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Will She Or Won't She
If I'm in a coma or otherwise incapacitated, kindly refrain from standing over me with a big crystal, recalibrating my "aura," reading my tarot cards, or trying to jam slippery elm up my nose. An excerpt from my will, which I just wrote, lest I get hit by a car as I'm walking across the street while reading:

For direction as to my wishes on my medical care, I do not believe in “alternative medicine,” and want data-based, scientifically driven medicine.

Orac of Respectful Insolence just posted on what happens to women who choose "alternative" medicine for breast cancer. ("Alternative" typically means the alternative to medicine proven to work.)

Here's an excerpt from the study by Chang et al, entitled "Outcomes of breast cancer in patients who use alternative therapies as primary treatment" (Am. J. Surg. 192:471-473):

CONCLUSIONS: Alternative therapies used as primary treatment for breast cancer are associated with increased recurrence and death. Homeopathy instead of surgery resulted in disease progression in most patients. These data may aid patients who are considering alternative therapies.

Orac writes:

One thing that is rather fascinating is the variety of alternative therapies that the study population opted for, including coral calcium, coenzyme Q10, herbs, dietary therapy, high dose vitamins, mushrooms, chelation therapy, poison hemlock (I'm still scratching my head over that one, particularly given how alties so frequently lambaste chemotherapy as "poison"), and a variety of unspecified therapies. At least there were no examples of coffee enemas that I could see. In any case, because of the sheer variety of therapies used and the low number of patients using each individual one that, as the authors put it, it was not possible to "identify particular alternative modalities that were particularly ineffective."

Who says scientific papers don't occasionally have sarcasm in them?

Sid Schwab, a retired surgeon I've linked to before, comments on Orac's post:

Forgive me if I've mentioned this before: our local paper ran a three-day series, breathlessly (and credulously) describing the bravery and take-control of a woman who'd been cured by conventional methods of cancer in one breast a few years earlier. She developed a new one in the opposite breast, and didn't what those "poisons" again. So she refused conventional therapy and followed alternative diets, meditation, and the bogus ministrations of a license-revoked MD who made potions of her urine (the paper helpfully provided contact info.) This was front page stuff with nice sidebars for three days running. The news of her death, around a year later, was buried on page 6, section four. At the time I'd left messages for the reporter, saying she was doing a disservice to women, but she never returned my calls.

Posted by aalkon at September 27, 2006 10:28 AM

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Amy,
You are (or should be) free to choose whatever treatment options you prefer. But I disagree with you about placing rock crystal aura, homeopathy and other alternative medicines in one lump.

For instance, I have used arnica cream or lotion rubbed on bruises many times and invariably found that it does help bring the bruise to the suface and allow faster healing than doing nothing. I would like to know if rubbing arnica on legs before a long-haul flight reduced the risk of deep-vein thrombosis, but not enough scientific studies have been made, or are likely to be made, to ensure we get a "scientific" view on the matter.

I also query the notion of scientific knowledge as an absolute. One hundred years ago an astromony book would proudly announce that there are eight planets in the solar system. Four weeks ago the correct number was nine. Today we're back to eight, but in the intervening time anyone who said Pluto wasn't a planet was laughed at, called crazy, accused of intelligent design worship etc. Similar things could be said about thalidomide, once a wonder drug, then the embodiment of the evil drug industry, now being tested for use in (non-pregnant) cancer sufferers.

Cannabis is well known to have herbal therapeutic remedies, including alleviating the side-effects of anti-AIDS and mutiple-sclerosis drugs. So much so that the AMA tried to oppose banning the substance once they realized that Randolf Hearst campaign to ban "marijuana" was in fact a ban on a useful product. Of course some of the scientists who insist on only using FDA-approved remedies then turn around and support drugs like Sativex, that are sythesized versions of cannabis.

I don't see anything wrong in using the chemical version: it has all the impurities taken out and it is tested on animals and humans. But it is very convenient for a drug industry with high price business model based on an $800 million development cost per drug to reject the raw product.

Acupuncture almost certainly does not do what it's worshippers believe, with "chi" and the "ying-yang". However the notion that stimulating pressure points (with needles or by other pressure) can have therapeutic effects is undeniable, it is after all exactly the same sort of stimulus that massage does. Surely there are conditions for which such treatments are worth a try: back pain? lower body paralysis? coma? I would.

