Dr. Wein addresses two issues: the terminology of unproven methods,
and patients reasons for using them. He prefers to use a
previously popular term, unproven therapies, to those in
common use today, although his term fails to account for the
complementary or adjunctive therapies used by the vast majority of
cancer patients who try complementary and alternative medicine. The
suggestion that we adopt a different label is consistent with the
ever-evolving terminology that characterizes this area of cancer care.
Terms applied to questionable cancer therapies have changed
dramatically over the decades. Reflecting varying degrees of
disapproval, the labels applied historically have included
questionable, unproven, and the American
Cancer Societys 1914 reproachquackery.
More recently, however, the term complementary came into
use in Europe and elsewhere, while alternative prevailed
initially in the United States, leading, for example, to the National
Institutes of Health (NIH) Office of Alternative Medicine,
which opened in 1992. Since that time, the European and North
American terminology has merged, so that todays most commonly
used label is complementary and alternative medicine, as
in the new NIH Center for Complementary and Alternative
Medicine. The American Cancer Society (ACS) changed the name of
its Questionable Methods Committee to Complementary
and Alternative Methods a few years ago.
Alternative vs Complementary Therapies
This language reflects the status of the field internationally. It
also enables important distinctions to be made between complementary
and alternative remedies. Alternative therapies often are promoted
for use instead of mainstream care, whereas complementary therapies
are used for symptom management and as adjuncts to mainstream care,
to enhance quality of life. This distinction was validated by the NIH
and ACS shifts in nomenclature and by the results of the largest
survey of public use of unconventional therapies. All but 2% of
those surveyed who used such remedies did so to complement, rather
than replace, mainstream care.
Although research evidence is scant, it appears that approximately
8% to 10% of tissue-biopsydiagnosed cancer patients refuse
mainstream therapy and immediately seek alternative care. The vast
majority of complementary and alternative medicine users seek
complementary, not alternative, therapies for cancer.
A glaring flaw in Dr. Weins taxonomic effort appears in his
proposed reasons for patients use of unproven
therapiesexplanations that he categorizes as fundamental
mechanisms and practical factors. The latter
category includes symptom relief. Remedies applied for symptom relief
are not consistent with his definition of unproven remedies as cure-oriented
and lacking data.
Furthermore, most complementary therapies used for pain and other
symptom control are often well supported by data. There are, for
example, numerous articles in the medical literature describing the
physiologic and psychological benefits of massage therapy,
acupuncture, music and art therapies, tai chi, meditation, yoga,
relaxation therapies, and so on. Complementary therapies represent an
extension of what we used to call supportive care in
oncology. Moreover, the NIH, including the National Cancer Institute,
is now backing several studies designed to evaluate complementary as
well as alternative or unproven therapies.
Nevertheless, the terminology of complementary and unproven medicine
will continue to evolve, and may even revert to past labels such as
unproven. Of greater import is the second aspect of the
article, Dr. Weins speculation about what he terms the
fundamental motives behind patients attraction to
Reaction to the Diagnosis
It is my contention, he says, that the use of
unproven therapies is a mechanism to deal with the fear of
deathin particular, where associated with cancer.
Although reaction to a diagnosis of cancer is culture-bound to some
degree, fear of death with an ensuing psychological need to
repress this fear is not the most accurate description of the
reaction of most North Americans. More typically, fear is followed by
efforts to deal with the problem, and those efforts most often take
the form of seeking recommended mainstream treatment.
Dr. Wein points to fears of death and of nonexistence, loneliness,
the unknown, pain, loss of control, and emptiness as the
fundamental reasons for use of unproven therapies by
cancer patients. But surely we all recognize these fears as virtually
universal reactions to the diagnosis itself, following which most
patients elect to receive mainstream care. Thus, it is equally
logical to explain patients willingness to undergo surgery,
chemotherapy, and radiation therapy as a reaction to such fears.
In addition, there is the fact that only about 55% of patients are
cured of cancer in the United States; in other countries, the
percentage is lower, and internationally it is 15%. If, as Dr.
Wein states, conventional physicians see patients as deluded when
they rely on unproven therapies to alter the course of cancer, what
label should we attach to people who believe that mainstream
oncologic care can alter the course of pancreatic and some other
Oncology Care: Imperfect
The popularity of alternative medicine may be a biting criticism of
mainstream medicine, but it is often and equally an opportunity for
patients to participate in their own care; to exert some control over
their lives and well-being. We skate on very thin ice when we
criticize or attach psychiatric labels to patients who seek unproven
methods. Oncology care too often remains imperfect. Dr. Wein cites
Cassileth as noting that there are few questionable methods for
curable illnesses. The questionable methods in cancer medicine will
disappear when we discover a universal cure for malignant disease.
Meanwhile, let us continue to attack the magic and mysticism,
recognize that manypossibly a majorityof alternative
practitioners are physicians, educate patients about the pros and
cons of popular therapies, and encourage the use of adjunctive
complementary techniques to ease the physical and emotional burden of
both cancer and its mainstream treatments.
1. Druss BG, Rosenheck RA: Association between use of unconventional
therapies and conventional medical services. JAMA 282:651-656, 1999.
2. Cassileth BR, Lusk EJ, Strouse TB, et al: Contemporary unorthodox
treatments in cancer medicine: A study of patients, treatments, and
practitioners. Ann Intern Med 101:105-112, 1984.
3. Pisanti P, Parkin DM, Bray F, et al: Estimates of worldwide
mortality from 25 cancers in 1990. Int J Cancer 83:18-29, 1999.