A canna’ change the laws of physics

Scotty, The Naked Time, stardate 1704.3, Episode 7

Cancer and the magic lamp

Posted by apgaylard on February 28, 2009

Could a magic lamp kill?  No, but believing it can cure cancer may well be fatal.  Take the case of Ms A, a woman from New Zealand diagnosed with breast cancer.  A biopsy confirmed that she had had “invasive ductal carcinoma with high grade features”.  A mastectomy was scheduled.

She subsequently decided to seek, “alternate options” after discussing her condition with a member of the New Zealand Light and Colour Therapy Institute.  As a result she received Bioptron Light Therapy for 2½ years, undergoing a total of 159 treatments, and “ended up paying quite a good amount of money”. 

Her condition progressively deteriorated and she eventually sought proper medical care.  A breast surgeon reviewed her condition and told her that she had, “advanced breast disease that [was] palliative”. 

Since then Ms A has been treated with several cycles of chemotherapy, “to control the cancer for some period of time” rather than “to cure it”. A CT scan has shown, “evidence of multiple lung metastases”; subsequently Ms A had a right mastectomy followed by further courses of chemotherapy.  She is dying. 

The role of the therapist in the healthcare decisions made by the patient is disputed.  Ms A’s mother alleged that the therapist “had informed her daughter that “chemo would kill her”.”  The patient recalled the therapist saying, “on a number of occasions that [she] would be cured” and that the therapist said she, “felt excited about [this]“.” 

To be fair, the therapist denied these claims and argued that she only provided Bioptron treatment as the patient was adamant that she was not going to seek proper treatment and she did not have the heart to turn her away. 

It’s not possible to say definitely whose belief in the magic of light has condemned this woman to an untimely end.  Regardless of how the belief was shared among the protagonists it is clear that an exaggerated belief in the power of Bioptron therapy was the fatal factor.  At the very least, the therapist participated in this unfortunate woman’s “alternative cure” fantasy. 

As this story unfolds we will see a manufacturer making exaggerated claims and an allied CAM Institution that’s just serving its commercial interests.  However, what interests me most about this case is the way the boundary between evidence and speculation has been crossed, with the journey progressing into pure fantasy.  

As we shall see, there is a little, limited, evidence that Bioptron therapy may have some uses.  One thing is certain: there is absolutely no reason to suppose that the Bioptron lamp can cure cancer. 

To emphasise this point the only published evidence, such as it is, describes a case of a patient with a malignant melanoma who, “Without consulting a physician, [...] applied [Bioptron] phototherapy onto the area for 30 months”.  He died, “from distant metastases 6 months after the diagnosis.” (Ulamec et al. 2008

One dead cancer patient: not an auspicious start. 

But before we look at where the boundary between evidence and wishful thinking lies: what is Bioptron therapy?

Bioptron 

The Bioptron lamp provides a source of, “polarized polychromatic non-coherent light”, which is used to illuminate parts of the body in the hope of treating disease.  The spectrum used (480 to 3400 nm) does not contain the potentially harmful UV wavelengths; but spans the visible spectrum from blue(ish) through the infrared

Is there any good reason to think that this ‘light’ may be therapeutic?   

There is weak evidence to suggest that infrared (and other) wavelengths may help promote cell growth and thus, it is conjectured, wound healing and some other benefits.  This technique is often referred to as Low-level laser therapy (LLLT).  It is not restricted to the use of infrared radiation, but typically the wavelengths used fall within the Near Infrared (NIR) band.  Some positive studies have been published, but the case is far from made. 

For instance a review by Whelan et al. (2001) stated, in part, that infrared illumination using LEDs: 

“produced improvement of greater than 40% in musculoskeletal training injuries in Navy SEAL team members, and decreased wound healing time in crew members aboard a U.S. Naval submarine. LED produced a 47% reduction in pain of children suffering from oral mucositis.” 

However, a more recent review by Posten et al. (2005) observed that:

“In humans, beneficial effects on superficial wound healing found in small case series have not been replicated in larger studies. [...] the literature does not appear to support widespread use of LLLT in wound healing at this time. [...] conflicting studies in the literature have limited low-level laser therapy (LLLT) use in the United States to investigational use only. [...] The fundamental question is whether there is sufficient evidence to support the use of LLLT.”

This is not very promising.  It is also clear that therapeutic claims are generally made for specific wavelengths – these being thought to elicit specific photo-biochemical effects.  In contrast the Bioptron lamp produces a wide range of wavelengths; though these do include allegedly therapeutic wavelengths. 

