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Related topic pages: Common Myths | Evaluating Medical Claims | The problems with testimonials
Natural "remedies" - Caveats of Dietary Supplements | The Skeptic's Case | Resources & Research News
CAM Survey | CAM Links  | Alerts! 

NEW REPORT and Discussion:

Complementary Medicine, Refusal of Conventional Cancer Therapy, and Survival Among Patients With Curable Cancers | Oncology | JAMA Oncology | JAMA Network http://bit.ly/2JNe7Up 

Alternative medicine the “complementary” edition – Science-Based Medicine http://bit.ly/2JPbpO3

Firstly, we wholeheartedly support and encourage practices that can help you, the patient or caregiver, to improve your fitness and general health.  Notably, wise changes in diet and exercise can  help you to achieve this and is associated with improved survival.

This topic is mainly about the types of medicines or practices that may be prescribed or promoted to treat lymphoma and disease-related symptoms. 

We believe that the word "medicine" should be reserved for interventions that have proven to be effective in clinical trials.  Without standards for medical claims (or what we call medicine) we'd have millions of choices but no basis for making an informed choice.

CAM stands for Complementary and Alternative "medicine."  CAM is an umbrella term for practices that are not generally given by mainstream medical doctors.  Here we describe CAM practices along with medical practices used to treat disease and disease-related symptoms.  

Complementary practices

These are practices that are sometimes a part of mainstream medical care, such as to help improve general health or to help to relieve symptoms. 

Yoga for pain or stress relief is an example.  Exercise to help manage fatigue is another.  Such activities are sometimes called integrative medicine when used by medical doctors. 

Alternative practices

These are theory-based practices that are used to replace mainstream medical care.   The promotions of alternative cancer practices are typically based on implausible scientific theories (pseudoscience), testimonials and conspiracy theories. 

Alternative practices can have low to significant direct risks to the patient. Tragic outcomes can result from delaying proven therapies.  These can also be expensive - draining families of their life savings despite having no basis for the claims that are made.

Note: 3 in 5 adults will have a diagnosis of cancer.  All people (even persons with a strong intelligence and excellence in their fields) are vulnerable to claims about non-toxic alternative cures.  Steve Jobs, for example, unwisely chose alternative practices at a time when he had a real chance to effectively treat his cancer.  Doctors, regulators, scientists also get cancer.  There is no conspiracy to suppress cures from you or their loved ones.

Evidence-based medicine

These are medical practices that are based on scientific discovery that have been proven by clinical testing to provide clinical benefit  - defined as living a longer life or by improving quality of life. 

These pre-defined (prospective) tests of the treatments (clinical trials) are carried out in patients who have the disease.  The results are reviewed by peers and independent regulatory agencies.   In the assessment the improvement in the condition (benefit) must outweigh the risks and side effects of the practice.

The prospective design of clinical trials helps to measure the rate of outcomes, such as response rate, and also the expected duration of response, side effects, and survival - for others.  Such as 30/100 responses.  A key principles of evidence-based medicine is to evaluate a treatment in  ways that predict the results for others.  Such as:

* Use of study design of sufficient size and uniform eligibility
 
* Pre-specifying the intervention (prospective design): the patient population, the number of participants (the denominator), how and when the outcomes will be measured, and the result that warrants approval 
 
* Reproducibility of the outcomes by other groups (verification)

Note:  Some medical conditions are difficult to treat effectively even with evidence-based medicines.   In some cases the goal of treatment can shift to best supportive care or palliative care - where the intent is to improve quality of life and to manage symptoms.

Best practice can be controversial, such when standard approaches that have side effects are not expected to help to control the disease and its symptoms.  In such cases, no treatment can be wise, or the consideration of clinical trials that are testing therapies that may work in other ways.
 

Clinical trials - investigational interventions

These are tests of study drugs or other interventions that have not proven to be effective or better than a standard approach to treating a medical condition.  To be approved for testing in humans, the investigational practice must be based on plausible science and carried out with careful oversight to minimize risks to the study participants - starting with finding the optimal safe dose.

Note: without clinical trials there can be no reliable advances in the practice of medicine to treat disease.  PAL urges patients to consider clinical trials routinely -- ideally with the help of an independent specialist in the field to help you to determine if a study might be appropriate for your unique clinical circumstance. 

See Trial Talk for a list of lymphoma specialists you might consult about trials as part of a second opinion.

Preventative practices and medicines

These are changes to life style that may reduce the risk of developing some kinds of disease. Most everyone agrees that preventive practices (adopting a healthful diet, increasing our exercise, cessation of smoking) are keys to better performance, decreasing the incidence of many diseases, and lowering medical costs.

Some obvious targets of such efforts would be the tobacco and food industries, but also public education. 

Popular Topics: Diet and exercise | Turmeric?

On Levels of Evidence	Credible Resources
About Science and "Alternative" Health Methods Cancer information and the Internet: Benefits and Risks, Maurie Markman, MD Cancer myths Natural "remedies" - Caveats of Dietary Supplements as treatment for any cancer Conspiracy Theory? | Slide Consumer Health Digest  ncahf.org NEW: Dose - the importance of getting it right Is it reputable?  - a checklist for judging online information PDF Elements of evidence   ... C-P-R: Credibility, Plausibility, Reproducibility. http://bit.ly/evidenceCPR  Evaluating medical claims and data   Mouse model?  A mouse is not a man (or women), by Bill Rose  PAL Red Flags and Free Speech Is it Reputable? ... PDF   | Slide Sciencethinking.com Questionable Cancer Therapies, Stephen Barrett, M.D. quackwatch.org   When Lay Persons Give Medical Advice	BCC guidance on CAM Below Consumer Report on Herbs and Supplements consumerreports.org Dietary Supplements in Patients With Cancer: Risks and Key Concepts Technical: Part I  Part II (Medscape) HerbMed® herbmed.org  Herbs & Supplements  alleghanyregional  Herbs or Natural Products That May Cause Cancer and Harm, Part Four Muriel J. Montbriand, PhD, RN - ons.org  How Quackery Harms Cancer Patients William T. Jarvis, Ph.D. http://bit.ly/28PlmwZ Linus Pauling Institute  lpi.oregonstate.edu/ Medicines from the Earth scienceblogs.com/terrasig/    MEDLINEplus: Alternative Medicine (National Library of Medicine) MEDLINEplus: Herbs and Supplements  Natural Products for Cancer Treatment NIH Office of Dietary Supplements Questionable Cancer Therapies, Stephen Barrett, M.D. quackwatch.org Vitamins umm.edu/
Tools	Studies
Drug/Supplement Interaction Checker drugreax.epnet  Complementary and Alternative Medicine Online Continuing Education Series Video Lectures	CAM studies recruiting patients ClinicalTrials.gov  Use of Complementary/Integrative Nutritional Therapies During Cancer Treatment: Implications in Clinical Practice Medscape NCI Cancer Complementary and Alternative Medicine

To avoid potential adverse interactions, 
be sure to let your health care provider know 
if you use supplements when receiving therapy.