"And what do you do?"
I dread being asked this question because my answer is often followed by the enquirer listing all of his or her recent symptoms in painstaking detail. However, because my mother taught me not to lie, I told the middle-aged woman sitting beside me on the airplane that I was a family doctor. This led her to share the story of her husband's heartbreaking struggle with cancer, to which he eventually succumbed. After surgery, radiation, and evermore toxic rounds of chemotherapy, he was told that he had a few months to live. The woman went on to explain how they had seen a number of alternative health practioners who gave them hope when all was lost and offered further treatment. Sadly, he lived the expected few more months despite shelling out thousands of dollars for these treatments.
I can understand patients and their families looking for alternatives when they are told nothing else can be done to prevent them or their loved one from dying. They grasp onto whatever therapeutic hope they have left--rationalizing that the cost is small when human life is part of the equation. I'm sure many of you have patients who have gone to clinics in the US or Mexico, where they claim to be able to help terminally ill cancer patients. However, this woman's husband was treated in my community with vitamin infusions, herbs, hyperthermia, and more.
I am sure many alternative practitioners believe in their treatments, but the fact is that they are profiting from terminally ill patients. I realize that oncologists and others also make a living taking care of cancer patients, but they adhere to evidence-based medicine and drug trials. It breaks my heart to watch families invest their savings in treatments that have little evidence to support their use.
It is a difficult conversation to have with dying patients and their families--advising them to discontinue these therapies--particularly when the alternative practitioner is advocating the opposite. I find it frustrating that there doesn't appear to be any control over these groups, and it makes me angry that I am powerless to stop it. If I were offering a for-profit treatment for terminal cancer without evidence of efficacy, I would be brought before the College in no time. These patients and families are already going through so much; they shouldn't have to sift through this quagmire of unproven cancer treatments in addition.
By questioning the benefits and appropriateness of these treatments I am often accused of mudslinging, turf protecting, or worse. Surely, there must be some course of action for us to take. I am sure it's a horrible thing to be told that you have run out of life-prolonging treatments. However, I think it would be better to focus energy on spending time with family and friends than delaying this process by getting involved in costly, ineffective therapies. I will continue to try to shield my dying patients from this practice, but I often feel powerless to stop it.
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:
- Only the first three authors are listed, followed by "et al."
- There is no period after the journal name.
- Page numbers are not abbreviated.
For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org