Penetration is also another issue.  As we all know human tissue is not transparent to the visible wavelengths – otherwise we would be partially see-through!  Generally, the longer the wavelength of electromagnetic radiation the further it can penetrate tissue.  Hold a torch on one side of your hand and you will see some red light make it through the tissue of your fingers. 

So the shorter wavelengths provided by the Bioptron lamp will not penetrate the skin.  Hence, unless the problem is on – or influenced by what happens at – the skin, this part of the lamp output does not have a chance of helping.  On the other hand the longer wavelengths can penetrate tissue, but this is because they are absorbed less easily.  Hence the energy “dose” they can provide to a region of tissue is reduced – limiting the chances that they can do any good. 

As for the polarised nature of Bioptron light, unless the target tissue or chemical process is sensitive to polarisation this will be entirely irrelevant.  However, proponents of this device advance hypotheses such as

“The Bioptron is believed to act on cell membranes, which are surrounded by fats and are where proteins are stored. Bioptron light rearranges and realigns these fats thereby enabling structural changes in the cell membrane [...]” 

This strikes me as a bit speculative. However, the manufacturer’s website also provides a list of papers that includes basic research. So, this therapy has a degree of plausibility.  Although it does look a bit thin to me.

The Manufacturer’s Evidence…

As they are selling this device as a treatment for people, I would hope that they have some decent evidence that the Bioptron can help people, rather than cells in a lab: so that’s what I will focus on. 

The only evidence on the manufacturer’s website for Bioptron therapy helping people is limited to wound healing.  Here are the five references. 

L.Medenica and M.Lens: The use of polarised polychromatic non-coherent light alone as a therapy for venous leg ulceration. Journal of Wound Care, 2003, 12(1); 37-40.  PMID: 12572235 

This was a, “pilot prospective case-series study”, sponsored by Bioptron AG – the manufacturer.  It evaluated the use of the Bioptron lamp on 25 people, “with venous leg ulcers.”  No other treatment was used.  A statistically significant reduction in the total number of ulcers and the wound surface area was noted. 

However, this was a small pilot study with no control group.  Little wonder that the authors concluded a, “well-designed randomised controlled study is needed to confirm the efficacy of this form of phototherapy and to objectively evaluate recommendations for its routine use in clinical practice.” 

This is self-evidently no basis for using the Bioptron in clinical practice. 

S.Monstrey, H.Hoeksema, H.Saelens, K.Depuydt, M.Hamdi, K.Van Landuyt and P.Blondeel: A conservative approach for deep dermal burn wounds using polarised-light therapy. British Journal of Plastic Surgery, 2002, 55; 420-426.  PMID: 12372372 

[Full paper is available on a Bioptron website.  Please note that it contains pictures of unpleasant burns - some of them on young children.] 

This study looked at the effect of Bioptron therapy on the healing of deep thermal burn wounds.  Twenty-two patients were selected (from a group of 67) on the basis of a clinical assessment that they had, “a very limited potential for spontaneous healing”.  On average, four out of six participating surgeons would have recommended surgery for 59% of these cases. 

Based on viewing slides of the burns, “The surgeons were asked to score the result as much worse, worse, comparable, better or much better than the result they would have expected after surgical or conventional conservative therapy.”  They were blinded to the type of therapy used. 

According to the authors, an independent statistical analysis found, “[...] the estimated time for healing was [...] significantly longer than the actual healing time”.  Moreover, the “rate of hypertrophic scarring was significantly lower than that expected by the observers”. 

Also, “The experts rated the clinical results at least comparable with the expected results after surgical treatment in 73.8% of cases [...]. In the subset of cases that were considered to require surgery, 65.3% scored comparable, better or much better. And, “Compared with a standard conservative treatment, 97.6% of the cases were rated at least comparable. Half of the cases were rated as better or much better.” 

The authors concluded: 

“[...] the results of this clinical study demonstrate that polarised-light therapy reduces the need for surgery in the treatment of deep dermal burns. In this group of patients, the use of polarised light accelerated wound healing and allowed very early pressure therapy, thus reducing hypertrophic scarring and contractures. No extension of the hospital stay was required. Because of the better aesthetic and functional results (especially in burns of the hands), polarised-light therapy has become the therapy of choice for deep dermal burns in our University Hospital.” 

