Respectful Insolence

One of the more onerous duties I have as faculty at our cancer center is to “show the flag” at our various affiliates by attending their tumor boards. I say “onerous” not so much because the tumor boards themselves are onerous but rather because traveling to them cuts into my already limited time for research given that these tumor boards are always scheduled on days on which I don’t have to be in clinic or the operating room. One of our affiliates is nearly an hour and a half away, and many of them are close to an hour away. When you add up travel time and the tumor board, that’s easily more than three hours eaten up, all too often right in the middle of the day. In actuality, though, several of the tumor boards themselves are quite good, one of which being the aforementioned one that requires nearly a 90 minute drive to reach. (It helps that they serve a really nice breakfast there, too, but they also have really stimulating discussion about various cancer cases.) One of the weird things about these tumor boards is that I am viewed as–and I quote–the “outside expert.” This was particularly disconcerting the first year I had this job. There I was, fresh out of fellowship, being looked up to as the “expert” by physicians who may have been in practice for 10, 20, or even 30 years. Somehow I managed to muddle through. These days, seven years later, I even feel as though, for breast cancer at least, I am worthy of the appellation of “outside expert.” (Unfortunately, sometimes these tumor boards discuss tumor types for which I am most definitely not an expert, and “winging it” takes on a new meaning.)

Last week, I found myself attending a tumor board at one of our affiliates that brought up issues that I do not see that often. More importantly, for purposes of this blog, one of the cases presented echoed a piece that I had written rather recently, and, given that, I decided that it was worth discussing here. For one thing, it brought up a rather difficult issue, one that I hadn’t given as much thought to before as perhaps I should have.

I hadn’t been expecting anything out of the ordinary when I arrived at the hospital auditorium. As usual, I said hello to the oncologist who runs the tumor board, a private practice oncologist for whom I had considerable respect and with whom I have shared a few patients. There were some amusing technological difficulties with the computer projection of the radiological studies and pathology slides having to do with a problem moving between a Mac and a PC with the projector, and my attempt to help was in essence rebuffed. So, I sat down and let them figure it out on their own without my input, concentrating instead on the coffee and breakfast that was provided. (A common theme for morning tumor boards is food, in case you hadn’t guessed by now.)

The first two cases presented were not particularly unusual, but the last case presented was tragic in the extreme. If you’ve been a regular reader of this blog, you probably have an idea of the general parameters, but this one shocked even me. The case involved a woman in her early 30’s, who presented to a surgeon with a small palpable breast mass. Her primary care doctor had appropriately ordered a mammogram and ultrasound, which the surgeon dutifully presented. The odd thing was that the films were from 2003. The surgeon presenting explained that this woman had presented over three years ago to him for the evaluation of this mass. On mammogram, there was a mass less than 1 cm in diameter, which was confirmed by ultrasound. The edges of the mass weren’t quite smooth enough to consider it very likely benign. Consequently, the mass fell into that gray areay that we in the biz call “indeterminate,” which is basically a code word for “we don’t know if it’s cancer or not and the imaging doesn’t look sufficiently ‘benign’ for us just to follow it,” meaning that it needs a biopsy. The surgeon described how he dutifully did an ultrasound-guided fine needle aspiration of the small nodule.

The results? Adenocarcinoma. Breast cancer.

Here’s where things get interesting. Apparently, this woman is a die-hard altie. And I do mean “die hard,” as she will quite likely die very hard for her beliefs. She absolutely refused any surgery or treatment for her cancer. It was explained to her that a less than 1 cm tumor with no evidence of spread to the lymph nodes carried a highly favorable prognosis, with upwards of 93% long term survival with proper surgery and adjuvant chemotherapy and/or hormonal therapy.

This woman would have none of it. She wanted to pursue “alternative” medicine. And pursue it she did, with a vengeance. For three years, she disappeared off the radar screen.

A few weeks ago, she reappeared in this surgeon’s office. In the interim, she had tried Essiac tea, homeopathy, the Hoxsey therapy, the Gerson treatment, and Reiki therapy, among others, all the while visiting various “healers.” The results? If you’ve been reading here, you can guess the result.

Her tumor had progressed.

