In the field of cancer treatment in Tai-wan, there's nothing more astounding than the dazzling variety of anything-goes folk treatments. The medical community has long criticized these as unfounded, arguing that they mislead the general public and are a major factor in lowering the rate of cancer survival. Still people flock to them, and tell tales of their miraculous curative powers.

Why is there such a gap between the medical community and the public?

The spring sunshine dapples the courtyard of a traditional family-compound-style home in Chungli. In the courtyard, four-year-old "Little Chung" is bike-riding with his cousins. With his lively appearance and pink, cherubic face, it's hard to imagine that three years ago he was diagnosed with a form of cancer known as neuroblastoma, and a doctor declared that he would probably not live more than another six months.

"When he was just over eight months old, we discovered two tumors, about the size of his little fist, in his abdomen. We took him into the hospital for examination, and the diagnosis was neuroblastoma," recalls Little Chung's mother. She was afraid that her child, being so small, would not survive surgery or chemotherapy. A devout Christian, she received guidance through prayer to seek an herbal medicine treatment for her child. A relative introduced her to a doctor of traditional Chinese medicine.

Many patients begin qigong after cancer surgery. It is mild exercise, and good for self-cultivation. Ko Yi-ming, shown in the photo here, went to mainland China to study "Guo Linxin qigong" after being diagnosed with cancer. Today he teaches this in Taiwan, fighting cancer side-by-side with others.

At the time, Chang got quite a disdainful look from a doctor at the modern teaching hospital where the diagnosis was made. One year later, she brought her son-very much alive and well-back to the same hospital for an ultrasound scan. "When the doctor discovered that the tumors had disappeared, I pointedly asked him: 'With no operation and no chemotherapy, how could the tumors just disappear?' His response was: 'Luck!'" Between science and tradition

Cancer has long been a leading cause of death among Taiwanese, so in recent years a growing number of so-called "alternative" treatments have arisen from sources other than mainstream medicine. The major source of these is traditional Chinese medicine, supplemented by well-known folk remedies.

Other alternative treatments come from abroad. One frequently hears stories of an ongoing "conceptual revolution" overseas involving herbal and nutritional solutions to health problems. One of these is the organic diet, popularized in the US. It emphasizes eating fresh vegetables and fruit which have not been treated with pesticides or chemical fertilizers. There are also spiritual treatments involving self-affirmation, qigong, and meditation. Homeopathy, based on traditional European medicine, seeks to treat illness and restore equilibrium to the patient's mind and body by focusing on energy levels and magnetic fields. And then there is the "Hasuma" vaccine discovered by a Japanese doctor of that name. The various schools not only offer a variety of theories, but an even more impressive array of products aimed at health preservation and disease prevention. Andrew T. Huang is the director of the "Koo Foundation Sun Yat-sen Cancer Center," the first institution in Taiwan specializing in the treatment of cancer. Huang, who criticizes alternative treatments as being scientifically unfounded, explains why they nonetheless remain attractive to many people: "In modern times the rationalist spirit has been dominant, and particularly in the last twenty years the progress of science has been dramatic, even to the point of unlocking the gene code. But alternative treatments persist because orthodox medicine emphasizes technology, and focuses on the disease, while sometimes overlooking the spiritual side of the patient."

He is concerned that this can be taken too far. "While in the West science and laboratory research are ascendant and traditional or alternative medicine is far behind, in Taiwan the forces of traditional or alternative medicine are immensely powerful, whereas the forces of modernization, science, and rationality are extremely weak." He says that this situation is particularly pronounced in the treatment of cancer, which is still seen as "incurable" by many people.

Three years ago, the departments of family medicine and nursing at National Taiwan University Hospital (NTUH) conducted a survey of the use of alternative treatments among more than 100 residents of the hospice ward for terminal cancer patients. At least 81.9% of the respondents were using at least one form of alternative treatment. The most common of these was "Chinese medicine, herbal medicine, or special formulas provided by doctors of Chinese medicine" (51.4%). Another 50% were using similar treatments, though provided by a source other than a doctor of Chinese medicine. These responses were followed by "other treatments such as special diets or foods" (34.8%), faith-healing (18.1%), qigong (10.9%), and acupuncture (5.1%).

Patients seriously ill with cancer are usually in pain and fearful. In the long battle against cancer, religious faith is a great help. The photo shows Sogyal Rinpoche, a Tibetan Buddhist monk, blessing patients at the Tzu Chi General Hospital in Hualien.

The same report compared these results to a study done in a London teaching hospital in 1994. In that study, only 16% of terminal cancer patients were using supplementary forms of treatment. Of these, the most common were faith, relaxation, meditation, diet, homeopathy, vitamins, and herbal medicine. Cure or killer?

