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science-based medicine vs the 'natural' kind

This week a very dear friend of mine is having surgery for bowel cancer, having already gone through a course of comibined chemo/radiotherapy in preparation. When I was talking with her last week, she commented that she wasn't looking forward to the operation, but the prospect of a few more years of reasonably comfortable life as a result of it was infinitely preferable to the alternative..

However, many people may well consider alternatives, particularly if they're worried about the chemo/radiotherapy side of things. And yes, chemo can be really rough - hardly surprising as we're talking cytotoxic (cell-killing) chemicals; the intention is that they kill off the tumour cells before they kill off everything else... And if you look, it's fairly easy to find testimonials along the lines of 'natural therapies cured my cancer'. But testimonial = anecdote, & anecdote =/= data; actual clinical trials of alternative therapies have been rare.

So I was interested to read Orac's review of a trial that did just that - looked at the effectiveness of a 'natural treatment' (the Gonzalez protocol) for pancreatic cancer, an unpleasant & fast-progressing disease that's just killed actor Patrick Swayze, compared to current best-practice chemotherapy. I'm not entirely sure what's 'natural' about the regime Gonzalez patients are subjected to, and you'll see why from what follows & from Orac's very thorough coverage of the research. (I used this topic in my Schol tut the other day - it generated some really interesting discussion.)

When patients were invited into the file they were classified according to the stage of their cancer, their 'performance' status (things like blood chemistry & cell counts), and their nutritional status (well nourished or moderately malnourished vs severely malnourished). They were offered one of 2 treatments and could self-select which one they entered. One of those treatments was chemotherapy + palliative care, easing patients' discomfort as much as possible. The other was the 'nutritional' arm using the Gonzalez protocol.

For 16 days, 4-hourly and at mealtimes, patients in the nutritional arm received oral pancreatic enzymes plus magnesium citrate plus papaya extract plus vitamins, minerals, trace elements & 'animal gland extracts' (whatever they are!) - well over 100 pills a day (hardly a 'natural' treatment!). They then had 5 'rest' days, after which the whole thing began again. They also ate a vegetarian 'metaboliser' (??) diet that excluded red meat, chicken & white sugar. All that would be a hard regimen to stick to - but on top of it patients in this arm of the trial also received twice-daily coffee enemas (yes, coffee enemas!) plus various baths, 'liver flushes' and purgings.

The health status & quality of life of all patients was regularly assessed, & the two treatment arms were apparently fairly well matched (given the selection bias inherent in patient self-selection).

The research team ended up with a total of 55 patients in the trial, of whom 23 received chemo and the other 32, the 'natural' treatment. And their findings? Orac talks about them in depth, including a graph from the original paper that I've copied here as it really speaks for itself. (The SEER curve gives survival rates for the 'average' pancreatic cancer patient.)


Given that the patients in the nutritional arm of the trial did worse than the 'average' patient, and reported a much lower quality of life than those in the chemo arm, this is a sad outcome. Made worse when you realise that each downward step on the graph represents a death. But it's not exactly unexpected, as this 'treatment' appears to be predicated on beliefs about what causes cancer & what can cure it rather than on any scientific evidence - a common theme for many complementary-&-alternative therapies. I know my friend has a different form of cancer, but gosh! am I glad she's opted for the current gold standard of care!

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I read that article, it's a good piece. What's really stunning to me, as Orac pointed out, is that the didn't pull the study at 4-5 months (say). It's obvious at that point that the two approaches have well and truly parted company in terms of how well the patients are faring. Apparently the results of this study have been "buried" from public release, too, which if true is a bit disturbing.

I'm curious as to why the data is flat after the first month, then steeply dives for the non-chemo. It makes me wonder if they excluded from the results those that didn't have at least one full month of treatment. If so, it'd be interesting to know the data for that month too.

I get a feeling we'll both be blogging about "natural remedy" vs. science-based medicine :-)

I agree, that whole study was horribly unethical. Unfortunately some of the commenters at Orac's seem to think that this somehow negates the actual data, which is ridiculous.

I _like_ 'natural' vs 'science-based' - such fertile ground for comment :-)

Hi Alison.

I think your readers would be really interested in the recent Broadcasting Standards Authority decision against Dr Shaun Holt. I have a half-hearted post about it, but my blog is aimed at friends, so it's audience is tiny. There are quite a few links on my post here:

If it interests you, I'd love to see you take on the matter.

Still lurk, still love your blog,

I have added your blog to my must-read folder ;-) & your post on the BSA story is really good. I find it appalling that they seem to be setting themselves up as sufficiently expert in a particular field of science to be able to make judgements on that science, rather than on the way it was portrayed. Just as well nobody asks me to talk on TV or I might be in trouble some day myself :-)
You've certainly sparked some serious reading on my part; I'll have to give some thought on whether I actually write something on it though. A case of 'keep half an eye on this space', perhaps?

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Recent Comments

  • Alison Campbell: I have added your blog to my must-read folder ;-) read more
  • Matty Smith: Hi Alison. I think your readers would be really interested read more
  • Alison Campbell: I agree, that whole study was horribly unethical. Unfortunately some read more
  • Grant: I read that article, it's a good piece. What's really read more