Alternative health from Alternative medicine.

I once had a patient that we needed to an insert a portacath into. A portacath is a catheter inserted into the large veins of the patient, to lower the risks of “thrombophlebitis” or inflammation of the veins during chemotherapy. Chemo-therapy is some nasty stuff, and the larger veins have thicker walls and a higher volume of blood, helping to dilute and protect against localised issues with chemo. This patient had secondary cancers throughout most of her systems, and was not having the port inserted for chemo use. She was having it inserted for ease of use when receiving her Vitamin C therapy.

I’m not going to explain how vit c therapy theoretically works, please go ahead and google it, but I will point out that even if you skim the surface of research, there are three prospectively randomized, placebo-controlled studies involving 367 patients documenting no consistent benefit from vitamin C among cancer patients with advanced disease.
On top of the lack of proven efficacy, high doses of vitamin C can have adverse effects. High oral doses can cause diarrhoea. High intravenous dosage has been reported to cause kidney failure due to clogging of the kidney tubules by oxalate crystals.

As you can tell from my lack of interest in the “facts” behind the therapy, and my disclosure of negative findings on it, this is a biased blog post! I am not a big fan of “alternative medicine”. For this reason…

"Alternative Medicine", I continue
"Has either not been proved to work,
Or been proved not to work.
Do you know what they call "alternative medicine"
That's been proved to work?
Medicine."
- Tim Minchen, “Storm”

But this post isn’t about debunking questionable therapy; it is about how our team responded to this. It probably isn’t what you would expect.

When I questioned the patient’s current state of condition and treatment, the surgeon informed the team why we were inserting the portacath, and the fact that the patient was receiving vit c in high dose transfusions from her GP.
There was a long pause, and then I asked the surgeon “what are your thoughts on vit c therapy for cancer?” The surgeon turned to the anaesthetist,
“What chance does this woman have of surviving these mets?” the anaesthetist glanced at the waiting nurses
“a snowballs chance in hell I’m afraid”. There was a heavy silence in the room. We joke about theatre staff being heartless “not people people” but the truth is, that everyone there cares deeply about the patient. The surgeon continued operating, and after a while he spoke.
“So the patient will not survive. There is nothing we can do. The patient obviously has a strong rapport with her GP. She believes that the vitamin C is improving her quality of life as well as her possible outcome, allowing her to live a fuller life for the time she has left… Who cares what MY thoughts are?”

I suddenly realised that for all that I worry that surgeons are outcome focused, there are a large number, like this one who respect that we are a small part of a bigger picture. We are an even smaller part for those patients whose cancer we cannot just cut out.

On one hand, it infuriates me that someone is making money out of this woman’s remaining months, for something which will have little, or no positive effect.
On the other hand, she believes that she feels better when she has it, and this in itself has an effect.

The problem is not in the patient, or the therapy.
It is in the fact that we allow the term “alternative medicine”, and yet it is not regulated in the same way as actual medicine.
Vitamin C is a dietary supplement, and until proven as such shouldn’t be marketed as cancer treatment.
If you would like to have your say on the way natural health products are regulated in NZ, now is your chance.

Public submissions are now being invited on the Natural Health Products Bill. The closing date for submissions is Friday, 24 February 2012.
This bill establishes a system for the regulation of low-risk natural health products in New Zealand.
The bill will require someone distributing “natural health products” to submit a product notification to the government. This notification must include health benefit claims made for the product and a declaration that the notifying person “holds evidence to support the health benefit claims.”
Unfortunately the term “evidence” is defined in the bill to include “substantial evidence” OR “evidence based on the traditional use of a substance or product.” Which opens a big ol’ can of worms in the way of anecdote, hearsay and myth being legally considered “evidence” of efficacy.

If and when this bill is passed, it can be a fantastic tool to allow the use of a wide range of proven therapies in conjunction with mainstream medicine to help people with their health, protecting the general public against the health and financial cost of unproven crud, pushed by those who should know better.
Because those who work in mainstream medicine know that patient outcomes are not just about survival, we understand the need for quality of life. We WANT people to have the best chance possible from wherever they receive it. But there is no reason that genuine proven therapy’s should be side-by-side on a shelf with unproven products all under the same title of “alternative medicine”.

Please, if you have an opinion, have your say.