Deception or Brilliant Medicine?
Part 1— Dying to be Better: The Mistletoe Man
Myth-busting is hard work. How do you debunk pseudoscientific claims and combat health fads, fallacies, and frauds?
I’ll put my cards on the table. My and my colleagues’ practice of medicine is based on the best available scientific evidence. Sometimes, though, you need to make a decision about a diagnosis or treatment when there is no solid scientific evidence to guide you. Sometimes you need to go on a hunch, a gut feeling based on experience. And acknowledge the limits of science and medicine.
There are times when it seems best to shrug and leave them be, those health myths and fads, fallacies and frauds. Compared to butting my head against people’s fixed beliefs—generally to no effect—it gives me fewer headaches.
In my last post, Goose Bumps, I wrote about the cosmos, but this time I return to medicine. Well, sort of. This is a true story from a few years ago. The names and identifying details of the characters have been changed to protect their privacy.
“Natural chemo”: promising blue skies
Image by rawpixel.com on Freepik, caption and question marks are mine.
“They told me I had a month to live. When they found the cancer. That was when I went to the doctor.”
It's Sunday, and I’m on call this weekend for my group of family physicians. I don’t know Joyce; she’s a patient of one of my associates, and I’m doing a house call because the answering service told me she’s a lung cancer patient and has developed fever and cough. If it’s pneumonia, it might be able to be treated at home. I’m hoping to save her an exhausting day in the hospital emergency department.
I find her apartment in an older, working-class part of town and park beside a rusted 2005 Ford Taurus. Her husband opens the door. John has bad teeth, and beneath his thin mop of grey hair I see anxiety in the widened darting eyes.
“Things aren’t goin’ too good. We’re tryin’ to raise some money for her treatment,” he says, stroking his left forearm absently. He leads me into the bedroom. It smells mustily of old blankets.
Joyce is coughing, propped up in a chair. She is gaunt from weight loss and the skin of her neck hangs in loose flaps. Her fingers are nicotine-stained. She is in her 50’s but deep wrinkles make her look older; from those years of heavy smoking, I think. I note the whites of her eyes are yellowed with jaundice and feel a tightness in my throat. The cancer has spread to her liver.
A Secret Reward
I take a history and examine her. Her liver is enlarged and hardened with cancer. However, the pneumonia is mild: I prescribe treatment, and tell her she can stay at home, go to the emergency only if she’s getting worse. Joyce smiles weakly, thanks me.
John asks if I’d like a cup of tea. Sure, I’ll stay a little. It’s Sunday, and I’m not rushed. And I’m curious to understand this couple. I sit and sip. Hearing patients’ stories is my secret reward.
“I’ve been getting treatments from the naturopath for a year, for the pains,” Joyce says. Her voice is quiet, husky. “But the pains were getting worse and I went to the doctor, you know, a regular doctor, not the naturopath, and he said it was cancer. In the lung.” She points a skinny finger at her right chest. “He said the cancer’s been spreading. He said I had a month to live if I didn’t have the radiation. So I had the radiation. That was October. Three months ago.” She stops for a coughing spell, drinks some water.
“Guess it worked, ‘cause I’m still here.”
I nod, sip some tea, wait for her to go on.
“After the radiation they said chemo would give me six more months. But I seen what happened to my friend, she got real sick with chemo. So I said no—I’ll do my own chemo. With the naturopath. His chemo just kills the bad cells, you know, not the good cells too like doctors’ chemo.”
I keep my face expressionless, a skill I’ve needed to learn. She tells me John is taking her regularly for the “natural chemo”. The practitioner claims he helps cancer patients with alternative medicines— “integrative oncology”, he calls it. He gives Joyce vitamin C and mistletoe, intravenously.
Neither of these have been shown to benefit cancer patients.1 2 3 Studies showing some benefit have major weaknesses, including a high risk of bias.4 5 There hasn’t been proper, high-quality research, and it is not approved for cancer treatment by the FDA in the U.S. or by Health Canada.
“I always feel better after the intravenous. For a couple of hours.”
I’m not surprised; when we believe strongly that something helps, a powerful placebo effect is created. Placebos can do wonders psychologically. But they absolutely don’t stop progressive cancer.
Talking has tired her out and Joyce closes her eyes. John refills my cup and takes over. He has no steady job, he says.
“I got a grade 7 education. That’s it. I couldn’t handle school, and out in the boonies where we lived back then, the school couldn’t handle me, either.” He grins, showing missing teeth.
He says that since Joyce had to stop working—she was a waitress in a Swiss Chalet restaurant—their only income comes from his temporary jobs as a labourer, and his old-age pension. It’s not much.
“And the naturopath ain’t cheap,” John says. “$250 a visit, two-three times a week. We’re tryin’ to fundraise.”
My stomach tightens. That’s money they sure don’t have. Unlike the doctor’s radiation and chemotherapy, this naturopath isn’t covered by Medicare. He’s making his dying patient beg for money for his sham medicine.
There’s no proper data to show that his expensive “treatments” will make the slightest difference to Joyce’s survival. They will neither prolong her life, nor—in the scant weeks or months she has left—will they improve her symptoms, her quality of life. If a medical doctor did this, he or she would be publicly shamed, lose their license.
Can you look at yourself in the mirror?
Has Mistletoe Man seen the scientific literature, the lack of evidence that he’s doing anything for the cancer? If he does know the truth, but carries on regardless, how can he look at himself in the mirror?
And what if he believes in what he’s doing, and just hasn’t bothered to check the facts? What are we to think of him then?
Back home, I can still see tired Joyce propped up in her chair, coughing. I search the Internet and find her GoFundMe site. But I’m torn. There’s a second image I can’t shake: the smiling practitioner of bogus medicine. It infuriates me to think of my donation going directly into his pocket.
And yet… for now, his “treatments” are making Joyce feel better for a few hours. For now, they’re giving her and John comfort, and a bit of hope. Even though it’s false.
I dig a little into my bank account. Maybe Mistletoe Man can’t look at himself in the mirror. But I need to be able to.
With respect to survival, a thorough review of the literature does not provide any indication to prescribe mistletoe to patients with cancer. https://pubmed.ncbi.nlm.nih.gov/30673873/
With respect to quality of life, a thorough review of the literature does not provide any indication to prescribe mistletoe to patients with cancer. https://pubmed.ncbi.nlm.nih.gov/30673872/
https://www.cancer.gov/about-cancer/treatment/cam/hp/mistletoe-pdq
This post, Dying to be Better: The Mistletoe Man, is part 1 of Deception or Brilliant Medicine?
Dear subscribers: a sequel is coming soon- stay tuned!
To see other posts on Peter’s Substack: Musings on Medicine and More, click here.
A very touching story, Peter. What a hard decision to make! It's clear though that your decision is deeply rooted in your compassion and ability to listen intensely to your patients.
Beautifully written, Peter. What a gut-wrenching situation. As usual, your compassion shines through.