Respectful Insolence

If there’s one thing I really detest, it’s cancer quackery. Indeed, one of the very earliest posts on this blog was about this very topic, and applying science, skepticism, and critical thinking to extraordinary claims of cancer cures has remained a major theme of this blog ever since. Shortly after that, I described how, because of the variable course of cancer and the fact that many cancers are cured with surgery alone, “testimonials” for cancer quackery can sound very convincing. It’s a topic I’ve covered several times over the three and a half year history of this blog. Whenever a high profile testimonial claiming to be evidence for the efficacy of this woo or other, I have a hard time resisting looking a bit more closely at the clinical situation (at least, as much as can be gleaned from the press reports or the testimonial itself) to see if the testimonial really is evidence for what it claims to be evidence for. It almost always isn’t, although sometimes (often intentionally, I suspect) there isn’t enough information to make a call one way or the other.

Here we go again. It’s time to tackle another one, this time from a most unexpected source.

Unfortunately, the source of this particular testimonial is, of all things, ABC News, which has given a woman named Joyce (who will not give her last name) prominent space on its blog to tell her story entitled Fighting Cancer, Chemo-Free. It’s just like all the others, only writ large on a major news outlet’s website. Like all the others, it starts out with the diagnosis:

“You have elevated lymphocytes,” the voice on the other end informed me. “You are being referred to a hematologist/oncologist.”

Surprisingly, the call was not from the doctor, but an assistant in the medical center. This was the beginning of diagnosing my disease, and I had no idea what it all meant at the time and what it would lead to, either.

I was struck by how routine it was for the assistant to convey the news to me — more routine than I would have imagined. That, plus the fact that I was not dealing directly with the doctor.

Like the subjects of so many alt-med testimonials, Joyce emphasizes the routine, seemingly depersonalized manner (from the patient’s point of view, at least) in which her diagnosis was relayed to her and she was dealt with by the “conventional” medical system. I sometimes wonder whether, if we as “conventional” cancer doctors could reliably eliminate that feeling of being a number or diagnosis and make patients feel like a human being, we could by so doing also eliminate much of the motivation that drives women like Joyce away from scientific medicine and into the arms of woo-meisters. At least, we could probably decrease the number of patients who succumb to the blandishments of quacks, although I realize that there are some people who wil never be swayed.

And driven into the arms of woo-meisters is what Joyce ultimately was. But first, she describes how “crunchy” her outlook was with regard to “natural” and “organic” living. Then she describes what kind of cancer she has:

After returning home from Arizona, grateful for the visit, I was scheduled within the week for a bone marrow biopsy. To many, this would be a very painful procedure, but five children and a strong spirit made it very bearable. Next was a CAT scan and a PET scan, and additional blood work, all of which took a month to complete due to scheduling. Then came the visit to the oncologist for the results.

Arriving at the office from work, I was quite anxious but spent time praying that the results would be favorable. After about 30 minutes in the room, a different doctor came in who works with my oncologist. At first look, she said, “You are going to be fine, I don’t really see anything to be concerned about.” I asked her, “what about the PET scan results?” Well, after the second review, she reported lymphoma. Actually, marginal zone lymphoma. Marginal sounded pretty good, like not the whole thing! She explained a bit about the type of cancer I had, a “waxing and waning” cancer, not curable and not necessarily needing treatment. Didn’t sound horrible … prayers answered? Not sure and not sure who to ask.

It turns out that marginal zone lymphoma is about the best possible cancer to become the subject of an alt-med testimonial. It has all the elements that allow for the appearance of efficacy for whatever woo is chosen. I’ll get to those elements in a moment. First, you should be aware that marginal cell lymphoma is an uncommon variety of B cell lymphoma that arises in the marginal zone of lymphatic tissue. It arises from three main sources:

  • Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphatic tissue (MALT) type. These lymphomas start in organs other than the lymph nodes and are the most common type. Most mucosa-associated lymphoid tissue (MALT) lymphomas arise in the stomach, although they can also arise in the lung, skin, thyroid, salivary glands, and tissues surrounding the eye. Usually these lymphomas are confined to the area where they arise and are not widespread.
  • Nodal marginal zone B-cell lymphoma. This is a rare form of lymphoma diagnosed primarily in older women. It involves lymph nodes are involved, but tumor cells can also sometimes be found in the bone marrow.
  • Splenic marginal zone lymphoma. This, too, is a rare lymphoma. It is found in the spleen (hence the name) and bone marrow.

