Alternative Medical Therapies:
Friend or Foe in Cancer Treatment
Jill Klessig, MD, UCLA associate professor and internist
This is a summary of a lecture presented on May12, 1998.
Editor's Note: Every time we present a lecture on alternative cancer therapies, the audience members respond in one of three ways: they either love it; think it could have been better; or strongly disagree with what they heard. We believe that there is no way around such controversy so we continue to invite new speakers with differing points of view, educational backgrounds and practical experiences. We hope that, in doing so, our audience members will have broader exposure to "what's out there" and a greater understanding of what may or may not be helpful to them in their healing processes.
The topic of alternative medical therapies is best begun with disclaimers: at this point in time, no one knows of an alternative therapy that can cure cancer or any other disease. With that in mind, however, many people believe that there are treatments that, when used in conjunction with standard Western medicine, can improve one's quality of life and may have positive effects on one's health and healing. The field of alternative medical therapy is changing rapidly and is driven by a variety of motivations including compassion and economics. The best advice we can give you is to become an informed consumer.
It's important to recognize that the terminology used to describe the field also is changing. The terms "alternative" and "complementary" are often used interchangeably to refer to non-traditional Western medicine. Some people see a difference between the two: alternative therapies are those treatments used instead of Western medicine while complementary therapies are those used in addition. Dr. Klessig advocates "integrated medical therapies" where the best options from all areas are combined to provide the most effective treatment and wellness plan for an individual.
As patients try to learn about alternative therapies, they usually can't find anyone who is knowledgeable about the various therapies that could be integrated. Most patients don't talk to their physicians about treatments they are considering or are using often because they feel they will be ridiculed in some way. Most physicians are not well trained in alternative therapies. This lack of communication can present serious problems because patients typically do not understand their standard treatments well enough to know if the addition of the alternative may be detrimental. For example, with one alternative called "juicing," patients drink special vegetable and fruit juices, taking in an extremely high level of vitamins and minerals. These high levels have been known to have a significant negative impact on the effectiveness of some chemo-therapies and can be toxic to the liver. It is essential, therefore, that patients tell their doctors about other approaches they are using or considering, and similarly, physicians need to be receptive to their patients' suggestions so that they can help sort out the possible negative interactions.
Questions to ask
When considering non-traditional approaches to wellness and healing, patients should ask the same types of questions as they would ask about traditional therapies. Here are some suggested questions to think about in evaluating alternative therapies:
What claim does this therapy make?
Is it touted as a cure?
Is it believed to reduce symptoms?
Is it believed to enhance overall health and well being?
Is it believed to assist with standard treatment?
What are the credentials of the people who promote the therapy?
What is their training?
Does their training seem consistent with the therapy that they are offering?
What kind of research is offered about the therapy?
Is the research published in a reputable journal?
Does the therapy rely only /upon testimonials?
Are the people who participated in the research similar to you?
Have any scientific controls been integrated into the research approach?
Has the research been conducted using humans, and if so, how many people were involved?
Is the therapy legal in the United States?
If not, why isn't it legal?
How might the therapy interfere with other therapies?
Is the therapy a fad?
How much does it cost?
Are you required to buy certain things from the promoters of the therapy?
Over time, what are your out-of-pocket expenses?
Is the cost relative to the value worth it to you?
Who benefits from the profits of this therapy?
Are you told to abandon other therapies?
What are the potential side effects of the therapy?
Have people died from the therapy?
Have people who used this therapy been hospitalized on an emergency basis?
Do you have a way to be cared for if you take a turn for the worse?
What safeguards are in place to insure that you will be cared for?
How will this treatment affect your quality of life?
Some Caveats
It is important to know that many research studies are never published, particularly if they show that a product or treatment has no effect. Keep in mind, too, that animals and humans are not interchangeable in most research studies. Just because a particular therapy has been shown to shrink tumors in mice doesn't automatically mean that it will shrink tumors in humans. It is important to evaluate whether the findings in animal studies were replicated using humans. You also should know something about the "placebo effect" in research studies. Sometimes, people participating in research studies show a degree of improvement because they think they are receiving a treatment that is effective. Double blind controlled trials are set up to try to account for this effect.
