Cancer is one of the scariest words
in the English language and when we are afraid we tend to become irrational –
even otherwise intelligent people. That is why there are more quackery around
cancer treatments than any other disease.
Cancer is likely second only to death itself in terms of stuff that frighten
people. And just like there are myths and charlatans exploiting our fear of
death, there is an entire voodoo industry to exploit the fear of patients with
cancer.
While complimentary and
alternative therapy for cancer is a universal phenomenon (I often see patients who
also take some form of alternative medicine for cancer here in USA too), it is
of a completely different and dangerous magnitude in India. I have seen this
first hand as I frequently get medical records of cancer patients for second
opinion from India, and it is very troubling to see the number of poor patients
who continues to be exploited by peddlers of alternative medicine in India.
As a recent example, from my visit
to Kerala in November 2017, one of the patients who came to see me for a second
opinion was someone I knew all the way from my childhood days who was
unfortunately diagnosed with bladder cancer around 6 months ago. He saw an
Oncologist and a Urologist at a highly reputed hospital in Kozhikode, who both appropriately
advised immediate surgery to take care of his early stage bladder cancer, which
could have been curative. Instead he decided to forego Modern Medicine and
sought treatment from an alternative medicine provider who claimed he could
cure this cancer with some “lehyam” and other quackery. As symptoms continued
to worsen patient went back to his original doctors, who repeated a CT scan. He
brought with him his CT scans, and I reviewed his old and new scans, and
unfortunately his disease had now progressed significantly and had become
inoperable. And sadly, patient also had gone in to renal failure due to the enlarging
tumor blocking his ureters. While we are constantly bombarded in social media
on the extremely rare instances of advanced cancers “being cured” with
alternative medicine, one never sees the much common occurrences like the case
above, where relying on alternative medicine and delaying modern medical
treatment become deadly.
The number of claims of medical miracles and magic diets for cancer is astounding. As discussed above, the
more frightening an issue is, the more willing people will be to believe in fairy
tales and subscribe to magical thinking. What is unfortunate is that, unlike in
the past, effective cancer treatments are now widely available and cancer death rate down. However, the key to
a good out come still remains early treatment. And many a time as in the case above, the
delay in early treatment while patient tries out various unproven alternative
medicines could change an early treatable disease to an advanced and incurable death
sentence.
Quacks and promoters of alternative
medicine comes in various forms. Some are “professional peddlers” who promote
their wares with benign sounding words (like “organic”, “plant derived” and so
on. A brief note here - just because some thing is derived from plant does not
make it automatically healthy – nicotine, the commonest cancer-causing agent in
the world, is an “absolutely organic and plant derived” product!) These
professional peddlers are very adept at marketing and experts at using social
media. Unfortunately, people are much keener on reading and disseminating extra
ordinary claims and conspiracy theories than what is truly scientific and
rational, so these charlatans have become very successful with the wide spread
use of social media.
Another and even more effective
form of peddlers are those who have been the very fortunate quacks who happened
to come across a case of spontaneous regression of cancer. These quacks have other
people, often cancer patients or relatives, vouching for their remarkable
recovery. Many of these are again totally fabricated stories, but some time
these could be real patients and real stories. So how would one explain those remarkable
stories, assuming the story is real? Can a patient with advanced cancer who
have failed all therapies can suddenly become cancer free?
Here is how to explain this – as briefly
noted, there is a well-known entity in cancer biology called “spontaneous
regression of cancer”. This is the disappearance of cancer without a
satisfactory explanation. There is an entire body of literature on this rare
but well described topic. And with a better understanding of cancer biology, especially
with advances in cancer immunology, this is no longer a “mysterious” or “miraculous”
subject but come totally within the realm of known cancer biology.