This is, again, a small study.  It essentially seeks to compare the expectations of experts to the eventual clinical outcome.  The Bioptron treatment seems to have resulted in, on average, a better outcome than the surgeons would have expected from conventional conservative treatment; one that compared well to surgery. 

I would like to see a larger trial, objective measures and independent replication before I would be too enthusiastic.  However, this is a positive outcome. 

P.Iordanou, G.Baltopoulos, M.Giannakopoulou, P.Bellou and E.Ktenas: Effect of polarized light in the healing process of pressure ulcers. International Journal of Nursing Practice, 2002, 8(1); 49-55. PMID: 11831427 

In a trial of 55 patients with two pressure ulcers (one acting as the control ulcer), over a two week period, the authors reported increased: values of epithelial tissue, the mean pink/white colour values and mean values of ‘no and minimal exudate’.  And, “mean surface areas of the experimental ulcers decreased”. 

There seems to be a bit of picking and choosing which measurement points on the trial’s timeline to compare, for example: “Mean surface areas of the experimental ulcers decreased significantly between the first and second measurements [...] and between the first and third measurements”.  Correcting for multiple comparisons would, at the least, render the increase in mean pink/white colour values of the experimental ulcers, between the first and second measurements, statistically insignificant. 

The bottom line is that this is, again, a very small trial. 

S.Monstrey, H.Hoeksema, K.Depuydt, G.Van Maele, K.Van Landuyt and P.Blondeel: The effect of polarized light on wound healing. European Journal of Plastic Surgery, 2002, 24(8); 377-382.

Invited commentary: W.Vanscheidt, The effect of polarized light on wound healing. European Journal of Plastic Surgery, 2002, 24(8); 383.   DOI: 10.1007/s00238-001-0305-0

[Paper available on-line, here.] 

The authors report on a, “randomized, prospective single blind study”.  The aim of the trial was to, “evaluate the effect of polarized light [Bioptron] [...] on the healing of standardized wounds”. 

They took, “Twenty pairs of identical donor areas of split thickness skin grafts, [...] on a similar location on each of [...] 20 patients.”  The authors state that these, “were treated according to an identical wound care protocol. The only difference was that one side was treated with polarized light and the other side without.” 

They state that, “The healing of these paired wounds was evaluated in a standardized manner and on a daily basis by two independent and blinded observers.” 

It appears that seven parameters were measured: (1) the degree of epithelialization, (2) the quality of the granulation tissue, (3) the degree of inflammation, (4) the degree of infection, (5) the aspect of the early scar tissue, (6) blister formation, and (7) the subjective feeling of the patient. 

Parameters (4) and (6) did not arise in either the experiment or control wounds.  For the twelve day treatment period the authors contended that significantly better healing scores had been obtained for the other five parameters. 

However, the P-values obtained varied quite a lot as the treatment period progressed.  For instance, if the results at the end of the treatment (day 12) are examined, and corrected for multiple inferences, only the “Degree of inflammation” and “Early scar tissue” parameters are statistically significant. 

It is also interesting to note that the study included long-term follow-up (1 month, 3 months, 6 months and 1 year).  No significant difference was found between the treated and control wounds for any of the parameters recorded. 

But, in the end, this is a very small trial. 

A.Simic, P.Pesco, M.Bjelovic, D.Stojakov, M.Todorovic, V.Todorovic, I.Jekic, M.Micev, P.Sabljak and M.Kotarak: BIOPTRON Light Therapy and Thoracophrenolaparotomy wound healing in patients operated due to cardiac carcinoma. Presented at the 4th International Gastric Congress, New York, USA, April 30 – May 2, 2001. 

This was a conference presentation which doesn’t seem to have made it into a journal article.  As the content is firmly locked behind a pay-wall, I can’t comment any further. 

So, the manufacturer’s evidence consists of four small trials and a conference paper that doesn’t seem to have led anywhere.  The most recent of the trials (Medenica and Lens, 2003) recommends that a, “well-designed randomised controlled study is needed to confirm the efficacy of this form of phototherapy and to objectively evaluate recommendations for its routine use in clinical practice.” 

I may be being a bit picky here, but this doesn’t seem anything like enough evidence to support the claims made on the website.  These four cherry-picked studies just look at wound healing. 

The manufacturer claims …

My experience with phototherapy devices is that the claims made by manufacturers extend far beyond the evidence provided by the small trials they usually cite.  Against this expectation, Bioptron AG does not disappoint.  Their website lists the following “Medical Indications” that can be treated.

