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IN 2013, a 21-year-old Spanish physics student, Mario Rodríguez, died of leukaemia after refusing a second round of chemotherapy in favour of “natural” remedies recommended by his homeopath.
In the wake of his son’s death, Mario’s grieving father, Julián Rodríguez, launched a legal action against the homeopath for reckless homicide and “professional intrusion” (essentially, falsely pretending to have medical knowledge).
The homeopath had prescribed 4000 euros worth of alternative medicines to Mario, including vitamins, fungi and alcohol, according to a report in the Independent.
He denied allegations he had claimed to be able to cure cancer, saying: “we train the body to enhance recovery and if cancer is cured, then perfect”.
The case became something of a cause célèbre in Spain, pitting those who are sceptical of alternative therapies against supporters.
Rodríguez senior became an active campaigner, forming an association to “protect the ill from pseudoscientific therapies”.
Earlier this year, Spanish courts absolved the homeopath of blame, saying Mario was responsible for the decision to abandon conventional treatment and criticising his father for attempting to turn the case into a trial of “so-called natural medicine” more generally.
Julián Rodríguez has vowed to fight on.
Without wishing to comment on the merits of this particular case, it does illuminate the biggest risk posed by the cornucopia of alternative treatments spruiked to people with cancer.
The vitamins and weird diets may not do any actual harm in themselves – though some alternative treatments are contraindicated with chemotherapy – but the real danger is that they seduce people away from the treatments that might actually give some hope of survival.
This may be the case even with complementary therapies, where treatments are used in combination with conventional treatment, according to an observational study published in JAMA this month.
The cohort study looked at patient characteristics and survival rates in people with cancer who had received at least one round of conventional treatment.
Those who used complementary therapies were twice as likely to die within 5 years compared with those who stuck to conventional treatments only, the study found.
The herbs and acupuncture were not deadly in themselves, of course, but patients using complementary therapies were more likely to delay or selectively refuse recommended medical treatment.
No significant mortality gap was found in those patients who fully adhered to conventional treatment alongside their use of complementary therapies, which may offer quality of life improvement in some patients.
Patients using complementary therapies tended to have characteristics that would otherwise be associated with better survival rates, the authors wrote: they were more likely to be younger, female, have private insurance, and to be more highly educated and of higher socio-economic status.
“The use of complementary and alternative medicine … is estimated to be a multibillion-dollar industry in the United States,” the authors wrote.
“Its growth has been attributed to its increased availability and marketing as well as congruence with patients’ beliefs, values, and philosophies regarding their health, especially the desire for direct self-autonomy.”
It may seem surprising that a physics student like Mario Rodríguez would accept cancer treatment advice from a homeopath, but the “desire for autonomy”, and resulting rejection of conventional medical advice, does seem to correlate more broadly with wealth and education.
A similar phenomenon can be observed with vaccination, where rates tend to be lower in more affluent areas.
In the end, there is a limit to how much people can be protected from themselves, as the Spanish courts apparently determined.
But the JAMA authors do stress the importance of health professionals being proactive in discussing complementary treatments with patients with cancer, given estimates that up to 88% of patients with cancer may be using them and “hesitance on behalf of patients to disclose nonmedical therapy to their clinicians”.
Such a proactive approach might at least give some hope that the therapies remain complementary, rather than becoming alternative.
Jane McCredie is a Sydney-based health and science writer and editor.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or MJA InSight unless that is so stated.
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Dr Anonymous commenting on every article wanting “medical acupuncture”. This means of course, doctors (preferably of Asian origin) sticking tiny needles at random points into patients instead of actually doing medicine. Dr Anonymous you’ve wasted your education. Try using medicine, CBT and supportive counselling. You’d be surprised how effective it is without the silly little needles.
Anyone offering a treatment – conventional or otherwise – should be able to discuss with the patient what the risk, harms, and effectiveness of that treatment is. Informed consent in the conventional medical fields is often suboptimal (interns obtaining, some risks not discussed, degrees of uncertainty, some therapies even with significant evidence base have different interpretations of that evidence e.g. stroke thrombolysis).
Despite all that, there is transparency, accountability, and the system tries to improve things e.g. common procedures have written consent forms including the most significant of the potential harms.
