Nothing Natural About It: Is the Internet Bad Medicine for Cancer Patients?

Published: Monday, Apr 16, 2007
What remains less certain, and unquestionably disturbing, is the degree to which this profoundly powerful tool—available to patients, physicians, researchers, and the general public—may actually be employed in ways that result in genuine harm.

A recent article featured in The New Yorker addressed this very topic, as it applies to traditional African medicine. Consider, for instance, the report from investigators at the University of Chicago, who queried a group of patients (n= 212) participating in phase I clinical trials on their use of unapproved biologically-based complementary and alternative medicine (CAM). Following their entry into the trials, these patients were scheduled to receive highly experimental anti-cancer agents. Thirty-four percent (n=72) of this population acknowledged that they were also using CAM while enrolled in the clinical trial. This figure is notable, and presumably a minimum percentage, as it is simply unknown how many more patients were not willing to openly admit they were regularly taking alternative medicines and supplements, possibly due to the disapproval such action would generate in their treating physicians.

The Proof is in the Prep

The University of Chicago research team correctly noted the potentially serious implications of their findings, both for the individual patients participating in the trials and for the impact on the research itself. Assuming the “herbal preparations” were actually biologically active, it is highly plausible that one (or more) of the following scenarios could occur, completely unrecognized by the researcher or patient. The herbal preparation could:

• Enhance the toxicity of the anti-cancer agent

• Independently produce a toxic eff ect that would be

incorrectly ascribed to the anti-cancer agent

• Interfere with a favorable biological eff ect of the

anti-cancer agent, possibly even leading to the inappropriate

abandonment of further study of the

drug in a particular setting

These outcomes may result in harm to the individual patients, as well as future patients participating in this particular trial, and may seriously interfere with an appropriate interpretation of the study. Where might patients (or their families) have learned about these “biological agents,” and where would they obtain their supply of these products? An even more provocative issue is the question of what information has been provided regarding these specific “biologicals” that would lead patients to make such a potentially risky decision to employ unapproved preparations when they are receiving highly experimental anti-cancer drugs, whose own side effects at this precise point in time are so poorly understood? A

number of sources for both information about and supplies of these supplements can be proposed, including health-food stores and the patient’s personal advisors (family, friends). However, it is also obvious that the Internet has increasingly become a major supplier of both the information and raw material that can lead to these potentially risky, if not outright dangerous, practices.

On the Internet, a health-related site describing what it claims is a truly eff ective, natural, and completely safe alternative (nonmainstream medicine-approved) cancer management strategy may appear to be as scientifi cally valid as a site explaining the results of a well-designed, peer-reviewed trial. Specifi cally, a randomized phase III trial conducted in the identical clinical condition noted the “modest impact on survival of a newly FDA-approved treatment that caused substantial, but generally manageable toxic eff ects,” according to JAMA.

Nature of the Beast

There is no clear reason to believe that the technical sophistication of—and bells and whistles contained within—a website will bear any relationship whatsoever on the medically relevant value of its content. However, human nature being what it is, when otherwise rational individuals (and their families) are forced to confront a truly life-threatening medical condition, is it any wonder that some patients may elect—with or without the strong encouragement of others—to take what is described as a “miracle herbal” preparation, along with the conventional (or experimental) treatment, regardless of what their oncologist may say? Also, when provided with two very diff erent messages—one off ering limited hope and concerns regarding toxicity, the other essentially guaranteeing a favorable outcome—which reality would patients, and their families, want

to believe?

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