GENERAL

BIOPTRON Light Therapy can:

  • Improve microcirculation
  • Harmonize metabolic processes
  • Reinforce the human defence system
  • Stimulate regenerative and reparative processes of the entire organism
  • Promote wound healing
  • Relieve pain or decrease its intensity

WOUND HEALING

BIOPTRON Light Therapy can be used as monotherapy and/or as complementary therapy for wound healing in the following indications:

  • Wounds after a trauma (injuries)
  • Burns
  • Wounds after operations
  • Leg ulcers
  • Decubitus (pressure sores)

PAIN TREATMENT

BIOPTRON Light Therapy can be used as monotherapy and/or as complementary therapy for pain treatment in the following indications:

Rheumatology

  • osteoarthritis
  • rheumatoid arthritis (chronic)
  • arthroses

Physiotherapy

  • low back pain
  • shoulder and neck pain
  • carpal tunnel syndrome
  • scar tissue
  • musculoskeletal injuries

Sports medicine

soft tissue injuries of muscles, tendons and ligaments like:

  • muscle spasm
  • sprains
  • strains
  • tendonitis
  • ligament and muscle tears
  • dislocations
  • contusions
  • tennis elbow

SKIN DISEASES

BIOPTRON Light Therapy can be used as a complementary therapy in the treatment of various skin problems, such as:

  • Acne
  • Eczema
  • Psoriasis
  • Skin infections (by viruses or bacteria)
  • Conditions affecting the mouth (ulcers, gum disease, inflammation of the lining of the mouth/lips, etc.)

SAD

Light therapy is standard treatment of seasonal affective disorder and related symptoms

  • Chronic fatigue syndrome
  • Lowered motivation
  • Increased need for sleep
  • Increased appetite and weight gain
  • The inability to feel happy

CHILDREN

BIOPTRON Light Therapy can be used in children as a complementary therapy to reduce pain and promote healing in various types of conditions, such as:

  • Skin disorders
  • Infections of the upper airways (common cold, sinus infection, tonsillitis)
  • Conditions affecting muscles, joints and bones

 Apparently, more than 500 scientists, 1000 clinics and 5,000 medical doctors are involved in some unclear way with this device.  Further, the manufacturer’s claim that: 

“Years of experience and research have affirmed the positive effects of BIOPTRON Light Therapy and have led to a wide range of applications in numerous fields of medicine. 

The therapy has become accepted as a new form of treatment in prevention, therapy and rehabilitation worldwide.” 

And yet all they point to in their list of scientific references, to support treating people, are four small published trials and a conference paper.  This doesn’t seem to be much of a return from 500 scientists. 

But I always try to be fair; so I thought I’d see what PubMed has to say.  Perhaps they are being coy:  are the Bioptron AG hiding their light under a bushel? 

What does PubMed say?

Searching PubMed for papers containing references to Bioptron therapy reveals 18 articles and a review.  I have already mentioned the death from cancer of someone who used the Bioptron as an alternative treatment. (Ulamec et al., 2008) 

Among the articles there are four German papers, all by the same author (Hass), where the abstract is not available in English.  Some others are basic studies using animal models or cell lines. 

Looking at the studies on people that have some information available in English: Durović et al (2008) reported a, “prospective randomized single-blind study involved 40 patients with stage I-III of pressure ulcer” and found that the therapy delivered, “significant improvement in pressure ulcer healing”. 

Stasinopoulos and Stasinopoulos (2006) (see here for a chart of the results.) compared Cyriax physiotherapy (n=25), a supervised exercise programme (n=25), and Bioptron light therapy (n=25) for the treatment of lateral epicondylitis [Tennis Elbow].  The supervised exercise programme “produced the largest effect in the reduction of pain and in the improvement of function at the end of the treatment and at any of the follow-up time points.”  Though they still said Bioptron therapy, “may be suitable” if it was (somehow) not possible to follow the supervised exercise programme. 

The largest study to date; the most conventional of the three interventions appears to come out best: not Bioptron therapy. 

The same authors, with another colleague, had previously reported a, “a preliminary, prospective, open clinical trial” on treating carpal tunnel syndrome (Stasinopoulos et al., 2005).  Their conclusions for this small (n=25) uncontrolled trial were that nocturnal pain and paraesthesia improved during the treatment; but, “Controlled clinical trials are needed to establish the absolute and relative effectiveness of this intervention.”  Perhaps this is enough to justify doing a better trail, but no more than that. 

