- Question from Stacey: Why is it when someone sees dramatic results using an alternative therapy, practitioners of Western medicine choose not to study it further?
It comes down to paradigms. Paradigms are literally world views. And if you have all your eggs in one paradigm basket, and another person comes up with another paradigm basket, then that can be very threatening. Most people have put their economic livelihood and their ego/self esteem into that one world view. When something outside their familiar paradigm is shown to be somewhat effective or even more effective, that can literally overwhelm the practitioner's paradigm and cause anxiety and self doubt.
Most people try to keep anxiety and self doubt at arm's length. The way some practitioners do that is by dismissing and belittling and ignoring and discounting dramatic improvements from another paradigm. Also, cancer patients' friends and family can do the same. We know you can't "catch" cancer, but cancer still has a lot of stigma and impact. I see patients in therapy groups, and what added insult to injury was their friends disappearing because they couldn't handle the mortality issues. Instead of trying to deal with their own anxiety, they kept it at arm's distance by keeping their friend, who now has cancer, at arm's distance. And that adds to the depression and feeling like damaged goods.
That's why support and therapy groups are essential. You hook up with people who are walking the walk, not just talking the talk, and you connect with people who care about you and aren't scared or threatened. Support groups improve quality of life, which means less anger, pain, rage, and better sleep, better pain control, and reduced post-operative complications compared to those who are isolated or don't have support.
Although they've had difficulty replicating Dr. Spiegel's work at Stanford with metastatic breast cancer patients, and Dr. Fawzy's malignant melanoma group at UCLA, they found that people who went to support groups had better quality of life, and the support group folks lived longer than those who weren't in groups. These studies haven't shown so much quantity of life as quality. So that's why people in general sometimes are dismissive, or don't want to give credit when they see other forms of treatment.
Adding to what Dr Lachman says, all of which I agree with, the support groups also give hope. They add positive ways of relating to illness that people explore and can help each other find and develop and enhance. They also serve to share information, because there is so much out there that it's impossible for one person to find all of it. So in a group of people with similar problems, many people can scan for information that's helpful to all.
I've been interested in the opposite question, namely how does change come about in people's attitude? And I have to say that the general public is way ahead of the medical profession. In 1993 and 1998, there were very important papers published by Dr. David Eisenberg at Harvard: surveys showing that almost as many dollars were spent by the public for complementary and alternative therapies as were spent for conventional medical treatment. These therapies were not covered by insurance, so it was clear people were paying that much money out-of-pocket. These surveys had the effect of opening doors in medical schools to exploring these therapies, which people were obviously finding worthwhile in a big way.
At the same time, doctors are cautious, and properly so, because snake oil and other treatments have been touted but found to be no more than sugar pills and sometimes poisonous pills. Doctors are also concerned that people might use these therapies as alternatives, and that's where the term "alternative therapy" has been threatening to doctors who think someone will find an alternative to their treatment, since they know little about it from their training. This is being corrected.
There is now an American Board of Holistic Medicine (ABHM), which is training and certifying doctors in these areas and giving them legitimacy. I was pleased and honored to be invited as a founding member of the ABHM to introduce evidence confirming that spiritual awareness and healing are effective modalities within this spectrum. Support groups often provide information that people can take back to their doctors. So they are not only asking the doctor about the therapy, they are educating the doctor as well. I've spent some 20 or more years collecting this sort of evidence in my books on Healing Research.
On the NIH (National Institutes of Health) Web site, May 2004, they surveyed over 31,000 people in the US. They found that 36% of all adults, not just cancer patients, were using some form of CAM (Complementary and Alternative Medicine). When they factored in vitamins and prayer, it rose to 62%. NIH in May states that women, more than men, tend to use CAM. People with higher education levels tend to use CAM. People who have been hospitalized in the last 12 months tend to use CAM. Former smokers use CAM more than current smokers.
CAM is used most frequently, at least in the US, for back problems, neck problems, headache, joint ache, chronic pain, colds, anxiety, depression, gastrointestinal disorders, and sleeping problems. 55% of those in the survey combined conventional and complementary to get the best of both. Citing a 1997 study, the American public spent between 36 and 47 billion dollars in 1997 on complementary and alternative medicine.
Jennifer Griggs, M.D., M.P.H.
I'd like to add an oncologist's perspective. In addition to physician discomfort over therapies, particularly therapies that people put in their bodies, with which they are not familiar, it is important to recognize the following. Even when randomized controlled trials costing millions of dollars demonstrate the benefit of a new therapy, treating physicians can be slow in taking up the use of a new treatment or diagnostic tool. In addition, even when drugs have been studied for years and been shown to be effective, long-term negative effects can show up even years after FDA approval. So as a group, physicians tend to be cautious — for better or for worse.
Obviously, caution is not always comfortable when we are dealing with cancer, but many of us believe that "doing no harm" is the most important thing we do for our patients.
Finally, many drugs that are used in "mainstream" medicine come from natural compounds, such as the bark of the Pacific yew tree (paclitaxel). So we oncologists do recognize the potential of the natural world to heal, but we also see the potential downsides of such products as well. We are no where near as cautious with treatments that aren't taken by mouth, such as massage and aromatherapy, but we may not be as familiar with these options.
On Wednesday, October 20, 2004, our Ask-the-Expert Online Conference was called Complementary and Holistic Techniques. Dan Benor, M.D.,Larry Lachman, Psy.D., and moderator Jennifer Griggs, M.D., M.P.H. answered your questions about the various complementary and holistic treatments that may benefit those with breast cancer.
The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.
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