10.5826/dpc.0403a22
application/pdf
2160-9381
818
en
Graham W. Sivyer
Copyright (c) 2014 Graham W. Sivyer
Dermatology Practical & Conceptual
Letter to the Editor
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Letter to the Editor
2014-07-31
2019-04-11
2014-07-31
2021-11-03
97-98
Dermatol Pract Concept
Graham W. Sivyer
2014/07/31
10.5826/dpc.0403a22
97
School of Medicine, The University of Queensland, Australia
2160-9381
en
98
Letter to the Editor
https://dpcj.org/index.php/dpc/article/download/818/dermatol-pract-concept-articleid-dp0403a22-pdf
             DERMATOLOGY PRACTICAL & CONCEPTUAL
                                                      www.derm101.com




                                           Letter to the Editor
                                                       Graham W. Sivyer1


1 School of Medicine, The University of Queensland, Australia



Citation: Sivyer GW. Letter to the Editor. Dermatol Pract Concept. 2014;4(3):22. http://dx.doi.org/10.5826/dpc.0403a22
Received: February 17, 2014; Accepted: February 18, 2014; Published: April 30, 2014
Copyright: ©2014 Sivyer. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Corresponding author: Graham Sivyer, MBBS(Hons) FSCCANZ. Email. graham.sivyer@ipnet.com.au




To the Editor,                                                        in CM is no exception; cancer is viewed as an expression or
    In her essay, “On the nature of thought processes and their       symptom of a deep-rooted underlying problem. Therefore,
relationship to the accumulation of knowledge, Part XIII:             CM cures often aim at treating this underlying problem rather
The nature of evidence” [1], Cris Anderson helps us to look           than the cancer itself. Thus, complementary therapies do not
at the question of why a person would choose an alternative           depend strongly upon a specific cancer diagnosis, but usu-
treatment rather than a conventional scientific one. Her essay        ally offer universal cures that are applicable for almost any
also stimulates us to look at our own process of argumenta-           malignancy. In addition a self-care element is central to many
tion as well as our own biases and prejudices. (For example,          treatments; the patient is put in charge of his/her own health
why should we become angry when a patient decides to act              [every patient is his/her own physician]. The over simplifica-
against our best medical advice and choose complementary              tion of the pathology and the self-care component in therapy
alternative medicine [CAM].)                                          constitute a large proportion of the attraction of CM cancer
    Despite the efforts of nine medical practitioners the             concept to the patient [3].
patient in the case study, “Application of black salve to a               One study in South Australia in 2004 revealed that com-
thin melanoma that subsequently progressed to metastatic              plementary alternative medicines [CAM] were used by 52.2%
melanoma: a case study,” the patient chose to treat her mela-         of the population. The conclusion of this study is: “Austra-
noma with black salve. She reluctantly agreed to conventional         lians continue to use high levels of CAM and CAM therapists.
medical treatment only after the melanoma had clinically              The public is often unaware that CAM’s are not tested by the
metastasized.                                                         Therapeutic Goods Administration for efficacy or safety” [4].
    I hypothesize that the patient suppressed the painful             We all live with cognitive dissonance to some degree.
memories of the death of her son and her brother from                     Cris Anderson states in her essay, “we all have so many
metastatic melanoma. I believe she just did not want to think         potential thoughts and memories stored in our brains we
about melanoma. There are many personal testimonies and               often do not call up information that is contradictory and we
anecdotal reports of positive outcomes using black salve to           continue to believe contradictory propositions; that is we all
treat cancer present on the Internet [2]. So perhaps an easier,       live with cognitive dissonance” [1]. “Imagination has enabled
less emotionally painful choice was to choose to believe these        us to survive, to prepare for the future and to dream of a
anecdotal stories and use black salve.                                better world. But the downside of this is that we are tempted
    Michael Shermer has pointed out “anecdotal thinking               to believe that what we imagine is true” [1]. As medical
comes naturally, science requires training.” [1] Ernst [3]            practitioners we try to practice evidence-based medicine. We
describes that complementary medicine [CM] tends to be                attempt to offer our patients the best “up to date” medical
built on untestable philosophies rather than on proven facts          advice based on the outcomes of logical thought processes
or testable hypotheses. The concept of cancer that prevails           and the scientific method. “Hypotheses are tested accord-



Letter | Dermatol Pract Concept 2014;4(3):21                                                                                         97
ing to a body of organizing principles and the test results        stituents of pastes such as black salve, and that these contain
are examined and interpreted independently by multiple             escharotics that will destroy normal tissue as well as cancerous
investigators” [1]. This seems to be “the best way to advance      tissue and we need to advise our patients of the dangers of
knowledge while minimizing opportunities for inconsistency         self-treating diagnosed and un-diagnosed skin lesions.
and contradiction” [1]. “Argumentation and science share the
                                                                   Graham W. Sivyer, MBBS
same principles in that people with differing views are willing
                                                                   Lecturer, School of Medicine University of Queensland
to look at a problem from differing perspectives and are will-
ing to risk being proved wrong in the interest of acquiring a
common understanding of an issue…” [1] (However, before            References
we rush to criticize other treatments we should bear in mind
                                                                   1. Anderson C. On the nature of thought processes and their relation-
that it is estimated that as little as a quarter of conventional      ship to the accumulation of knowledge. Part XIII: The nature of
medicine is based on “level 1 evidence” [5].)                         evidence. Dermatol Pract Concept. 2014;4(1):3.
     The question is: can the use of black salve to treat mela-    2. Website. www.altcancer.com. Accessed October 20, 2013.
noma and non-melanoma skin cancer with a potentially disas-        3. Ernst E. Complementary cancer treatments: hope or hazard? Clin
                                                                      Oncol (R Coll Radiol). 1995:7:259-63.
trous outcome be prevented? Because we are all human beings
                                                                   4. MacLennan AH, Myers SP, Taylor AW. The continuing use of
at times using illogical thought processes, the answer to this
                                                                      complementary and alternative medicine in South Australia: costs
question is “probably not.” However with adequate knowl-              and beliefs in 2004. Med J Aust. 2006; 184(1):27-31.
edge, I believe we can reduce the risk for our patients. We need   5. Albeni D, Girardelli CR, Masini C, et al. What proportion of
to accept that the use of CAM by our patients, according to           dermatological patients receive evidence-based treatment? Arch
surveys, is high. We need to have an understanding of the con-        Dermatol. 2001;137:771-6.




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