Naturally, the popular enthusiasm for alternative treatments worries the medical community in Taiwan. They see it as one of the main causes of the relatively low rate of cancer survival here. But the common man continues, through deed and word, to challenge medical convention.

Ms. Chen, a writer by trade, saw first-hand the popularity of alternative treatments when her father had to stay in the hospital for treatment of intestinal cancer. "It didn't matter whether they knew you or not, every day people were coming around the patients' beds talking about this or that famous doctor, secret cure, medicine, or cancer-related group. There were even people providing channels for directly purchasing medications and inoculations from abroad." One thing she found especially remarkable was the frequent sight of can after can of some nameless inky black liquid on the bedside tables of patients. Periodically there is some craze among the public for one or another medicine, food, or technique that is supposed to cure cancer. Examples include gigong, urine treatment, expulsion of toxins, fasting, and cryolite.

Last year, Tung Ta-cheng, a professor emeritus at National Taiwan University, attracted a great deal of attention with a study that concluded that a species of bean native to Taiwan-the jack bean (Canavalia ensiformis)-could form "natural killer cells" which can repress cancer cells. The price of this heretofore neglected and inexpensive bean skyrocketed to NT$3000-5000 per kilogram.

Crazes for anti-cancer gimmicks can reach bizarre levels. People seem willing to try anything. No tale is more astounding than that of the so-called "coffin mushroom." This mushroom, allegedly with cancer-fighting properties, is said to grow in or on the skull of a corpse inside a coffin. Because it can only be found on a deceased person in a coffin-and indeed is said only to grow on the skulls of persons who consumed high-quality ginger for long periods of time while alive-supply is naturally very limited, and the price is correspondingly outrageous.

Chang Cheng-gwo, chairman of the Committee of Chinese Medicine and Pharmacy at the Department of Health, went personally to the traditional market on Tihua Street in Taipei to check out the situation. He discovered that "coffin mushroom" was selling for as much as NT$1,000,000 per kilo. He warns: "Not only have its alleged medicinal properties not been tested, no one can even say for sure that it is not toxic." In the lore of Chinese medicine, Shen Nong is credited with having discovered countless medicines by trying out various herbs on himself, but even he would have to be amazed at the willingness of people in modern Taiwan to experiment on themselves.

Many people think of cancer as a death sentence. If they are unlucky enough to be hit, they become desperate and will risk any kind of treatment, however unorthodox. In fact, this is not hard to understand.

"But what I can't accept is that people frequently undertake these treatments on their own, and don't think to make sure that these methods have no harmful side effects. Many people who originally had some hope of being saved die because of this," says Jacqueline Whang-Peng, director of the Division of Cancer Research at the National Health Research Institutes. But still many patients deliberately hide their use of alternative treatments, or even give up orthodox treatments altogether, for fear their orthodox practitioner will oppose the use of alternatives.

The parents of Little Chung, who was diagnosed with neuroblastoma at the age of eight months, sought treatment through Chinese medicine. Although he is not ye t completely well, he has enjoyed a healthy and happy childhood.

The NTUH survey of terminal cancer patients indicates that more than half of those patients using alternative treatments said that they did not tell their doctor, and 12.3% indicated that they had completely halted orthodox treatment. A last chance?

The medical community gives two main reasons why there is such wide acceptance of alternative treatments: superstition, and inadequate understanding of cancer treatment. But patients point mostly to the fact that they are tired of suffering.

"Currently hospitals provide only three options-surgery, chemotherapy, and radiotherapy. When these are exhausted, one can only hope that the cancer cells do not spread elsewhere or start growing again," says Anna Wang, a media professional who discovered last year that she had breast cancer. While undergoing surgery and chemotherapy, she met many patients similar to herself. Among them were terminal cases for whom the hospital had decided there would be no further treatment. She has come to realize that patients who have exhausted orthodox treatments and are deemed "beyond help" have no choice but to seek their own salvation.

Lin Hou-shu, who was diagnosed with liver cancer three years ago, is on a regimen of Chinese medicine. He still lives at home, independent and at peace.

Naturally there are many stories of miraculous, or at least amazingly coincidental, cures. The problem is that alternative medicine has no statistical support, while practitioners of orthodox medicine disdain anecdotal success stories. There's virtually no interaction between the two sides. Each makes its claims independent of the other, while patients can only watch in pain from the sidelines. A question of confidence

The ranks of users of alternative treatments include highly-educated social elites. They by no means accept all alternatives indiscriminately, nor are they superstitious. On the contrary, they opt for alternative treatments after rational consideration and evaluation of people's experiences.

