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Dr. Ernst is Director of the Department of Complementary Medicine, School of Postgraduate Medicine and Health Sciences, University of Exeter.
Correspondence to: Edzard Ernst, MD, PhD, Department of Complementary Medicine, Postgraduate Medical School, 25 Victoria Rd, Exeter EX 2 4NT, UK; e-mail: e.ernst{at}exeter.ac.uk
On average, unconventional cancer therapies (UCTs) are used by 31% of all cancer patients.1 Many oncologists view this level of popularity with a mixture of bewilderment or worry and ask, "Why do patients insist on trying unproven and potentially hazardous treatments?" The answer is probably complex, and some people are tempted to refer to the zeitgeist or even point out the dawning of an "age of unreason." But cancer patients are desperate individuals who understandably want to "leave no stone unturned." Recently, it has been suggested that usage of UCTs might be a marker of anxiety in these patients.2 Cancer sufferers may also be disappointed with what they perceive as the depersonalized care of mainstream oncology and look toward the highly empathetic and personal attention of alternative practitioners.1
Every decade, it seems, has its favorite UCT. Usually, the life cycle is remarkably similar. Intensive lobbying initially creates pressure on the scientific community to investigate the UCT. When the scientific community finally gives in to this pressure and conducts clinical trials, the results turn out to be negative. At this stage, oncologists (wrongly) think their job is done and the UCT has been successfully debunked. Enthusiasts, by contrast, invariably claim that the tests were in some way invalid and therefore the results cannot be trusted. Subsequently, the UCT assumes some sort of an underground existence at the fringes of oncology, and a myth is created that "the establishment" is deliberately suppressing effective cancer cures. UCTs that have gone through this cycle include laetrile, thymus therapy, hydrazine sulfate, shark cartilage, and most recently, the Di Bella therapy.3 4
This issue of CHEST (see page 591) contains a most fascinating case report of an apparent cure with germanium sesquioxide in a patient suffering from pulmonary spindle cell carcinoma. The authors have to be applauded for their efforts to describe the case in sufficient detail and to critically discuss the possibility of a causal relationship between the self-administration of germanium and the subsequent complete tumor regression. Spontaneous remission, rare as it is, cannot be ruled out.
A case report is obviously no sound basis for an assessment of an UCT. The authors are therefore rightly cautious in their interpretation of this particular case. They point out that various phase II trials have not yielded promising results and that germanium is burdened with considerable toxicity. Other writers on the subject are less critical. They assure us that we are dealing with an "unusually nontoxic substance" and that it is "potentially effective in the treatment of cancer."5 This discrepancy between statements made by responsible scientists and authors of lay books on alternative medicine is no exception and may render lay books of this type a risk factor for good health.6 Yet it just might be that germanium, even though it shows little effect in most malignancies, is highly effective in carcinosarcomas–no doubt a "long shot," but a possibility. Thus, one has to agree with the authors that further studies are warranted.
The danger here is that one might raise false hopes in highly vulnerable patients who don’t need any additional distress. Or worse still, one might indirectly hinder the access of some cancer patients to effective treatments. Desperate patients or alternative practitioners will almost certainly hear about this case and could take the wrong conclusions; they might opt for germanium therapy instead of mainstream treatments. The use of UCTs as true alternatives is perhaps the biggest danger associated with such treatments.7
Three things seem to follow. Firstly, we should do the necessary research as soon and as rigorously as possible. It seems a good idea to intimately involve the proponents of a given therapy in all stages of this research. Secondly, we have an obligation to make sure that the results of such investigations are not distorted and reach those patients who are desperate and likely to try anything. Thirdly, we must demonstrate more understanding of patients using UCTs. Many patients are afraid or embarrassed to tell their doctor of their UCT use.8 Our lack of understanding for and knowledge of UCTs significantly increases the risk of such therapies being used as true alternatives to mainstream medicine. If this is true, it is our closed minds that render UCTs more hazardous than they already may be.
References
This article has been cited by other articles:
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  H. Singh, G. Maskarinec, and D. M. Shumay Understanding the Motivation for Conventional and Complementary/Alternative Medicine Use Among Men With Prostate Cancer Integr Cancer Ther, June 1, 2005; 4(2): 187 - 194. [Abstract] [PDF]
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 E. Ernst "Alternative" Therapies For Asthma : Reason For Concern? Chest, November 1, 2001; 120(5): 1433 - 1434. [Full Text] [PDF]
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 L. J. Hoffer Proof versus plausibility: rules of engagement for the struggle to evaluate alternative cancer therapies Can. Med. Assoc. J., February 1, 2001; 164(3): 351 - 353. [Full Text] [PDF]
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 S. J Padayatty and M. Levine Reevaluation of Ascorbate in Cancer Treatment: Emerging Evidence, Open Minds and Serendipity J. Am. Coll. Nutr., August 1, 2000; 19(4): 423 - 425. [Abstract] [Full Text] [PDF]
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