Not only had the tumor progressed, but it had progressed a lot. When the surgeon saw her again, now more than three years after her diagnosis, her tumor had grown to 5-6 cm in size. It was now stuck to the chest wall, distorting her nipple, and ulcerating through the skin in a five centimeter area of bleeding, disgusting goo. Indeed, the surgeon even showed a picture of it. In addition, she had developed easily palpable axillary lymph nodes (the lymph nodes under the arm) on physical exam and complained of bone pain strongly suggestive of metastases to the bone. Even if she did not now have metatastic disease to the bone, her chances of cure had been vastly diminished, as she had clearly moved up from a highly curable clinical Stage I to a difficult to cure clinical stage IIIC. (If she had bone metastases, she was no longer curable at all.) This patient was in serious trouble. You would think that, finally–finally–she would have realized her mistake in not having gone with surgery and conventional medicine.

You would be mistaken.

The patient still steadfastly refused all surgery, chemotherapy, and radiation. Against all evidence that the course she had chosen thus far had not resulted in the elimination of her tumor that she expected, she nonetheless insisted on continuing with various alternative medicine treatments. Against all evidence to the contrary, she continued to refuse any form of “conventional medicine.” She still believed that her ” healer” could save her life, even though she now had a large, bleeding, stinking mass in her breast stuck to her chest wall that had three years ago been a pea-sized cancer that could have easily been excised with a small surgical procedure. She was well on her way to dying in the horrific way that so many women died of this disease 100 years ago. And the cost was more than just the growth of the tumor. The woman had three small children at the time of her diagnosis. Seeing what was happening to her, her husband had finally recently filed for divorce and custody of the children, basing his claim on the fact that, due to her progressing cancer, the poor woman would soon no longer be able to care for them properly and that she had rebuffed all of his attempts to persuad her to get proper medical treatment. Hearing this tragic case, I felt myself becoming simultaneously enraged and a little bit choked up. By presenting this case, the surgeon was in essence asking for advice, and none of us really had any words of wisdom to give him. He was up against religious or quasireligious fervor, and no amount of reality would change this woman’s mind in any way.

It was at this point the discussion took a second unexpected turn.

The medical oncologist who runs this particular tumor board stood up and addressed the attendees. She emphatically said that she viewed this case as a failure of the medical system. The medical system failed, she claimed, because it had been unable to reach this woman, because this woman had not gotten psychological help to help her to see the truly self-destructive course that she was taking. I had to disagree strongly and told her so.

The discussion became considerably more animated after that, with several doctors taking issue, including me.

How, I (and others) asked, could this be a failure of the medical system when the woman was given all the information necessary to make an informed choice and chose quackery? How, we asked, can this be a failure of the medical system when the woman continued in this course despite the fact that her primary care doctor, her surgeon, and her family begged her to reconsider? How, we asked, can this be a failure of the medical system when the tumor’s progression was obvious to even the most casual observer, given that it now was bleeding and eroding through the skin? We pointed out that the old clichĂ© that you can take a horse to water but you can’t make him drink applies very well to this case. The woman had been given every opportunity. She had been brought right up to the water three years ago. It was not the system’s fault that she wouldn’t take the last step and take a drink. She was (and is) a competent adult; unlike minors like Abraham Cherrix, she is perfectly free to refuse treatment or to opt for whatever treatment she wishes. There are just some people for whom no amount of counseling or discussion will persuade. Respect for patient autonomy tells us that we must not force her to undergo the appropriate treatment, no matter how much it breaks our hearts to see a young woman with three young children throw her life way.

Faced with these objections, the oncologist changed her emphasis a little, and said that, had this been her patient, she would have viewed the failure to persuade her to see reason as a personal failure. I could see this point of view somewhat, but even so she seemed to be being a bit harsh on herself. On the one hand, I could respect her point of view, in which the inability to persuade a patient not to throw her life away would have been viewed as a profound professional and personal failure as a doctor. On the other hand, not everyone can be persuaded, no matter how good you are. If this woman had any mental illness that was leading her down this path, it couldn’t be discerned, unless you define failure to face reality as a mental illness. If that were the case, a large proportion of the population would have to be hospitalized, given the rampant credulity and failure to face reality about so many issues that plagues our society. Indeed, refusing to face reality seems to be part of human nature. It’s just uncommon for it to be taken to such an extreme.

