Proof versus plausibility: rules of engagement for the struggle to evaluate alternative cancer therapies
L. John Hoffer
CMAJ 2001;164(3):351-3 [PDF]
The debate that has been taking place in CMAJ about alternative cancer therapies is extremely valuable, especially when considered against the backdrop of intense public interest in this subject.1,2,3,4,5,6 Like it or not, government agencies and medical research centres are willing to evaluate alternative therapies, and money from public and private sources is available to pay the costs. The paradox, of course, is that by definition unconventional, unorthodox or complementary therapies — whatever one's favourite term may be — lack scientific credibility. How, then, does one select the most promising of them for evaluation, and what assessment procedures will be regarded as sufficiently thorough and definitive by mainstream medical scientists, government agencies and the proponents of alternative therapy?
Practitioners of alternative medicine and community physicians can, no doubt, form successful partnerships with the aim of providing high-quality, holistic care. Many mainstream Canadian physicians already integrate elements of alternative therapy into their practices. Alternative and Western science–based medicine are either partners or amicable neighbours in most parts of the world.
But it would be a triumph of hope over experience to assume that alternative therapists and clinical researchers will easily develop partnerships to test alternative cancer therapies. This situation has to change because each side needs to learn from the other. The alternative therapists need expertise in rigorous documentation and the principles of clinical investigation, as well as the physical and intellectual resources necessary to design and conduct informative clinical trials. Clinical researchers need information about the specific aims of a given alternative therapy, insight into how it is used and the perspective necessary to design pragmatic trials that assess it fairly. The effort should be made to identify genuinely promising new approaches and to explore, rather than refute, them.7,8,9 Young scientific investigators may be disinclined to travel this rocky road. My own dean — now retired — encouraged my interest in alternative medicine, but added, "Keep your day job."
Correspondence to: Dr. L. John Hoffer, Lady Davis Institute for Medical Research, 3755 Chemin de la Côte-Sainte-Catherine, Montreal QC H3T 1E2
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2. Hoey J. The arrogance of science and the pitfalls of hope. CMAJ 1998;159(7):803-4. [MEDLINE]
3. Iscoe NA, Bruera E, Choo RC. Prostate cancer: 10. Palliative care. CMAJ 1999;160(3):365-71. [MEDLINE]
4. Sagar SM. Alternative views on alternative therapies [letter]. CMAJ 1999;160(12):1697-8. [MEDLINE]
5. Bégin M, Kaegi E. Unconventional therapies and cancer [letter]. CMAJ 1999;161(6):686-7. [MEDLINE]
6. Hoaken PCS. Alternative therapies [letter]. CMAJ 2000;162(5):632-3. [MEDLINE]
7. Horrobin DF. The philosophical basis of peer review and the suppression of innovation. JAMA 1990;263:1438-41. [MEDLINE]
8. Ernst E, Cassileth BR. How useful are unconventional cancer treatments? Eur J Cancer 1999;35:1608-13. [MEDLINE]
9. Ernst E. Unconventional cancer therapies: what we need is rigorous research, not closed minds. Chest 2000;117:307-8. [MEDLINE]
Medscape General Medicine, 3/04
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