The same can be said for the lead author’s uncontrolled four-week pilot study (n=25) for the treatment of acute tennis elbow (Stasinopoulos, 2005).  It reported a positive outcome but concluded, “controlled studies are needed to establish the relative and absolute effectiveness of Bioptron 2″. 

Huliar and Lymans’kyĭ (2003) claim to have their, “own and literary experimental data about the development of physiological responses (analgesia) to BIOPTRON-light exposure on the acupuncture points or biologically active zones.”  The article is in Ukranian and the English abstract contains no hint as to what the data might be.  Their invocation of acupuncture points removes the need to consider this further. 

Desiateryk et al. (2002) investigated the use of the Bioptron for improving, “general state and healing of wounds and trophic ulcers in 57 patients with obliterating atherosclerosis of lower extremities, chronic venous insufficiency of extremities, purulent postoperative complications, purulent-septic complications in patients with diabetes mellitus”.  They claim that, “Main mechanisms of the polarized light action in “Bioptron” apparatus were enlighted, effective schemes of its usage were determined.”  Again this work is only available in Ukranian and the English abstract contains no further details. 

Tomashuk and Tomashuk (2001) reported, in Russian, “clinical treatment of just 9 patients with diabetes mellitus and diabetic angiopathy using alprostan in combination with rays “Bioptron-II” and iruxol-miramistinum”.  Their result: “In 6 patients pain in lower extremities disappeared, ulcers epithelized, in 3–ulcers reduced by 50%.”  Of course there is no way of knowing if was the Bioptron that did the trick (if there was one) or the drugs. 

So what has PubMed revealed?  One dead cancer sufferer; one controlled trail that was negative; three small positive uncontrolled trails and a number of other studies with insufficient details available to make much of a judgement. 

Neither is there a paper among them published in a top-notch journal.  Finally, there is evidence that German and Russian CAM trails generally tend to have a higher than expected proportion of ‘positive’ outcomes. 

In terms of the conditions addressed in the ‘positive’ trials, these are limited to pain/inflamation (Stasinopoulos and Stasinopoulos, 2006; Stasinopoulos et al., 2005; Stasinopoulos, 2005; Tomashuk and Tomashuk, 2001), paraesthesia (Stasinopoulos et al., 2005) and wound healing (Durović et al, 2008; Desiateryk et al., 2002; Tomashuk and Tomashuk, 2001). 

In the case of Tennis Elbow (Stasinopoulos and Stasinopoulos, 2006) Bioptron therapy was inferior to a supervised exercise programme. 

Again, this is less than impressive.  The manufacture appears to have overlooked some fairly obscure small positive trials.  More worrying is the omission of the Stasinopoulos and Stasinopoulos (2006) paper. 

Perhaps I’m still missing some evidence though? 

What does the Cochrane Library reveal?

Searching for “”polarized light” in the Cochrane Library identified the following relevant articles.

Colić et al. (2004) reports on a clinical investigation of the use of this light therapy on, patients who had, “aesthetic surgery procedures”.  The trial method was to treat, “One side of the surgically treated area [...] with polarized light, whereas the other side served as a control. The results were compared using clinical examination only including signs of recovery such as resolution of swelling and bruises.”  The claimed result was that, “in most cases” there was a, “significant difference between the treated and untreated sides.”    No further details are available on this side of a pay-wall. 

Kymplová et al. (2003) compared Bioptron therapy with a 670 nm laser for the treatment of episiotomies.  This large trial (n= 2,436) seems to have been a ‘win’ for the laser, but the authors also noted the Bioptron, “exerted favorable therapeutic effects.”  Once again, the presence of a pay-wall prevents me from offering further comment. 

Ozturk et al. (2005) “investigate[d] the effect of polarized light as an alternative therapeutic modality in 40 consecutive patients with gonarthrosis. The patients were randomly assigned in equal numbers to treatment groups and were employed either polarized light + progressive resistive exercise (PRE) or heat lamps + PRE lasting 15 sessions.”  No statistically significant difference was found between the two groups. 

Ugrinovic D et al (2002) apparently investigated, “Venous ulceration treatment by combination of bioptron light and compressive therapy”.  No further details are freely available. 

The result: two negative trials and two with insufficient details available to really make much of a judgement. 

