It is easy to understand why a person diagnosed with a malignant disease would seek out unorthodox therapies. Many patients with cancer will reach the point at which proven therapy is not very effective. In this situation most physicians will offer pain control and nutritional supplementation for its palliative benefit. Fueled by the current epidemic of HIV, the number of unconventional therapies is on the rise.

Studies have demonstrated that patients most likely to seek out unorthodox therapies have a higher education level and a higher median income. These patients tend to be sophisticated and capable of searching out unconventional modalities. The typical psychological profile of these patients is:

1. higher socioeconomic status;
2. "in charge" all of their lives;
3. active role in medical management.

Frequently a physician's management plan is so complex and high in technology that it is difficult to understand by most individuals. Patients wish to be active participants in their care and to help out in any way they can. Although participation is a very positive motivation, it may not be realistic in light of the known biology of malignancy. Many unscrupulous practitioners are able to take advantage of this mind set. Most unconventional therapies offer easy to understand treatments that have a "logical" rationale. Most of these will also allow for active participation by the patient and often carry the logo "holistic".

Mental imagery is one such technique. Patients are instructed to draw a mental picture of their underlying tumor and then recruit "all" parts of the immune system, particularly the white blood cells to attack and thereby destroy the tumor. This technique allows the patient to participate and is easy for the patient to understand even though the mechanism is unrealistic. The unscrupulous practitioner will also supply a large body of unsubstantiated data that would suggest mental imagery can be channeled into the destruction of a tumor. No data exists that this is an effective technique. The technique is valuable in that it emphasizes a positive attitude and a good outlook, but this does not translate into tumor response.

Nutrition is a very important aspect of unconventional therapies. Anti-cancer diets are heavily promoted. These diets by and large tend to be healthful in that they are low in saturated fats, high in fiber and naturally occurring vitamins. However, there are those that are highly restrictive and may constitute simply barley or rice and water which can result in extreme degrees of weight loss which is generally not to the patient's best advantage. Even when a patient consumes a healthful diet, there is no evidence this is effective in treating cancer. As much as we would like a diet to be effective in the treatment of cancer, there is no evidence that dietary manipulation can result in the regression of an established malignancy. It is generally good for all people in all age groups to eat a healthful diet, but extremes need to be avoided. Many fraudulent cancer practices involve magical thinking. One such notion is that the bowel contains many toxic substances and poisons. This hypothesis justifies the use of enemas and purgatives to detoxify poisonous substances in the bowel, removing them from the system. This has led to the use of coffee enemas and irrigations to purge the bowel. Patients frequently have a magical notion about the role of vitamins in human nutrition. Vitamins are known to be coenzymes that help catalyze biochemical reactions. Nonetheless people view vitamins as "pick me ups", "energizers" and general "feel good" pills. People take iron regularly for anemia, whether anemia is related to iron deficiency or not.

Unscrupulous practitioners are becoming increasingly sophisticated in their presentation of fraudulent therapies to the public at large. Cell specific cancer therapy in Santa Domingo, Dominican Republic, has recently been promoted in a number of underground magazines as a new treatment for cancer. Fundamentally, this is a technique where magnets are used to attack the malignancy. The presentation is in a very polished brochure, seems very logical, but a review of the National Library of Medicine database reveals no citations for this technique and with no peer-reviewed confirmation this technique must be considered unproven and highly likely to be fraudulent. A second technique that has recently come to our attention is gene activation therapy using auto-transfusion with patient's own white blood cells, also known as tumor-specific cytokines in cancer therapy. This title alone indicates a high level of sophistication. This technique is currently being administered by a practitioner in Memphis who is not a member of the American Society of Clinical Oncology or the American Society of Hematology. Reportedly, the patient's blood cells are sent to Germany for cytokine activation and are subsequently returned to the patient to boost the immune system. No IND exists for this process with the FDA. I am unable to confirm a registered protocol with the National Cancer Institute, nor can I confirm that there is an institutional review board involved confirming this as a research protocol. On review of the pamphlets they provide, they have many testimonials to the effectiveness of the technique. Moreover, the mechanism of action is very, very logical and would easily seduce the unwary as to its effectiveness. Nonetheless, this technique does not appear to be applied by reputable researchers in scientific medical centers and, therefore, must be considered unproven. I have come across many other similar unproven techniques that are offered to desperate cancer patients, but they all seem to have similar common facets such as a scientific explanation that does not hold up, proof via testimonials, and no peer-reviewed scientific articles.

One of the drawbacks of cancer therapy that involves the patient's participation is the inevitable psychological result if treatment fails. A common scenario for patients whose malignant disease progresses following fraudulent treatment is:

1. they came too late for treatment and if only they had come earlier...;
   
2. they didn't have sufficient faith in the technique to make it work and, therefore, the fact that their cancer has progressed is their responsibility;
   
3. the technique was not followed properly in accord with the recommendations of the fraudulent practitioner and, therefore progression is the patient's responsibility once again.

This results in a tremendous burden for the patient. Not only do they have to cope with the fact that they have a malignancy, but they have the added burden that it is their fault.

Fraudulent medical practice dates back to antiquity and it is unlikely that any law, regulatory agency or congressional panel will ever eradicate fraudulent therapies promoted to desperate individuals. Adequate communication between an experienced physician and the patient can uncover notions that the patient might have in seeking unconventional therapy. Since, in the treatment of cancer, there are frequently situations where no effective treatment exists, all we can often give is our time. Effective communications between the cancer patient and his or her physician is the best treatment to prevent fraudulent practice.

REFERENCES

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2. Anonymous author: Questionable Methods of Cancer Management: Electronic Devices: A Cancer Journal for Clinicians. 44(2):115-27, 1994, Mar-Apr.
   
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4. Hauser SP: Unproven Methods in Cancer Treatment. Current Opinion in Oncology. 5(4):646-54, 1993, July.
   
5. Mahaney FX Jr.: Unconventional Methods Under Review by NIH. Journal of the National Cancer Institute. 84(14):1067, 1992, July 15.
   
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