A guest article from former naturopathic doctor Britt Marie Hermes.
What is a licensed naturopath?
Licensed naturopaths attend four-year post-graduate naturopathic programs. There are seven programs in North America, two of which are in Canada. The Boucher Institute of Naturopathic Medicine is located in British Colombia and the Canadian College for Naturopathic Medicine is located in Toronto. All seven North American naturopathic programs are accredited by the Council on Naturopathic Medical Education (CNME).
Naturopathic programmatic accreditation means that procedural and operational standards related to organizing and running an academic program have been approved by the CNME. The CNME is not affiliated with the North American organization that sets the standards for conventional medical schools. The naturopathic curriculum is not evaluated by government organizations.
As of 2016, 18 U.S. states and five Canadian provinces have regulated naturopathic practitioners. The registered provinces include British Colombia, Alberta, Saskatchewan, Manitoba, and Ontario. In a licensed jurisdiction, naturopaths may call themselves naturopathic doctors (N.D). In unlicensed jurisdictions, naturopaths are not permitted to practice medicine or call themselves doctors or physicians.
There are considerable legal risks for naturopaths practicing without a license.
The naturopathic belief system
Naturopaths believe that the forces of nature can cure disease. Naturopaths refer to this power as the “vis,” which they claim resides inside the human body. Other systems of pre-modern medicine have similar ideas about healing energies. In traditional Chinese medicine, it is called qi. In Ayurvedic medicine, it is called prana.
In naturopathy, the vis is manipulated using treatments that are based on food, water, plants, minerals, and physical contact. The mainstay naturopathic therapies are nutrition, hydrotherapy, herbal medicine, spinal manipulation, homeopathy, and traditional Chinese medicine. Some naturopaths utilize methods and substances that are more familiar to modern medicine, including intravenous injections and pharmaceutical drugs.
Naturopathic training is commonly described as being “similar to medical doctors.” This phrasing can be misleading to patients who are not familiar with modern medical training.
Naturopathic students complete a minimum of 850 hours in a naturopathic clinic and see at least 450 patients. This training primarily takes place in a clinic affiliated with a naturopathic program. Naturopathic clinics are out-patient clinics, which means patients are not hospitalized. Emergency medicine and urgent care are not offered in naturopathic clinics.
A residency is not required for naturopaths to practice. After a naturopathic student graduates, he or she may move directly into practice after passing two licensing exams that primarily focus on testing knowledge about naturopathic therapies and philosophy, such as homeopathy and herbs.
In comparison, medical doctors (MDs) complete the majority of their clinical training in a university hospital. Medical students are exposed to thousands of patients across specialty areas. This exposure ensures a comprehensive medical education. Medical students are required to pass three sets of licensing exams, depending on their country of training, including a clinical skills part that tests the clinician’s physical exam and diagnostic skills, in order to become licensed. A medical residency is usually compulsory in order to practice in any field of medicine.
After completing a medical residency, the MD can then choose to become board certified in a specialty, which requires demonstrating clinical expertise and another comprehensive specialty exam. The average physician has completed about 20,000 hours of clinical training and has seen tens of thousands of patients during his or her medical education.
Naturopathic training in cancer care
Naturopathic students take one lecture course (about 20 classroom hours) in cancer care. In my course at Bastyr University, I was taught that no natural substance has been proven to cure cancer.
Most naturopaths start practicing directly after passing their licensing exams and can immediately go on to consider themselves cancer specialists. Some naturopaths choose to complete a voluntary residency program in naturopathic oncology. These residency positions are typically two years long, and are sponsored by clinics that provide alternative cancer therapies to patients in an out-patient setting.
Residents in naturopathic cancer care learn practices that are delivered independent of, or alongside, modern medical care. They do not learn how to prescribe or use radiation, surgery, or chemotherapy.
After completing a residency in cancer care, a naturopath can take a certification exam administered by the American Board of Naturopathic Oncology to become a fellow and place “FABNO” after his or her name. Those who have not completed a residency may also sit for the exam if they have many years of experience practicing naturopathic cancer care. Thus, not all naturopaths with the FABNO title have completed naturopathic residency training, and not all naturopathic “oncologists” have the FABNO credential.
What is naturopathic cancer care?
Naturopathic cancer therapies are not a part of standardized medical protocols that are set by evidence-based guidelines, common medical practice, or scientific consensus.
Naturopathic cancer care comes in a variety of packages and flavors. There is no such thing as a typical naturopathic treatment plan. Since naturopathic protocols are not standardized, plans are fluid, usually picking up and eliminating various therapies as treatment is underway.