Posted by: Antoine Clarke at September 27, 2006 4:54 AM

What a lot of muddled thinking. "I also query the notion of scientific knowledge as an absolute." Who has this notion? Science changes its mind whenever the evidence changes. It's religion that claims to deal with absolutes. As far as medicine is concerned, science goes looking for the evidence and reports what it finds. It costs money to do this, and it's up to "us" to pay for it - there is no "them" (the gumment?) to do it for us. So there's plenty unknown areas where no searching has been done and new therapies may be hiding. Treatments that can be shown to work are called "medicine." Others - either shown not to work, or not shown to work - are called " medicine" where can be "alternative", "complementary", "new-age" or whatever you like. You are free to choose. You are free to join in the search.


"Science" just means "knowledge". In today's Googled world everyone should be aware that there is loads of information on any topic under the sun to be had at the click of a button. I would hope that people are also becoming aware that the quality of information ranges from absolute crap through to the most reliable that we can discover. This latter is what "science" aims to find. The reliable information that we have accumulated over the last few hundred years is the most valuable thing we have ever produced as a species.

Posted by: Norman at September 27, 2006 5:32 AM

Yes, Antoine, some herbs may be effective, but many are not, and are used on the advice of some gray-skinned person at a health food store, and are untested.

Many, many people took echinacea for colds, for example. When echinacea was tested, well, it didn't come out so well:

http://www.nytimes.com/2005/07/28/health/28cold.html?ex=1280203200&en=7c1018f0a5ac9450&ei=5090&partner=rssuserland&emc=rss

Posted by: Amy Alkon at September 27, 2006 7:12 AM

Recently you've made several posts that referenced the female mammary gland. You have alternately called it the "breast" or, more colorfully, the "boobie". I would like to remind you that the genius that is Mel Gibson has given us the definitive label for that gland: Sugartit. Please use that term exclusively in your future posts. I realize that in this post you were quoting others, and were thus handicapped. The authors should have said "Sugartit cancer" and "opposite Sugartit", respectively. Thank you for your attention to this matter.

Posted by: Hasan at September 27, 2006 8:02 AM

Antoine, I think you're misunderstanding what I'm saying, which isn't "all herbs are bad" (they aren't, and many are the basis of important, useful drugs). What I'm saying is I want data-based medicine, not wishful thinking-based "alternative treatment." Often, it's an alternative to smart, useful, working treatment.

Take, for example, the "colon cleansing" idiocy. Guess what? Your colon doesn't need cleaning! Links on that here:

http://www.ebm-first.com/?cat=12

Posted by: Amy "Sugar Tits" Alkon at September 27, 2006 8:05 AM

"Amy "Sugar Tits" Alkon"

Thank you.

Posted by: Hasan at September 27, 2006 8:08 AM

"For direction as to my wishes on my medical care, I do not believe in “alternative medicine,” and want data-based, scientifically driven medicine."

Wow-- that's a statement I need to carry around in my wallet, for sure! Great idea.

Amy, have you read Quackwatch's extensive pages on cancer patients duped to death by alt-med? Truly sad stuff, and even sadder that people keep falling for it.

Posted by: Melissa at September 27, 2006 8:53 AM

We don't much have to worry about falling into coma and being treated with crystals and the eye of a newt. Doctors are too afraid of getting sued to try anything but the most legally defensible treatments. Were they challenged in court after your death, they'd face well-credentialed experts, not Shirley Maclaine. But it's good to let our friends know what's what. There's no doubt that Amy's done that.

The Schwab anecdote is what it is, but there may be more to it. For all we know, the woman was going to die six months later anyway. Modern medicine doesn't always cure cancer. Breast cancer is a hideously painful way to go, and after those last hours, few people ask why life couldn't have been extended even further.

People may be stupid in love with primitive medicine, but maybe what they really admire in that yingy-yangy stuff is a willingness to admit that the natural world is in charge. The western approach to medicine is built around competition and relentless reasoning, which reject humility at every turn.

Death sucks. The death of each of us will almost certainly suck. It may well go on for months, it'll be painful, it'll be expensive, and it'll be a burden to the people we want least to offend, unless we're cared for by strangers. People don't like to talk about it much, and while I have no love for the macabre, it would be better if they did. Hitchens is concise:

"This ends badly."

