Of the many things that patients fear being told by their doctor, a diagnosis of cancer ranks near the top.

Doctors have long recognized that patients with cancer, as with any serious disease, are not always able or motivated to sort the wheat from the chaff when it comes to claims of treatment or cure of dreaded diseases.[1] 

Good doctors have always taken care to deliver the best scientific medicine in a compassionate way, and we know that even in desperate circumstances it is important to give patients a sense of hope and control. This is not always easy because doctors are also bound by a covenant of truthfulness. Offering false hope or profiting from the fears of patients by offering ineffective therapies is not only considered unprofessional, but also flies in the face of basic tenets of consumer protection.

Every day, family doctors and specialists work hard to steer their pa­tients into the best treatments, even in situations where limited resources make it difficult to provide optimal care. Compounding the difficulties faced by cancer patients are the innumerable array of nostrums and legions of purveyors of questionable therapies all willing to offer (false) hope—at a price—to people in desperate circumstances.

One would think that stewards of the health care system would recognize such a situation and celebrate those who deliver valid care. But re­sources are scarce, and those of us toiling in the trenches are left to assume that when funds become available, they will be directed to where they can deliver proven benefits.

The recent government announcement of $5 million for InspireHealth’s “Integrative Medicine”[2] (alternative medicine treatments offered alongside purportedly conventional therapies) has understandably raised eyebrows in the medical community.[3] Claiming that their patients have “significantly better survival,”[4] InspireHealth’s website delineates what it is that separates InspireHealth from typical cancer support programs. These “healing modalities”[5] include: 

• Naturopathic medicine (whose scope of practice, we are told, “includes all aspects of family and primary care”). 
• Acupuncture (“to restore the normal and smooth flow of energy in the body”). 
• Lymph massage.
• Counseling from a “facilitator of body energy and meridian therapies.”

The InspireHealth Integrated Cancer Care Guide adds a long list of her­bal remedies, supplements, and oth­er modalities for cancer patients including mistletoe, homeopathic remedies, “714X,” therapeutic touch, SHEN (specific human energy nexus) therapy, chelation, ozone, colonics, and intravenous hydrogen peroxide.

Doubters of the utility of the above value-added offerings at Inspire­Health might wonder how patients attending such a program might have “significantly better survival” than patients deprived of what the government presumably sees as truly effective therapies. 

The answer may be no more complicated than the simple fact that healthy and motivated people able to participate in and comply with any program—be it effective or not—are more likely to come from the upper part of the health bell curve no matter what their disease. The fact that many of the programs at InspireHealth come at a price simply shifts the potential selection bias into a higher income bracket—a known correlate of better health to begin with.

But statistics and science must take their place among other important determinants of whether programs deserve government endorsement. The list of supporters of InspireHealth includes Prince Charles, a longtime proponent of complementary medicine, who visited the clinic in 2009.[6]

The take-home message for doctors is not encouraging. We live in a time when government is determined that physicians continue to provide evidence-based care in a flat-line fiscal environment. Indeed, government has suggested that on-call services be supplied for free. And what of the patients who suffer for want of un­funded, but truly effective services? Perhaps they can take a tip from the InspireHealth website: “Prayer can benefit patients even if they are un­aware that they are being prayed for.”

With scarce public funds being spent on integrative medicine, prayer might be the only thing we can offer those who will suffer the resulting shortfall of needed services.
—Lloyd Oppel, MD, Chair, Allied Health Practices Committee

This article is the opinion of the Council on Health Promotion and has not been peer reviewed by the BCMJ Editorial Board.

References

1. Passalacqua R, Campione F, Caminiti C, et al. Patients’ opinions, feelings, and attitudes after a campaign to promote the Di Bella therapy. Lancet 1999;353:1310-1314.
2. InspireHealth. BC cancer care reaches a historic milestone [press release]. Ac­cessed 3 November 2011. www.inspirehealth.ca/news/2011/06/29/bc-cancer-care-reaches-historic-milestone [10].
3. Preshaw RM. (Another) modest proposal. BCMJ 2011;53:455.
4. InspireHealth. In-House Research: Retro­spective studies. Accessed 3 November 2011. http://inspirehealth.ca/research/inhouse [11]. 
5. InspireHealth. Cancer Care Programs: Healing Modalities. Accessed 3 Nov­ember 2011. www.inspirehealth.ca/programs/healing [12].
6. InspireHealth. Prince Charles makes historic visit to InspireHealth [press release]. Accessed 3 November 2011. www.inspirehealth.ca/news/2009/12/02/prince-charles-makes-historic-visit-inspirehealth [13].