by Dr. Helmy Haja Mydin. A version of this article was published in The Sun 30 March 2012
One of the more depressing aspects of my job is informing a patient that there is nothing more that can be done about his (increasingly, this is a ‘her’) lung cancer. This is partly due to the fact that up to 2/3 of patients present with lung cancer that has already spread to the rest of the body, making curative intervention a non-starter.
Although not exclusive to this group, the majority of those who develop lung cancer are victims of the tobacco industry i.e. smokers or ex-smokers. It would therefore be reasonable to assume that individuals with a history of smoking who develop worrying symptoms (e.g. a cough that will not go away or coughing up blood) would seek urgent medical review.
However, reality is not all that straightforward. A study published in the British
Journal of Cancer revealed that non-recognition of symptom seriousness is the main patient-mediated factor in delayed presentation. Other factors include older age, lower socio-economic status, lower education levels and an actual fear of cancer being confirmed as the diagnosis. On the flip side, sanctioning of help seeking by others can be a powerful mediator in reducing this delay. In other words, it is usually helpful to have someone around who will nag you into seeking advice for your symptoms.
The last statement comes with a caveat though, as it depends on where you seek advice from. The following aphorism is worth bearing in mind: the road to hell is paved with good intentions.
A story I remember vividly is that of Uncle J, a middle-aged businessman who smoked all his life. He developed a cough that did not go away after a couple of months and over time, had begun to feel more tired and listless. A family friend advised him to seek help – not from a doctor, but from a ‘holy’ man who specialises in these situations. Apparently, Uncle J’s symptoms were a result of being cursed by jealous business rivals. Uncle J consented to meeting this ‘holy’ man, who ‘treated’ him with a series of rituals and a list of verses to utter every morning, along with a rather comprehensive list of items to avoid eating.
Fast forward a few months and Uncle J had not only failed to improve, but had become increasingly breathless. He had also lost weight, along with a few thousand ringgit. He was eventually brought to the attention of his GP, who referred him to a lung specialist. He was diagnosed with lung cancer that had spread to his brain. By the time he was seen by the specialist, Uncle J was hardly able to walk (despite his clinical deterioration, he was reassured by friends and relatives that the ‘holy’ man was doing all he can) and was not fit for a haircut, let alone chemotherapy. He died a few weeks later. When his wife confronted the ‘holy’ man, she was told that it was all takdir (fate).
The use of alternative medicine is not a phenomenon unique to Malaysia – it is a multibillion-dollar global industry, with more than US$30 billion spent in the USA alone. The term is used to describe practices that do not conform to established medical practice. It covers a range of interventions from herbal remedies to homeopathy to being treated by a witchdoctor.
Most individuals are referred to an alternative medicine practitioner by word of mouth. However, it is important to remember that good personal/individual response does not equate to general applicability. This is the rationale for legislating new drugs – clinical trials are performed to not only ensure that the drugs do work, but to identify side effects.
Conventional medicine is not necessarily superior. After all, a fair proportion of conventional medicine is sourced naturally. However, these are studied more thoroughly and give us not only a degree of confidence that they will work, but a clear expectation of potential adverse effects. Many alternative medicinal items and services are provided without the support of these evidence-based trials and without a framework of regulation.
The use of unproven ‘medicinal’ interventions can not only lead to dangerous physical consequences, but also to suboptimal health-behaviour (as illustrated above). Further examples abound – for example, it is not unknown for some ‘holy’ men to persuade patients of the merits of avoiding chemotherapy in order to allow the alternative therapy to work.
Whilst some do have their customers’ interests in mind, it is worth remembering that many of us would not think twice of sacrificing a lifetime of savings if we were offered a ray of hope in hunting for a cure for cancer. These opportunities are unfortunately seized upon by charlatans who have no qualms of fleecing off individuals who are at their most vulnerable.
Those who profess themselves able to intervene must always be held accountable against accepted standards. Although I am an advocate of minimal state intervention, the regulation of unsubstantiated substances is an area that deserves more attention. After all, some of these individuals do not abide by the basic tenet of medicine: Prima non nocere (first, do no harm).
Misleading an individual from seeking the right help from the right place is, in my mind, tantamount to manslaughter. Presenting earlier to a doctor might not cure a cancer that has already invaded the body, but it will definitely increase the treatment options available and the ability of the individual to withstand it.
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By Dr. Helmy Haja Mydin, fellow at IDEAS
Image Credit: Puja Wellness