In an example of conventional medicine at its worst, a patient of mine recently had her beautiful hope dashed.
This inspiring young mum of two was recently diagnosed with stage 4 breast cancer and after exploring all treatment options decided on a combination of conventional and complementary treatment options. So, what possible treatment could have scared her GP practice so much? Shock, horror – intravenous vitamin C (IVC)!
This ‘complementary’ treatment is actually relatively mainstream and is being used by ICU units in America. There is a plethora of research around it, including its use in oncology patients (2, 3, 4).
Despite this research, however, this amazingly inspiring woman was told by her GP practice that they were not prepared to perform her IVC as they ‘didn’t want to raise false hope!’
Let’s just sit with that for a moment so the true horror of what they said can be digested. For a moment, please imagine you or a family member had stage 4 cancer and heard those words.
Along similar lines, I recently rang an oncologist about another patient, a young mother with CML, to see if he would consider referring her for a peripheral inserted central catheter (PICC) for her chosen course of IVC. He replied that he would not as ‘the hospital couldn’t endorse homeopathic treatments’!
Just to clarify for the unaware, IVC is not a homeopathic treatment, as I’m sure the above research will make clear. Additionally, during this period, her GP applied a significant amount of pressure on her by telling her she was being irresponsible to her family if she did not accept the chemotherapy.
Statistics is another ‘noose’ that some practitioners apply to their patients necks when it suits them. However, conventional medicine is very selective with which statistics it applies.
Statistics are very much thrown at patients when it comes to cardiovascular disease risk and cancer prognosis statistics but are rarely mentioned when it applies, for example, to the number needed to treat (NNT) for a medication (for one person to benefit).
Using aspirin, as an example, ‘The estimated number needed to treat (NNT) for 10 years to prevent 1 event was 265’ with alarmingly ‘the absolute increase in bleeding risk exceeded the absolute decrease in adverse CV events, regardless of baseline CV risk’ (5).
One of my very first patients as a house-surgeon (yes, I know this is not a meta-analysis of randomised placebo-controlled trials) displayed a classic example of how powerful hope can be. He was a man in his 60’s who (back in the days where patients were cared for much longer in hospital) spent two weeks in hospital with gastrointestinal symptoms, unresponsive to conventional care while they investigated the cause.
In the interim, and because he felt relatively well compared to the other patients on his ward, he assigned himself the task of ‘ward entertainer’ in an attempt to make the other patients laugh. Eventually, oesophageal cancer was diagnosed and a prognosis of months given. On that day this previously ambulant man took himself to bed and died three days later.
Yes, of course it’s possible this could have happened even if he had not been given a prognosis. However, thanks to placebo controlled trials, even my most conventional of colleagues have to admit to the power of the mind in healing or its opposite.
I respectfully have to say, ‘Shame on my colleagues and anyone else who takes away a patient’s hope’.
I’m certain they would wish their families and themselves to be given hope, even in the grimmest of scenarios. As medical practitioners we undertake a pledge that ‘the health and well-being of my patient will be my first consideration’; and ‘I will respect the autonomy and dignity of my patient’; and ‘I will share my medical knowledge for the benefit of the patient’ (6).
Taking away hope goes against the first pledge; pressurising patients to only choose conventional treatments only goes against the second; and not informing patients of all possible therapeutic options goes against the third.
Regarding prognosis, of course patients have a right to plan their life based on the best knowledge we currently have but prognosis must only be given if a patient specifically asks for it. And even then they should be told it is simply a statistic; that they are not a statistic; and that there are cases of radical remission.
It smells strongly of narcissism for healthcare practitioners to attempt to decide for our patients what they should and shouldn’t hope for. If a therapy has no contraindications for the individual patient; potential drug interactions have been ruled out; and risks and benefits of ALL potential therapies have been discussed, why not allow our patients to have hope?
A pure and simple four-letter word, without the egotistical and patriarchal adjective applied as in the above example? Language is powerful, ask anyone who has been verbally abused, or bullied.
- Intravenous vitamin C administration improves quality of life in breast cancer patients during chemo-/radiotherapy and aftercare: results of a retrospective, multicentre, epidemiological cohort study in Germany. Vollbracht, C., Schneider, B., et al. (2011). In Vivo, 25(6), 983-990. http://www.ncbi.nlm.nih.gov/pubmed/22021693
- The effect of intravenous vitamin C on cancer- and chemotherapy-related fatigue and quality of life. Carr, A. C., Vissers, M. C. M., et al. (2014). Frontiers in Oncology, 4, 283. (4) http://journal.frontiersin.org/Journal/10.3389/fonc.2014.00283/abstract
- Intravenous vitamin C in the supportive care of cancer patients: a review and rational approach. Klimant, E., Wright, H., et al. (2018). Current oncology, 25, 139-148. http://dx.doi.org/10.3747/co.25.3790