Why do people choose an alternative and/or complementary path?
In recent years the use of alternative and complementary methods (ACM) has significantly increased around the world. A number of studies have shown that ACM was used by 90% of all patients in at least one stage of cancer treatment. However, patients rarely ever inform their doctor. Only after detailed and lengthy discussions does it come to light what a patient has used, what he is using and what he plans on using in the future. In the majority of cases it’s nothing serious. Often times they are methods that have been recommended by friends or relatives. One has to be careful not to criticise the patient too harshly. If the patient believes that it is genuinely helping him and if the doctor believes that it isn’t harmful, then it’s better to support these methods rather than chastising the patient and risking the possibility of losing his trust. The patient will most likely continue to use the treatment anyway (it’s even possible that another doctor has recommended it), but he’ll be reluctant to tell his oncologist about it, now unsure if his doctor has his best interests at heart.
It’s not that the vast majority of patients are dissatisfied with traditional methods of therapy. However, non-traditional therapies on offer are often more in keeping with their expectations, hopes, personal philosophies and understanding of health, illnesses and the methods that can influence them. The factually-based understanding of the disease asserts that the development of cancer cells is caused by genetic changes as a result of physical or chemical carcinogens, infections or inherited predispositions and that cancer can be either a localised or systemic disease, whose malignant cells can, for the most part, be destroyed with traditional methods of therapy. The alternative, or intuition-based understanding of cancer sees the illness as a manifestation of internal and external disorder in the body brought about by incorrect diet, lack of exercise, stress, chronic fatigue, mental exhaustion, negative thoughts and energy and other factors. Its practitioners see it as a result of chaos within the body and believe that traditional methods of therapy (radiation, chemotherapy) only interfere with the body’s natural defence mechanisms and decrease its ability to fight off of the illness. They believe that therapy should rely on the rejuvenation of the body’s natural powers to help itself. In this we’ll have to agree to disagree.
Supporters of non-traditional methods are often cancer patients who are affluent and well educated. Of the cases I’ve seen in my career where the tumour has taken root or metastasize, the majority of the patients were people with university degrees, some even with medical degrees. Alternative therapy isn’t cheap and not everyone can afford it. But sometimes it makes you wonder how much money people are willing to spend on completely questionable things. Among these patients you’ll also find people with large psychosocial burdens (anxiety, fear, depression) who have lost faith in traditional methods, younger patients and people with discouraging prognoses or a relapse of the disease who think “I don’t have anything to lose, I’ll give it a try.” A large group is also made up of patients who have had insufficient communication with their doctors.
I would conditionally divide these non-traditional travellers into two large groups – the desperate (they’ve tried all of the traditional treatment methods, including innovative medications, but the disease has continued to progress and the patient no longer believes that modern medicine can help him or he possibly has even received a passionless, cold-hearted prognosis from his doctor) and the “divergent” thinking (who have refused surgery, radiation or, most commonly, drug treatment, because they believe it will only make things worse). Both are unhappy and both require a solution. However, it has to begin with a discussion of the patient’s motives for believing what they believe. The notion that “modern medicine can no longer help, because I’ve tried everything” is in itself false and only pushes the patient farther away. Only an extremely narrow-minded doctor could say something like that, possibly because he’s not sure if he wants to deal with a symptomatic patient. But modern medicine can alleviate suffering, painful side effects and mental exhaustion.
An oncologist also has to be a master communicator, as he often has to convince a patient to undergo methods of therapy, which are far from easy. Today doctors and anyone who has earned a degree in medicine are well informed about the aetiology of diseases, molecular mechanisms and pathogenic therapy, but aren’t prepared for a simple dialogue about these topics with patients, their loved ones or even with colleagues with different specialities. Moreover, they only gain the ability to convince, listen to, console and to inspire through experience and by making mistakes. It’s this inability to communicate that often points patients in the direction of alternative and complementary methods.
In place of the faith healers and medicine men of yesteryear, nearly half of today’s non-traditional medical practitioners are certified doctors. Their arguments are impressive and convincing and they have established practices, private healing spaces and even clinics. In Table 1 I tried to contrast typical outpatient situations experienced by patients in the private and public sectors. We can see quite vividly that the patient is at the centre of private medical clinics. If we treat the patient well, are polite and sympathetic toward him, he’ll definitely come back, or at least recommend the clinic to family and friends. I don’t see anything wrong with that, because people want be treated with dignity and are prepared to pay for it.
Patients often get carried away by words and statements like “natural”, “made exclusively from natural ingredients or whole plants, not just their roots, flowers or leaves.” The vast majority of drugs used today are pharmaceuticals derived from natural products. The statement that “these natural remedies have been used for thousands of years in folk medicine” also doesn’t hold water. They might be able to cure a cough, but definitely not cancer. Yes, they can alleviate symptoms and improve wellbeing, but they’re not a cure. When a person arrives at my office with a laundry list of recommendations (vitamins, food additives, shark cartilage, beaver gland extract, etc. that cost hundreds of euro) all of which should supposedly be used to protect oneself from cancer or from a relapse, I usually tell them: “If something like that existed that could be bought in a pharmacy, on the street, on the Internet or in some underground passageway, which would protect you from cancer then no one would contract the disease or die from it.” That usually makes sense to most people.
The number of patients who continue to trust in traditional methods when a relapse of cancer occurs dramatically decreases. Unfortunately, very few doctors explain the goals of therapy in a straightforward and honest manner – to treat, to prolong life and to lessen suffering. The average person thinks that “treatment” is synonymous with a “cure”. That’s not the case with the majority of cancers and other chronic, non-infectious diseases. In the majority of cases, at least in Latvia, we can significantly prolong life and offer relief for many symptoms. The fact that modern medicine can’t help 100% of patients promotes a lack of faith and leads to a feeling of helplessness. With this state of mind, a patient can become an easy target of advertisements that promise miracles, which haven’t been proven (protects against cancer; cures cancer). But even clinically proven “lifesaving” drugs that are highly-acclaimed are also a subtle advertisement for treatments that still don’t guarantee a cure for 100% of patients or even absolute safety. The patient is faced with a difficult decision. But to share a quote (which can also be applied to doctors) by one of Latvia’s greatest writers Rūdolfs Blaumanis: “He who walks the path honourably, Will never lose his way. But who will tell such a man, About the wonders found in the deep forest?”
It’s also worth mentioning palliative therapy. The general public often has a sceptical view of this term often equating it with “hospice care for the terminally ill” or as care when nothing more can be done to save the patient. But this is wrong. Palliative care is a method of therapy that isn’t radical and is often used when the disease has progressed very quickly from the start or when it has relapsed. We shouldn’t fear the word “palliative”, because that could also mean surgery, radiation or chemotherapy. What, after all, are these widely advertised innovative therapies we’ve heard so much about? They are by definition palliative, because they are treating tumours that already exist or have perhaps metastasised. Palliative therapy doesn’t guarantee a cure and doctors should be straightforward when discussing this with their patients. That said, many cancer patients survive for many years with a good quality of life due to palliative therapy methods.