The patron saint of cancer
patients is St Peregrine, OSM (1265-1345), a 14th century priest whose
cancerous leg became ulcerated and festered for years and was, according to
Christian legend, healed by Divine intervention the night before he was
scheduled to undergo amputation.1,2 Case reports like this fits the
general rubric of “spontaneous regression.”3
Discounting these unique events
may be the easiest course of action but it is unscientific, as medical
historian and hematologist Dr Jocalyn Duffin noted in an analysis of Vatican
archives in her book, “Medical Miracles: Doctors, Saints, and Healing in the
Modern World”.4 Her interest in this subject started when Dr Duffin
was sent pathology slides for interpretation from the Vatican regarding a
patient diagnosed with acute myeloblastic leukemia, who was supposed to have
been cured “miraculously”. The source of the slides was unknown to her at
first, though more than 30 years later the patient is alive after initially
failing standard therapy.4,5
Critical analysis of cases of
spontaneous regression by sober and scientific observers dates back more than a
century to physicians like Dr William Coley, Dr G.L. Rohdenburg in 1918,
landmark studies by Drs J.J. and J.H. Morton in 1953, and the widely cited
review by Drs T. Everson and W. Cole in 1956.6-8 The latter study
defined the modern version of spontaneous regression of cancer as: “the partial
or complete disappearance of a malignant tumor in the absence of all treatment,
or in the presence of therapy which is considered inadequate to exert a
significant influence on neoplastic disease.”
Medical literature is now filled
with observations of biopsy-confirmed malignancies with computerized tomography
(CT) scans or magnetic resonance images (MRIs) showing widespread disease that
spontaneously regresses, which encompasses nearly every cancer type and
histology. Examples include: acute myelocytic leukemia, chronic lymphocytic
leukemia, Hodgkin lymphoma, non-Hodgkin lymphoma, breast cancer, non–small cell
and small cell lung cancer, testicular cancer, prostate cancer, cervical
cancer, hepatocellular cancer, colon cancer, Merkel cell carcinoma, sarcoma,
melanoma, neuroblastoma, astrocytoma, and renal cell carcinoma.9-26
The mechanisms most-often
implicated in driving the spontaneous regression of cancer are thought to be
mediated by immune system activation (or reactivation). Sometimes the driving
force is an acute intercurrent bacterial or viral infection. Initiated by the
work of Dr Lloyd Old, the founder of modern cancer immunology, the US Food and
Drug Administration (FDA) in 1990 approved the first bacterial immunotherapy,
Bacillus Calmette-Guerin (BCG), for in situ bladder cancer. More recently the
FDA approved T-Vec [talimogene laherparepvec], a viral vaccine used to evoke an
immune response in patients with advanced melanoma.27-29
The development of other viral
and bacterial vectors is an active area of new drug development, with further
success anticipated.30,31 The recent approval of checkpoint inhibitors against an array of cancers and chimeric antigen receptor (CAR)-Tcell therapy are testimonies to the power of the immune system, when it awakes
from its slumber, to simulate a process historically regarded as “miraculous.”32,33
The immuno-editing theory
proposed by Drs Robert Schreiber, Mark Smyth, and Lloyd Old has helped to
refine medical understanding of spontaneous regression, which may be seen as
the interplay of cancer undergoing incomplete elimination, equilibrium, and
escape.34 Under ideal conditions the innate and adaptive elements of
the immune system work in concert to eliminate the cancer (often imperfectly)
with regulatory (CD4+) and cytotoxic (CD8+) T cells, dendritic (or antigen
presenting cells), natural killer (NK) cells, and macrophages along with a host
of immune-activating secreted proteins such as interferon gamma, interleukin
12, and tumor necrosis factor (TNF) all working in harmony. Spontaneous
regression may in some cases be a manifestation of this dynamic process, and
immunoediting fits well into observations that some cancers that undergo
spontaneous regression recur, sometimes years later.
Another example of this
phenomenon can be seen with the so-called abscopal (or out-of-field) effects of
radiation therapy, which causes the immune system to mount a systemic response
to distant metastases.35
I expect that in the future, as
our understanding of cancer immunity matures, the fascinating phenomenon of
spontaneous regression will help guide us towards developing safer and even more
effective drugs. What is remarkable is that, these rare cases of “spontaneous regression
of cancer”, once ascribed to miraculous intervention or unproven “herbal” and
other remedies, now have a very scientific explanation. Unfortunately, how this
plays out in the real world currently is however different; a patient with an advanced malignancy
who was fortunate to have such a case of spontaneous remission may end up with
a lucky quack, who claims full credit for this rare natural phenomenon; and the
news spread like wild fire in the social media jungle; prompting a deluge of desperate
patients flocking to get this “magical herb”, while the herb had nothing to do
with the spontaneous remission. And while a sole case of spontaneous remission
is broadcast through out the world, millions of more lives are cut short trying
these voodoo "treatments" from alternative medicine practitioners. And with the Indian Government's proposed recent legislation that could allow a back door entry for alternative medical practitioners to practice Modern Medicine, public will have even more trouble in the future to distinguish between real Medicine and quackery in India.
References:
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