"Alternative treatments offer a chance," says Tseng Chu-wei, chairman of the Department of Finance at National Chengchi University. A victim of muscle-tissue cancer, he had been through surgery and chemotherapy. Deciding that he had to do more to help himself, he has also tried urine therapy, an organic diet, and homeopathy.

At a seminar, Tseng discussed his personal experience: "When you have cancer, the whole process of diagnosis and treatment that modern medicine puts you through, every bit of it-the shots, sections, probing, and even the changing expressions on the doctors' faces-is frightening." When patients are at their most vulnerable and powerless, they need hope and confidence.

"Perhaps alternative treatments lack a scientific foundation in comparison to modern medicine. But from the point of view of the patient, no matter what else they may do, they at least represent hope. As long as these treatments can provide confidence, that alone is of immeasurable help. Thus the significance and value of alternative treatments far transcends any evaluation of them from a purely scientific angle," says Tseng.

Tung Ta-cheng, who retired from National Taiwan University ten years ago and is now a professor emeritus, was diagnosed with bladder cancer eight years ago and had his bladder removed. As a result he joined the ranks of anti cancer fighters. Now a director of the Anti Cancer Association, Tung has recently gotten a lot of attention with his claim that the jack bean has anti-cancer properties.

Confidence, a pillar of support in time of need, can come from variety of sources, including religion or something the doctor says, and it can also come from alternative treatments. "Moreover, these alternative treatments certainly changed my lifestyle. For example, I gave up drinking and smoking, began going to bed early and getting up early, and every day run 5,000 meters." Although Tseng is only just entering the second year of his fight against cancer, he feels that based on his own experience-the cancer is still in remission, and he is able to work more than ten hours per day-these changes in his lifestyle have been very beneficial to his health. Self-help for the terminally ill

Lin Hou-shu, who is 71 years old this year, suffers from liver cancer. Lin thinks modern medicine is much too expensive, and is cold and impersonal and strips the patient of dignity; instead he has opted for traditional Chinese medicine.

Formerly a teacher in a vocational high school, Lin routinely went for physical check-ups. He was thus surprised when, three years ago, when he went in for a check-up because his appetite was off, it was discovered that he had a tumor in his liver that had already reached 22 centimeters across. He most likely had only three to six months to live, and was considered beyond help from surgery, chemotherapy, or radiotherapy.

Lin, who took the news philosophically, asked his children to find out about hospice care for terminal patients, but discovered that hospital rules require that a family member be always in attendance. "My wife suffers from manic depression, and my four children all have jobs or families. How could they spend all their time in hospital looking after me?"

the jack bean.

He finally decided to go home and take care of himself. Later, through a friend, he was introduced to a physician of Chinese medicine who began to treat him at a cost of about NT$30,000 per month. "I didn't have high expectations, and didn't think that I could avoid death. I only hoped that I wouldn't be too much of a burden on others, and that I could leave this world as peacefully and in as little pain as possible," says Lin. Since then, three years have gone by. He has discovered that, although he's getting progressively weaker, he has no major problems in getting around or living an ordinary life. In particular, he hasn't experienced the hydroperitoneum or pain commonly experienced by terminal liver cancer patients. "I'm over 70, and that can't be considered a short life, so I'm very satisfied." New frontiers in medicine

"Alternative treatments are not entirely without foundation," says a practitioner of Chinese medicine named Hsu, who treated "Little Chung." Although Hsu does not have a license to practice medicine in Taiwan, he says that his diagnosis and examinations are based on concrete statistical measures from diagnostic tests (such as "electrodermal screening") based on theories of Chinese medicine. "Chinese medicine is the product of thousands of years of accumulated experience and discoveries by our ancestors. These are the result of direct experimentation and clinical experience on patients. How can you say there's no scientific basis, or that there's no evidence?" This practitioner of Chinese medicine, who studied for four years in a medical school in Dalian in mainland China, states that there, Chinese medicine is even today favored over Western medicine for the treatment of cancer. Obviously it is by no means fixed what should be considered mainstream and what alternative. But others feel that people have excessive expectations of alternative treatments. Lai Gi-ming is a senior staff member at the Cancer Cooperative Ward at NTUH and director of the Division of Cancer Research of the Taiwan Cooperative Oncology Group of the National Health Research Institutes. He says: "In Western medicine, any method that has a success rate of less than 20% is considered ineffective. But among the general public, if alternative treatments are used in 1,000 cases and even one of these survives, people make a big deal out of it."

