Navigating the world of complementary and alternative healthcare information.
By: Dr. Ellen McDonell, ND.
The internet, television and bookstore host a wealth of health information. There has been a boom in documentaries, books and blogs on the topic of complementary and alternative medicine for cancer.
While some are well written and appropriately researched, others misrepresent information and can lead patients to make potentially dangerous decisions surrounding their healthcare. Furthermore, conflicting or extreme information can leave patients confused, overwhelmed and unsure of the best steps to take for their health.
Outlined below is a series of ways that information can be distorted. Evaluating health related information is about looking at the totality of information provided and coming to a rational conclusion based on facts and clear arguments.
It is important to note that nothing can replace the individualized advice and expertise of a qualified healthcare provider working in cancer care. Your oncologist, oncology nurse, family doctor, and licensed naturopathic doctor with experience in integrative cancer care are great people to discuss healthcare options with. Naturopathic Doctors at the OICC are excellent resources for navigating complementary and integrative therapies for cancer care.
Tips to be an informed consumer: tactics to be cautious of
To be blunt: only people who survive are able to give testimonials, and thus there is an inherent bias that comes from the story told. Testimonials do not adequately represent the totality of experiences, and most importantly the experience others might expect. As an example, it would not be hard to find one woman who drank excessively during her pregnancy, and had a healthy child. Of course, that would not prove that heavy drinking is safe during pregnancy. Testimonials provide little meaningful information regarding the safety and effectiveness of a treatment.
Testimonials can be useful for getting a sense of a person’s experience with a treatment, but they cannot be used to justify or prove a treatment’s efficacy.
One-sided story telling
If a website, documentary or healthcare provider tells only one side of the story, be wary. Claiming that all conventional treatments are “toxic” for example, fails to acknowledge the ongoing improvements in survival rates of many cancers. Stage 1 breast cancer now has a 5-year survival rate of over 98%. (1)
There are many areas in cancer care where the successes have not been this profound, and survival of course is not the only relevant factor. Quality of life and long-term prevention of recurrence are incredibly important considerations that are not addressed by 5-year survival statistics. However, to imply that there is not a place for western medicine is to paint all cancers and all drugs as the same and is a gross misrepresentation of the information.
Statements that sound too good to be true probably are. Any sentence with the formula “_____ cures cancer” is probably a falsification or exaggeration. While there may be a grain of truth in some of these claims, we are not aware of any natural treatments for cancer that work in all people, in all cancer types, all of the time.
Preclinical, in vitro or animal research being presented as human research
This one can be harder to spot. Frequently the media doesn’t differentiate between in vitro (in a petri dish on a counter), animal and human based evidence. You are not a mouse, and you most certainly are not a petri dish. While animal and in vitro research is important, it is also limited in its applicability to humans. What happens in a test tube or an artificially created mouse model may not happen in the complex, interconnected systems of the human body.
Conflicts of interest: people making money from their recommendations
Just because someone is making a living from their healthcare services or products, does not inherently mean they aren’t to be trusted. However, disclosing conflicts of interest is important. Be wary if every statement or recommendation on a website is a hyperlink to a page where you can purchase the product, or if the individual works for or owns a natural health product company. Ideally there should be a conflict of interest statement, however, this is often not the case.
The Ottawa Integrative Cancer Centre is a not-for-profit organization, and has a strict no conflict of interest policy. No practitioner or anyone associated with the OICC receives any compensation from supplement or product sales. Income generated through these sales goes directly back into the clinic to fund clinic operations, free and subsidized programming, subsidized care, and research. This policy reduces the risk of conflict of interest and supports our clinicians to provide the best objective care for our patients.
Politics and money certainly play a role in our healthcare. However, let’s not forget that the supplement industry is also a billion dollar industry. Conspiracy theories may sometimes have a basis in truth, but they can be used to manipulate and create mistrust of medicine. There is no doubt that our healthcare system has flaws, however, pointing out flaws in one system does not negate the whole system nor prove the validity of another approach.
Treating all cancers as one disease
Cancer is not one disease but a variety of conditions with similar features and underlying pathophysiology. A variety of factors will determine the most appropriate treatment for an individual, including:
- The type of cancer
- The stage of cancer
- The age and health of the individual
- The goals of the individual
Stage 1 cancers are very different from stage 4 cancers, and to apply the same treatment approach to both scenarios is not appropriate and can have very real and negative consequences.
In the hierarchy of evidence, expert opinion is near the bottom. Expert opinion can be valuable by bringing context and experience to an issue, particularly if there is a consensus amongst a group of experts. However, having one person give their opinion without hearing alternative views, or having evidence to back up claims, can be false and misleading. Just because someone is an MD, ND, PhD, or holds a position of authority does not mean they are best informed.