Based on Joyce’s description, she most likely has nodal marginal zone B-cell lymphoma, although I could be wrong about this. The fact that it’s in her bone marrow leaves out a MALT tumor. There’s also no mention of an enlarged spleen, which is virtually always present for the splenic variety of this tumor.

More importantly, there are several reasons why marginal zone lymphoma is perfect for an alt-med testimonial of Joyce’s variety. First, it’s a very indolent tumor. Patients can do quite well with it for long periods of time. Symptoms may wax and wane, and the tumor may also wax and wane, although the general course is slow progression. Indeed, often the treatment is nothing more than observation, with treatment with low-intensity chemotherapy held in reserve until and if the tumor progresses. Overall, this sort of lymphoma is generally treated in a manner similar to follicular lymphoma, which is often not treated until it starts to cause symptoms or organ abnormalities. One other thing to be aware of is that marginal zone lymphomas can either recur or transform into diffuse large cell B lymphomas, a more aggressive lymphoma that requires more aggressive treatment.

When Joyce’s tumor apparently progressed, chemotherapy was recommended. If you’ve read this sort of testimonial before, you know what’s coming next:

Over the next days, I prayed and asked for wisdom as I faced the likelihood of this path of treatment. Being one who hasn’t taken even a Motrin for many, many years, how could I possibly undergo something like this? Based on everything I knew from my self-study of nutrition and wellness, this was not an option.

Of course not. It never is for believers like Joyce. Unfortunately, this little thing we call reality has a funny way of intervening, whether we like it or not. It would be wonderful if it were otherwise, but it’s not. Nobody likes the prospect of having to undergo chemotherapy, but declaring such prospect “not an option” when you have cancer is nothing more than wishful thinking. Unfortunately, an attentive naturopath and wishful thinking can go a long way:

My meeting with this doctor began with an hour consultation where he questioned me on everything: symptoms, personal and family history, places where I lived, toxin exposure, stressful events, et cetera. He recorded every bit of information. I was absolutely fascinated with his approach — his questions, the way he was taking in the information and then immediately creating a beginning protocol for healing. Wow, quite different from “we don’t know how people get lymphoma, waxing and waning type of cancer, no real cure, we’ll wait and see.”

The problem is, however, that that’s simple honesty. We physicians may understand a lot, but we don’t understand enough about exactly how cancer develops to say with confidence that we know why cancer occurs or exactly what causes it. There are usually multiple potential causes. In addition, medical ethics demands that we be honest in telling patients about the uncertainty in our predicted treatment outcomes. Woo-meisters like naturopaths labor under no such limitation on what they tell patients. After all, they tend to believe fervently that they know why cancer forms. They can tell patients that it’s “acidification,” “toxins,” or other catch-all “causes” of cancer and do it with confidence and utter sincerity. They can also tell patients with confidence and utter sincerity that they can offer patients a treatment that is “non-toxic” and just as effective as chemotherapy. Unfortunately, sincerity aside, their explanations for what they propose to do are generally simple, reasonable-sounding–and almost always utterly wrong. But they sure do sound convincing to patients who don’t understand understand science and/or who are predisposed to belief that “natural” must be better.

Patients like Joyce.

Indeed, among comment after credulous comment praising Joyce for being “brave” and having chosen “wisely,” one commenter named Eric actually nailed the true situation it is as well or better than I ever could:

Most telling is the statement by the naturopath that he can definitely improve or cure the patient, which she finds much more acceptable than the uncertain prognosis offered by the mainstream physician. This is the means by which quacks flourish. Unfortunately, in the real world lymphoma does not have some universal cause like poor nutrition and while medical therapy is sometimes quite effective, low-grade lymphomas often don’t respond well, which is why “wait and see” is preferable (many people live a long time with their disease before treatment is required).

And of course, diseases that “come and go” with variable symptoms are tailor-made for quacks – they claim credit for the naturally-occurring remissions, and when the patient’s condition worsens it’s his/her fault for not seeking the quack’s help sooner or for having sought conventional treatment first.

Patients, too, who receive both “conventional” and “alternative” therapies for cancer often give credit to the “alternative” therapy when they do well or blame the “conventional therapy” when they do not. It’s a “heads-I-win-tails-you-lose” prospect for “alternative” medicine practitioners.