Posted by: Crid at September 27, 2006 10:07 AM

I also query the notion of scientific knowledge as an absolute. One hundred years ago an astromony book would proudly announce that there are eight planets in the solar system. Four weeks ago the correct number was nine. Today we're back to eight, but in the intervening time anyone who said Pluto wasn't a planet was laughed at, called crazy, accused of intelligent design worship etc. Similar things could be said about thalidomide, once a wonder drug, then the embodiment of the evil drug industry, now being tested for use in (non-pregnant) cancer sufferers.

Ah, yes, I wondered how long it would be before the Galileo Gambit made an appearance. Remember, heresy does not equal correctness. (Oh, and thalidomide was never sold in the US; the evil FDA never approved it.)

Yes, they did laugh at Copernicus. They also laughed at Bozo the Clown. Just because someone laughs at you does not mean you are correct.

Posted by: Orac at September 27, 2006 10:21 AM

"Doctors are too afraid of getting sued to try anything but the most legally defensible treatments"

Yes, but if you're in a coma and your woo-woo relatives are in charge, if you're me, you don't want them giving you coffee enemas to see if they can wake you up ass-backward.

Posted by: Amy Alkon at September 27, 2006 11:00 AM

But what if the coffee enema is brewed from Ristretto?

Posted by: snakeman99 at September 27, 2006 11:21 AM

"...anyone who said Pluto wasn't a planet was laughed at, called crazy, accused of intelligent design worship etc."


Melissa, can you substantiate this claim? I remember reading that Pluto was a bit of an oddball, because its orbital plane is significantly different to the other planets (by 17 degrees) and its orbit is so eccentric that it comes inside Neptune's orbit. It was always the only one of its kind, and the recent change in its status is because of new discoveries that mean it's no longer alone in its class.


But most of all, and I don't know how to express this very well, we have on the one hand our attempts to describe the universe, and on the other, the universe itself. Melissa, your arguments about Pluto seem to me to be about the description rather than the things themselves. To be fair you are not an extreme case! The extreme cases are the religious nuts who argue about evolution, as if it can be decided by argument or some kind of vote. Questions like that can't. The ultimate decision is always the facts as disclosed by experiment and observation. Our description is an attempt to make sense of the facts.


Anyway, I see that Melissa has not posted in a while, so perhaps we should stop beating on her. She must feel as if she has trodden on a wasps' nest.

Posted by: Norman at September 27, 2006 11:46 AM

Starbucks grande half-caf, no cream, no sugar

Posted by: Crid at September 27, 2006 11:57 AM

Amy,

Please tell me that in your will you're DNR as well.

Posted by: Bunco at September 27, 2006 1:22 PM

"Please tell me that in your will you're DNR as well."

I didn't want to go all lawyer-nit-picky on the board, but since this thread is seemingly well-populated, let me advise all readers that any DNR or other medical wishes should be expressed in a separate Advance Health Care Directive (aka a Living Will aka your Terry Shiavo document). Your last will and testament should be a separate document dealing with property disposition.

Posted by: snakeman99 at September 27, 2006 1:28 PM

Personally I am wary of 'natural products' because they are rarely tested under the same conditions as drugs. But, given that corperations cant patent a plant there is no incentive to test natural remidies.

That being said, I blew out my knee in the Army, I am 26 yrs old and using a cane, the durg i wa getting thru the VA dulled the pain but made me drowsy and I was still using the cane. A friend gave me this 'naural product and within 3 weeks I was virtally pain free and off that damn cane, unless i had done something particuarly stupid like helping someone move. Just to test I stoped taking it and the pain came back. Oddly enough the only side effect I've noticed is that my allergies are gone.

But even with my experience wih this natral product I wouldnt rely on it to save my life from cancer or any other deadly condition

Posted by: lujlp at September 27, 2006 2:06 PM

Antoine Clarke wrote:

"...anyone who said Pluto wasn't a planet was laughed at, called crazy, accused of intelligent design worship etc."

Norman wrote:

"Melissa, can you substantiate this claim?

:snip:

Anyway, I see that Melissa has not posted in a while, so perhaps we should stop beating on her. She must feel as if she has trodden on a wasps' nest."

Um, Norman, the statement that you are asking me for substantiation on was made by Antoine Clarke, in post #1.

Please do not attribute words to me which I did not utter, especially when said words are fallacious arguments with which I disagree.