Patients often visit their naturopath for treatment two to three times per week, for stretches as long as twelve months, or even several years. When conventional cancer treatments have ended, naturopaths often recommend that patients still receive naturopathic therapies a few times per month, indefinitely. Most naturopaths believe these treatments are necessary to prevent cancer recurrence.
Common language used to describe naturopathic cancer treatments
Naturopaths tend to use an attractive set of phrases to describe natural cancer care. When looking at naturopathic clinic websites, you will likely read statements like these:
It is important to remember that no natural treatment has been scientifically proven to effectively treat cancer [1,2].
What does science say about some of the most common naturopathic treatments?
The cancerous process is very complex, and involves the breakdown and dysregulation of many molecular processes simultaneously . Sometimes cancer is related to a heritable genetic defect . Other times, it is just bad luck .
Common naturopathic therapies include strict diet changes, intravenous injections with high-dose vitamin C, injections with the herbal substance Mistletoe, and treating your blood with ozone gas.
Strict Diet Changes
The most ubiquitous naturopathic recommendation for cancer is a strict diet to reduce or eliminate foods that are believed to promote cancer growth or weaken the body’s immune system. Example diet recommendations include:
The most common diet recommendation is to avoid sugar. This recommendation is based on a belief that sugar “feeds” cancer cells . This is based on laboratory experiments that showed cancer cells “take-up” more sugar compared to healthy cells, as cancer cells have a higher metabolic rate than the average healthy cell .
Excessive sugar intake does have negative health consequences, namely, obesity . There is an increased risk of cancer due to obesity, which is a complex process that is caused by multiple behavioral, environmental, and genetic risk factors . There have been no conclusive studies directly linking sugar intake to increased cancer risk, and no studies have shown that sugar-free diets are associated with increased survival rates in cancer patients [10,11].
Following a strict diet can have negative consequences. Chemotherapy often results in significant weight loss. A diet that makes it difficult to eat typical meals may exacerbate muscle loss and wasting. Patients adhering to restrictive diets sometimes report a decrease in their quality of life from stress related to adhering to the diet [12,13]. There may be an increased cost of food associated with special diets . Patients may also feel unable to participate in social gatherings, due to their diet restrictions, which can translate to feelings of depression, isolation, and loneliness .
It is generally recommended to eat a well balanced diet, rich in fruits and vegetables, and to follow specific instructions from your medical doctor.
Intravenous High-Dose Vitamin C (IVC)
Vitamin C, also called L-ascorbate or L-ascorbic acid, is used by naturopaths for all types of cancers. It is injected intravenously in order achieve very high doses in the blood that are not attainable through oral supplementation .
Naturopaths believe high-dose vitamin C has many therapeutic actions, including:
These claims are based on the understanding of how vitamin C normally functions in the body. At low or moderate levels, vitamin C is an anti-oxidant and is essential for the production of collagen .
At high doses, vitamin C no longer works like an anti-oxidant. Instead, it makes reactive oxygen species, including hydrogen peroxide . In laboratory experiments and studies on rodents, this hydrogen peroxide has been shown to kill cancer cells, but safety and effectiveness has not been demonstrated in human trials [19-23]
Justification for using high-dose vitamin C in cancer patients is based predominately on case studies and trials that have not been controlled . These types of studies are considered weak forms of evidence and their findings should be taken with a grain of salt.
The evidence for improving a patient’s quality of life is limited; further studies are needed to know for certain what the effect of high-dose vitamin C has on a patient’s well-being 
High-dose vitamin C has also been shown to decrease the effectiveness of certain chemotherapy agents [25-28]. It is essential to inform your medical oncologist if you are receiving high-dose vitamin C while undergoing chemotherapy or radiation.
High-dose vitamin C is generally well-tolerated by patients . From my experience, common side effects include dehydration and increased thirst, pain and redness at the injection site, and feeling tired.
Mistletoe (Viscum album) is a naturopathic treatment commonly used as a supportive cancer therapy. Naturopaths claim that mistletoe may increase patient survival and improve one’s quality of life [29,30] In petri dish experiments, mistletoe has shown anti-cancer effects [31-36]. In human experiments, mistletoe has been suggested to increase the activity of the immune system through increasing the number of white blood cells and special immune chemicals called cytokine . Mistletoe is usually delivered in a small injection under the skin .
