to his
or her mortality. So before we even think about the role of medicine we
must consider their needs for moral and spiritual support. At times like
this a close supportive family and membership of a faith community are
invaluable and should not be “medicalized”. Sadly there are many cancer
sufferers who lack family support and in these secular days have no
spiritual mentor. Such people may be drawn to “new age” belief groups in
order to fill this aching void. If this provides some kind of spiritual
solace I have no problem but if this is dressed up as “cure by magic” I
draw the line.
The next need for the cancer subject is to be free of whatever symptoms
plague their life as a result of the disease. Of course in the early
stages the patients may be symptom free but in the later stages suffering
from pain, nausea and weakness. Here we need collaboration by a team that
includes doctors, nurses, and practitioners in professions that are
complementary to medicine to help the patient feel better and improve the
quality of life. The science of pain control is well established and
palliative care for those close to the end is a well-developed specialty
in the UK thanks to our hospice movement. Relatively new is the discipline
of “Psycho-social oncology” which aims to identify and manage the more
subtle subjective symptoms of cancer such as anxiety and depression. This
field of activity really took off about 20 years ago with the development
of psychometric instruments that could identify these often hidden
problems. I chair the psychosocial oncology studies group of our National
Cancer Research Institute, which includes membership from our consumers
group in addition to nurses, psychiatrists, psychologists and cancer
clinicians. In this domain I believe there is a role for interventions
such as therapeutic massage, acupuncture and counselling to help the
patient feel better but again I draw the line at claims that these
approaches alone can cure cancer. I concede that there exists a mind body
nexus that in theory could be modulated to influence the natural course of
the disease and through my committee am trying to encourage such research
but at present I’m unaware of any reliable evidence that a psycho-somatic
approach can replace proven medical therapy.
The third need of cancer victims is to be cured or at least have their
lives prolonged. At this point a short digression is in order to consider
a brief history of the subject. From the years 200 to 1800 CE, following
the teachings of Aristotle and Galen, cancer was believed to be a
consequence of the coagulation of “black bile” (melancholia) in the target
organ. Black bile was one of the four metaphysical humours (black bile,
yellow bile, phlegm and blood) that needed to be in balance for perfect
health. The therapeutic responses to this belief were purgation (enemas),
leaching, cupping, blood letting and extreme diets. Please note the
similarity of this portfolio to popular alternative remedies of today.
They didn’t work and the patient’s suffering was increased. In the last
200 years we have learnt much about the exquisite mechanisms of the body
at molecular, cellular, whole organ and whole person levels. The realities
are more beautiful, awesome and mysterious than ever dreamt of in Galen’s
philosophy.
In the late 19thC with the development of anaesthesia and antisepsis
radical surgery began to replace irrational nostrums. Not long after this
radiotherapy was introduced that increased the chances of local control of
the cancer. These early successes in functional and symptomatic relief
lead to a period of complacency in my profession which began to be shaken
with the development of effective (albeit toxic) chemotherapy regimens and
less toxic hormonal agents for hormone sensitive cancers such as those of
the breast and prostate about 30 years ago. At the same time, the
randomised controlled trial was introduced to critically evaluate
combinations of these three modalities measuring both efficacy
(improvement in survival) and tolerability. Using this approach we have
made slow incremental improvements and can now negotiate with our patients
“trade offs” between increasing length of life and the toxicity/ side
effects of the treatments with a degree of precision and individualization
that increases with each trial completed.
In my own subject, breast cancer, the last 20 years has shown remarkable
progress. Having inherited the radical mastectomy as therapeutic dogma we
can now safely offer breast preservation without compromising cure whilst
the addition of drugs tailored to the biology of the disease has
contributed to a 25% reduction in mortality. [1]
20 years ago I wrote an article in the Evening Standard in response to the
challenge of HRH the Prince of Wales to the BMA on its 150th anniversary.
Yes the profession has been complacent in the past in ignoring the
humanitarian aspects of medicine but that has changed and the “humanities”
are now central to our undergraduate curriculum (please note that I am
visiting professor in medical humanities at my University) but of equal
importance is the evaluation of evidence. Modern medicine is now evidence
based and being practiced with increasing humanity. The proponents of
alternative medicine do not have a monopoly on compassion and empathy and
the promotion of unproven therapies or the diversion of scarce resources
from rational treatment to the practices popular in the dark ages, is
unlikely to contribute greatly in reducing the sum of human suffering.
Envoi
As chance would have it there where two media events last week (beginning
Oct. 4th) that are particularly relevant to this debate. Firstly BBC “
Watchdog” secretly filmed a woman seeking advise from a cancer clinic
promoting a version of the Gerson diet. This was offered as an alternative
to the orthodox treatment she was on and she was specifically advised to
stop taking tamoxifen. In effect denying her a 10% additional chance of
surviving relapse free for 10 years. [2] The regimen of strict diet,
coffee enemas and vitamin supplements was not only hugely expensive in
time and money but according to anecdotal reports from the grieving
husbands of two victims, more toxic than the worst of chemotherapy. In the
same week the Lancet published a meta-analysis of trials investigating the
role of vitamin and antioxidants in the prevention of colo-rectal cancer.
