ALTERNATIVE AND COMPLEMENTARY APPROACHES TO CANCER CARE
Research shows that, at least, half of the cancer patients use complementary or alternative medicines in addition to conventional medicine (and one suspects that a lot of the remainder is simply not telling us). These come in many varieties and include traditional therapies used by patients from ethnic minorities. Although the terms ‘complementary’ and ‘alternative’ are sometimes used interchangeably, it is helpful to distinguish between different varieties of what may be termed to be outside mainstream medical practice. I will, therefore, refer to complementary medicines as those aimed at running alongside conventional therapies as a form of support. An example would be aromatherapy, which does not fundamentally conflict with the patient continuing their conventional therapy. Indeed, aromatherapy may aid compliance with treatment or reduce the need for additional medications such as laxatives or painkillers. As well as quasi-medical therapies like aromatherapy, there are treatments such as acupuncture and homeopathy that may be available both via mainstream healthcare and via other ‘therapists’. Alternative medicines, on the other hand, are aimed at replacing the mainstream treatment with one that conventional medicine would regard as unproven at best and harmful at worst. In practice, it is impossible to rigidly separate treatments into one or other category, as while one patient may use a remedy alongside the conventional, another may use the same remedy in place of it – the distinction is one of intent as much as content.
There are a huge number of different alternative and complementary medicines, including homeopathy, acupuncture, dietary therapies, herbal remedies, aromatherapy, as well as techniques such as crystal therapy, visualization, and traditional therapies used by ethnic minorities. A full analysis of each of these is beyond the scope of this book, so I will try and select a few examples to make general points about how complementary and alternative treatments interact with cancer therapy. Before doing so, it is worth getting a feel for the massive extent of usage of such treatments. While countries may vary, usage in the USA is likely to be pretty typical of use in the developed world. As it is easy to quantify spending in the USA, I will give a breakdown of recent figures produced by the American National Institutes for Health. The headline figure is that 88 million Americans spent $33.9 billion on complementary or alternative medicines in 2007. This amounted to over 10% of all ‘out of pocket’ expenditure on health in the USA. In addition, a further $23 billion was spent on vitamin and mineral supplements. Given the very high medical bills faced by US citizens, it is clearly astonishing that they would spend such a sum in addition. At the 2007 exchange rate, this would have provided all healthcare for the UK population for about 6 months. These figures clearly relate to total expenditure, not money spent specifically by cancer patients; however, they do give a good feel for the extent to which these treatments are used. Similar expenditures occur in all industrialized countries. Why do citizens in all the most educated societies in the world, generally provided with healthcare which, as we have seen, keeps most of them alive into old age, shell out such huge sums on additional, mostly unproven, therapies? Clearly, in less wealthy societies, traditional remedies may be all that part of the population can afford, and thus different forces may be at play.
Before moving on to try and address this, it is worth looking at a breakdown of what the money goes on. Again, I will refer to the US figures, and clearly, the split elsewhere may vary, but I believe it gives a feel of the sorts of things people want. If we understand that, it may help explain the paradox above.