I wish Joyce nothing but the best. I really do. In fact, that’s why I hope that she will figure out before it’s to late that the path she has chosen is not in her best interest and will ultimately result in the deterioration of her health sooner than it needs to deteriorate. However, my wishing that Joyce will see the light does not absolve ABC. I am highly disturbed that ABC News would give Joyce and her “journey” a pulpit in the form of a blog from which to spread her message of faith in naturopathy with statements like this:

I’m a big believer in the possibility that alternative medicine provides for treating any type of illness and for prevention. And that is what I’ll focus on in this blog, going forward. I hope it helps any of you who are reading it.

The only people Joyce’s blog will help, I’m afraid, are cancer quacks, particularly given the large number of alt-med testimonials and words of encouragement posted in the comment section relative to the few skeptical comments warning Joyce about the course she is on. It is certain that Joyce’s blog will not help any cancer patients unless bad things end up happening to Joyce and she realizes her mistake too late, which would be tragic for her and any patients who may have listened to her in the meantime. In fact, if Joyce’s blog persuades any patients unfortunate enough not to have a tumor as indolent as hers to abandon conventional therapy and pursue quackery, Joyce could well, as a promoter of quackery, lead cancer patients to their deaths. I realize she doesn’t see it that way, but that’s the way I see it. Also, the longer she keeps it up, the more likely her glowing testimonial is to lead a cancer patient to abandon effective therapy to his detriment. Fortunately for Joyce but unfortunately for such patients, because of the very nature of her disease Joyce is likely to be around quite a while regardless of what she ultimately chooses to do.

What’s worst of all, though, is that ABC gave her the forum through which to do it. If any patients die due to foregoing effective therapy based on Joyce’s story, ABC News will share in the blame. Joyce’s promotion of naturopathy is understandable in that she’s at present a believer, but ABC News should know better than to give a believer in quackery a regular soapbox. That’s also the way I see it.

Comments

  1. #1 Marilyn Mann
    September 9, 2008

    Interesting. A friend of mine (a family practitioner) writes for ABC. I will send him this. I have never seen him advocating any quackery.

  2. #2 Dianne
    September 9, 2008

    What strikes me as odd is that she lived the “natural” lifestyle that proponents say will protect you from cancer and every other Bad Thing. But she still got cancer. Yet this did not lead her to question whether the proponents of alternative medicine and naturopathy might be wrong in their claims. Why? If she’d had chemotherapy and felt terrible afterwards (say, for example, if she were one of the unlucky few people for whom antiemetics aren’t completely effective), I’m sure she would be discussing in great detail how this proved that her doctors didn’t know what they were talking about.

    The other thing that I find interesting is that she preferred the authoritarian style of the naturopath, who told her “here’s what you must do” to the open, involved style of the oncologist who told her “here’s what we know and don’t know, here are some options.” Despite all the babble about “taking responsibility for your illness” and so on, I suspect that alties are really looking for a parent figure to make it all right.

  3. #3 sailor
    September 9, 2008

    that web blog and comments may be dangerous, driving people to seek quack cures before medical treatment, when time might make the difference between life and death.
    The comment section there is full of anecdotes about woos who were cured. If anyone has the appropriate stories it might save a few lives if there were some posts there about people who choose quacks and died because the did not seek proper medical attention.

  4. #4 Bryan
    September 9, 2008

    This is becoming all-to-common. Back in the days when this kind of thing was rare it made for entertaining stories; today it is reaching the point where far too many people are forgoing proper therapy in favour of “natural” treatments.

    They get natural all right – the natural progression of their disease that is. And it isn’t just cancer – vaccines, MS (I have an aunt trying a “natural” treatment for MS as we speak), you name it.

    Maybe we should be more pro-active, and post more stories of the consequences of naturalpathic medicine. They have killed people in the past, and most certainly will again. Moreover, they are tricking patients out of therapies with proven effectiveness (even if the effectiveness is low, as in the case of many cancers) and tricking them into treatments with either an unknown effectiveness, or a proven ineffectiveness.

    The a-hole in me wants to just throw up my hands and let evolution take its course, but that’s a hard attitude to keep when friends and family are falling for the naturalpathic BS.

  5. #5 D. C. Sessions
    September 9, 2008

    What strikes me as odd is that she lived the “natural” lifestyle that proponents say will protect you from cancer and every other Bad Thing. But she still got cancer. Yet this did not lead her to question whether the proponents of alternative medicine and naturopathy might be wrong in their claims.