The negative trails addressed arthritis of the knee (Ozturk et al., 2005) and treating episiotomies (Kymplová et al., 2003). 

The two (perhaps) positive studies address wound healing.

Time to get real 

Of the whole host of claims the manufacturer makes there are published studies investigating wound healing, pain/inflammation and paraesthesia.  The larger trials tend not to favour Bioptron therapy (Stasinopoulos and Stasinopoulos, 2006; Kymplová et al., 2003). 

The positive trials tend to be small and not necessarily include a control group. 

Being generous, using Bioptron therapy along with conventional wound management may have some degree of justification: but it’s weak. 

I’ll also concede that the device seems to provide a reasonable, though expensive, light source for treating SAD

Out of bounds 

From my reading of the published literature (and please feel free to correct me if I am wrong) the following claims are either made without good evidence or in the teeth of evidence to the contrary: 

Reinforce the human defence system, Stimulate regenerative and reparative processes of the entire organism, osteoarthritis, rheumatoid arthritis (chronic), arthroses, low back pain, shoulder and neck pain, scar tissue, musculoskeletal injuries, soft tissue injuries of muscles, tendons and ligaments like: muscle spasm, sprains, strains, tendonitis, ligament and muscle tears, dislocations, contusions, tennis elbow, Acne, Eczema, Psoriasis, Skin infections (by viruses or bacteria), Conditions affecting the mouth (ulcers, gum disease, inflammation of the lining of the mouth/lips, etc.), Chronic fatigue syndrome, Lowered motivation, Increased need for sleep, Increased appetite and weight gain, The inability to feel happy, Skin disorders in children, Infections of the upper airways (common cold, sinus infection, tonsillitis) of children, Conditions affecting muscles, joints and bones of children.

Now, if the manufacturer promotes a culture of transgressing the boundary between interventions supported by (at least some) evidence and those with no (decent) evidence: can it really be a surprise that an under-educated therapist might go a step further? 

Les Rolton, a spokesman for the prestigious institute to which this therapist belongs, The New  Zealand Light & Colour Therapy Institute Inc., was quoted as saying that Bioptron therapy was effective in healing a range of complaints, but cancer was not one of them. He added: 

“It can help with the pain, which is a big thing … but we have to be careful to make claims that can’t be substantiated. You can’t lead people on.” 

People certainly shouldn’t be led on.  Yet this organisation is nothing more than a promotional tool for Bioptron therapy.  Its website makes clear that it was, “created out of a need by Bioptron agents for more detailed information on how their therapy worked.”  Note: not if their therapy worked. 

It also appears to be a member of the “Breakfree Group” along with the Zepter International, “Independant [sic] Promotion Managers for Bioptron.”  A conflict of interest perhaps?

Whilst the promoters say that it cannot treat cancer, they do make a raft of evidence-free assertions; claiming that it can assist the body to heal

cuts, grazes, scratches, leg ulcers, bed sores, amputations and skin  grafts; Acne, psoriasis, eczema, dermatitis, lupus, scars and wrinkles;  All physical pain including joints, headaches, migraines, wounds etc.;   Coughs, colds, eyes, ears, tinnitus, energy, bone breaks, sprains, torn ligaments & muscles, stiff necks, frozen shoulders, rotator cuff etc. etc. 

Apparently this group have, “trained all Bioptron Agents since 2000″ and are, “members of the New Zealand Light & Colour Therapy Institute”. 

Yet the Institute Code of Ethics includes the requirement, “To advocate only those treatments using Phototherapy that have been prescribed and proven to be effective“. 

In a wild CAM irony the Institute’s Code of Ethics is breached on the same website that hosts the Institution; by a member of the same commercial operation. 

If these are the people that trained and regulated Ms A’s therapist, is it any wonder that she may have wandered over the boundary between evidence-based therapy and speculation – continuing on into fantasy? 

This sorry story highlights a danger of ‘CAM culture': building a weak cherry-picked evidence base and then ignoring its boundaries. 

When it comes down to it, is it really fair just to blame the individual therapist?  She may have enabled her client’s delusion; but what about those responsible for enabling her healing fantasies?

So, what was the result of the inquiry by New Zealand’s Health and Disability Commission?  

The therapist “provided a written apology for her breaches of the Code. This has been forwarded to Ms A”.  Apparently she has also, “reflected on the care provided to Ms A.”  The commissioner acknowledged her, “unreserved admission of responsibility, and the changes she has undertaken to implement in her practice.” 