Mistletoe is popular in European countries, especially Germany and Switzerland. As a result, mistletoe is frequently marketed as a “European” cancer drug . The U.S. FDA does not approve mistletoe for use, even in homeopathic forms. This means it is not legal for medical providers to import mistletoe into the U.S.A. It is possible to receive mistletoe treatments in some Canadian provinces.
Common side effects from mistletoe injections include pain and irritation at the injection site  Flu-like symptoms, fevers, headaches, and chills are often reported .
Since mistletoe is not available for use in the United States, I have limited experience with this therapy. I am aware that American naturopaths import mistletoe from overseas and teach patients how to administer injections themselves at home. If an American naturopath offering this therapy, please be aware that in doing so, the naturopath may be breaking U.S. laws.
Ozone therapy is marketed for just about everything, including all types of cancer. It is most commonly associated with claims related to boosting the activity of the immune system .
Ozone (O3) is a gas made up of three oxygen molecules . Ozone is a very strong oxidizing molecule that can form products known to be damaging to the respiratory system . Ozone is categorized as a toxic gas and environmental hazard .
Ozone is delivered to patients in a variety of ways, including through the nose, ear, mouth, rectum, vagina, and skin, but for cancer treatment, ozone is most often delivered via autohaemotherapy . In this method, blood is taken out of a patient. This blood is then treated with ozone gas. The treated blood is then injected back into the patient [37,41]. Autohaemotherapy carries significant risks; some patients have died from this application, and as a result, autohaemotherapy with ozone has been illegal in Germany since 1984 [37,42].
The rationale for ozone use in cancer is based on a theory from the 1930s that demonstrated cancer cells can live and grow easily in low-oxygen environments inside the body  It is suggested that applying ozone gas to the blood will bring more oxygen to the cancerous tumor, thus causing cancer cells to die. However, tumors are very heterogeneous . While some cancer cells within a tumor potentially prefer a low oxygen environment, others readily thrive in the presence of oxygen .
The U.S. FDA and Health Canada do not allow manufacturers to advertise or sell ozone generators for medical use [45,46].
Editor's note: You can read more about these specific naturopathic compounds, and others, at the U.S. National Cancer Institute Website.
If you are considering naturopathic treatments
Patients should bear in mind that complementary and alternative therapies are not risk-free. There is preliminary evidence showing cancer patients who used complementary and alternative therapies in addition to conventional care experienced a decrease in the quality of their life .
Additionally, patients undergoing complementary and alternative treatments in conjunction with conventional treatments did not live longer compared to cancer patients receiving conventional treatment alone . A 2003 study from Norway reported patients undergoing complementary and alternative treatments died sooner than patients who did not integrate complementary and alternative methods into their cancer care .
In order to help you make an informed decision about naturopathic cancer care, I have compiled a short list of questions to ask your naturopathic provider:
Ask for the above answers to be provided to you in writing.
It is also essential to document your treatment plan. Naturopathic patients are often uncertain about which substances they are receiving. To assist with keeping track of your care, you can do the following:
If your naturopath asks you to keep your care secret, or asks you to stop seeing your oncologist, consider this a red flag for inappropriate treatment and medical misconduct.
Finally, and perhaps most importantly, take your time in deciding to pursue naturopathic cancer care. There should be no rush to implement naturopathic therapies, as no natural therapy has ever been proven to cure cancer.
Today, I no longer consider myself a naturopathic doctor. I left my practice after I discovered my former boss was importing a non-FDA approved substance called Ukrain, and delivering it to terminally ill cancer patients. I retired after I learned more about the lack of evidence and risks associated with naturopathic treatments.
In my former practice, patients would often ask me hypothetically whether I would recommend naturopathic treatment to my family members.
My answer is still “No.”
Read more articles by Britt Marie Hermes on naturopathic medicine at naturopathicdiaries.com
Susan McPeak-Sirois, a former cancer patient who co-chairs the Quebec Breast Cancer Foundation’s 20th anniversary fundraising campaign, said in a Montreal Gazette article:
"It's well known that patients in clinical research trials do better than those who aren't."
It made me wonder: What in her experience led to this belief? Do cancer patients who enroll in clinical trials do better than those who don't?
I have read a lot of marketing material for clinical trials and cancer research, but I'd never seen 'better care' listed as one of the benefits of joining a trial. Of course any health care team would provide the same level of care for all their patients, regardless of whether they join a trial, would they not? I am sure that Research Ethics Boards would not approve any patient information that would suggest that by participating in a clinical trial a patient would get better care.