    It’s much like any other religion. Those who are most exacting in their practices are also the most likely to perceive every little thing that goes wrong as punishment for the remaining sins, and if they’re not aware of any sins then they’ll look all the harder for undiscovered ones.

    In the religious model, at some point the Pious find themselves being punished for the sins of others because the Pious were not exacting enough in spreading the Truth or in demanding piety from the Faithful.

    Similarly, the World of Woo has their own brands of vicarious punishment, because after all you can never avoid all possible sources of [strike]evil spirits[/strike]toxins. That car that drove past your farm last week? Exhaust fumes. Maybe one of your neighbors secretly vaccinated one of her children (I’m not joking; I’ve seen posts arguing that “vaccine toxins” spread to others near the vaccinee.) You can never be too pure.

  6. #6 MKandefer
    September 9, 2008

    Testimonials speak well to people, and it might be beneficial to provide negative testimonials, whenever possible. However, when it comes to testimonials in life-or-death situations it is problematic, since the dead don’t speak.

  7. #7 Bryan
    September 9, 2008

    “However, when it comes to testimonials in life-or-death situations it is problematic, since the dead don’t speak.”

    Those testimonials can come from others – family, friends, MD’s, etc.

    Bryan

  8. #8 DonZilla
    September 9, 2008

    Somebody, hand Orac a towel. He’s beating his head against the wall until it’s bloody. Again!

    But since he won’t stop, I’ll just tell everyone my favorite comment on the ABC blog that just stated, simply: “R. I. P.” Brilliant!

    Donzie

  9. #9 MKandefer
    September 9, 2008

    I was only attempting to make a statement similar to that made by Diagoras. I’m aware that others can provide anecdotes about those who have been lost to “woo”.

  10. #10 daijiyobu
    September 9, 2008

    One of my favorite ***I say this facetiously, of course***

    cancer ‘quackery’ sites are those put up on the web by the Fred Hutchinson Cancer Research Center

    claiming that naturopathy is a “branch of medical science [...and a] natural health science”

    (see http://www.fhcrc.org/about/ne/news/2002/02/05/greenlee.html ).

    Naturopathy, in fact has created its own oncology “board certification”

    (see http://www.oncanp.org/about_us.html ).

    While naturopathy, of course, is based upon ‘that science-ejected great figment of alternative medicine’ — vitalism

    (see http://web.archive.org/web/20041020032511/http:/www.oregon.gov/OBNE/docs/Philosophy.htm ).

    -r.c.

  11. #11 joe
    September 9, 2008

    Orac: I sometimes wonder whether, if we as “conventional” cancer doctors could reliably eliminate that feeling of being a number or diagnosis and make patients feel like a human being, we could by so doing also eliminate much of the motivation that drives women like Joyce away from scientific medicine and into the arms of woo-meisters

    Yeah think? That people may distrust systems and individuals who treat them as objects? That since they don’t know anything in the field of expertise, they may make their judgments based upon things they do have expertise in, such as treating someone who is afraid and sick as if they were a frightened and sick human being?

    Wowee-wow-wow. How do you hope to get compliance if this is a deep thought? 1942 is calling — it wants its hospitalism back.

  12. #12 Marilyn
    September 9, 2008

    If ABC is going to provide a forum for this kind of thing, they should at least provide context for Joyce’s unfortunate and misguided views. They should, on the same page, have a comment by an oncologist or other competent physician.

  13. #13 D. C. Sessions
    September 9, 2008

    Yeah think? That people may distrust systems and individuals who treat them as objects? That since they don’t know anything in the field of expertise, they may make their judgments based upon things they do have expertise in, such as treating someone who is afraid and sick as if they were a frightened and sick human being?

    Wowee-wow-wow. How do you hope to get compliance if this is a deep thought? 1942 is calling — it wants its hospitalism back.

    Warning: totally unscientific anecdote follows.

    Speaking strictly as a patient, I’m always amazed at the amount of time my providers are willing to spend with me, not least because I know they’re not being compensated for it.

    You hear things, both pre- and post-surgery (yeah, privacy. I’ve heard of it.) Considering what the staff was helping the other patients nearby deal with, they could have pretty much ignored me. They didn’t. Not remotely. I’ve always ended up on the edge of feeling guilty for the amount of time they’ve spend on me.

    That extends to office visits, by the way — my GP makes a point of doing a thorough consult no matter whether I’m in for a routine oil & radiator check or a full brake job.