When someone can call themselves ‘doctor’ (e.g. chiropractors in Australia) and recommend treatments, it is inconceivable that they can offer them without any accountability for the assurances they give their patients. The title carries weight to their patients even if it is regarded as a joke amongst the more scientific community.
Placebo can be powerful. Autonomy can be therapeutic. Patients who get some benefit – even nebulous ‘wellness’ – should have the option of whatever treatment they want to pursue, but as per anonymous above – the practitioners are the problem. Something approaching informed consent with recourse for lying to their patients would be a minimum.
Reply to Jarrod McMaugh:
In answer to YOUR question: Of course Medical Acupuncture is not a treatment for cancer. It does have however high level clinically valid trials demonstrating significant reductions in fatigue, pain, anxiety depression QOL in post chemo patients. So the point is that this treatment is evidence based, mainstream and ‘should occur’. (contrary to you opinion)
But you appear to have missed the main point that I made: ” Indeed it is actually the alternative PRACTITIONERS where the problem lies. They have no real medical training and find themselves sitting in a position of ill-conceived power spruking to a vulnerable cancer audience.” This occurs whatever unscientific ‘potion’ they are selling.
There is level one evidence that acupuncture is no more effective than placebo.
The rise of all this ‘voodoo’ practice (no other description suffices really) has occurred since the 1970s with cognitive dissonance more and more entrenched in society. This is now happily aided and abetted by Big Vitamin and Big Supplement (as opposed to Big Pharma’ that at least is constrained to some degree financially and ethically by the requirements of the Scientific Method and government legislation).
One needs to ask what has occurred in developed western societies since then to have this dangerous nonsense to flourish (fake science if you like). This problem could be easily sorted out. All these pseudo-doctors should be registered separately from AHPRA by the Commonwealth Govt. and all should be required to hold high level insurance so that the ambulance chasing lawyers will have a larger pool to feed off in civil litigation. i.e. let the lawyers sort these crooks out because the politicians certainly won’t.
In reply to the first comment….
The nature of the article doesn’t need to address whether acupuncture is evidence based – nor any other modality.
The point is that the use of a “complementary” therapy instead of allopathic medicine should not occur.
Surely you would agree that no person should use acupuncture as their only treatment for cancer?
Survival rates for cancer patients having conventional treatment are not very good. Obviously cancers found early have a much better rate of 5 or 10 year survival, than those discovered late, and certain things like testicular cancer, and childhood leukaemias are success stories, but most still succumb to their cancers, especially if there are metastases
Many of the patients I have spoken to tell of their oncologists referring to any kind of complementary treatments as “voodoo”. The National Cancer Institute in USA recognises that high dose IV vitamin C , for example, reduces the side effects of chemotherapy, although there is some evidence of Vitamin C interfering with some chemotherapeutic agents. Assuming that there is no interaction, why is there such antipathy to something that makes your patients feel better, or at least less ill, instead of a blanket denial that anything other than “cut, burn, poison” can help.
After all, we all take an oath which states that “first we do no harm”, and chemptherapy certainly doesn’t make patients feel well.
I always assumed my patients with malignant diseases would seek alternative treatments, before during and after surgery or chemo-radiotherapy–I just asked them to let me know before starting these treatments so I could make sure they were not incompatible or harmful. I also explained that the expense and effectiveness were likely to be inversely related. I didn’t have any patients that completely rejected conventional treatment, and the case discussed in the article is very sad. But all of us who have practiced medicine over a long period know that patients can have illogical or invalid belief systems that are hard to shake.
When w ill we finally get a MJA author actually saying that acupuncture is valid evidence based therapeutic intervention; rather than an ‘alternative therapy’. If the MJA actually did some research they would find out that medical acupuncture has Level 1 evidence and is first line medical treatment for a number of medical conditions particularly in relation to pain.
Further research would reveal that evidence based medical acupuncture is actually used to reduce chemotherapy side effects, prolong the use of chemotherapy and prolong life.
Using figures from the non medical side of acupuncture/herbal to denigrate the treatment is typically playing to, and increasing prejudice. Indeed it is actually the alternative practitioners where the problem lies. They have no real medical training and find themselves sitting in a position of ill-conceived power spruking to a vulnerable cancer audience.