The discussion ended unresolved, although most of us weren’t able to think of anything further that could have been done in 2003, nor could we think of anything that could be done now, given that the patient was still refusing any sort of non-alternative therapy. Indeed, we were rather puzzled why she came back now if she were sure that she had no intention of accepting any sort of conventional therapy. Perhaps even she didn’t know, or perhaps her coming back was a cry for help, a manifestation of a realization that she doesn’t want to face that her choice is clearly not working and her health is seriously deterioriating. Whatever the case, in situations like this, no matter how frustrated and powerless we feel, all we can do as doctors is to be there, ready to help and nonjudgmental as possible–and hope that when and if the patient comes back there is still something we can do.

Comments

  1. #1 TheProbe
    October 9, 2006

    I cannot help but wonder why this woman came back to haunt the oncologist. I asked myself what she had to gain from it. The only answer is that she wanted to tell the oncologist that it was the oncologists fault for not persuading her more strongly.

    What else could the oncologist have done? Referred her for burial counseling? Ask her what sort of flowers does she like? Start having estate attorneys call her?

    Tell the oncologist she did not fail.

  2. #2 quitter
    October 9, 2006

    A practical suggestion on the travel, maybe you guys should try teleconferencing? A few cameras to monitor presentations and investing in some software has got to be cheaper than wasting hours and hours of a surgeon’s time.

    Other than that, this is sad. It sounds like a fatal case of denialism. I forgot to include aternative medicine (at least hard core belief in it) in my list of denialist worldviews, but it’s quite clear, they’re experiencing the same rejection of reality and science that other denialists are guilty of. And as a result she’s toast. Pathetic.

  3. #3 Andrew Dodds
    October 9, 2006

    If anyone is to blame, then those people who push ‘alternative’ therapy knowing full well that it is completely ineffective should be to blame. It’s just that question of how to get them to take responsability..

  4. #4 DouglasG
    October 9, 2006

    Strip all of the identifying information, and put it together for the next person. This person may not be able to learn from her mistake, but it could be useful for the next person, and the next, and the next…

    If you could collect enough of these anectdotes (with ultrasounds, etc), then you could put together a good presentation of the effectiveness of alternative medicine.

  5. #5 David Harmon
    October 9, 2006

    “Faced with these objections, the oncologist changed her emphasis a little, and said that, had this been her patient, she would have viewed her failure to persuade her to see reason as a personal failure.”

    Like you, I can sympathize, but not agree with her, for all the reasons you gave. There might even have been some argument that could have persuaded her, but persuading someone who’s determined not to believe you, really isn’t a matter of medicine as such.

    However, it might be worthwhile to work up a “standard” set of arguments and props for doctors to use in such cases. E.g:

    “This is what your tumor will look like in a couple of years”.

    “This wo/man over here [some staffer who’s had a lump removed] had a similar lump to yours. She had it removed, and has had no problems since.”

    “This mortician specializes in cancer patients. About half the time, he manages to avoid a closed-coffin funeral.”

    Or perhaps, a series of three pictures: “This woman started out in exactly your situation. Here’s what she looked like after 3 years of “alternative” therapy. And here’s her coffin being lowered into the ground….”

  6. #6 Robster
    October 9, 2006

    Sounds like it will soon be time for the husband to sue her altie practitioners for wrongful death, suffering, practicing medicine without a license. I think it would really be hard for a jury to turn him down.

  7. #7 TheProbe
    October 9, 2006

    Robster:

    Sounds like it will soon be time for the husband to sue her altie practitioners for wrongful death, suffering, practicing medicine without a license. I think it would really be hard for a jury to turn him down.

    If I were a juror, I would kick the case out of court. The woman CHOSE to avoid real treatment and assumed the risk of not surviving after being told what the consequences are. While I do not absolve the alt-quacktitioners of responsbility, the simple fact is that she caused her own demise.

    As for the oncologist/surgeon who is placed in this predicament, I suggest a very blunt letter to the patient and the person that they list as their next of kin, laying out in gruesome detail what the sequelae of the choice to go altie means.

