response to Authoritarian vs. Alternative Thinking from Jenny Rankine

http://pl.net/~keithr/JennyRankine19990526.html

response to Authoritarian vs. Alternative Thinking
from Jenny Rankine 26 May 1999

I have to take issue with Keith Rankin's analysis of the controversy about Liam. I don't disagree that both right and left thinkers can be authoritarian.

What I do disagree with is the assumptions behind his statement that "Parents should be allowed to make informed choices about the best forms of treatment for their children."

As was clear from the interview in the Listener, the practitioners who use the "quantum booster" have no research studies to back up their claims. They do not provide informed consent to their clients, but by their own admission regularly hide information from them. They also blithely claim to cure some cancers in a few weeks, a claim that the doctors treating Liam never made.

Informed consent includes being provided with full knowledge of the effects of the various treatment options available. Extremely few of the alternative cancer treatments on offer have any results that are other than anecdotal to support their claims.

The strongest evidence for any treatment comes from random controlled trials. These experiments test different treatments against a placebo (such as a sugar pill) and against each other for large groups of people with the same condition, who have all agreed to take part. They show up the biases in anecdotal evidence, as well as in the experience of individual doctors observing a few hundred patients. Only about one in three current treatments used by medical practitioners have been tested with these trials, but I would guess the figure would be less than 1% for alternative treatments.

The "quantum booster" is unlikely to be tested in this way, because it is a business. Sales of the machine depend on the business owners' control of the advertising, which are the selected success stories from other users. In this context, there is no such thing as informed. This kind of behaviour from an oncologist would be unethical and would cause them to be struck off the list of doctors registered to practice.

I had a friend with bone cancer who died last year. She tried every alternative treatment out there, going from one to another as they either made her sicker in other ways or didn't help. I didn't go to these practitioners with her, but she talked about them in detail and several of them sounded obvious charlatans. Others sounded genuine and concerned, and some were able to help her in her attitudes and response to her illness.

She did manage to turn the cancer around for a year, reducing it to a dot on the cat scan to the amazement of her oncologist. So I believe there is plenty of room for improving diet, immune system strength and mental attitude in cancer and other conditions like HIV. Some alternative treatments help with this.

But the whole unregulated alternative field is a fertile breeding ground for charlatans and quacks, and informed consent (to the standards expected of conventional medicine) is nowhere to be found.

Jenny Rankine

rejoinder from Keith Rankin

I agree with many of Jenny's points. I do however believe that there are limitations in even 'double-blind' "random controlled trials", in that they may not fully replicate the actual conditions of many alternative treatments. In particular, I believe that the placebo effect is in large part what makes many alternative treatments appear to work. If that is the case, then faith in alternative (or conventional) treatments is something that needs to be present. I strongly suspect that faith is more important with respect to alternative cancer treatments than with chemotherapy because of the damage that chemotherapy does to the immune system. The placebo effect (which has been proved through controlled double-blind trial) is, in essence, a well-primed immune system.

Medical science is an area in which 'proof of cure' is in short supply for both conventional and alternative treatments. Indeed the words 'proof' (see my Immunisation, Science and the Burden of Proof) and 'cure' are both inappropriate in this context. Medical proofs and cures are relative, and, given the mind-body dynamics of the placebo effect, somewhat miss the point.

With cancer, bad outcomes frequently happen whatever the treatment. Remission is a good outcome that is not a cure. A 'cure' may coexist with bad outcomes. Chemotherapy makes one sick, it damages the immune system (as AIDS does), and it can have other permanent side-effects, especially on children's development. (Chemotherapy does not conform with "the first principle of medicine: 'Do no harm'." ["The Cure" NZ Listener May 29]). Further, the argument that chemotherapy is promoted by transnational drug companies and medical practitioners with interests other than scientific objectivity is probably as valid as the claim that many alternative therapists are exploitative profit maximisers. In the history of medicine, most conventional treatments have been superseded and some have been proved, with hindsight, to be harmful. Also, orthodox practitioners have a long history of withholding their full diagnoses from their patients.

Cancer is an area in which the best possible information is far from perfect, often contradictory and rarely disinterested. It may just be better for some cancer patients to have a little less conflicting information when medical politics and harsh prognoses compromise belief that a good outcome is probable. In the real world, we economise on information, every day; there are things we choose to not know. Choosing to not know something may be irresponsible sometimes, especially when a child's life is involved. Nevertheless, more often than not, the choice should be respected. There is much that the 20th century medical establishment does not know.

They say that believers live longer than sceptics. I may never know if that's really true, because I do not plan to find out. Yet I believe that it's true. Probably.