Be aware of the fact that some therapies are effective only at certain levels - at low levels, they may have no effect while at high levels they may become toxic. Most drugs that have received FDA approval have had their ranges of effectiveness and toxicity determined. These ranges are not as well known in therapies that have not gone through the FDA process, and certain amounts may be very harmful.
It is equally important to know that many non-traditional therapies are not regulated in any way. Even though a label may say that a therapy contains a specific herb, mineral or vitamin, you have no way of knowing if that is true or what else may be present. The processing methods are not consistent and when the contents have been analyzed, many substances have been found not to contain what is stated on the label. In one herbal therapy, for example, the entire plant was used when the only active ingredient is found in the flower.
Take a few moments to consider what you think the word "natural" means. Many people think that it means that something is okay and will promote good health. In reality, an ingredient may be natural but it also may be contaminated with bug spray. The regulations are minimal about the disclosure of pesticides present in various herbs. Levels greater than 1% must be disclosed. A particular herb, however, could be subject to several different pesticides each having a level of less than 1% and nothing would have to be reported on the label. Contaminants pose a similar problem - there is no way to know if a particular herb has been exposed to polluted water or the like. In addition, many "natural" substances are actually poisonous. Keep in mind, too, that many traditional Western medicines are derived from natural substances: taxol originally came from the bark of the Pacific Yew tree.
Where to Get Information
Getting reliable information is probably one of the most difficult aspects of being an informed consumer. Medical schools do not tend to be good sources because they are in the business of traditional treatments and do not have extensive research programs in these alternatives. Books are often problematic because their information frequently is outdated by the time it is printed. There are some responsible Internet web sites; be mindful, however, that anyone can create a web site and sell products on it. Some web sites with reliable information are:
American Cancer Society
http://www.cancer.org/bottom.html
The British Columbia Cancer Society
http://www.yt.sympatico.ca/Contents/Health/DIRECTORY /B1.html
The American Botanical Society is another good resource. It is in the process of translating the German manuscripts known as "Monograph E" which are believed to be the most comprehensive and accurate compilation of information on specific products and their contents.
To locate reputable practitioners of alternative medicine, contact the local or national chapter of the specific professional society. The State Board of Consumer Affairs keeps track of complaints against practitioners and will provide information on any registered complaints. Talk to your friends and fellow patients about their experiences with specific practitioners and evaluate carefully what they tell you. Ultimately, the decision is yours, and you will have to bear its consequences so make certain that you feel comfortable with the choices that you make.
Therapies to avoid
Two therapies that are controversial and that seem to have somewhat harmful effects with no proven benefits are:
The Gerson therapy provided by the Gerson Clinic in Tijuana, Mexico. This therapy involves injections of raw liver, juicing using foods and blenders purchased from the Clinic, and coffee enemas. The potential negative side effects include death, infections, severe diarrhea and imbalances in the body's levels of sodium and potassium. The cost of this treatment is about $4,000 per week and it is recommended for a minimum of six weeks, for a minimum total of $25,000. There are several other costs which make the actual expense much higher. San Diego-area hospitals report on average two deaths per year related to this treatment.
The Krebiozen treatment involves injecting patients with substances obtained from horse blood drawn after the horse was infected with a fungus and killed. Legal prosecutions against this treatment ended only after convictions of jury tampering.
Useful therapies
Acupuncture is an ancient treatment that may have substantial benefits in improving a patient's well being and in managing pain and nausea. A licensing procedure is in place for practitioners of acupuncture. Non-M.D. acupuncturists usually have much more training and experience with other areas of Chinese medicine.
Qi-Gong is considered the healing aspect of T'ai Chi, an eastern meditation and movement therapy that is part of a larger general lifestyle approach. Qi-Gong has no known harmful effects, and generally has been found to have a positive effect on well being, anxiety, stress and energy. (Editor's note: The July 13, 1999 Insights Into Cancer lecture is on acupuncture and Qi-Gong, and the Center currently has a QiGong group.)
Gentle, therapeutic massage can be relaxing and soothing and may help in managing pain and stress. Massage increases blood circulation and the production of endorphins, decreases edema and oxygen consumption, and lowers heart rate and blood pressure. Licensed massage therapists must have 500 hours of supervised experience. Please note that massage may not be safe in situations where the spleen is enlarged, an infection is present, if cancer has metastasized to the bones or if fractures are a concern. Rolfing, a harsh manipulation of the muscle-skeletal system, is not recommended.
