Evaluating unconventional therapies
CMAJ 1998;159:759-60
In response to: J. Lunney; C.A. Anderson; T. Hajto, R. Saller; L. Oppel
See also:
- Editorial: Unconventional therapies for cancer: A refuge from the rules of evidence?
- Editorial: The arrogance of science and the pitfalls of hope
The organizations that supported the preparation and publication of the series on unconventional therapies (the Canadian Breast Cancer Research Initiative, the Canadian Cancer Society and CMAJ) recognize that this material is only a preliminary step in the acquisition of new knowledge about these increasingly popular products. There is clearly a need for more reliable, scientifically validated information about their safety and effectiveness. Nonetheless, we have been surprised and gratified by the level of interest expressed by both physicians and patients in the articles and the accompanying patient's guide.
We thank Dr. Lunney for his enthusiastic support. The Ontario Division of the Canadian Cancer Society is monitoring the availability of other information products and will consider preparing additional materials to address unmet public needs.
Dr. Anderson expresses concern that green tea derived from Camellia sinensis might be confused with a green-coloured tea made from Ilex paraguayensis. The latter, commonly known as maté, is used predominantly in South America. We checked several common texts and consulted the staff of several health food stores in Toronto and London to determine the likelihood that these 2 very different products could be confused. We found no reference to maté as "green tea," and the many products to which we were directed when we requested green tea were all derived from C. sinensis; products made from I. paraguayensis were all labeled "maté." We were advised that maté is not very popular in Canada and is frequently out of stock. Nonetheless, Anderson makes an important point. Where products are relatively unregulated, customers must gather the relevant information, ask lots of questions, check labels and purchase carefully.
Drs. Hajto and Saller correctly note that viscotoxins are not lectins; they are polypeptides. As Hajto and Saller note, the biological effects of mistletoe lectins are currently generating significant research interest. Research into the effects of the viscotoxins is at a very early stage.
Dr. Oppel raises an issue that has been voiced by several people who are concerned that standards for establishing safety and effectiveness may be inappropriately relaxed for unconventional therapies. We share this concern. As noted in the methodology section of the first article of our series, the Task Force on Alternative Therapies of the Canadian Breast Cancer Research Initiative found that the quality of the research available on the chosen therapies (both positive and negative findings) was not adequate to allow a formal critical analysis. The articles were therefore presented as summaries of the information found while preparing the 6 annotated bibliographies. These bibliographies were originally prepared to assist researchers with an interest in conducting high-quality research in this field by facilitating their access to the existing literature. Following completion of the literature reviews it became clear to the task force that the features of some unconventional therapies (specifically, the degree of patient involvement, the individualization of the treatment protocols and the extensive combinations of treatments) might require new or modified research strategies. Several Canadian researchers are now directing their creativity and energies to meet these challenges using sound scientific approaches, innovation, skills and a high degree of open-mindedness.
Oppel also expresses concern that patients will be unable to interpret the information they gather about unconventional therapies and their providers. Whether patients can interpret the information they obtain may be debatable; what is not in doubt is that they are using these unconventional therapies. They need, and are entitled to, accurate and understandable summaries of information on various alternative therapies as well as some guidance on how to collect and interpret the available information. We are trying to contribute to meeting these needs.
Elizabeth Kaegi, MB, ChB, MSc
Former Director
Medical Affairs and Cancer Control
Canadian Cancer Society and
National Cancer Institute of Canada
Toronto, Ont.
Marilyn Schneider, PhD
Research Program Director
Canadian Breast Cancer Research Initiative
Toronto, Ont.
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