Should governments spend health care dollars on naturopathic medicine, acupuncture, and hypnotherapy, all in the name of “integrative” cancer care? If you live in British Columbia, your government has answered “yes”.
This past June the BC provincial government [pdf] announced new funding for five “integrative cancer care centres” in the province. The private provider, Inspire Health, calls itself “a world leader in providing cancer care programs” and says that their goal is “providing access to integrative care for all British Columbians living with cancer – a first in the world”. They claim to “[combine] nutrition, exercise, and stress management programs with standard cancer treatment to promote an overall healthier lifestyle, which is proven to lead to better patient outcomes and cancer survival rates” [emphasis added].
What is “integrative” oncology (cancer care)? Dr. David Gorski, an oncologist and editor at Science-Based Medicine describes it thusly:
The claim behind “integrative oncology” is that it is “integrating the best of science-based and ‘alternative’ medicine,” but in reality all too often it is “integrating” quackery with science-based medicine. … “integrative oncology” rebrands modalities that have no reason not to be counted as part of science-based medicine as “alternative” or “integrative” … They then lump together pseudoscience like reiki and acupuncture with the rebranded modalities, such as herbal therapies.
Is that the case with Inspire Health? Yes. Inspire Health offers scientifically unproven healing modalities like naturopathic medicine, acupuncture, and hypnotherapy to people with cancer — now on the government dime. Standard cancer treatment, such as what is currently offered by the British Columbia Cancer Agency (BCCA), already incorporates nutrition, exercise, medical treatment, and stress management to optimize patient care. Where’s the evidence to suggest that Inspire Health, with it’s obsession with “toxins” and “natural” foods, offers any additional value to standard care and deserves funding over the BCCA?
Any program worth its salt evaluates its own programs and makes that data publicly available for peer and stakeholder review (you know, to “empower” and “inform” — buzzwords seen on Inspire Health’s website). With cancer, health outcomes and cost-effectiveness are particularly important endpoints. Unfortunately, there currently is no objective proof of improved outcomes and survival rates in the years Inspire Health has been active because they are currently relying on unfinished and unpublished studies. The apparent absence/non-completion of these critical components implies that government endorsement and expansion of Inspire Health is premature at best — though premature endorsement of CAM-based treatments wouldn’t be a first in BC.
Hopefully this data will be publicized shortly. Ideally, Inspire Health has kept careful statistics to separate outcomes based on modality, otherwise they risk over/under-estimating the effectiveness of CAM or science-based medicine when they do finally publish their results. Without this separation, they also risk the inappropriate allocation of funds — every dollar Inspire Health spends on an unproven modality like acupuncture (and spend they do, as is apparent in their literature) is a dollar that could be spent on science-based treatment and prevention. For example, the Integrated Cancer Care Guide [pdf] (found here) runs the gambit from toxins paranoia to the naturalistic fallacy among these care plan components:
“Guide to: Self-Care, Healthful Nutrition, Exercise, Vitamins, Supplements, and Complementary Medical Therapies.”
To summarize: The program is “free” except they offer an optional $445 weekend course that is a “MUST” according to their highlighted testimonial and also apparently encourages additional spending within the multi-billion dollar, evidence-poor CAM industry in the handouts. Oh, how silly of me, no they don’t:
The Content provided in the ICC Guide is for informational purposes only and is not professional medical advice, diagnosis, treatment or care, nor is it intended to be a substitute therefore. …
See? The information on CAM treatments for cancer (in among a few reasonable suggestions) isn’t medical advice …even though the handout is given in a treatment context for a program that provides courses on these same modalities to a vulnerable population predisposed to interpret information presented as relevant to their survival as advice. What does that disclaimer even mean? I’m not sure what the intended “purpose” of this information is in this context if not to suggest that these therapies are effective and that patients should try them. Handouts are intended to educate and add to patient care, not obfuscate with vaguely-purposed information shielded by a disclaimer. Do they also have to wink when they hand it out?
Imagine the BC government announced that it was going to fund the provision of tin foil hats (after all, they have been used for years in many cultures) to people with schizophrenia and that they were going to also provide integrative anti-alien protection, and all natural vitamin-based CIA tracking neutralization, etc. though five care centers throughout the province that are mainly supported by testimonials and an irrelevant social history (data is coming, we promise!). The centres provide handouts (for information purposes only) detailing the benefits of tinfoil hats, anti-alien protection, etc. and for only $445, patients can participate in an optional weekend course that “provides powerful tools to improve health, recovery, and survival”. What would be the public response to that? What would be the response if the company could provide testimonials that these services were in demand within the community of people with schizophrenia?
Having never been diagnosed with cancer, I am not a personal expert on the psychosocial issues surrounding cancer, and don’t claim to be. But as a human being I can understand the desire to try anything at all to live. Also as a human being, however, I can’t abide government-given false legitimacy to unproven modalities, in a vulnerable population such as people with cancer, that have about as much supporting evidence as a tin foil hat. When objective science is not the standard of care, determining quality and outcomes (and therefore the justification of funding) becomes very difficult and the door is opened for almost anything to become a “treatment” as long as it can be justified with even the most obscure argumentation.
There is nothing wrong with having a health center dedicated to providing lifestyle-management services such as nutrition, exercise, and relaxation services. However, there is something wrong with also providing unproven care techniques based on testimonials, current popularity trends, and desperation — which almost inevitably leads to using the emotionality of the issue in order to stifle debate (i.e., “Who are you to deny a cancer patient what they want?” and “What’s the harm?”). All of the modalities paraded out in front are science-based components that are already implemented in standard cancer care programs; the rest is pseudoscience. Why duplicate a successful service only to add modalities that have not been sufficiently proven effective and/or have sufficiently proved to be ineffective? Good intentions are not enough to cure cancer.
The government of BC should be funding science-based programs with transparent, objective evaluation procedures to prove the effectiveness of treatment and positive patient outcomes, not doing the equivalent of subsidizing the well-meaning, but ineffectively justified tin foil hat industry.
Health Inspire quotes their CEO, an MLA who was a family doctor, a cancer patient, and the CEO of the Provincial Health Services Authority. None of these people are listed as an oncologist or BCCA member. (In fact, they don’t seem to have any oncologists or dietitians — specialists in the services they offer — listed on staff.) They also quote BC Minister of Health, Michael de Jong [contact info in the link] who said:
“Integrative cancer care is part of our commitment to support British Columbians make healthier choice [sic]. Integrative cancer care provides cancer patients with access to improved physical, emotional and nutritional health as well as new opportunities for patients to engage with practitioners about natural therapy interventions and healthy lifestyles.” [emphasis added]
He’s missing the important phrase “science-based”. Not all “choices” are of equal merit.
If you’d like to express an opinion on this issue, you can contact Mr. de Jong via phone, email, or post using the link above.