    Perhaps such bluntness may help them think once (I do not believe that the choice to go altie is “thinking” in the traditional sense.)

  8. #8 Sastra
    October 9, 2006

    If you look at the claims for most alternative therapies, they are very heavy on spiritual and supernatural types of assumptions regarding potent powers, forces, and intentions — either on a personal level or Nature as a benevolent guide. AltMed functions like religion, complete with those unenlightened dark forces of the Other Side that fail to “get it” and want to prevent you from seeing the Big Picture, too.

    Trying to argue a True Believer out of Alt Med is like trying to argue against the existence of God to just about anyone. The tricks and denials built into the apologetics will not only help them disregard just about anything you say, but they’ll feel virtuous and wise while doing it. The oncologist is up against it, hard, in a culture which puts “being scientific” slightly lower than “having faith” on the personal merit scale.

  9. #9 Robster
    October 9, 2006

    Probe, Perhaps it wouldn’t make it to court, but if it was made a civil case, it would only require a 9 of 12 majority up or down to reach a verdict.

    I have to admit that I reacted out of anger in writing my comment, and have a heavy bias against alties (with a brother in law (brother’s wife’s brother) is an alti who calls himself a doctor, no credentials), and could never be a juror in such a case. That being said, depending on the circumstances, a case could be made that they are practicing medicine. They certainly have contributed to her death, especially if they discouraged her from seeking real medical help.

    Maybe it would work, maybe not.

    Regardless, I’d love to see this written up as a case study.

  10. #10 Koray
    October 9, 2006

    Firstly, I don’t get why the patient went to see a doctor at all. Was it for the diagnosis alone? Is she ok with doctors diagnosing her as long as they don’t treat her? Why can’t her alties diagnose her and save the real doctors the undeserved frustration and guilt?

    It’s too bad that she got three kids as she truly deserved a Darwin award.

  11. #11 bcpmoon
    October 9, 2006

    You just have to replace “failure of the medical system” with “the devil”. Perhaps it is too difficult for some people that you can be and have to be responsible for your own decisions.

  12. #12 PhysioProf
    October 9, 2006

    Very moving piece. I just wanted to thank you for your continued efforts to provide insight into the professional life of a physician. I am a medical school professor, but not an MD, and your posts are very helpful to me in getting a sense for what my students’ future will be like.

    My responsibility is to teach them the scientific content of physiology, but I try when I can to make it relevant to their ultimate concern, treating patients.

  13. #13 Dianne
    October 9, 2006

    I don’t believe that the death which is inevitably and unfortunately coming to this young woman is the fault of her oncologist personally or the medical system in general, but I do think that the question “Could we have done anything different that would have persuaded her to accept reality and get the life saving treatment she needed?” is a useful one. But be prepared for the possibility that the answer is “no”. Sometimes nothing works. Some tumors grow and recur no matter what you do, some people are unwilling to accept treatment no matter what you say to them.

    Incidently, if you want to talk about failures of the medical system, I have a better example: A young woman I saw during fellowship who had had an ovarian tumor removed 18 months after it was discovered by ultrasound. Why the delay? She lost her job and therefore her insurance just after getting the U/S and it took her that long to get on medicaid. It was only dumb luck that it turned out to be a tumor of low malignant potential and therefore had not spread.

  14. #14 #1 Dinosaur
    October 9, 2006

    Somewhere between “appalling” and “tragic”.

    The oncologist should consider a brief psychological intervention (for herself) to deal with the guilt. It’s akin to a psychiatrist who loses a patient to suicide even after doing everything right. Some people are and will always remain beyond our ability to help them. It’s our responsibility not to become paralyzed (by guilt, angst, anger, frustration, etc.) when it happens to us.

  15. #15 Renee
    October 9, 2006

    There may be an approach that would have persuaded this patient to continue with conventional treatment. At Thomas Jefferson U. Hospital in Philadelphia, there is a center for Integrative Medicine (http://www.jeffersonhospital.org/cim/article5033.html) that works with cancer patients. Though they offer things like acupuncture, massage therapy, herbal medicine, etc, they do emphasize that these are to compliment, not replace, conventional cancer treatments. And since they’re located right at the hospital and close to the Kimmel Cancer center there, the people at the integrative center would be able to intervene and get a patient back on track if she was reluctant to see surgeons, oncologists, etc.

