Dr. Jeff Kane: Crazy treatments?
Forty years ago, when I was practicing standard medicine, I watched as cancer patients sometimes chose an “alternative” treatment over what mainstream docs offered.
One said, “I’m going to check out laetrile treatment in Mexico.” Another said, “I’m going to use intravenous vitamin C and peroxide.” Or acupuncture, shark cartilage, or turkey tail mushrooms. Today over a third of cancer patients choose combinations of orthodox and alternative care, and a few opt for no treatment at all.
I wasn’t the only one unsettled by the more exotic strategies. Patients’ loved ones contacted me, asking that I talk sense into their relative. But the more carefully I listened to patients, the less enthused I became about influencing their decisions.
People with life-threatening conditions see things differently than those not yet diagnosed. Having our face pushed into the mortality mirror encourages us to put all our cards on the table, to examine our most heartfelt values to determine direction regardless of anyone else’s opinion.
We popularly value life at all costs, but those who bear serious illness — who actually know the costs, week by week — tend to think differently. They might tire of the side effects of medications, the usurpation of their life by doctor visits, tests, and treatments, the burden their family endures, and the eventual prospect of being tethered to machines. They face a dilemma that almost all of us will confront, the question of quantity versus quality of life.
That issue deserves more discussion in medical circles. A study a few years ago asked doctors to choose between two treatment plans for a hypothetical patient. Plan A was aggressive, offering longer survival potential but extensive and even disabling side effects. Plan B was gentler, with fewer side effects but statistically shorter survival. Most of the docs chose Plan A. When they were then asked to choose between the two plans if they were the patient, most chose Plan B — shorter survival but higher life quality. Which would I choose? I don’t know now. Ask me when it happens.
Watching hundreds of patients go their individual, sometimes mystifying ways, I saw a fascinating correlation. The ones who seemed to me to optimally balance quantity with quality were those most passionate about their treatment choices, whether they be chemo, diet, ayurvedic herbs, prayer, or a Romanian clinic. Of course, that’s necessarily a subjective impression, since there’s no way to quantify quality. But that’s OK, since we don’t make life’s major decisions by consulting a spreadsheet. Medicine — and life itself — is as much art as logic.
Jeff Kane is a physician and writer in Nevada City.
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