In the well over nine years that I’ve been blogging, there’s one tried and true, completely reliable topic to blog about, one that I can almost always find. I’m referring, of course, to the credulous news story about pseudoscience. The pseudoscience can be quackery, creationism, anthropogenic global warming denialist arguments, or whatever; inevitably, there will be some journalist, somewhere, who will fall for it and write a story that basically toes the line that supporters of pseudoscience like to see. Given that I pay the most attention to medicine, I notice this phenomenon the most when applied to quackery and, as I like to call it, quackademic medicine.
Two messages are constant in such credulous stories about the infiltration of quackery into mainstream medicine. The first message is that it’s not quackery, even though you and I know that it is. The second message is that it’s becoming enormously popular, embraced not just by patients but by physicians, the latter of whom are putting their imprimatur of medical authority on these modalities. The subtext to these two messages is that all these “alternative” treatments, this “complementary and alternative medicine” (CAM), this “integrative medicine” is something new and wonderful that should be not just tolerated but celebrated. A perfect example of such lazy, credulous reporting popped up in my Google Alerts yesterday. At first I thought I’d ignore it, but it kept irritating me, to the point that I decided, what the heck, it’s deserving of some not-so-Respectful Insolence. And so it shall receive some.
The article, by Elizabeth Payne, appeared in The Ottawa Citizen under the title, Patients, doctors embracing alternative medicine in battle against cancer: Naturopathy, acupuncture among techniques increasingly being used alongside established treatments. Yes, I’m sure regular readers can tell that such a title is akin to waving the proverbial red cape in front of the bull. Unfortunately, the story doesn’t “disappoint.” It’s every bit the mess I expected it to be when I read the title. It begins with the story of a woo-loving patient named Jennifer Miriguay, who is in the middle of her second battle with breast cancer and wanted to “take control of her health.” Man, I hate that cliche, but it’s a cliche that seems to appear in just about every one of these articles about the infiltration of quackery into mainstream medicine. Why is it that embracing quackery is “taking control of your health”? On a strictly trivial level, I suppose that it is, but in exactly the wrong way. Think of it this way. Taking control of your health does not require embracing quackery, but the unrelenting message from those who promote quackery is that it does and infiltrates the discourse about CAM or “integrative medicine,” or whatever the term du jour is. This embrace of quackery led to:
Her appointment with a naturopath at the Ottawa Integrative Cancer Centre was a “watershed,” she says. But Miriguay said she feared her oncologist wouldn’t be as positive about her embrace of naturopathy and acupuncture while being treated for metastatic breast cancer.
She was wrong. Her doctor didn’t balk, telling her he wished all his patients would take diet and nutrition as seriously.
The 41-year-old mother of two is part of a quiet, but significant, shift that is breaking down walls between traditional medicine and complementary therapies for treating cancer.
It’s a movement cancer patients have long pushed for, often to be met with negative or uncertain responses from their doctors. But that is changing. And a nondescript Hintonburg clinic is part of the shift.
No, it’s a shift that is breaking down the walls between quackery and science-based medicine by “integrating” quackery with conventional medicine. Contrary to what this writer seems to think, this is not a good thing. Even worse is that this article reads far more like an advertisement for the Ottawa Integrative Cancer Centre (OICC) than it does a news story. In fact, it reads like a PR reaction to a negative story that circulated about the clinic last week. The story mentions that a patient died after being taken from the clinic to a hospital, but then goes right into a statement that the police had determined that the death of a patient in the late stages of cancer was not suspicious. The original story appeared on April 4, and I haven’t been able to find out much since then. I can only assume that the authorities didn’t find anything. Patients with advanced cancer are prone to dying suddenly, whether they’re undergoing conventional therapy or naturopathic therapy. Without knowing the specifics of what treatments this patient was undergoing, I simply can’t comment.
I can comment, however, on this:
The clinic is supported by doctors, including Shailendra Verma, a medical oncologist at The Ottawa Hospital, who sees the importance to patients of breaking down barriers between conventional and complementary cancer therapies. It is also supported by the Ottawa Regional Cancer Foundation.
Verma, who is a scientific adviser to OICC, calls it a much-needed bridge.
“For far too long, disciplines have worked in isolation without communication and our patients have often felt caught between differing therapeutic philosophies, often to their detriment.”
