Olivia has breast cancer but refuses medical care, opting instead for natural herbs. This is alternative medicine.
Olivia has breast cancer and follows the recommendations of her oncologists, but also consumes natural herbs. This is complementary medicine.
While the refusal of medical treatment to pursue an alternative can be clearly understood as dangerous, we may ask, 鈥淲hat鈥檚 the harm?鈥�, if medicine is not replaced but simply complemented.
A tiny window into the world of cancer patients who use alternative and complementary medicine has been opened by a team at Yale School of Medicine. It is a small, imperfect and possibly distorted opening, because their had to accept a number of limitations, but it warns us that the phrase 鈥渃omplementary medicine鈥� may often be a misnomer.
Here鈥檚 what the team did. They looked at the National Cancer Database, which captures about 70% of new cancer cases in the U.S., and identified the almost 2 million patients who had been registered between 2004 and 2013 for the four most common cancers: breast, prostate, lung, and colorectum. They excluded people with stage IV cancer (meaning cancer with distant metastases) in order to study only curable cancers.
They wanted to know, compared to similar patients, do cancer patients who use either alternative medicine (AM) or complementary medicine (CM) fare worse? And who are these people?
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Complementary and alternative medicine is bad for your survival
You will not be surprised to learn that patients who refuse medical care and declare they will use an 鈥渦nproven鈥� alternative 鈥渁dministered by non-medical personnel鈥�. Five years after their diagnosis, 55% of them were still alive, compared to 78% of similar patients who underwent chemotherapy, radiotherapy, surgery and/or hormone therapy. But what about those who embraced both medicine and complementary remedies?
The good news is that, in, they did not delay medical treatment. The bad news is that many of them flat out refused it. Because certain cancers are treated with more than one modality (e.g. surgery and chemo), it is possible to accept one medical treatment (e.g. surgery) but refuse another (e.g. chemo), substituting it for a complementary therapy (e.g. herbs). The percentage of patients who took complementary medicine and refused a treatment was compared to that same percentage among patients who did not take complementary medicine, and the differences were staggering for surgery (7% versus 0.1% refusal), chemotherapy (34% versus 3%), hormone therapy (34% versus 3%), and radiotherapy (53% versus 2%).
Patients who made use of complementary medicine had a poorer five-year survival (though the difference was not as drastic as with the people who refused medical care completely), and this difference disappeared when the study authors took into account 鈥渢reatment delay or refusal鈥�. This means that, in this context, when complementary medicine kills, it does so because its adherent refuses a medical treatment, not because of the complementary treatment鈥檚 negative effect on the body.
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Patients who chose AM and CM were not poor and illiterate; they tended to be well-off and educated
In this sample, the patients with cancer who chose either alternative or complementary therapies tended to be younger; to be women; to have breast or colorectal cancer; to have higher socioeconomic status and educational level; and to live in the Western part of the U.S. The heartbreaking part of all this is the following quote from the paper: 鈥淲e found that [complementary medicine] use (vs non-use) was associated with variables generally associated with improved survival鈥� (emphasis mine). The kinds of people who use complementary treatments鈥攜ounger on average, with better means鈥攚ould normally live longer, but because of the refusal of medical treatment that seemingly comes with the complementary medicine culture, they die earlier.
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Limitations
No study is ever perfect, and these two studies on alternative and complementary medicine unfortunately suffer from small sample sizes.
The authors write in their introduction that 48% to 88% of patients with cancer say they use AM or CM; however, after looking up almost 2 million patients in the cancer database, they only found 258 (a meagre 0.01%) that had been coded as undergoing medical treatment and also choosing complementary medicine. How representative is this 258 figure is hard to know.
The problem is that few patients seemingly told their physician that they were choosing AM or CM, which makes research into the impact of these choices quite challenging. Also, the AM/CM umbrella is vast and includes interventions that are essentially harmless (like yoga and tai chi) as well as others with serious potential to harm (like traditional Chinese herbs, many of which are toxic to your liver). This study did not have access to the particular therapy chosen by each patient. All in all, this is a particularly challenging phenomenon to study, and this data set, while quite limited, offers us a glimpse of this reality.
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The smokescreen of complementary medicine
Is it surprising that a system of beliefs which claims both a universal boogeyman and a one-size-fits-all remedy would not stop at 鈥渃omplement鈥� but would seduce its user to forego proven medical treatments?
Imagine if the situation were flipped.
Imagine a world in which alternative medicine鈥攈omeopathy, Reiki, acupuncture鈥攈ad major side effects and was the mainstream treatment for cancer, while oncology鈥攔adiation, surgery, chemotherapy, hormone therapy鈥攚as sold as an esoteric, harmless complement. Except that oncologists would tell you that they have studies backing up their interventions; that their scientific philosophy had a pretty good grasp on the nature and evolution of cancer; and that they could actually shrink if not completely remove your tumour. Would you simply use medicine as a complement鈥� or would you be tempted to skip a recommended round of herbalism if it caused major side effects, and use a side-effect-free chemotherapy regimen as a replacement rather than a complement?
What this example hopefully illustrates is that so-called 鈥渃omplementary medicine鈥� is not a bit of sugar to help the medicine go down; it is by definition an alternative to science-based medicine, with its own worldview and cure-alls. These two recent studies illustrate, with great poignancy, this very point. For many people, complementary medicine turns out to be alternative medicine. By rejecting effective treatments, vulnerable patients, lured by the siren song of an all-natural salvation, end up jeopardizing their very survival.
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