A Skeptical Look at "Mind-Body Medicine"
for Cancer Patients
Peter J Moran, MB, BS, BSc(Med), FRACS, FRCS(Eng)
Part of the appeal of "alternative medicine" is its offer to put cancer patients back "in control.” This is in part a reaction to the submissiveness expected of patients in more paternalistic and authoritarian medical circles. Mind-body approaches purport to offer people more personal control over their fate. All very fine, but those with cancer would be wise to ensure that they are not simply surrendering governance to equally controlling but less trustworthy influences.
The problem with cancer is that without aggressive treatment it is commonly relentless and largely resistant to most kinds of outside influence. I don't need to prove that—it is such general experience that every testimonial depends upon the assumption that things would have gone badly were it not for the claimant's luck in finding something that worked. Some types/stages of cancers have virtually a 100% mortality regardless of every effort by mainstream "alternative" practitioners, or the hopes. prayers and will of the patient. Even if mind-body concepts did occasionally work with some less aggressive or less advanced kinds of cancer, it can be argued that overall they do far more harm than good to cancer sufferers.
It is generally believed that support groups and other psychological aids can reduce anxiety and otherwise improve the quality of life of many cancer sufferers. This would presumably apply regardless of whether the support is from mainstream or "alternative" sources. Many go further and believe that a positive attitude or various mind-body practices can influence cancer survival. Some doctors think so. There is nevertheless very little support for this viewpoint in either general experience or from scientific studies.
Testimonial evidence is exceptionally weak, because it is rare for mind-body and closely related spiritual approaches to be used by themselves. Most people who profess to have overcome their cancer this way will have undergone standard treatments of known effectiveness. Many will also have used alternative methods, with no reason other than personal preference for emphasizing one component over any other. Such testimony should be interpreted as a manifestation of the person's engagement in mind-body or spiritual practices; i.e. an expression of faith, or of the obligatory positive mental attitude, rather than a statement of observable fact.
Whenever this subject arises, one reported study is sure to surface, even though it has been shown to be flawed and the results could not be replicated in a larger, better designed study in which the original author also participated. The original study, reported in 1989 by David Spiegel, M.D., purportedly showed that attending a psychosocial support group could double length of survival in patients with metastatic breast cancer . Even in that report, no patient is described as undergoing remission purely from the psychological support. In fact the support group had about the same prognosis as metastatic breast cancer in the general population. The results appear to have been due to unusually poor outcomes in the "untreated" group, supporting other evidence that the patients were not properly randomized. Patients not attending the support groups all died within 48 months, whereas metastatic breast normally has quite a few five-year survivors (15-20%). A subsequent study conducted at several cancer canters concluded that supportive–expressive group therapy might improve mood and pain perception but does not prolong survival in women with metastatic breast cancer .
Most other studies have shown no survival benefit from psychological interventions or any association of survival with patient states of mind, even while suggesting benefits upon patient anxiety and general well-being from involvement support groups. In my opinion, the evidence even for that is rather weak due to likely effects from patient selection and reporting biases, so I don't think cancer patients should feel they have to seek out a that kind of support if they don't feel the need. Wallace Sampson, M.D. has summarized the evidence .
Alternative practitioners, if pressed for an opinion on the usefulness of mind-body techniques in cancer treatment, will usually assert that cancer is best treated by a holistic approach in which mind-body and spiritual practices are merely an important component. This idea also lacks support. Obviously beneficial effects on cancer from any combination of alternative methods are quite rare—so rare that the findings are just as likely to be due to one of the many other reasons why cancer sometimes doesn't behave as expected. I have outlined those in my essay What Is So Hard about Showing That a Cancer Cure Works? and issued a simple challenge in the second part of that series to anyone who thinks otherwise. Some of the methods discussed in my essay What do alternative methods really do?—the Inside Story aim to be holistic. Nowadays most serious users of "alternatives" employ a multi-pronged attack that includes mind-body or spiritual practices.