    I myself have had a consultation at the Rena Rowan breast cancer center at the U. of Pennsylvania (turns out I had a benign condition). In each of the exam rooms there, there is a sign that reads “Feeling overwhelmed with your diagnosis? Please call Patient and Family Services. We are here to help you.”

    Perhaps these avenues would have made an impact on this woman, and gotten through to her before she gave up on even having surgery. Perhaps a counseler would have found out what was behind her decision (fear of surgery? fear of chemotherapy? bad experience with a doctor?) Perhaps these avenues wouldn’t have worked, either, if she was truly a diehard.

    I don’t know have prevalent these hospital-based intergrative centers are, though I would imagine there is at least one in most large cities on the East Coast.

  16. #16 Chris
    October 9, 2006

    Unfortunately, I don’t see any way to escape the conclusion that this woman dug her own grave and will soon have to lie in it. I’m sure it’s human to feel that you could have done something more, could have done something different; but the nature of the universe is that no matter how good you are, you don’t win every time. For a doctor that means you don’t save every patient.

  17. #17 Kay
    October 9, 2006

    I obviously don’t know this woman and don’t know the doctor but I know from own experience my attitude towards my physicians has changed. In my twenties I had a lot of confidence in my physicians. Now in my forties I have much less confidence. What changed my mind? Two misdiagnoses with life changing problems from the treatments. My GP letting her practice grow out of control to where labs results are frequently getting lost by her and her staff and not listening to me when I express concerns that seem to slow down her day. She, at times, disregards what I tell her leaving me to wonder if she thinks I am naive or stupid about the symptoms I experience.

    I think patients need to have an accurate knowledge of state of medicine. A lot of it is amazingly good — but when doctors are overly optimistic or represent themselves as possessing more knowledge than they really do, it can damage the doctor-patient relationship — with increased risks to mortality and morbidity if a patient can’t communicate with the physician.

  18. #18 epador
    October 9, 2006

    Been there, done that, have all the T-shirts.

    Teleconferencing is a little more complicated, getting the appropriate equipment and making sure patient confidentiality is secure isn’t as simple as it seems, and getting folks at the far end to avoid other distractions (putting a chair against my door might keep folks out of my room, but won’t stop them from banging on the door and beeping me in the middle of my teleconference).

    Being there to press the flesh is better, and you get all kinds of curbside consults before and after that help folks that you are not likely to get in a teleconference.

    And hopefully the food is good.

    As far as this case goes, I agree heartily that the apologist oncologist needs the counselling! As professionals, we all too often overlook our peers problems before they cascade out of control. And sometimes after.

    I would also say that it might have been interesting to know if she (the patient) had allowed or refused communication with the husband at the outset. He could have been included early in the treatment and diagnosis information visits – it might have provided him with some leverage towards either convincing her to consider real Rx or he might have been able to pull the financial plug on her altie care. Its not clear to me from your description, to use an overused phrase, “how much he knew when.” He certainly needs counselling, as well as the kids.

    A local hospice might be a good referral for them as well as the patient for at least bereavement counselling (if the patient refuses even hospice, maybe the hospice would see the family).

  19. #19 epador
    October 9, 2006

    Perhaps she’ll eventually have a change of heart. I saw a woman with a similar history who finally saw the light with a similar tumor. After 6 months of CA followed by Taxol/Carbo (this was 11 years ago and I was winging it) she was back to a 1 cm lesion, that turned out to be necrotic after partial mastectomy. She was so pleased that she avoided a MRM (which she admitted was her original unfounded fear), and had a good understanding of her risk for relapse, etc.

    You never know when someone will have an epiphany.

  20. #20 Hyperion
    October 10, 2006

    My guess is that even without the altie influence, such a woman would likely have simply procrastinated and attempted to convince herself that it was nothing, just a bruise or perhaps that her brassiere was too tight or chafing or whatever.

