Cancer and the Power of Placebo

An Interview With Paul A. Offit, MD

Lidia Schapira, MD; Paul A. Offit, MD

Disclosures

December 13, 2013

In This Article

Editor's Note:
Although often grouped together, complementary and alternative medicines are different therapeutic approaches.[1] Complementary therapies are adjuncts to conventional care, often used in cancer patients for symptom control or to improve physical or emotional well-being during and after treatment. In contrast, alternative medicine involves therapies that substitute for conventional treatments. Both approaches are largely unregulated.

In his book, Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine, [2] Paul A. Offit, MD, explains why these unregulated industries continue to tempt millions of patients who are desperate for a cure, and who believe that anything that is "natural" must be good for them. Lidia Schapira, MD, spoke with Dr. Offit about his book and the use of alternative therapies for patients with cancer.

Chemo Is More Efficacious Than Emu Oil and Prayer

Dr. Schapira: Your book is a wonderful reminder of the power of stories that people tell themselves to explain illness and bring order to chaotic or terrifying experiences. You say that Steve Jobs "was seduced by bogus cancer cures." What is the seduction of alternative therapies for patients diagnosed with a serious illness, such as cancer?

Dr. Offit: These alternative therapies -- in Jobs' case, acupuncture, bowel cleansings, and fruit and vegetable juices -- are seductive because they exist under an untouchable halo. They can only help; they can't possibly hurt and are far less frightening than chemotherapy, radiation, or surgery. The notion that such therapies can help without the harms associated with conventional cancer treatments is very seductive -- wrong, but seductive.

Dr. Schapira: When patients ask about these treatments, hoping that they have an anticancer effect, how should we respond? Should we confront them with data?

Dr. Offit: Science is what separates fact from ignorance, and the question is how to make it compelling. A 10-year-old girl in Akron, Ohio, the child of Amish parents, was diagnosed with non-Hodgkin lymphoma. An oncologist said that she had an 85% chance of survival with chemotherapy.[3] Her Amish parents preferred alternative medicine. During her first round of chemotherapy, she was nauseous, so her parents decided to treat her lymphoma with megavitamins and supplements instead.

There are no data to support the alternative therapies that her parents chose for her. Although more toxic than emu oil and prayer, modern therapies offer this patient the best chance of living a long and fruitful life.

Medicine and science are evidence-based systems. They aren't belief systems. How do you get someone away from a religious way of thinking to a more evidence-based way of thinking? That is the challenge.

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