Response to appearance of William O'Neill and Dr. KhaledTed Vandenberg, M.DOncologist This article is in response to claims made by William O'Neill of the Canadian Cancer Research Group, an Ottawa based cancer information service that has been involved in several high profile Canadian cancer caaes, including Sandra Schmirler, and Tyrell Dueck. They both appeared on the same radio broadcast on June 24, 2000 of Christine McPhee's The Touch of Health Show on Canadian radio. The broadcast is available on the WWW every Saturday afternoon between 2-4:00 EDT. Dr. Vandenberg is in a position, as an oncologist, to judge O'Neill's claims and the toll that those practices may exact on desperate cancer patients. 1-Conventional cancer therapy is criticized by O'Neill because it is based on the belief that cancer is a proliferative disease. In fact, the oncology community realizes very well that carcinogenesis and metastatic behavior is much more complex, involving many cellular and intracellular factors. That is why many of the treatments that have been recently used employ other mechanisms to control disease (inhibition of aromatase enzymes that produce estrogen in postmenopausal women with breast cancer). The research community is rapidly exploring new avenues and therapies that focus more on growth regulation (eg: herceptin), but this will take time. Rome was not built overnight! O'Neill actually commits the same sin that he accuses conventional medical practice of! He feels that the immune system is the key to cancer, when, in fact, it is only a small part of the process. Testing a patient's "biochemical and metabolic profile" (whatever that means) and using orthomolecular medicine assume that you know how to melt an iceberg by testing the snow on top of it. I wish it was that easy. O'Neill claims to take "leading edge approaches" when, in fact, he is really taking a simplistic approach. 2-O'Neill states that our food chain is extremely polluted. This is a dangerous statement, because of its generalization. Maybe we are overusing antibiotics in some cases. However, this can be taken too far. Some may claim that altering our water supply with fluoridation or chlorine constitutes pollution. I wonder what the people in Walkerton would say to that? 3. O'Neill states that we haven't affected the lifetime survival rate of cancer. This is bunk! Statistics Canada has clear evidence (reported in the Globe and Mail in April, 2000) of significant declines in mortality, especially for breast and colon cancer. In fact, in the past 15 years, the mortality rate for breast cancer among women aged 50-69 has declined by 25%. In fact, if it wasn't for the impact of smoking, we would be seeing significant overall declines in cancer deaths. The other thing one has to keep in mind is that more people in absolute terms are dying of cancer because fewer are getting heart attacks and strokes. Cancer is a disease of aging and the older you get, the more cancer you see. We are also curing about 80% of paediatric cancers and a good proportion of lymphomas. 4. O'Neill claims that his approaches are all natural and uses "natural drugs". Because something is natural, does not prove that it is safe. An excellent example of this is the 46% rate of urothelial cancer associated with the Chinese herb aristolochia fangchi (New Engl J Med 2000;342:1686-92). Several studies have shown discrepancies in the concentration of natural drugs sold over the counter. One could imagine what would happen if this occurred with foxglove. In fact, contamination of platain with digitalis was reported recently (New Engl J Med 1998;339:806-11).The California Department of Health Services screened imported herbal medicines. At Least 32% included undeclared pharmaceuticals or heavy metals including lead, mercury and arsenic (new Engl J Med 1998;339: 847). 5. O'Neill states that sickness and vomiting doesn't have to be the case with cancer treatments. I agree. Here are now better drugs with lesser toxicities and there are better treatments (eg: HT-3 receptor blockers such as ondansetron, granisetron and dolasetron) which have markedly reduced the incidence and severity of chemotherapy associated nausea and vomiting. Things aren't perfect, but they are a lot better than they used to be. 6. O'Neill comments on contrasting the "sociological approaches" in our cancer centres. Sometimes people feel depressed because they have had an honest discussion with their oncologist and the news is not good. Honesty is what most people want. That does not mean that we do not ask patients first if they wish to hear the details of the general prognosis in their situation. If they cannot, we don't tell them. What is worse, telling people the truth, in terms of general statistics, to the best of our abilities or giving people false hope? Which is healthier, a reactive depression to a serious illness which we can deal with by support or pathologic denial fostered by unrealistic expectations of unproven treatments? What happens when somebody hasn't prepared a will and the family has to deal with the results? We respect people first by listening to their concerns and wishes and secondly, by being honest with them when they want all the information available. Secondly, recent surveys have clearly shown that most take unproven treatments not because they are unhappy with their conventional care, but because this reflects their own underlying philosophy and beliefs about life. 7. O'Neill claims his approaches are now working. Prove it! Di Bella claimed his therapy worked. The Italian government had to spend close to $30 million and countless hours of effort a few years ago to prove it was worthless. What a waste. If we are going to spend money on research, let's put in the most likely areas that will pay off, not what is currently in vogue. A recent review of research in complementary/alternative medicine showed no definitive evidence that these treatments altered disease progression in patients with breast cancer (J Clin Oncol 18;2000, 668-83).
T Vandenberg Medical Oncologist
|