What is “Integrative Oncology” & is it Good for Patients?

I’ve written about so-called “integrative medicine” in the past, and my conclusion was that it is largely a Trojan horse intended to exempt certain alternative therapies from rigorous scientific scrutiny and gain mainstream acceptance without appropriate evidence of safety and efficacy. This is accomplished partly by muddying the waters of what “alternative” and conventional therapies are, claiming certain perfectly ordinary science-based practices such as exercise and a healthy diet are “alternative,” and then using the good data for these to imply that all integrative therapies are equally legitimate. Integrative medicine is largely a marketing concept designed to gradually erode skepticism of unproven and implausible methods without actually demonstrating their value scientifically.

There is an interesting and thoughtful discussion of the specific variety of this phenomenon known as “integrative oncology,” in the current issue of Nature (free with registration). Since the same kinds of language and arguments presented for integrative oncology in humans crop up in veterinary oncology fairly often, this article seems quite pertinent to veterinary medicine.

I encourage anyone interested to read the full article, but here are a few selections:

Integrative oncology is often touted as being useful for relieving symptoms, rather than as a primary treatment for the actual cancer. Unfortunately, a closer examination of many CAM modalities indicates that the vast majority of them rest on principles that, from a strictly basic science standpoint, range from highly implausible to virtually impossible — some rest on principles whose precepts violate well-established laws of physics and chemistry and/or are rooted in pre-scientific vitalism (such as homeopathy and energy medicine…In CAM, as in science-based medicine, prior plausibility is no guarantee of positive results, but prior probabilities that are as close to zero as those of homeopathy are a good guarantee of negative results.

To the extent that conventional medicine might underemphasize non-pharmaceutical health-promoting activities, such as lifestyle interventions and nutrition, integrative oncology could be argued to be useful in its reintroduction of an emphasis on consuming a balanced diet, exercising, and doing things that promote general wellness, some of which could conceivably at least improve the quality of life in cancer patients, if not their overall chances of surviving their disease. However, this reintroduction is not without a price, and it is questionable whether the claimed benefits are worth this price.

Integrative oncology integrates unscientific practices into science-based medicine, and, worse, the non-biologically based subdivisions of CAM is so pervasive, so embedded in the very fabric of integrative oncology, that it opens the door to clinical trials of dubious efficacy and the wasting of time and resources.

…in its current form at least, integrative medicine integrates a great deal of pseudoscience and bad science with science-based oncology.
It does not need to be this way…practicing truly holistic oncology does not require rejecting science and embracing pseudoscience. It is possible to introduce scientifically supportable elements of CAM, such as certain dietary and lifestyle interventions, into oncology as science- and evidence-based supportive modalities There should be no such thing as alternative or integrative medicine. There should only be medicine with strong evidence supporting efficacy and safety. Unfortunately, most of what is being ‘integrated’ with science-based medicine in integrative oncology is either unproven or has been proven not to work. Patients with cancer deserve better.

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6 Responses to What is “Integrative Oncology” & is it Good for Patients?

  1. Beccy Higman says:

    I have a friend who is dying of cancer (it’s in the meninges now) and have found her turning to alternative ‘medicine’ difficult, in part because she had previously been one of the most rational people I knew. The ethics of the people who sell this trumped up snake oil are severely wanting.

  2. Jennifer Robinson says:

    No question, there are a lot of treatments being marketed whose value, if any, derives from the placebo effect. However, for those excluded from scientific medicine by its high price tag, a placebo effect may be better than nothing. I am horrified by drug companies promoting therapies that run tens to hundreds of thousand dollars a year while neglecting research on everyday medicinals and leaving their manufacture to poorly regulated nations like India and China (see eg. http://www.nytimes.com/2014/02/15/world/asia/medicines-made-in-india-set-off-safety-worries.html?ref=health&_r=3 ).
    I suspect one reason people start looking for veterinary alternatives is frustration with the mainstream system and the tendency of drug companies to exploit people’s emotional attachment to their pets. The standard drugs for heartworm, roundworm and tapeworm are available in both dog and livestock/fish/human formulations (Ivermectin, Pyrantel paomate and Praziquantel). The dog formulations are several times, and in some cases more than 20X more expensive than the other formulations, and heart worm medicines require a prescription. Spinosad is sufficiently inexpensive that organic growers apply it over acres of cropland, yet a six month supply of Comfortis for a Labrador will cost me $100. The way that annual vaccination was promoted and is still promoted in some places, when there was overwhelming evidence that the vaccine was good for three or more years, also leads to distrust.
    If I had a dog, especially an elderly dog, who came down with a complex cancer requiring many thousands of dollars for treatment, I would probably end out euthanizing. I might, however, be tempted to try some witch doctor’s remedy before pts’ing.