I have no problem with legitimate scientific and medical disciplines communicating, the better to serve and care for patients. In fact, I applaud and encourage it. It’s often been true in the past that different specialties work in their own little silos, not communicating adequately. This is becoming less and less true, as cancer care becomes more and more interdisciplinary, but that’s not the point, and that’s not what bothers me. Where I have a problem is when that “communication” involves lending legitimacy to pseudoscience, such as the various forms of quackery that are at the heart of naturopathy, such that they are treated as co-equals with science-based medicine. It needs to be emphasized that these “differing therapeutic philosophies” have an incredibly wide chasm between them. It’s the difference between science and pseudoscience, medicine and quackery. What’s detrimental, in this case, is not shutting out naturopaths. It’s letting them in and treating them as legitimate health care professionals.
Given this credulous advertisement for the OICC, I thought I’d mosey on over to its website and see what sorts of treatments it offers. Sadly, I wasn’t surprised. Certainly, there is the usual stuff, like exercise, massage therapy, “psychosocial support,” yoga, lymphedema and lymphatic drainage, and “nutrition.” In addition to this seemingly benign, “gateway” woo, there’s naturopathy, a veritable cornucopia of different quack techniques based on pseudoscience, vitalism, and prescientific thinking; acupuncture (of course!); and reflexology (or, as I like to call it, a foot and hand massage with delusions of grandeur).
There’s more than just that, though. The OICC offers intravenous vitamin C therapy, which is unapproved, unproven, and, as administered by naturopaths, basically cancer quackery. Intravenous vitamin C, however, isn’t what surprised me. What surprised me is that the OICC offers intravenous dichloroacetate (DCA). You remember DCA, don’t you? It’s a small molecule drug that was tested in an animal model of cancer and had impressive anticancer activity in that model. In response to that rodent study, scammers popped up selling DCA to desperate cancer patients. The man, Jim Tassano, was a pesticide salesman who, as far as I can tell, purchased DCA from China and synthesized some of it on his own. (It’s a simple molecule, not that difficult to make for a chemist.) Ultimately, he was shut down by the FDA, but who knows what damage he did in the meantime?
These patients self-reported their results but, as all too often is the case in such self-selected support groups, they didn’t have an understanding of cancer, how to determine response, or clinical trials, which led even the best educated among them to misinterpret their results. Indeed, a husband-wife team in Edmonton even began offering DCA themselves. Ultimately, there was a human clinical trial, a phase I trial in glioblastoma. The results were not unpromising, but they were hardly earth-shattering. At the time, I pointed out how initially highly promising results in animal studies all too often disappoint in actual human studies. It happens. In fact, it happens far more often than the same miraculous results are observed in human clinical trials. That’s why we academic physicians have learned to temper our optimism and be very skeptical of preclinical studies in animals.
And the OICC is administering it to cancer patients. I don’t know what the law regarding approval of drugs and off-label prescribing is, but this is off-label prescribing on par with Stanislaw Burzynski prescribing phenylbutyrate off-label for cancer, in order to generate antineoplastons. There’s no strong evidence (yet) that DCA is effective against advanced cancers, just a preliminary phase I trial that produced biochemical evidence suggesting possible efficacy. There are some ongoing clinical trials right now, two in head and neck cancer. There’s a study that was terminated for “higher than expected risk and safety concerns the study should be closed” and a study that was withdrawn before it started accruing.
In other words, there’s no justification for anyone, much less a bunch of naturopaths at the OICC, to be administering DCA to cancer patients outside of the context of a clinical trial.
Finally, it turns out that we’ve met the executive director before Dugald Seely, ND, FABNO, who practices the “integrative” modality known as “naturopathic oncology,” or, as I like to call it, “integrating” cancer quackery into oncology, which Seely reported, although not using such language. He’s also tried to convince people that adding naturopathic treatment to the treatment of cardiovascular disease can result in improved Framingham risk scores. It didn’t, at least not as touted.
So what we have, in the end, is an article that is, in effect, an advertisement for the OICC, that ignores just how much quackery is in “naturopathic oncology,” and that touts what naturopaths told the reporter, namely how “integrative medicine” and alternative therapies are becoming mainstream. There is a grain of truth in that; otherwise, I wouldn’t be doing what I’m doing. But, make no mistake, it’s a minority of physicians who embrace this pseudoscience. The problem is that the vast majority of physicians, even as they realize it’s pseudoscience, are shruggies and do nothing about it.