    One of the other sciencebloggers, might have been Dr. Charles, had an essay about a man with a tumor on his jaw who must have seen it while shaving every day and had managed to will himself not to see it.

    Fear is likely the overriding factor, the desire to believe that it will go away on its own, or with some simple treatment, because it really can’t be that bad, it couldn’t be life-threatening, or even terminal because even considering the possibility is too much of a mind-fuck.

    Or perhaps it’s fatalism, a belief that death is inevitable and not wanting false hope. I don’t know.

    But the oncologist was right, it’s a failure. It may be nobody’s fault, the oncologist may have tried everything, but it is a failure nonetheless. Blame is irrelevant, it is just irrational frustration at such a wasteful and unnecessary situation.

    Psychosocial intervention might help, but keep in mind that altie beliefs generally tend to coincide with anti-psych beliefs, which makes a certain amount of sense when you consider that both stem from the irrational rejection of evidence-based medicine in favor of instinctively appealing simplistic explanations. So there’s a very real possibility that increased access to counseling isn’t going to help these situations.

    Scare tactics would also be too much of a knee-jerk reaction from frustration. It might scare a few patients into treatment, but it might also feed the despair that’s driving some of them away. I’d think that discussing the situation with a survivor might be a better option, if possible. Not just the idea of someone with personal experience of what they’re going through, but in seeing that survival is a very real possibility and that there is hope if they get treatment quickly. These are patients who will respond far mroe readily to personal appeal and “gut instinct” than to evidence and statistics.

  21. #21 nevins
    October 10, 2006

    You can’t be 100% in convincing patients of your point of view. From irrationalism to merely differing personal values, patients (all of us eventually) will have a range of responses to every possible situation. If an oncologist were to boast that all of their patients follow their wishes then 1) they havn’t been practicing long, 2) they are fooling themselves, or 3) they are so coercive and heavy handed in their ‘consent’ process that they are violating patient autonomy.

    If by the middle of a medical career one has not had a patient reject your proposed therapy then one must wonder if their consent process respects patient autonomy for decision making.

  22. #22 David Harmon
    October 10, 2006

    Hyperion: “These are patients who will respond far mroe readily to personal appeal and “gut instinct” than to evidence and statistics.”

    Which is why I was suggesting photographs, and personal appearances by such humans as can “testify” for the value of proper treatment.

  23. #23 Frumious B
    October 10, 2006

    I might just call it a failure of the medical system, but not because her doctor didn’t send her for psychological help. That was pretty condescending. The failure is in whatever drives these people away from MD’s. Sometimes it’s too many experiences with individual doctors who can’t process information for shit, or individual doctors who resent having their authority challenged, or even individual doctors who think that if they give a patient a bunch of facts that the only clear, rational choice is to agree with them or be sent off to counseling. Evidence based medicine may be the only clear, rational choice, but dismissing another persons viewpoint is just plain old paternalistic, and is a turn off.
    The fact that alternative medicine even exists and is profitable means there is a failure in the medical system somewhere.

  24. #24 Big Al
    October 10, 2006

    Perhaps when she heard how much it would cost, she just didn’t have the money. Perhaps the second visit was for enough morphine tablets to kill the pain, and everything else.

  25. #25 Patrick
    October 11, 2006

    Thanks for that insightful blog.
    I do not see this as simply a failure of the medical system, but a more widespread failure of our education system. We live at a time where basic tenets of science are taught in our high schools, and contested in some states. A person with a good education would have made a better decision – one to reject “alternative medicine” because it is baseless. The alties feed off the ignorance of people. If we had a good eduction system, their supply of ignorant people would dwindle.
    Perhaps I’m being overly optimistic, though. Everyday I see the frustration of reasonable people when they try to talk to Christians about evolution, when medical people try to discuss what the consequences of “alternative medicine” really are. Rational people often give up in frustration and say “there is no arguing with such a believer, even in the face of insurmountable evidence.”

    Patrick

  26. #26 James
    October 11, 2006

    A lot of highly educated people fall for this crap, education is not enough. However, you may be right that a better education system (teaching children about the scientific method for instance) could help.

