I have expressed a good deal of skepticism about certain aspects of complementary and alternative medicine (CAM), but I’d emphasize that CAM is a diverse array of approaches, some becomingly increasingly studied and accepted by more conventional  (acupuncture, massage, potentially some supplements), while others (far more likely to be alternative than complementary strategies) continue to evade scientific scrutiny and probably should because they’re fraudulent and expensive. 

  The Seattle Times just ran a series of articles on energy medicine machines that was highly critical of these approaches as a modern day “snake oil”, a successful money-making scan without medical merit and that could be harmful directly or in keeping people from pursuing more conventional and proven helpful conventional medical treatments.  This is pretty much a verbatim assessment of my take on this industry, but I would extend my skepticism and concern about opportunism (including any anticancer bracelet or other jewelry) and some brick and mortar alternative medicine centers. 

   This is also a topic that was covered in the ACCP guidelines about CAM approaches for lung cancer (abstract here).  Specifically, the relevant evidence-based guideline reads as follows:  For lung cancer patients, therapies based on manipulation of putative bioenergy fields are not recommended.   Simple enough, and this is based on an absence of any evidence of a medical benefit from either biofield or electromagnetic energy fields.  The idea behind biofield approaches is that these can modify the energy fields that surround and penetrate the body.  Electromagnetic field therapies, as the name implies, are designed to use electrical fields and/or magnetic fields in novel ways.  This work is based on research on how electromagnetic fields alter cancer risk, related to questions of whether exposure to power lines or cell phones increases risk of cancer (abstracts here and here). 

    The take home message is that there’s never been any evidence from any study that treatments aimed at manipulating biofield or electromagnetic energy improves survival.  

    Now, since that series came out in the Seattle times a couple of weeks ago, many letters to the editor have been submitted on the topic.  Most applauded this series, saying that it’s surprising that we don’t have enough cultural memory to recognize the current iterations of hucksterism that touted all sorts of miracle cures in the late 19th and early 20th centuries.  But some people said that the newspaper should be ashamed for highlighting the cases of people who were not served by these approaches rather than identifying  people who feel that these machines have helped them.

   This is a classic situation of anecdotes vs. data.  We have trouble processing ideas like median overall survival for a randomized population, but we are swayed by how someone we know tolerated chemo, or whether an individual person on a website did well with a new drug.  Anecdotes are not nearly as informative as big clinical trials, but they affect behavior profoundly.  Cancer centers, both conventional and alternative, routinely market around an identifiable, sympathetic person (”I left the my old doctors because they told me they couldn’t cure me, but I came here and am still alive 4 years later!”).  You don’t see the other 499 people who came over but didn’t do as well, and it’s not clear whether the person did well because of the treatment at the new center or just good luck.  Even a broken clock is right twice a day.  But it’s not just patients and family members who rely greatly on anecdotes.  Although physicians are increasingly trained to use data from well conducted clinical trials guide our decisions, we still think about the amazing “before and after” scans for patients who did remarkably well with a particularly treatment when we make a treatment recommendation.  Every oncologist I know thinks about a pair of scans like this when they talk about EGFR inhibitors for bronchioloalveolar carcinoma (BAC):

But that’s still docs thinking of anecdotes rather than data (fortunately, the data on EGFR inhibitors and BAC also is pretty supportive of using this treatment early).  And I need look no further than the last response I gave to a member question (here) where I describe a potential treatment option based on — how many? — one patient who had a favorable results with the combination of avastin/tarceva.

   My point is that I think we all should be wary of making too many decisions based on the results from a person or two.  Trials with hundreds of patients should give us a much better ability to predict outcomes than how someone in a cancer support group or internet testimonial, or my last patient, did.  The entire industry of energy machines and many other aspects of alternative medicines are predicated on testimonials that thus far have never held up to scientific scrutiny.  If people want to pursue those options, it’s not for me to say they shouldn’t, but buyer beware.