Many oncologists are barraged with questions and declarations from patients regarding therapies and products that are available from drug or health food stores or other unconventional sources. Individuals faced with a potential life-threatening problem often explore their options by consulting friends or the Internet and are often promised wonderful results from treatments with which physicians are unfamiliar.
Already overwhelmed by stacks of medical literature dealing with conventional medicine, however, few physicians have the time or energy to delve into the science of alternative and complementary medicine. The Alternative Medicine Handbook: The Complete Guide to Alternative and Complementary Therapies promises to provide a quick, easy-to-read overview of therapies that are popular or gaining popularity, and it succeeds in fulfilling this mission. It also gave this reader an unpleasant reminder of just how susceptible the general population is to believing advertisements and quick promises.
The author, Dr. Barrie Cassileth—a professor of medicine who serves on the Advisory Council of the National Institutes of Health (NIH) Office of Alternative Medicine—divides her book into alternative and complementary therapies. Not all therapies that are thought to fall under the heading of alternative medicine are truly alternative. Alternative therapy is prescribed instead of conventional medicine, while complementary therapy is used to supplement conventional treatment. The alternative therapies tend to be unproved and can sometimes be dangerous.
The book is divided into seven sections: spiritual healing approaches, dietary and herbal remedies, mind-body medicine, alternative biological treatment, bodywork therapies, sensory treatment, and the use of external energy forces. Each chapter within each section addresses a different therapy, providing a historical overview and some scientific background on that therapy and attempting to place it within the spectrum of potential medical management of cancer.
As some therapies are not easily categorized, however, there is some overlap of material within the book. Furthermore, this is not the book to use if one is searching for data on clinical trials of treatments; rather, it provides capsule summaries of known information.
The author avoids making judgments about the various therapies, but rather, offers objective commentaries on what is known. Such an approach is useful when one wants to photocopy a chapter for an inquisitive patient. The photocopied chapter can then provide a jumping-off point for a discussion between physician and patient.
In addition, the book offers several very useful resources, including a list of vitamins and minerals, their functions, recommended doses, signs of deficiency and overdose, and the need for supplementation. Licensure and professional organizations are listed at the end of each chapter, so that further information on treatment or qualified practitioners can be obtained. The index and glossary also increase the book’s value as a resource.
Specific chapters deserve further mention. In the chapter on herbal medicine, a list sizes up the different herbs that are available or touted in health food stores, with their potential effects on disease. However, while the chapter provides little scientific data (the author notes that the quality of many studies is poor), it does include tables that warn of potential dangers.
In addition, I found the chapter on dietary therapy to be particularly helpful. Several of my patients are on vegetarian and/or macrobiotic diets, and this chapter provides a short overview on their specifics.
I also learned about homeopathy, which uses the approach of treating “like” with “like.” For example, vomiting and diarrhea are treated with a very dilute substance of an herb, mineral, or other substance known to cause vomiting and diarrhea (an approach akin to inoculation). Most of these solutions are so dilute that a bottle may contain only one potentially effective molecule, however. A quick scan of a shelf in a health food store allows one to see just how easily consumers can be duped.
Complementary therapies are also discussed. Some of these, such as yoga, massage, t’ai chi, biofeedback, acupuncture, and various hydrotherapies, may be familiar to clinicians. I was aware of, but not particularly familiar with, other complementary therapies described in the book, including rolfing (structural therapy), craniosacral therapy, reflexology, pure chiropractic medicine, and Alexander techniques. Having read this handbook, I now have increased insight into these therapies when my patients discuss their use.
In summary, I applaud Dr. Cassileth for completing a fair, well-organized text. This book is not the ultimate source of information with which to judge the scientific merit of alternative or complementary therapies. Instead, its accessible, short chapters represent a useful resource for busy physicians, as well as information-hungry patients. Ultimately, patients interested in these approaches should be encouraged to enroll in clinical trials, such as those currently evaluating retinoids, shark cartilage, and melatonin(Drug information on melatonin).
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