    I will confess, though, that I don’t always see eye-to-eye with the staff. One night nurse in particular just would not believe that I didn’t need more pain control. Poor thing was worried that if I didn’t stay ahead of it, I’d have a hard time getting back to something tolerable.

  14. #14 Dianne
    September 9, 2008

    That people may distrust systems and individuals who treat them as objects?

    Nice thought, except that, based on this testimonial, being treated as an object or at least an incompetent is what some people appear to want. Consider the quote, “…he questioned me on everything: symptoms, personal and family history, places where I lived, toxin exposure, stressful events, et cetera. He recorded every bit of information. I was absolutely fascinated with his approach — his questions, the way he was taking in the information and then immediately creating a beginning protocol for healing. Wow, quite different from ‘we don’t know how people get lymphoma, waxing and waning type of cancer, no real cure, we’ll wait and see.’”

    So she wanted a practitioner who would ask a bunch of prying, irrelevant questions, tell her the plan rather than discuss options with her (i.e. “creating a protocol for healing” rather than discussing the disease and why no true cure is likely), and unsupported authoritarianism.

    Sounds like someone who wants god or a parent or some other authority figure to come make it all better, not someone looking for a practitioner who will treat them as an adult and an equal and give them accurate information on how to cope with an incurable disease. So I’d have to say it’s more a case of, “The patient called 1942 (or maybe 1842) and is begging it to bring its hospitalism back.”

  15. #15 alyric
    September 9, 2008

    Orac wrote:

    “I sometimes wonder whether, if we as “conventional” cancer doctors could reliably eliminate that feeling of being a number or diagnosis and make patients feel like a human being, we could by so doing also eliminate much of the motivation that drives women like Joyce away from scientific medicine and into the arms of woo-meisters.”

    This is rather topical for me at the moment and my thinking on it has not been completely worked out but I do have some preliminary thoughts on the subject. i have a recent (very recent) diagnosis of cancer, metastasised, and have been through the routine ‘evaluation’ process. And yes, you do feel like a diagnosis, with x prognosis. It’s not a good feeling, but I do feel that a very large contributing factor is the atheistic beliefs of a large number of oncologists, mine included. The trouble with atheism and a materialist philosophy in general is that the human spirit is presumed to be a religious artefact so the oncologist is in no position to support something he’s quite sure isn’t there. Unfortunately, this is inevitably dehumanising, as despite copious evidence to the contrary, humans tend to look for ways to support their spiritual side, sometimes in bizarre places and occasionally in a commitment to causes. As far as the medical sitiation is concerned, I think that it would be a rare event that an oncologist could invoke the placebo effect, since this ( I think) is intimately tied to a support of the human spirit. Given the exigencies of current oncological treatments, this is not a good thing (the patient needs all the support they can get)and no surprise to me that people seek what is not offered by atheist oncologists in quackery.

    For the record, I’m currently into the standard chemo therapy and also a research subject in a clinical trial, which is fascinating and certainly a different perspective from being a ‘pharma shill’. Astro Zeneca ruLes, OK!

  16. #16 Matthew, RN
    September 9, 2008

    D.C. Sessions: I will confess, though, that I don’t always see eye-to-eye with the staff. One night nurse in particular just would not believe that I didn’t need more pain control. Poor thing was worried that if I didn’t stay ahead of it, I’d have a hard time getting back to something tolerable.

    Well, at least s/he did emphasize pain control as important.

    Continued non-scientific anecdote: one of the biggest complaints I get (as an oncology nurse) is that nurses do not spend enough time evaluating and assisting to provide pain control.

  17. #17 Rowan
    September 9, 2008

    A friend of mine had a lump in her breast shortly after giving birth to her fourth child. Doctor scheduled a mammogram. Machine was out of order on day she went. Three months later lump in breast is significantly larger. Gets mammogram and a biopsy. Receives a phone call on her cell as she is driving to tell her _over_the_phone_ she has Stage Four cancer.

    She nearly wrecks the van.

    Over ten days from receipt of call cancer spreads to nodes on both sides of her body. Devout christian she has a conversation with god who tells her she won’t die from the tumor. Opts for chemo only, a macrobiotic diet and prayer. Tumor and all signs of cancer seemingly vanish over six months of treatment.

    Cancer in remission for two years before it reappears. She declines chemo because she has faith in god having told her she wasn’t going to die. She goes to a faith healer who lays on hands. Throughout this time of the second cancer appearance her oncologist and many of us friends pleaded with her to accept treatment. She refused.