Visualization and imagery techniques are used by patients to help them relax and to imagine that their immune systems are fighting the cancer. The data on these techniques as a cure for cancer is not well supported. Its use as an adjunct to feeling more relaxed, more in control, and having less pain is better documented. There is some data that this may make your immune system more active.
Support groups have a demonstrated impact on psychological well-being, quality of life and stress reduction. There is some evidence to suggest that individuals who participate in support groups may also experience greater longevity than those who do not although research in this area is difficult to carry out. Support groups vary as much as the people who attend them, and they are not for everyone. It is important to find a group that feels comfortable and meets your individual needs.
Meditation is believed to have a positive impact on psychological and physical well being, stress reduction, and a sense of control. There are no known harmful side effects of meditation.
Therapies of Mixed Benefit
Magnet therapy has not been proven through systematic research to be an effective therapy for the treatment of cancer.
Shark cartilage, according to some, should be an effective treatment for cancer because sharks don't get cancer. New data, however, indicates that sharks do get cancer especially melanoma. Shark cartilage may have an active ingredient that, when injected directly into artificial tumors, may help prevent cancer growth by inhibiting the formation of blood vessels that supply the tumor. This hypothesis has not been proven to date. Analyses of shark cartilage pills have shown that some do not contain shark cartilage; others appeared to be contaminated with bacteria. One problem with these pills is that the stomach does not absorb the pertinent molecules. In order to get enough of the cartilage to be effective, one would have to ingest 90 to 140 pills per day. This amount supplies too much calcium and may cause constipation. There is no data to support that this is an effective cancer therapy or that it has any impact on well being or quality of life. Bovine (cow) cartilage is actually more promising as a cancer treatment for humans and is much less expensive.
Calcium supplements usually are derived from the bones of pigs, cows, and other animals or oyster shells. Lead may be present in those from animal sources, and oyster shells contain arsenic. High doses of these supplements, therefore, could be harmful. Lower doses may be appropriate to build bone density. The animal sources are the worst because some "natural products" are 4% lead, which can be very toxic. Non-animal natural sources are much safer, as are synthetics.
Herbs, roots, and supplements provide an infinite number of options. People take them on their own or they seek out the assistance of someone who specializes in traditional Chinese herbal medicines, which typically use combinations of different substances. The research that is carried out usually investigates single substances rather than combinations. Their effectiveness is not always well known and some are problematic. Some of the common preparations are as follows:
Real licorice (not licorice candy) has been advocated to help decrease menopausal symptoms associated with tamoxifen treatment. It can cause, however, increased blood pressure.
Slippery Elm can be helpful for coughs related to lung cancer or metastases.
Mistletoe has been suggested as a treatment for breast cancer, but there is no scientific evidence to support its effectiveness.
The milk thistle pod is believed to help protect the liver against toxins and may be helpful for patients receiving chemotherapy. Many of the preparations, however, contain the whole plant and little or no pod.
Garlic is believed to be helpful in preventing some cancers and in lowering cholesterol and blood pressure levels. The natural cloves appear to be more helpful than garlic pills.
Ginger and peppermint each are believed to be helpful in relieving nausea and therefore may be useful to people on chemotherapy. They stimulate the intestines and can help increase food intake.
Ginseng is often taken by people with cancer and may help improve one's quality of life. A study of 54 ginseng products recently found, however, that 25% contained no ginseng and 60% contained only trace amounts.
Watermelon frost is a Chinese herb that originally was used for canker sores. Some believe that it is helpful in treating stomatitis. It is an immunosuppresant which is good for cankar sores but ill-advised for chemotherapy patients.
Yams seem to help some people feel better but they should not be eaten in large quantities because they contain some level of steroids.
Black Cohosh is an herb that has been advocated as an effective treatment for menopausal symptoms; it acts like estrogen, however, and may have adverse effects including the promotion of breast and uterine tumors. Red Cohosh is not safe.
Ma Huang is an herb which may be dangerous because it contains ephedra, which can have negative impact on the heart and lungs. Many Chinese medications contain this herb.
Dong Qui has been advocated as a therapy for menopause but there is no evidence to support its effectiveness.
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