Alternative medicine in Journal of Clinical Oncology

I finally just got around to reading the 1 Dec issue of the Journal of Clinical Oncology and was struck by two, back-to-back articles that address two interesting aspects of alternative medicine in cancer treatment. Mind you, I'm a basic scientist but I find the struggles that oncologists face to be quite interesting in this regard.

First is an article (free full text here) from a feature called, The Art of Oncology: When the Tumor is not the Target. The title alludes to some high-profile legal cases that arose over the summer, but does not discuss specifically the Cherrix case:

Do Parents Have the Right to Refuse Standard Treatment for Their Child With Favorable-Prognosis Cancer? Ethical and Legal Concerns.

Since you can read the full text yourself, I'll only make two points.

First, is that courts will generally rule in favor of parents wishing to use alternative therapies (even against the preponderence of data that standard therapy is superior) if that therapy is administered by a licensed medical doctor. The courts give great latitude to physicians in pursuing therapies they believe is best for their patients, even when medical evidence indicates that some physicians may be overseeing modalities that are inferior to known, curative therapies.

So, how do the authors address cases where physicians have clearly led families in using alternative therapies that do not meet the standard of care? Here is their carefully couched closing paragraph:

In summary, pediatric oncologists should be prepared for the many implications brought by a case such as this, in which parents refuse standard treatment for their child with cancer who has a favorable prognosis. As the probability of encountering a similar situation increases, so does the need to fully understand the relevant laws and ethical principles that apply. In dealing with the issues presented here, the oncologist must act as an advocate fighting to ensure that the child is given the best chance of cure while trying to balance the harms that may occur. In addition, the oncologist should consider reporting any physician to the state medical board who may have failed to meet the minimal standards of care.

To be balanced, the authors did an excellent job of describing the trauma a family incurs when a child is diagnosed with cancer and takes very seriously the aversion that many have to standard chemotherapy and radiation therapy. The authors also note the role of the media in such high profile cases noting, "a local television station posted an internet-based survey, and 83% of the 395 responders supported the parents' "right to choose the kind of treatment for their kids.""

Regardless of the side you fall on in this issue, the article makes for great reading in laying out the basics of medical ethics, the thoughtful consideration of caring for children with cancer, and the legal and medical outcomes of the battle between alternative medicine and standard-of-care oncology.

Next, I will discuss a second, subscription-only article that reviewed critically the use of complementary and alternative medical modalities in managing cancer pain.