  3. skeptvet says:

    for those excluded from scientific medicine by its high price tag, a placebo effect may be better than nothing.

    The problem with this reasoning is that a “placebo effect” is, by definition, the perception of improvement where there actually is none. And in the case of veterinary medicine, where the effect operates mostly on owners, what this means is that we feel like we’ve made the pet better, but the pet actually is not any better. So there is no value to such an effect, and in fact it is harmful because we will stop trying to treat symptoms if we think we have made them better, which leaves the pet to suffer from something we only imagine we’ve helped.

    I agree that expense limits the care some can provide. And I don’t doubt that the expense is sometimes not justifiable. I will say, though, that if you put the time and money into sufficient research to get an FDA approval for any therapy, from stems cells to dietary supplements, you would have spent millions of dollars and many years achieving this. Such therapies are going to be more expensive than those people simply claim are safe and effective without doing the necessary research to show this claim is true. Good medicine costs more than making stuff up. We have to decide, as animal owners, whether we think rolling the dice without doing the research is acceptable, because it’s more affordable, or if we can and want to pay more for medicine that has been properly tested. And as consumers, we need to decide whether we want regulations to ensure the products we give our pets are safe and effective, or if we prefer less expensive treatments without much oversight.

    So while I agree that cost is a factor, we have to remember that science isn’t free, and that the fact that it costs more to research a product thoroughly doesn’t mean there are no risks to using a product that hasn’t been adequately studied.

  4. Anthro says:

    I use Care Credit now for my pet and have been able to pay a modest monthly amount on a schedule that allows me to pay off the balance interest free. I am now able to get things done in a timely way without so much “sticker shock”. The account was easy to get (I don’t have perfect credit) and most vets accept it. I looked into health insurance but that was prohibitively expensive on a level that would cover most things.

    I do think many vet products/meds are pricey and I often wonder how much they are marked up by the practice. I wonder why you can’t go to a vet pharmacy–it seems that the individual vet has a monopoly on dispensing meds and supplies. I paid $40 for some medicated shampoo once, for a nonspecific dermatological problem no less! There seems to be a lack of competition here.

  5. skeptvet says:

    The debate about how much is appropriate/fair/necessary to charge is an endless one, among vets and between vets and clients. I don’t own a practice, so I have no direct involvement in these sorts of decisions. I will say, I never met a client who felt they should have paid more, and I’ve rarely met a vet who felt they should earn less. Everyone has their perspective, and I don’t think there’s a simple or objective way to decide how to set prices.

    I will say, though, that vets do not have a monopoly of prescriptions, at least in my state. We are required to give written prescriptions for clients who wish to get medications at human pharmacies or online. So depending on where you live, you should have a choice in that regard.

  6. Anthro says:

    Thanks for the discussion of a touchy issue. Point of reference is everything and “affordable” a very relative term. I don’t begrudge the vet a living, my beef is with the takeover of many practices by “BigVet” companies that put the vet on salary and up the fees to please–wait for it–shareholders. I have solved this by shopping around for a still-independent practice. The fees are similar, but the vets (a couple) are in charge and can answer for themselves (I didn’t like hearing, “I’m just an employee, it’s not up to me”).

    As to meds, I guess the state matters indeed, because it was as you describe in the state I used to live in, but seems different in my current state. I will dig a bit deeper on this and see if I have options.

    Thank you again for the reply.

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