Cherry-picking research studies
There are a variety of reasons why a study might produce a particular result. Results can be skewed due to the way a study was performed, who the study was performed in (the population), the number of people in the study, the dose of agent used, the length of time an agent was administered, etc. This is why we seek to replicate and repeat studies, to ensure the result was real and not just an artifact of the research methodology used. For many drugs or natural therapies studied in cancer, there will be one or two studies that have different results from the others. In evaluating the evidence it is essential to look at the whole or totality of the evidence.
To reduce this kind of bias and confusion, there is a type of study called a systematic review which pulls together the results from all studies without bias. In a further rendition, meta-analyses of systematically reviewed data are more powerful, as they pool together the results from all of the studies done in a particular area to come out with one final number or recommendation. Authors should either present all of the research on a particular topic, or reference a recent meta-analysis if one has been done. Picking out the one or few studies that confirms an idea or recommendation (unless the other studies were invalid for some reason) does not lead to good medicine, and is certainly not scientific.
Statements without references
Claims about curative abilities of treatments should have a reference to the research study the result came from. References should be peer-reviewed sources (see PubMed (nih.gov) ) for an index of peer-reviewed scientific papers) and NOT based on uncited blogs, opinion pieces or even books.
Anyone can write a book, make a documentary or post a blog. This is where peer-reviewed journals come into play. For a study to be published in a peer-reviewed journal means it has been critically evaluated by experts in the field to ensure that the study was performed well, that the results were presented accurately, that other research is accounted for, and that the conclusions drawn from the study were appropriate. For example, if a study in a rat finds that cranberry kills cancer cells, and the authors conclude that “this study demonstrates that cranberry is an effective treatment for cancer in humans”, that paper would not be published as it would not pass the peer-review process. It is important to recognize that peer-review is not perfect either and scientific studies even when published can become discredited if later found to be inaccurate or falsified.
Some information online makes surgery, chemotherapy, radiation and hormone therapy sound so terrible that the reader has no choice but to refuse it. Conversely, sometimes complementary and alternative therapies are made to sound inherently dangerous and expensive. Neither of these are fair representations. Be cautious of flashy headlines and bold statements, which can play to the emotions of a person with a recent diagnosis.
There is nothing that you did to directly cause your cancer, and there is nothing you did or did not do from a lifestyle or dietary perspective to prevent a cure. A reputable organization or treatment will never blame the patient for his or her own treatment failure. Never allow yourself to be made to feel that you are the reason you have cancer, or you are the reason you haven’t been cured.
Finding good information
While some information online and in documentaries is far from accurate, there are many good resources as well. Here is a list of reputable places to gather information. This list is by no means exhaustive, and inclusion on this list does not mean that everything found within is correct. Always be critical as nothing is without bias, information becomes out of date very quickly, errors can always occur, and interpreting research is complex. These websites provide good places to start, and can supplement the information you receive from your oncology team. And again, none of these replace consultations with your healthcare team.
- PubMed (PubMed (nih.gov) – peer reviewed medical papers
- Google Scholar (https://scholar.google.ca/) – another source of (mostly) peer reviewed papers
- National Cancer Institute (www.cancer.gov)
- Canadian Cancer Society (www.cancer.ca)
- Ottawa Integrative Cancer Centre (www.oicc.ca)
- American Institute for Cancer Research (www.aicr.org)
- Memorial Sloan Kettering Cancer Centre (www.mskcc.org)
- Mayo Clinic (www.mayoclinic.org)
- World Cancer Research Fund (www.wcrf.org)
Other helpful resources:
- College of Naturopaths of Ontario (www.collegeofnaturopaths.on.ca) The public register lists all licensed naturopathic doctors in Ontario. If your “naturopathic doctor” is not listed here, they are not a licensed naturopathic doctor! Other regulated provinces have websites with similar search abilities.
- Oncology Association of Naturopathic Physicians (www.oncanp.org)
- Canadian Association of Naturopathic Doctors (www.cand.ca)
You have the right and autonomy to make decisions regarding your healthcare. Our goal at the OICC is to provide people with accurate information to help avoid individuals making decisions based on misinformation. In health, like many areas in life, extremes can be dangerous. This is your health; be critical, ask questions, and make informed decisions.
(1) Howlader N, Noone AM, Krapcho M, Miller D, Bishop K, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2013, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2013/, based on November 2015 SEER data submission, posted to the SEER web site, April 2016.