Posted by: Melissa at September 27, 2006 3:20 PM

Thanks, Snake -- I have to dig that Living Will out of the pile of papers in my office. But, I no, I don't want to live as a human turnip. Of course, if I fall and crack my head on the pavement in some minor way, I want them to try to wake me up.

And, much as I love Ristretto (ristrettoroaster.com - get the Sumatra Mandheling, like drinking velvet), thanks, but I'll take the coffee in the usual place.

Posted by: Amy Alkon at September 27, 2006 5:56 PM

"Sumatra Mandheling, like drinking velvet"

Mmmm, coffee porn!

Posted by: Melissa at September 27, 2006 8:47 PM

See, I can see the basic point that there are more things in heaven and earth than the pharmaceutical companies dream of, and that natural remedies *might* be beneficial. I take 400mg of vitamin B2 daily to prevent migraines (based on a few studies that have shown its effectiveness), I virtually never get colds when I remember to take my megadose of vitamin C every day, etc. etc. If I were to get diagnosed with cancer of any import, you'd better believe I'd be trying out a macrobiotic diet or something similarly benign...IN ADDITION TO the best that Western medicine could throw at my tumor(s). And therein lies my real divergence from the alt-med folks. What's the point of cutting off a means of treatment, except in those rare cases when you've only got three months to live without chemo or four extremely painful months to live with it? If alt-med stuff works, Western medicine is unlikely to interfere with it. (My excellent migraine medication appears to work hand-in-glove with the B2 to eliminate my migraines, praise Jeebus.) And if it DOESN'T work, well, you've got something else to work with...plus, the placebo effect can be mighty powerful. If you think you'll get better faster if you eat a macrobiotic diet while on chemo, you just might. Acupuncture has been shown to increase the pregnancy rate from in vitro fertilization, if you want an example of high-tech medicine combined with a safe alt-medicine technique. I'm an acupuncture skeptic, but the mind is a powerful thing.

(I should note that I'm not talking about coffee enemas or chelation-type alt-medicine here. Ew ew ew, to the first especially.)

Sigh. All of this is reminding me of that classic "Law & Order" episode with the quack doctor who promised women with breast cancer that they could avoid mastectomies. Anyone else remember that one? It was during the Claire Kincaid years. "I can tell you this: if she had been MY patient, she'd still be alive."

Posted by: marion at September 27, 2006 9:46 PM

Hitchens is concise: "This ends badly."

Fran Lebowitz is concise too: "Life is one thing after another. Death is a caberet."

PS, Crid: I think of death every day. It lives in my clothes.

Posted by: Lena at September 27, 2006 10:02 PM

I thought that was Oswald, your giant white pet snake.

Posted by: Amy Alkon at September 28, 2006 2:57 AM

If I, you, or anyone else is in a coma, why would I give a shit if someone waves crystals over me?

Provided it can't provably make things worse, I see no reason to object to whatever crazy shit people do when I'm unconscious.

Posted by: LYT at September 28, 2006 3:30 AM

Melissa-


I don't know how I ended up using your name instead of Antoine's. My apologies.

Posted by: Norman at September 28, 2006 3:54 AM

Amy's Sugar Tits - the only 2 lumps I want with my coffee. Oh hell, are we back off boobs now?
Marion, you have the right of it - saying 'all Western/allopathic medicine is evil and artificial and the work of The Man' is stupid. Can't speak for the hundreds of other types of 'alternative' medicine, but Chinese medicine, acupuncture and medicinals both, is meant to be used in concert with standard Western techniques. That's what they do in China, and that's what the most vociferous critics of those (Chinese) modalities generally don't know or don't care.
re fertility, in the April 2002 issue of Fertility and Sterility, German researchers announced that they had increased the success rate of women undergoing in vitro fertilization. I do fertility-enhancement acupuncture myself, and I assure you that a belief in 'chi' or whatever is not necessary for its success.

Posted by: Cat brother at September 28, 2006 6:35 AM

No problem, Norman. It must've been all the crystals in my coffee reversing the polarity of my aura. ;)

Posted by: Melissa at September 28, 2006 8:42 AM

"I see no reason to object to whatever crazy shit people do when I'm unconscious."

Sure, as long as they don't see crazy shit as a viable substitute for shit that might actually help you get better (or die faster).

Posted by: Lena at September 28, 2006 12:23 PM

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