It is thus possible to hold the view that mind-body effects upon cancer are either negligible, or too weak or infrequent to be obvious in either everyday experience or in clinical studies. Even if you think I am underestimating the power of mind-body medicine, read on, for you will certainly be experiencing some of the side effects of mind-body theory as commonly applied—or misapplied.
Why the Concern?
That is a very brief look at the evidence, as I am not in this trying to dissuade cancer sufferers from using mind-body approaches if they should wish to do so. My aim is partly to reassure those who find certain mind-body concepts intrusive and difficult to embrace.
I do have one pet hate. It is bad enough to find yourself dying of cancer without also feeling wretched because you didn't have enough faith or couldn't think the right thoughts. Hence the quotation at the beginning of this. They are the words of someone with active cancer trying to take charge of her own health, as exhorted by many alternative sources and an entire alternative cancer industry. There is a brutal downside if the cancer sufferer feels like a failure while others are succeeding (een though they are not). I distain any kind of medicine that blames the patient when it doesn't work.
But my main concern in this is to show how despite their very dubious potential for good, common mind-body theories seriously inhibit the emergence of useful knowledge about alternative methods. It is one reason why cancer sufferers find it so difficult to obtain useful information from those professing to be in the know. What are the known scams? Which methods are just too scientifically ludicrous to be worthy of consideration? Which, if any, are best supported by real evidence?
Why are subjects of such immediate interest to cancer sufferers never discussed in any depth by alternative sources? With very little trouble I have been able to find and present on this web site information that gives quite a clear idea of what can be expected from certain commonly used "alternatives." You will NEVER find such an analysis in alternative sources and an ultra-protectiveness of the alternative-using cancer patient in accordance with mind-body theories is partly responsible. (There are other reasons that I can be less charitable about.)
In its rawest form mind-body theory states "if you believe, it will work." Its corollary is more obvious in practice—that cancer sufferers are vulnerable to and should be protected from "negativity." Belief and a positive attitude must be sustained at all costs.
I confess to also (mostly) being protective of, and trying to sustain hope in cancer patients, while not always being quite sure whose comfort I am protecting And there is nearly always some hope—from spontaneous remissions, misdiagnosis or mis-staging, unusually good responses to palliative treatments, or the possibility of better treatments just around the corner.
The key question is whether the way alternative circles go about sustaining hope and a positive attitude (assuming that is even possible as a sheer act of will) is worth the adverse effects.
How Mind-Body Concepts Help Prevent Alternative Medicine Accumulating Useful Knowledge.
Elements of alternative medicine carry mind-body theory to extremes. The following are commonly encountered notions:
- Inactive alternative methods can nevertheless affect cancer via the placebo effect.
- "If you believe, it will work" (a direct quote from the manifesto of an “alternative” discussion list).
- A positive attitude is essential if you are to beat cancer.
- Various psychological interventions (e.g. meditation, imaging) can treat cancer in their own right or via strengthening the immune system.
- Cancer can be caused by stress, anger or wrong thinking and cured by reversing them.
These beliefs are either completely unsupported, patently wrong (e.g. that placebos affect cancer , or extremes to which very few would wholly subscribe. Yet they are very influential. Mind-body theories lurk in the background of every alternative discussion, clouding basically simple questions as to whether “alternative” methods do help cure cancer, how we can know this, which methods are almost certainly useless, and how to best advise cancer sufferers coming to “alternative” circles seeking help.
It does this by tending to stifle the forthright discussion and analysis that is the stuff of all worthwhile human enquiry. Outright nonsense and transparent fraud routinely escape challenge because the less worldly-wise may be staking their life on them. “Alternative” newsgroups rarely discuss whether reported experiences truly support a treatment method or challenged posted claims when it should be obvious that they do not. And testimonials are almost never modified or retracted when later events prove that they mere reflect what a person believed or wanted to believe at one point in their illness. Overt skeptical opinion is severely discouraged or even completely censored.