[3] They don’t work and if anything might be associated with increased
mortality. So much for the claims of the alternative regimen, that sparked
this debate, to improve length and quality of life. The lesson we must
take away is that the term “unproven” remedy encompasses unproven for both
harm and efficacy.
References
[1] Peto R, Boreham J, Clarke M, Davies C, Beral V. UK and USA breast
cancer deaths down 25% in year 2000 at ages 20-69 years. Lancet 2000; 355:
1822.
[2]Early Breast Cancer Trialists' Collaborative Group. Polychemotherapy
for early breast cancer: an overview of the randomised Early Breast Cancer
Trialists' Collaborative Group. Tamoxifen for early breast cancer: an
overview of the randomised trials. Lancet 1998b; 351: 1451-1467
[3] Bjelakovic G, Nikolova D, Simonetti RG, Gluud C, Antioxidant
supplements for prevention of gastrointestinal cancers: a systematic
review and meta-analysis. Lancet 2004; 364: 1219- 1228
Competing interests:
None declared
Competing interests: No competing interests
Re: The Prince and the Pauper
In what he ambitiously calls, “a brief history of the subject,” Dr
Baum contends that the ancient, “therapeutic responses [to disease]…were
purgation (enemas), leaching, cupping, blood letting and extreme diets.
Please note the similarity of this portfolio to popular alternative
remedies of today. They didn’t work and the patient’s suffering was
increased.”
It is quite true that the CAM modalities and their theories of
disease represent a challenge to medical orthodoxy, but rather than
turning its back, it is a challenge that should be faced by orthodoxy with
greater flexibility and sympathetic interest, rather than the outright
hostility coming from 'science fundamentalists' like Baum.
One point is that any unprejudiced study of sickness reveals that it
is rarely if ever a localised affair, but nearly always some systemic
problem lies at its root. Cancer is merely one extreme example of this.
A further point deriving from such impartial observation, is that
treatments focused at the local and chemical levels tend to fail because
they so often lead merely to temporary palliation of symptoms, recurrent
relapses and enduring medical dependency, rather than to lasting cure or
autonomous health. The key to success always lies in systemic treatment
and stimulation of the innate recuperative powers, both to cleanse and
restore the entire system [retuning and rebalancing them] and in
restoring/increasing a stabilised form of health autonomy and homeostasis.
As we all know, removing symptoms may not lead to good health.
Impartial study of the various medical systems also leads one to the
inevitable conclusion that sickness cause does not reside at the local and
chemical levels—which is the reason that treatments focused at those
levels ultimately fails to secure success beyond transient palliation and
relapse. The cause lies at the systemic and vital levels, where more
subtle treatments can and do induce more stable cures and non-relapsing
autonomous good health.
Because scientific medicine has chosen to focus its therapeutic
efforts mostly at the local and chemical levels, so it must be regarded as
a solely non-curative [palliative] medical system, the two points being
mutually co-dependent. As the ancient medical systems and the CAM systems,
by contrast, do not focus their therapeutic efforts at local or chemical
levels, but at the whole and the vital, so they are more truly curative
and therefore offer the best hope of more lasting cures. Again, these
points are co-dependent.
Impartial study of CAM and medical history show they are mutually
supportive and their continued study ever stimulates fresh insights about
the nature of each and the nature of sickness and its behaviour and good
treatment. Even the ancient ‘bleed and purge’ treatments that Baum blindly
derides did have a curative effect in many cases, and a reliable
underlying rationale. This much can be confirmed through studying nature
cure.
Study of scientific medicine, by contrast, merely reinforces one's
appreciation of its limited nature as a failed medical system that has too
willingly accepted the inferior goal of being uncurative, health-deranging
and therefore fundamentally unsuitable to living organisms. By ‘uncurative
and health-deranging’ one means it does not cure the innate sickness of
people and its methods tend to create more illness than naturally arises
from innate organism sources. On scrutiny, its apparent cures are always
temporary, never systemic or enduring and in this sense they are therefore
illusory.
Medicine should abandon its limited focus on the local and chemical
aspects of sickness and strive to work beyond these limited parameters of
sickness cause. It should begin to develop whole person and non-molecular
perspectives that will lead it towards predictably more curative methods
that are purificatory and health-enhancing. The map for this transition is
already charted and comprises the ancient systems and CAM, past and
present, where whole person techniques can deliver stable cures of sick
individuals, rather than transient chemical tinkering at the local level,
which only ever leads to the cycle of uncurative relapse, palliation,
medical dependency and degraded health we see rampant in the 'developed
world' at the current time. The two points are mutually dependent.
These are the real lessons medicine can learn from an unprejudiced
study of CAM and the ancient medical systems, but when this challenge will
be taken up more widely and resolutely remains to be seen.
Competing interests:
None declared
Competing interests: No competing interests