But on the other hand he does not completely deny the potential of alternative medicine. He explains: "In fact, at present there's a trend in the global medical community to seek 'alternative' solutions to many of the impasses faced by contemporary medicine." He has personally seen cases in which patients using urine treatments were able to improve their condition and extend their life expectancy. After doing further research, he extracted from urine a substance which can induce cancer cell differentiation, and he hopes it can be developed into a new medication for treating cancer.

Besides research and development, Lai also believes that health care professionals should look at things from the patient's point of view. They should take the initiative to provide information and guide patients in alternative treatments, so that patients don't blindly act on their own and suffer for it. Lai suggests that if patients request guidance in finding treatments, then doctors could inform them of several of the more reliable options and their underlying medical rationales.

Options include medications or foods which can strengthen the immune system or repress cancer cells; treatments which can induce cancer cell differentiation, causing the cancer cells to metamorphose from malignant to benign, and then to die off naturally; angiostatins, which can suppress the growth of blood vessels in tumors, to prevent cancer cells from spreading throughout the body by following the circulatory system; as well as treatments using Chinese herbal medicine. These have already been affirmed by the scientific community. Though they lack clear clinical evidence, and thus few practitioners formally offer them, for patients seeking alternatives these are more acceptable to mainstream doctors.

"If patients want to eat jack bean or the like, as far as the doctor is concerned, as long as these are not too expensive, there's no harm. In the West it is believed that the re-occurrence of cancer can be controlled or prevented through diet. Currently many health food products are being developed based on this idea." Doctor Lai adds that there has recently been a rumor circulating that cancer can be combated by eating pasture grass, and some patients have gone out into the countryside to pick it for themselves. He does not oppose this, provided it is only supplementary and patients do not abandon orthodox treatments. "In any case, pasture grass is high in fiber, it doesn't cost any money, and going out in the fields to cut plants is good exercise." Who knows the answers?

While some doctors are understanding, the overall environment generally disappoints patients who seek alternatives. Cancer victims desperately searching for new treatments or medications are unable to put much hope in local medical research or pharmaceuticals development.

The practitioner of Chinese medicine named Hsu states: "The government is very reluctant to invest in medical research and pharmaceuticals development. That is why many commonly used traditional and folk treatments lack laboratory confirmation of their effectiveness. Inevitably people are hesitant about using them." Thirty years ago, the effectiveness of a given treatment could be determined by doctors' experience and the conclusions of the general public. But things are not so simple today. Modern clinical pharmacology-the basis of Western standards of drug approval-says that the safety and effectiveness of a given medicine can only be determined by expensive and extended clinical studies.

Hsu says: "The private sector cannot afford such an investment of manpower, material, and money. The government must establish a special institution, supported by the resources of the state, to do the job. Right now the Department of Health only spends about NT$30 million a year on research into traditional Chinese medicine. This is why so many obviously effective treatments have not yet been accepted into the mainstream."

Take for example the recent stir involving the jack bean. Tung Ta-cheng, an expert in biochemistry, who eight years ago was diagnosed with carcinoma of the bladder, concluded on the basis of his personal research that jack bean is effective. But he could not get support for further research to garner statistical evidence and thus win the acceptance of the medical community. Ultimately Tung, now 84 years old, had to resort to putting out this product as a "health food" in order to avoid the time-consuming process of pharmaceuticals approval and make it available to cancer sufferers at the earliest possible time.

With regard to this problem, legislator Hsiao Chin-lan held a hearing entitled "How to establish a testing system for traditional Chinese medicines and encourage the modernization of folk treatments." She states that naturally there's nothing wrong with the Department of Health denying jack bean the status of an anti-cancer medication so long as there is no clinical evidence either way. At the same time, she says, it is also a fact that the DOH pays little attention to, and invests very little research money in, such potentially effective foods or plants.

During the jack bean controversy, someone wrote a letter to a newspaper stating: "As a cancer victim, what I want to say is that I work very hard and pay tens of thousands of NT dollars every year in taxes. But the National Health Insurance Bureau is so strict about giving out any of the four major types of cancer medications, while reports of scholarly seminars on the jack bean don't really tell me what I want to know. When all is said and done, is jack bean effective or not? How should it be taken? With regard to biological treatments, including organic foods, the medical community has the responsibility to inform the general public, and request that the government appropriate funds to do biochemical technology research to help citizens protect themselves against and treat cancer."

As far as cancer sufferers are concerned, it is unimportant what is considered mainstream and what is alternative. What they want is the opportunity to extend their lives. Cancer sufferers and their families all look forward to the time when, under government guidance, the mainstream and alternative can join forces to seek breakthroughs in the treatment of all forms of cancer. This would be a major contribution to the worldwide fight against cancer. The problem is, can those currently suffering afford to wait?