“Mind-body doctrine” is a protected species, too. The extreme versions are quite commonly expressed but rarely overtly challenged, even though they could and should be in the interests of cancer sufferers everywhere. Of course, no extreme view is ever finally rejected through general consensus in alternative circles because at the last ditch it is likely to come up against another unspoken but pervasive influence—postmodernist, New Age, cultural relativism, wherein there is no such thing as a stable truth..
Hypocrisy and Inconsistency
The cancer sufferer wants facts but is mostly left, in my opinion, with worthless mush, if not also left dispirited by the breathtaking hypocrisy and inconsistency with which mind-body theory is commonly applied .
Huh? Yes, the state of intellectual paralysis is such that anyone announcing that castor oil packs over the liver can remove toxins and help cure cancer, or who supports equivalent nonsense or fraudulence is likely to get a polite hearing. But if you happen to care about the morale of the 95+% of alternative seekers who have already undergone or who may yet have to undergo conventional treatment, just try mentioning the mountain of studies showing that those methods can cure or palliate or prolong the survival of many cancer sufferers. The niceness is likely to suddenly evaporate. Invective that could only have the most adverse mind-body effects on this predominant section of the readership may well ensue.
Yes, I refer to the malevolent "slash, burn, poison" material that regularly appears upon and that is tacitly condoned in all alternative forums. Mind-body niceties be damned, when it comes to those who retain any allegiance to the mainstream! If mind-body theory were correct this predominant section of the "alternative" audience would be irretrievably harmed.
This is something that more moderate “alternative” circles should be thinking about and discussing, if they want to ever be regarded as a positive influence within medicine. Every silly claim, every invalid testimonial and every unjustified slur upon the mainstream (yes, some are justified) has the potential to mislead or harm hundreds of other cancer sufferers. That more cancer patients don't suffer, missing out on the chance of cure or of useful palliation, is a testament to the good sense of a less vocal majority. Perhaps most cancer sufferers are switched on to the rather strained element of childlike make-believe involved, when medical treatments have to be supported not by hard evidence that they ever do anything, but by outlandish allegations of world-wide conspiracy and claims that almost an entire service profession is governed by blatant ill-will towards its cancer patients .
My concern is the few who lack such discrimination and who are led to entrust their lives to alternatives exclusively. Truly complementary use is mostly harmless and limited to the consumption of precious time and resources.
Surely there is some way of striking a compromise, some formula whereby well-meaning cancer sufferers can be discouraged from posting misleading material while also receiving the kindness that their plight undoubtedly entitles them to.
The above barely scratches the surface of the problems created by the inability of alternative medicine to take a stand on this issue. There are the ethical considerations, when alternative supporters stand by and allow cancer sufferers to entrust their lives to treatments they themselves suspect are fake. For the holistic practitioner there is the extreme difficulty in providing accurate informed consent if he cannot show that his approach ever works and never bothers to try. Then there is the philosophical/scientific question as to whether the truth is worth pursuing in the interests of cancer patients in general, even if at some small cost to some individuals.
I allow that most of the testimonial and other material spread about by cancer sufferers and alternative supporters is well-intended. But there is a self-serving undercurrent. Stories of success, no matter how dubious, are met with much enthusiasm and positive stroking. There is the thrill of being asked for advice or being regarded as an expert by dint of one's status as a cancer survivor. Some become agents for alternative products creating another dubious influence.
- Spiegel D and others. Effects of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet Oct 14:2:888-891, 1989.
- Goodwin PJ. The effect of group psychosocial support on survival in metastatic breast cancer. New England Journal of Medicine 345:1719-1726, 2001.
- Sampson W. Controversies in cancer and the mind: Effects of psychosocial support. Seminars in Oncology 29:595-600, 2002.
This article was posted on March 5, 2006.