And the dubious Institute was sent a copy of the report. 

Meanwhile Ms A is experiencing rather more severe consequences as a result of her belief in the magic of Bioptron therapy. 

Further Reading

The Report of the Inquiry

Alternative Therapist, Mrs C, A Report by the Deputy Health and Disability Commissioner, Case 08HDC00218, 16 December 2008, http://www.hdc.org.nz/files/hdc/opinions/08hdc00218alternative-therapist.pdf (Accessed 27th February 2009) 

Press Coverage

Hill, R,   Light therapist didn’t warn cancer patient, The Dominion Post, Wednesday, 11 February 2009. http://www.stuff.co.nz/4843711a11.html (Accessed 27th February 2009) 

Blogs

Consumist [blog], ‘Alternative’ Medicine idiocy, 11th February 2009.   http://consumeist.wordpress.com/2009/02/11/alternative-medicine-idiocy/ (Accessed 27th February 2009) 

Bioptron Fans

Passe, M, Bioptron Light Therapy, worldwideHEALTH.com, 1st January 2006.  http://www.worldwidehealth.com/health-article-Bioptron-Light-Therapy.html (Accessed 27th February 2009) 

Colour Therapy – South Africa http://www.colourtherapy.co.za/medical.htm (Accessed 27th February 2009) 

ConformUK.com http://www.conformuk.com/bioptron-light-therapy-lamps.html (Accessed 27th February 2009)  [Contains a classic CAM comedy moment: “The BIOPTRON electromagnetic spectrum does not contain radiation”!) 

Haber, One Monroeville Center, http://www.ampmcenter.com/photon_bioptron.html (Accessed 27th February 2009)  [Nonsense from a , "doctorate of chiropractic".] 

http://www.odysseymagazine.co.za/ezine/ezine_archive/septoct2006/docs/PMB_008_EN_Rev1104_LowRes.pdf

Skrobic, M.  BIOPTRON PHOTOTHERAPY , http://www.bioptron.net.au/DrSkrobiconBioptronPhototherapynet.pdf (Accessed 27th February 2009) 

Misc. Medical Reference

Stasinopoulos DI and Johnson, M (2004) Polarised polychromatic non-coherent light (Bioptron light) and tennis elbow/lateral epicondylitis. Letter.  BMJ Rapid Response.  http://www.bmj.com/cgi/eletters/327/7410/330 [a rather incoherent piece of advocacy].

 

Acknowledgement

I picked up this story from DC‘s miniblog.

Disclaimer

This blog may discuss medical topics but certainly does not provide medical advice.  If you need that please go and see a proper doctor. 

[BPSDB]

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10 Responses to “Cancer and the magic lamp”

  1. draust said

    Congrats on a marvellous post and some first-rate research, Adrian.

    If one of the medical students had written this I’d tell them to try and publish it in a journal!

  2. dvnutrix said

    Donded for Dr Aust’s comment. Your fine analysis strongly reminds me of Dr Dave Gorski’s compassionate piece on a woman with breast cancer who had opted for alternative treatment modalities with sad, yet inevitable, consequences.

  3. alanhenness said

    Another brilliant piece with amazing and thorough research!

  4. apgaylard said

    Thanks all: your comments are too kind. This is really not much more than a bit of ferreting about with google, PubMed and the Cochrane Library.

    I should also mention that a previous comment by Dr Aust contributed to my thinking here.

    I must say that I’m still a bit conflicted over the basic plausibility of this therapy on the narrow topic of wound healing. I really struggle to see the relevance of the polarisation; though I think I need to do a bit more reading before I make up my mind.

    dvnutrix Thanks for the SBM link. I had totally forgotten about Gorski’s article.

  5. douglas34 said

    i believe that the public should have access to western and non-western alternative approaches to health care. however, the published versus anectdotal efficacy/risk and cost/benefit ratios should be shared with patients in an a priori manner so that the consumers will understand the probability of success, and potential costs (monetary, advanced morbidity) associated with moving down one treatment path versus another.

    nice post

  6. jdc325 said

    Excellent post Adrian. I liked that you weren’t satisfied with simply comparing the manufacturer’s impressive claims with the rather unimpressive evidence they offer on their website, so you went through Pubmed and Cochrane too. A fair – and pretty thorough! – way look at the evidence.

