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Questionable Cancer Therapies
Stephen Barrett, M.D.
 
Victor Herbert, M.D., J.D.
 The American Cancer Society (ACS) has defined questionable methods as lifestyle practices, clinical tests, or therapeutic modalities that are promoted for 
 general 
use for the prevention, diagnosis, or treatment of cancer and which are, on the basis of carefulreview by scientists and/or clinicians, deemed to have no real evidence of value [1].Under the rules of science (and federal law), proponents who make health claims bear the burden of proof. It is their responsibility to conduct suitable studies and report them insufficient detail to permit evaluation and confirmation by others. The ACS evaluatescancer methods by asking three questions:
•
 
Has the method been objectively demonstrated in the peer-reviewed scientificliterature to be effective?
•
 
Has the method shown potential for benefit that clearly exceeds the potential for harm?
•
 
Have objective studies been correctly conducted under appropriate peer review toanswer these questions?FDA Historian Wallace F. Janssen has noted that in every decade since 1940, aquestionable cancer remedy has attracted a large following and become a national issue[2]. It was Koch Antitoxins in the 1940s, Hoxsey treatment in the 1950s, Krebiozen in the1960s [3], laetrile in the 1970s, and immuno-augmentative therapy in the 1980s. Today'squestionable methods include corrosive agents, plant products, special diets and "dietarysupplements," drugs, correction of "imbalances," biologic methods, devices,miscellaneous concoctions, psychological approaches, and worthless diagnostic tests.Many promoters combine methods to make themselves more marketable. A 1987 ACSinvestigation found that 452 (9%) of 5,047 cancer patients identified through atelephone survey had used questionable treatments. Of these, 49% had used "mindtherapies" (mental imagery, hypnosis, or psychic therapy) and 38% had used diets[4]. The dangers of using questionable treatments include delay in getting appropriatetreatment, decreased quality of life, direct physical harm, interference with proventreatment, waste of valuable time, financial harm, and psychological damage [5].Quackwatch has heard from several people who have been defrauded of large sums of money pursuing nonexistent cancer "cures." Most of these cases involved offshore clinicsto whom money was wired in advance. The Federal Bureau of Investigation (FBI) has jurisdiction over cases involving wire fraud.
Americans who believe they have beenvictims of wire fraud should report what happened to the FBI.
 
 
Typical Misrepresentations
 Proponents of questionable methods typically claim that marketplace demand andtestimonials from satisfied customers are proof that their remedies work. However, proponents almost never keep score or reveal what percentage of their cases end infailure. Cancer cures attributed to questionable methods usually fall into one or more of five categories:1.
 
The patient never had cancer.2.
 
A cancer was cured or put into remission by proven therapy, but questionabletherapy was also used and erroneously credited for the beneficial result3.
 
The cancer is progressing but is erroneously represented as slowed or cured.4.
 
The patient has died as a result of the cancer (or is lost to follow-up) but isrepresented as cured.5.
 
The patient had a spontaneous remission (very rare) or slow-growing cancer thatis publicized as a cure.Promoters of questionable methods often misrepresent their methods as "alternatives."
Genuine
alternatives are comparable methods that have met the criteria for safety andeffectiveness.
 Experimental 
alternatives are unproven but have a plausible rationale andare undergoing responsible investigation.
Questionable
"alternatives" are unproven andlack a scientifically plausible rationale. When referring to the latter, we use quotationmarks because they are not true alternatives. Some promoters of "alternative" methodsare physicians or other highly educated scientists who have strayed from scientificthought. The factors that motivate them can include delusional thinking, misinterpretationof personal experience, financial considerations, and pleasure derived from notorietyand/or patient adulation.Misinformation about questionable cancer therapies is spread through books, articles,audiotapes, videotapes, talk shows, news reports, lectures, health expositions,"alternative" practitioners, information and referral services, and word of mouth.Promoters typically explain their approach in commonsense terms and appear to offer  patients an active role in their care: (a) cancer is a symptom, not a disease; (b) symptomsare caused by diet, stress, or environment; (c) proper fitness, nutrition, and mentalattitude allow biologic and mental defense against cancer; and (d) conventional therapyweakens the body's reserves, treats the symptoms rather than the disease [6].Questionable therapies are portrayed as natural and nontoxic, while standard(responsible) therapies are portrayed as highly dangerous. The figure below comes from amisleading comic book designed to undermine public trust in conventional methods.
 
 During the past few years, the news media have publicized "alternative" methods in waysthat are causing great public confusion. Most of these reports have contained no criticalevaluation and have featured the views of proponents and their satisfied clients. Manyhave exaggerated the significance of the National Institutes of Health (NIH)'s Office of Alternative Medicine (OAM) -- now called the Center for Research in Alternative andComplementary Medicine -- whose creation was spearheaded by promoters of questionable cancer therapies who wanted more attention paid to their methods. Most of the its advisory panel members have been promoters of "alternative" therapies. In 1994,the OAM's first director resigned, charging that political interference had hampered hisability to carry out OAM's mission in a scientific manner [7]. The OAM has fundedseveral dozen studies related to "alternative" methods, including a few related to cancer treatment. However, it remains to be seen whether such research will yield useful results.Even if it does, the benefit is unlikely to outweigh the publicity bonanza given toquestionable methods. Some of today's "alternative" methods are described below inalphabetical order. Longer reports on many of the methods can be accessed by followingthe hyperlinks.
Antineoplastons
 Stanislaw R. Burzynski, M.D., has given the name "antineoplastons" to substances heclaims can "normalize" cancer cells that are constantly being produced within the body.He has published many papers stating that antineoplastons extracted from urine or synthesized in his laboratory have proven effective against cancer in laboratoryexperiments. He also claims to have helped many people with cancer get well. A 1992analysis concluded that none of Burzynski's "antineoplastons" has been proven tonormalize tumor cells [8].In 1988, Burzynski got a tremendous boost when talk-show hostess Sally Jesse Raphaelfeatured four "miracles," patients of Burzynski, who she said were cancer-free. The patients stated that Burzynski had cured them when conventional methods had failed. In1992, "Inside Edition" reported that two of the four patients had died and a third washaving a recurrence of her cancer. (The fourth patient had bladder cancer, which has a
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