BMJ Press Release issued 24th November 2006

Personal View: Shark cartilage in the water
(BMJ 2006; 333: 1129)

It is time to protect patients from “vile and cynical exploitation” by the alternative medicines industry, argues a cancer expert in this week's BMJ.

It is estimated that up to 80% of all patients with cancer take a complementary treatment or follow a dietary programme to help treat their cancer, writes Jonathan Waxman, Professor of Oncology at Imperial College London.

Yet the rationale for the use of many of these approaches is obtuse – one might even be tempted to write misleading, he says.

Indeed the claims made by companies to support the sales of such products may be overtly and malignly incorrect and, in many cases, the products may be doctored by chemicals borrowed from the conventional pharmaceutical industry. The reason that these products are accessible to patients is that they are not subject to the testing of pharmaceuticals because they are classified as food supplements.

So why do patients take alternative medicines? Why is science disregarded? How can it be that treatments that don't work are regarded as life saving?

Waxman believes that it is because the complementary therapists offer something that doctors cannot offer – hope. If you eat this, take that, avoid this, and really believe this then we can promise you sincerely that you will be cured.

And if the patient is not cured, it is the patient who has failed, not the alternative therapy. The patient has let down the alternative practitioner and disappointed his family who have encouraged his “treatment.”

As well as the complementary medicines they take, many patients will have changed their diets in order to cure their cancers, says the author. But although there is a strong dietary basis to the development of cancer, once cancer has been diagnosed no change in diet will lead to any improvement in cancer outcomes, he writes.

Why do patients change their diet? For some it is a way of taking back some control of a situation that is entirely out of their control, says Waxman. For others it is because of the pressure put on them by families, friends or vested interest groups to “go organic.”

“It's time for legislation to focus on a particularly vulnerable section of our society and do something to limit the exploitation of our patients,” he says. Why not subject the alternative medicines industry to the level of scrutiny that defines pharmaceuticals?

“Reclassify these agents as drugs - for this is after all how they are marketed - and protect our patients from vile and cynical exploitation whose intellectual basis, at best, might be viewed as delusional. The current EU initiative to bring forward legislation on this matter is welcomed.”

Contact:
Jonathan Waxman, Professor of Oncology, Faculty of Medicine, Imperial College, London, UK
Tel: +44 (0)208 383 4561

Click on link to view paper (p3 of pdf): http://press.psprings.co.uk/bmj/november/pv1129.pdf

ANH comment by Dr Damien Downing, Medical Director:

For those of you unfortunate enough to read any articles or see any television reports featuring Professor Jonathan Waxman, a natural products-hating oncologist from Imperial College, London, indulge yourself in some soothing words from ANH's Medical Director, Dr Damien Downing.

On seeing Professor Waxman's ‘Personal View' issued in the pages of the British Medical Journal yesterday (BMJ 2006; 333:1129. For full article refer to pg 3 of the following link http://press.psprings.co.uk/bmj/november/pv1129.pdf), Damien immediately responded via the BMJ's Rapid Response pages and posted the following response:

Professor Waxman employs and perpetuates a crucial medical myth — that, in contrast to complementary therapies, conventional therapies are all evidence-based, on sound science. But the BMJ's website Clinical Evidence reports that, of the 2404 treatments they have surveyed, only 15% are rated as beneficial, while 47% are of unknown effectiveness¹. In his own speciality, indeed, chemotherapy for cancer was found in a 2004 systematic review of studies in the USA and Australia² to improve overall 5-year survival chances by less than 2.5%. Interestingly, the review of dietary interventions he cites³ derived an odds ratio for the effect of a healthy diet, with or without dietary supplements, of 0.90 — which appears to make them probably 4 times as effective as chemotherapy. Different end-points, granted, and a big confidence interval, but nevertheless “absence of evidence is not evidence of absence”.

Talk of “vile and cynical exploitation” could with equal justification be applied to the cancer industry, into which billions has been poured in recent decades, to very little effect.  Surely Professor Waxman should be careful not to become, as discussed in the same issue of BMJ, “a lapdog to drug firms”?

¹ http://www.clinicalevidence.com/ceweb/about/knowledge.jsp
² Morgan G, Ward R, Barton M. The contribution of cytotoxic chemotherapy to 5-year survival in adult malignancies. Clin Oncol (R Coll Radiol), 2004; 16(8): 549-60.
³ Davies AA, Davey Smith G, et al.. Nutritional interventions and outcome in patients with cancer or preinvasive lesions: systematic review. J Natl Cancer Inst 2006; 14: 961-73.

It's clear from Professor Waxman's response that a threat is perceived not only from dietary/food supplements used by millions to support their health, but he has also taken a sideswipe at organic food, produced by a branch of agriculture supported by increasing numbers of consumers that is threatening Big Food and agri-business.  The irony, of course, is that those most interested in minimising both the burden on the healthcare system and time spent in doctors' waiting rooms are those who will be more likely to consume both organic foods and high quality food supplements.  Market research has demonstrated that most users of food supplements do not use these products to counter poor diet, but rather use them to add nutrients that they believe are missing as a result of modern agriculture and food processing methods.

The increasingly vocal hatred expressed by key opinion leaders within the orthodox medical community has to be an expression of the threat that they perceive from the millions of people around the world who continue to use products derived from nature as key components of their healthcare regime. 

You'll appreciate that this is no time for anyone to put their head in the sand!