Many cancer patients choose therapy outside of established medical practice. Proponents describe those treatments as "alternative" therapies.

How can a patient distinguish between an "alternative" treatment that is useless or actually dangerous -- the kinds of treatments collectively known as quackery -- and an unproven approach that is controversial but eventually may prove to be a valid treatment option?

Contrary to popular belief, the majority of patients seeking alternative treatments are not terminal cancer patients for whom traditional medicine has nothing left to offer. More often, they have rejected available, approved treatments in favor of approaches that have no verifiable medical basis nor documented record of success.

Patients seek these risky treatments because they fear approved treatments more than the disease itself.

Against a background of fear and uncertainty, patients often develop additional serious problems in navigating their way through our complex health care system and relating to the people responsible for their care. To anxiety-ridden cancer patients and their families, large medical institutions with their impersonal, highly technical procedures frequently seem frightening and uncaring, and that leaves many patients feeling that they are being treated more like a collection of organs than as whole people with emotional as well as physical concerns.

As a consequence, they are drawn to those who offer a holistic philosophy accompanied by some "alternative" therapy. Therapists offering unorthodox treatments very often appear to be warm, outgoing, charismatic individuals -- appealing rebels against established medicine and ideal salespeople for their own techniques.

Their personal approach focuses on treating the whole body, not just the disease. The "alternative" treatment in question is presented as free from any of the disabling or painful side effects that make traditional treatments so frightening.

Perhaps most important, however, is the fact that many of these practitioners claim to guarantee a cure. There may be some acknowledgement that the treatment "may not work for everyone," but in spite of occasional disclaimers, the overwhelming message conveys that cancer can be vanquished with the practitioner's special treatment.

In a culture that encourages us to think anything is technologically possible, patients find it difficult to accept that a cure for their disease is not available, particularly when massive amounts of money have been allocated to find that cure. Some patients believe that a cure must exist, if only they were rich enough or powerful enough to acquire it. In this emotional climate, the claims of an unorthodox therapist are easily accepted.

Finally, some cancer patients may find appropriate medical advice psychologically impossible to follow, especially when that advice is not to treat the disease. Some cancers cannot be cured, but they progress at a slow enough rate that they are best left alone until they begin to cause trouble. Patients in this situation may seek any treatment, regardless of its probable success, because they can't tolerate the anxiety of living with such a dread disease without "doing something."

For the lay person, it is not always easy to discern the difference between a fraudulent treatment and a legitimate approach that has generated valid scientific controversy.

Moreover, whether or not their treatments have worth, "alternative" practitioners are not always slick con artists knowingly selling "snake oil." Many are fervently sincere in their belief that they have a cure for cancer.

To help cancer patients and their families struggling with treatment decisions, I suggest 10 criteria by which claims for new cancer therapies should be judged:

1. Is the treatment based on an untested theory? Check to see whether or not treatment claims have been published in a reputable scientific journal. 2. Does the remedy require, or include, special nutritional support? Proper nutrition is critical in maintaining good health. However, special foods and fad diets will not cure cancer.

3. Is the treatment claimed to be harmless, painless and nontoxic? Many alternative treatments that promise to cause no discomfort or side affects have, in fact, turned out to be poisonous.

4. Are claims for the treatment frequently published in the media? Many, though not all, reporters try to present both sides of a story, but people tend to remember the sensational claims rather than the doubts cast upon them.

5. Are the claims of benefit due just to the power of suggestion? People frequently respond to a new drug or therapy by actually feeling better, even when no change has taken place in their medical condition.

6. Are the treatment's major promoters recognized experts in cancer therapy?

7. Do the treatment's promoters back up their claims with controlled studies? Without controlled studies, it is impossible to know what factors are responsible for possible changes in the course of a patient's illness.

8. Does the treatment have a "secret formula?" Can only "specially trained" physicians claim to produce results with it?

9. Do the treatment's promoters attack the medical and scientific establishment? Quack therapists claim that the scientific establishment conspires against them.

10. Do the promoters of the treatment demand "freedom of choice" regarding drugs? This is a ploy to generate support for exemption from government restrictions that protect the Amercian public against drugs not yet proven to be both safe and effective.