So what would make someone think they would ‘do better’ in a clinical trial?
I had my a-ha moment during a patient's presentation at the Cancer Quality Council of Ontario meeting. The patient spoke about how frustrating it is to wait by the phone to receive calls for test appointments. In his experience, the biggest challenge in getting cancer treatment was time management. His idea of an ideal patient-centered care approach would be to have a ‘specific time frame for treatment…so we could actually plan our lives’. In other words, if you are going to have a cancer journey, why not start out with a good map? I believe that a clinical trial provides that map.
The benefits of a clinical trial
A surveyof patients who completed clinical trials reported that the large majority - 89% - would consider participating in another clinical trial. Why was this percentage so high? Having to stick around after chemotherapy to provide multiple blood samples can't be enjoyable. Additional tumor biopsies are not fun. Going to the center for more visits and to fill out multiple questionnaires does not fit well into a good work/life balance. What positive experiences of a clinical trial would make a patient want to participate again?
If you do a literature search asking 'Do you get better care on a clinical trial?’ there are several academic articles that pop up. Some might suggest that clinical trial patients have better survival outcomes, but there is no definitive answer in any of these articles, However there is one common theme. No study that I've seen says that clinical trial patients do worse. One study’s conclusion even recommended patients to insist on treatment as part of a protocol.
When putting all these ideas together, I started to connect the dots. The difference is two things: structure, and personal touch.
As referenced in the Quality Council presentation, patients want structure in their treatment. Where do clinical trial patients find this structure? In the consent document. The document may be a long read, but it spells out the expected length of time for participation, a description of all the procedures that will be completed, possible side effects, and more.
The clinical trial also follows a protocol, which is like a recipe for the health-care team. The protocol describes, in detail, the plan for conducting the clinical study and how to carry it out. Any deviations from treatments, tests, scans, visits, or timing in the protocol must be well-documented and in some cases reported to an Ethics Board or other oversight groups. No one likes to do extra paperwork, so someone must be making sure all the treatment, tests, and scans are being done, and done on time.
The personal touch comes from the clinical research coordinator (CRC). It has been said that the CRC is the heart and soul of the research study and plays a significant role in the success. This is the person who makes sure all the tests, and scans are being done on time. In most clinical trials, patients spend more time with their CRC than their doctor. Even after patients complete their participation in treatment part of the clinical trial, the CRC will continue to follow up with the patient to monitor their progress.
As for all the extra tests, scans, and questionnaires that a clinical trial participant has to complete, is there a benefit to the patient? I think so. Who would not welcome all the extra requirements if it meant being more closely monitored, and knowing as soon as possible if there is a change in their disease or how their treatment is working?
How to find a clinical trial
Is a clinical trial perceived as better care? Maybe, but sometimes perception is reality. If 89% of clinical trial patients want to participate in another clinical trial, I think it's more than just for altruistic purposes.
Am I biased because I am part of a clinical research team? Yes! However, I have seen the difference and I believe clinical trials provide what many patients are looking for in their treatment. For some people, the structure and additional personal touch of a clinical trial is considered better care.
Ultimately, it is up to each patient to decide whether participating in a clinical trial is right for them. If the ‘better care’ is perceived or real, it is worth considering a clinical trial.
There are many ways to find clinical trial information, but I recommend http://itstartswithme.ca in Canada and the National Cancer Institute website in the U.S. You can also talk to your doctors: ask them if any clinical trials would be appropriate for you.
Millions of dollars are spent on cancer research every year. Cancer fundraisers are everywhere - walks, runs, bike rides, head shaving, growing moustaches and beards, even streaking through urban centres in our undies.
So it's only fair that one reader asked the question: Are we making any progress?
It's a good question to ask. If you read certain websites or social media posts, people might claim that we're no farther ahead than we were many years ago. It might be hard to know what to believe. Has the whole cancer research effort been for nothing?
Fortunately, we have some new U.S. data on the subject, reporting on survival rates for cancer patients going back several decades.
Let's boil it down to a simple question. Who would survive longer: a patient diagnosed with cancer back in 1975, or a patient diagnosed more recently?
For patients diagnosed with cancer in 1975, only 49% were still alive 5 years later. But for patients diagnosed in 2010, that number jumps up to 69%. Instead of more than half of patients dying before 5 years, it's now fewer than one-third.
Other countries, including Canada, have achieved similar numbers. Internationally, these improvements translate into millions of patients getting past the all-important 5-year mark. This 5-year statistic is meaningful, because in many cases, being alive 5 years after a cancer diagnosis means that a patient is cured.