    She died four months after the second diagnosis.

    She told me that the worst part was learning of her cancer via a phone call. Not a call asking her to come in for a face to face appointment, but a call to tell her she was terminal. I see that as a failure of the medical professionals she was seeing to treat others as they would like to be treated themselves as individuals…with respect for human emotions at such news.

  18. #18 Tsu Dho Nimh
    September 9, 2008

    I was scheduled within the week for a bone marrow biopsy. To many, this would be a very painful procedure, but five children and a strong spirit made it very bearable.

    I have seen MANY bone marrow biopsies done. They are done under local anaesthesia, and the patient is warned that “despite the local anaesthetic, you will feel a sudden sharp pain but it doesn’t last”. One patient described it as being like “when my cousin hit me with a cattle prod”.

    None of them had any more than that …yes, it hurts like hell, but only for a split second.

  19. #19 Abel Pharmboy
    September 10, 2008

    I think you’ve done a great service: the link to Joyce’s story at the ABC News blog is officially dead and I cannot find it even using their search engine. Good on ya, doc!

  20. #20 khan
    September 10, 2008

    I do feel that a very large contributing factor is the atheistic beliefs of a large number of oncologists, mine included. The trouble with atheism and a materialist philosophy in general is that the human spirit is presumed to be a religious artefact so the oncologist is in no position to support something he’s quite sure isn’t there. Unfortunately, this is inevitably dehumanising, as despite copious evidence to the contrary, humans tend to look for ways to support their spiritual side, sometimes in bizarre places and occasionally in a commitment to causes.

    Then don’t go to the evil materialist doctor, just pray for the gods to cure the cancer.

    ea

  21. #21 Dawn
    September 10, 2008

    The ONLY way to combat cancer is to first figure out the source and second figure out the cure. Well, if cancer cells cause your body to become too acidic – alkalize it!! Tsu Dho Nimh take note: the trick is to have your body alkalized instead of acidic. Start researching it because you may need this info down the line considering the SV-40 virus thing. If you want to take the advice of the crazies, by all means do so. Cut, burn, and possibly kill yourself. Either way, you are not identifying the source or fixing the true problem.

  22. #22 sailor
    September 11, 2008

    yes that site seems to be gone. Let us hope they suddenly realized with horror what they were doing, and became responsible.

  23. #23 marcia
    September 11, 2008

    I posted a comment over there. I’m thinking others your post encouraged did, too.

    Thanks for alerting those like myself.

    Hopefully it will stay gone.

  24. #24 melissa young
    September 21, 2008

    I have splenic marginal zone lymphoma. About five years before diagnosis, I was consulting with a practitioner at a health food store because I also had food allergies. I now know that many of my allergy symptoms were due to the lymphoma.
    The regime of herbal, mineral and vitamin supplements, combined with a severely restricted diet, temporarily masked the symptoms of lymphoma. Eventually, the feeling of dis-ease returned, even though I was still adhering to a “health food” regime.
    Though the alternative treatment did not cure, (or even effectively treat) my lymphoma. I did become a more educated health consumer; I learned to be responsible for finding answers for my lack of health.
    My eventual diagnosis was patient-driven. I insisted on the CT scan that revealed the splenomegaly. I would have eventually been diagnosed because of developing pancytopenia, but not for another year. By the time I was diagnosed, I was stage IV, with bone marrow involvement. My oncologist said that I had probably been living with lymphoma for at least a decade.
    Until the point of diagnosis, I was I was increasingly viewed as a hypochondriac. I was in treatment with a psychologist for what was assumed to be a somatization disorder. My symptoms were vague and diffuse, and compelling to no one but myself. I believe I was failed by many in the medical profession. The one MD who was always an ally was my allegist/immunologist, perhaps because her training led her to more carefully consider symptoms that were vague and persistent, with unknown etiology.
    I am no great champion of alternative medicine. Much of it is quackery. But I was also failed by conventional medicine, and because of that, pursued my diagnosis largely unaided.
    I am currently on Rituxan maintenance. The incidence of lymphoma is on the rise. My opinion (as a layperson)is that the antibiotic age has resulted in a longer lifespan for patients such as myself. A generation ago, I would have probably died from secondary infection, instead of living long enough to fully manifest symptoms of this disease.
    Until diagnostic procedure for lymphoma is improved, the medical community must bear part of the responsibility for the patient’s perceived need to pursue alternative medicine.

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