    A few years ago I read a behavioural economic article studying some of the common cognitive biases. One finding was that the more statistics a person had studies the less pronouned their cognitive biases were. Correlation isn’t causation, but still I thought the finding was intriguing.

  27. #27 Justin Moretti
    October 11, 2006

    Patrick, I beg to differ with some of the points in your post. Most of the alties I know are medical professionals themselves (traitors! :-p ) or university educated upper middle class professionals whose jobs require them to be able to think rationally and scientifically.

    I think alties DO feed off people’s ignorance, but I think they also cannot recognise their own – they have totally failed all tests for self deception, or alternatively they are malignant criminals (like some whom Peter Bowditch or quackwatch.org might name).

    I would also be careful about making the dichotomy between reasonable people and Christians when discussing evolution/creation. There are many reasonable men and women out there who call themselves Christian and argue that God was indispensible in creating the universe, but are more than happy to describe that universe in modern evolutionary and cosmological ways. If anything, the alternative is a failure of theology to recognise the limits of its own competence and to overrate those of science. My biggest frustration was sitting talking with a bunch of Christian youths, some of whom were just entering university and AFRAID of studying the evolutionary science in their biology courses in case there were ‘consequences’ from ‘denying the word of God’.

    The saddest case I have ever seen was of a woman who had a small, treatable, resectable Ca breast diagnosed and chickened out of surgery at the last moment because she was ‘scared of hospitals’ (no mention of alt therapy). She came back with the entire breast transformed into an ulcerated, scirrhous mass with what in retrospect must have been carcinomatous lymphangitis of the skin. It was the closest I have ever come to losing my composure in front of a patient. The patient knew she’d dug her own grave, and I admitted her and turned her over to the breast unit and tried very hard to forget what I had seen. Without success.

  28. #28 Jen
    October 19, 2006

    This is horrifying on so many levels. And what I wouldn’t have done for a Stage I diagnosis– I had Stage IIIC breast cancer. And yes, it is difficult to treat, but hopefully (fingers crossed) it is cured.

    I don’t think all ‘alties’ are horrible. I went to an accupuncturist who is a cancer survivor, and who readily credits western medicine for saving his life. He may be a bit more thoughtful in how best to combine the two than the average altie.

    As for who is to blame for this woman’s unfortunate outcome…sounds like she was an incredibly selfish person…she clearly thought that she was infallible, in spite of medical evidence and her husband’s pleading, and in spite of having three young children. And the ‘alties’ who supported her, they should be called to task. For all the tasteless marketing of breast cancer during the month of October, this would be a good story to highlight.

  29. #29 Mel
    October 27, 2006

    One thing I’ve noticed about all the anti-alt med stories is that they’re always about the most deluded or malicious of quacks. All of the alt med practioners I’ve met use real medical tests and refer to conventional doctors when necessary, and consider alt medicine to be more of a preventive/overall health booster than a curative for major problems–they’re not hardcore, I suppose, and some of what they do is based on nutritional studies and the like. All of them would have told that woman to go back to the medical doctors and have the lump removed.

    Which is not to say that all what they do is any more scientifically based than the extreme quacks. It’s not. But they’re also not encouraging people to turn their backs on conventional medicine.

    I’m not sure about using stories like this to scare patients into treatment–that’s using the same tactics as the chelation people, and in the long run, it still encourages patients to believe whoever tells them the scariest story, not whoever tells them the facts.

  30. #30 sophia8
    October 29, 2006

    Mel – Undoubtedly there are ethical CAM practitioners. Just as there are many decent Christians who who support gay rights and abortion rights, and oppose killing, war and injustice.
    However, that has never stopped desperate people from being fleeced by scammers who promise salvation/health in return for their cash.

  31. #31 Robin Peters
    November 10, 2006

    I wonder if this woman considered the effects on her children of refusing conventional treatment. This is the sole thing I think her docs could have done differently – to try to persuade her somehow that her children needed her, and that she had a better chance of surviving if she’d had that tumor taken care of when it was 1 CM big.

    I think her husband did the right thing. She may perceive that as abandonment, but a spouse can only take so much. This woman simply refused to see that by refusing clearly-beneficial conventional treatment when it could help her, she was depriving her husband and children of her company when they needed her most.

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