    BTW – the discussion of CAM culture and the enabling of healing fantasies reminded me of the case of Barbara Nash. Why is it that manufacturers, institutes offering training, and professional bodies are so rarely criticised for the part they play in these sad cases?
    And what is it with people breaking their own code-of-ethics on their own website? First the Society of Homeopaths, now members of the New Zealand Light & Colour Therapy Institute.

    Cheers,
    James.

  7. apgaylard said

    douglas34 Thanks, I appreciate your comment; I agree with much of what you say. I am definitely happy with allowing people to make informed decisions about their own healthcare. I have no problem if people wish to fund their own Bioptron therapy, reflexology or homeopathy – as long as they aren’t being misled.

    Not that you have suggested it; but I do have a problem with people being fed distorted evidence, or distortions about what constitutes good evidence; particularly by people with a financial interest in a particular outcome – no matter if the therapy is conventional or CAM.

    My view is that where a society provides healthcare interventions, through taxation, that all modalities should face the same evidential burden. For example, in the UK that all CAM provision within the NHS should go through the NICE evaluation process. I’m not a fan of the current double-standard where CAM interventions don’t have to be effective to be funded (e.g. Homeopathy within the UK’s NHS provision).

    My one point of departure from your comment is that I don’t think that the “Western” / “non-Western” distinction is particularly helpful. Broadly, there are interventions that have a favourable cost-benefit ratio and those which do not. Though I accept that “favourable” will depend – to some extent – on personal judgements and the resources available. I don’t think that it should matter where a therapy originated.

    Afterall, contributions have been made to conventional medicine by decidedly non-Western people and homeopathy, for example was invented in Germany and the Bioptron seems to (originally) hail from Hungary.

    James Thanks for your kind words. This case did remind me of the Barbara Nash case too. I take your points entirely, the ‘professional bodies’ and ‘educators’ should get much more scrutiny. I do think that it’s unfair to heap all the opprobrium on a therapist whose been ‘educated’ to think that evidence isn’t required and that the pill, potion or machine is a panacea.

    The New Zealand Light & Colour Therapy Institute look like a “spare bedroom” institute to me.

  8. Interesting that the above bloggers use “false names” or dont show there CV.Maybe you should show how drug Cos play with Stat’s.Anyone who says LLLT is Bonk, needs to reevaluate there research.Please note the above LLLT does not say ANYWHERE that is kills cancer cells.You talk about CHERRY-PICKING.

    • apgaylard said

      Peter Lockwood – What a plainly silly comment. Pseudonyms are not “false names” and people have a wide range of honourable reasons for being pseudonymous online. I entirely understand why people might want to keep online and ‘real life’ identities separate. You might like to note that I have not chosen to do so myself, though sometimes I think I should have done!

      Cherry picking? You don’t seem to know what that means. If you had cared to read the piece with a modicum of understanding you would have noted that I was very careful to say where the claim to treat can cancer had come from. I then provide a fairly broad review of the claims and evidence for LLLT. I looked at the articles cited by a particular manufacturer and listed in major databases (PubMed. Cochrane). If you have any more evidence to cite, please do. I should not have to point out that cherry picking is picking a subset of evidence to ‘prove’ a preconceived notion; not reviewing all the evidence you can find and assessing what it shows. Neither is discussing a specific claim or incident cherry picking.

      I nowhere claim LLLT is “bonk” (or “bunk”). If you think I have missed some decent evidence or given insufficient weight to the evidence I have reviewed, please show me where I have erred.

      So, re-read my post, try and understand it and provide some specific criticism or additional evidence. As it stands you just sound like an LLLT fan, who doesn’t like what I’ve written but has no grounds for complaint.

    • apgaylard said

      Peter Lockwood – A small additional point or two: you suggest that the pharmaceutical industry behaves poorly and that I should write about it. Well, there are people who are much better qualified to write on this topic than I am (like Ben Goldacre and Margaret McCartney). I suggest you have a look at their work. As for me, I write about what interests me and what I can understand.

      I hope that you are not suggesting that the sins of Pharma mean that Bioptron works, LLLT is marvellous or shouldn’t be looked at critically; because that makes no sense at all.

      As for whether bloggers should publish their CVs, I’m unconvinced. Ideas should stand on their own merit, not on the authority of the author. Perhaps you mean that potential conflicts of interest should be identified? Perhaps, and you’ll note that I make a declaration regarding my independence on this blog. Maybe you’d like to get things started and publish your CV?

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