Let's look at the numbers for some specific cancers:
You can look up other types of cancers in the original report, published by the American Cancer Society. All numbers are relative survivals, meaning they are adjusted for normal life expectancies.
In this table we can see some enormous improvements, and also some more modest ones. For some cancers, even though the numbers are better, the survivals remain low. This is particularly true for lung cancer (which kills more men and women than any other cancer), pancreas cancer, and stomach cancer. There is still much work to be done. But the good news is that improvements keep coming.
Why is it important to get this message out? With this information, patients can be confident that the system really is improving. People who donate their time and money can be reassured that their efforts are having an impact.
So if someone tells you that we're not making any progress against cancer, tell them it's not true. Share this page with others.
And continue to support cancer research: donate, ride, walk, or get your head shaved, even if it's only in your underwear!
When I tell people I work as a Cancer Librarian, they’re often surprised. The common reply is: “I didn’t realize there were librarians working in hospitals!”
Believe it or not, there are many roles for librarians beyond the traditional public library in your neighborhood. There are librarians who work in law firms, government, universities, banks and insurance companies, and importantly, hospitals and cancer centers. A cancer librarian can be a key ally in your fight against cancer.
Many cancer centers have libraries with cancer librarians, and they’re especially common in teaching hospitals. Sometimes we’re called Clinical Librarians, Medical Librarians, or Hospital Librarians, but despite our different titles, our primary role is always the same - to link patients and care providers to the best published evidence in order to make sure patients get the best treatment!
I work with nearly all members of the healthcare team to provide access to the latest medical information. This includes doctors, scientists working in laboratories, residents, nurses and nurse practitioners, graduate students and even health care administrators. I have four major roles as part of the healthcare team: I search the literature for the best evidence supporting direct patient care, I make sure our collection of books and journals is up to date and optimized, I provide access to research that is not readily available through the library’s subscriptions, and finally, I help oncologists research and publish their work. See some examples of our publications.
But I don’t only work with staff - I also serve patients! Many cancer patients need more information than just the basics. While websites provide excellent resources for understanding the intricacies of cancer, sometimes patients need even more, would prefer a different format (print vs. electronic), or even would like a literature search completed by a Cancer Librarian to answer a highly complex question that they can’t find an answer to online.
This is where I can help!
The resources in our libraries provide advanced detailson all types of cancer, from lung to cervical, ovarian, breast, prostate, colorectal, metastatic disease…. from the newest therapies like Stereotactic Ablative Radiation Therapy (SABR) and personalized medicine, to resources on palliative care, drug and chemotherapy information, and even uncommon cancers. My library does have a website that links to some of the similar online examples of basic patient information, but if you think that you need more information about cancer and the basic patient resources aren’t answering your questions, then it might be time to talk to a Cancer Librarian about finding some advanced answers to some advanced questions.
So feel free to get in touch, either with me, or with a cancer librarian at your center! We’re here to help you to get the information you need to be well-informed.
Here are some of the questions:
"If you are diagnosed with Her2 positive breast cancer, can you receive the herceptin without having chemo or do they need to go hand in hand?"
"Do you have a link to the latest information for BRCA2 positive patients?"
Going Beyond Patient Information Websites
If patient information websites don't provide enough information, the solution is to go where doctors look. There are websites geared toward doctors, and they provide detailed information that we use in day-to-day practice. As a patient, you can access these websites as well.
These websites do use medical terms, so you'll probably need to use a medical dictionary to help.
Make sure you read the basic patient information websites first, so you have a good background before starting.
1. NCCN Guidelines for Physicians
The NCCN guidelines also cover cancer prevention, hereditary cancers (like the BRCA2 question above), and supportive care for symptoms like nausea, pain and fatigue.
Many physicians rely on UpToDate daily to help with their medical practice. If someone asks me a medical question and I don't know the answer, it's the first place I look. In my experience, it's the best medical knowledge tool available.
The downside to UpToDate is that it's not free. Physicians (including me) who want to use it pay for an annual subscription. Patients can access some specific patient information for free. Fortunately, UpToDate offers short term subscriptions of 1 week or 1 month, so you can get the information you need without having to pay the price that doctors pay for an annual subscription.
If you're not sure whether UpToDate will be helpful, you can search the database for free, and only buy a short subscription once you find something useful.
[Note that I receive no royalties from UpToDate. I pay for an annual membership. The price is steep but it makes a big difference in clinical practice.]
3. Your Doctor