This is part 2 of the article

Pascal's Wager

The complete abandonment of conventional methods has to involve one of the above kinds of blindness to the realities of cancer.

The more usual complementary ("as well as") use of dubious methods can, however, be looked upon as a kind of "Pascal's wager". Blaise Pascal (1623-1662) suggested that it was wise to believe in God, even when doubtful, because there was little downside if He did not exist but a huge payoff later if He did. Pascal's proposition was debatable on both logical and theological grounds, but the possible outcomes for the cancer patient are surely sufficiently extreme as to justify gambling against considerable odds. Contract bridge players apply similar logic when a difficult contract can only be made if the cards lie in one improbable way.

I sense that despite the rather rah-rah atmosphere of alternative newsgroups and mailing lists, dominated as they are by vocal extremists, most alternative users don't need to be told that the chances of them working are rather small. Even very sympathetic and thorough alternative cancer investigators such as Michael Lerner, author of "Choices in Healing", and Ralph Moss, a constant critic of conventional medicine's dealings with alternatives, have been unable to offer very optimistic estimates as to how often they work, or even, after all their researches, firm data as to whether any work consistently at all. It is also revealing that the staunchest supporters of alternative methods always react to criticism, not by producing any body of cured patients, but by dwelling on those areas where conventional methods are (also?) rather ineffective!

Yet, when the stakes are so high, why not go against the odds?

"Science Doesn't Know Everything"

Reinforcing this kind of reasoning, everyone knows that science can sometimes get things wrong. The use of "alternatives", could, at a stretch, be viewed as a quite sophisticated application of the principle that all scientific knowledge is provisional to varying degrees. The customary, knee-jerk, sceptical opinion may wrong in disregarding some of the methods. The cancer sufferer might be lucky enough to hit upon some good ones if they try enough of them.

That is true, I suppose. Unfortunately it doesn't improve the odds much. "Science doesn't know everything" is no answer to the only question that really matters, and that is: "how do the promoters of the treatment know/show that it does what they claim?" This is invariably where the true deficiency lies and where cancer patients should be demanding more detailed information and learning to ask more penetrating questions.. As explained on other pages, it should be easy to show that a cancer cure works, if it worked as well as the promoters of alternative treatments usually imply [see here].

This is one situation where "absence of evidence IS evidence of absence", once we ask how such important medical claims as the ability to cure cancer could ever be made with no more than a smattering of highly selected, poor quality testimonials. Either the more usual, overall results are not very pretty to look at and best kept quiet, or the claimants are so cancer-naive as to not understand what a good cancer treatment should look like. In either case, buyer beware.

Tipping The Balance

Lastly, it could be argued that even when lacking obvious effects on its own against established human cancer, an "alternative" may sometimes help keep patients in remission, or improve ultimate cure rates when used alongside other methods i.e. "adjuvant" use.. Or it may simply slow cancer progress.

These possibilities cannot be discounted on the available evidence. Some cancers remain dormant for long periods after initial treatment, and it is often not clear why they can suddenly and aggressively flare up after many years. Might a little tweaking of the immune system or other weak anti-cancer influence sometimes tip the balance in favour of the patient rather than the cancer in such cases?

The mainstream has considerable experience of such adjuvant use of various physical, hormonal, immunological and chemotherapeutic agents, but has so far achieved only modest improvements in results even from agents that can have quite powerful activity against the same cancers in other settings. So it is not yet clear how a method that has little activity against cancer in its own right would have significant activity in these other roles..

And again, the problem arises as to how it could be known that a treatment possessed such activity, without quite sophisticated trials involving large numbers of patients. The natural variability of outcomes with many kinds of cancer would otherwise swamp the weak effect. Testimonial would merely show one end of the normal range of possible outcomes without the treatment.

Still, such minor effects can also not be entirely discounted without the appropriate studies

Conclusions

For the above reasons I can mostly sympathise with cancer patients using alternative treatments, when at their own expense and risk.

I cannot bring myself to actively encourage it. The medical profession (and that should include alternative medicine) has obligations with respect to the expansion of medical knowledge and the interests of ALL cancer patients, even those yet to come, that go well beyond the world-view of the individual patient.

Also, the above is a defence of some of the cancer patient's choices without in any way justifying the other side of the deal. It remains immoral to offer seriously ill patients a treatment without being able to show that it regularly has the claimed benefits, and I fail to see how any person can defend this.

This is also no defence of cancer patients who claim they have been cured by these methods without considering everything that might bear upon such a claim. Are their moral obligations any less? After all, their testimonials sustain the entire alternative cancer industry. It is disheartening that the most well-intended of testimonials typically do not show what they supposed to --- yet they can be seen to be influencing others in life and death decisions.