David Rosenthal, MD, director of Harvard University’s Health Services, introduced the speakers: Eric Winer, MD, of Dana-Farber Cancer Institute; Eric Small, MD, of the University of California, San Francisco; Maurie Markman, MD, of the Cleveland Clinic Foundation; Norman Farnsworth, PhD, of the University of Illinois; Jimmie Holland, MD, of Memorial Sloan-Kettering Cancer Center; and Michael Hawkins, MD, of the Washington Hospital Center. I have nothing against any of these fine people, but none of them is a CAM practitioner. In fact, Dr. Winer, who described himself as a "traditional" medical oncologist, opened his presentation by asking, "Why am I here?" and then set the tone for the symposium by telling the audience of nearly 200 oncologists, "I have NOT done research in complementary therapies." Dr. Winer went on to speak about CAM use among women with breast cancer, although his derogatory attitude towards CAM was apparent when he stated, "We do a real disservice to our psychosocial colleagues to classify psychotherapy as a complementary therapy." In other words, the CAM label is a stigma. Eric Small, MD, of the University of California, San Francisco, presented information on dietary and herbal approaches to prostate cancer, and reviewed research on the herbal formula PC SPES, a project he described as "not for the faint of heart." After showing that PC SPES was effective even in some hormone-refractory prostate cancer patients, Dr. Small had arranged a clinical trial to compare PC SPES to the drug DES in advanced prostate cancer. However, when he discovered a minute amount of DES in the herbal formula (3 percent of the dose used in the DES arm of the study), he and his colleagues cancelled the study. This was a decision I still could not understand, even after his attempt at an explanation. Dr. Maurie Markman, a co-chair of the symposium, spoke on safety issues in CAM. He began by asserting, "My intent is not to indict CAM. The evidence overall is that [these treatments] are remarkably safe." He then proceeded to run down almost every alternative treatment, reciting a litany of alleged horrors: toxic effects, harmful interactions with other medications, problems in methods of administration, reduced effectiveness of standard therapies, impairment in overall quality of life, and delays in obtaining known effective therapy. According to Dr. Markman, almost every alternative cancer treatment, such as laetrile, shark cartilage, hydrazine sulfate, macrobiotic diets, and antineoplastons, is toxic. Horror piled on horror. He even claimed that green tea could cause "nausea, vomiting, insomnia, fatigue, diarrhea, abdominal pain and confusion," a remark that caused some nervous laughter among the tea drinkers in the audience. Herbal medicines, Dr. Markman said, are bedeviled by contamination, crop variability, misidentified plant species, renal and hepatic toxicity, and outright fraud. Chiropractic could cause "cerebrovascular accidents," while acupuncture could cause pneumothorax, hemorrhaging, the transmission of infection, and injury from "forgotten needles." Dr. Markman included in this Grand Guignol the damage caused by herbs that, by his own admission, are not even used in treating cancer. The main problem with his presentation was a failure to contextualize. How frequently do such effects occur? Very rarely. It is likely that millions of cups of green tea are drunk for every case of nausea, vomiting and confusion. As Paracelsus said in 1564, "Everything is a poison. There is nothing without poison. Only the dose makes a thing not a poison. For example, every food and every drink, if taken beyond its dose, is poison." The "toxicity" of CAM treatments needs to be compared to truly dangerous treatments, such as chemotherapy. This simply wasn’t done. Dr. Markman was followed by Norman Farnsworth, PhD, a distinguished professor at the University of Illinois and a voice of reason in the field of herbalism. His first comment: "I feel like sneaking out the back door after hearing the previous speaker." Farnsworth then gave a subdued presentation on the attempt to isolate chemotherapeutic drugs from herbal sources, which he characterized as "looking for needles in a haystack." He did not discuss any of the herbal remedies for cancer that are of greatest interest to patients. Michael J. Hawkins, MD (who is chairman of the NIH panel on which I serve) gave a detailed presentation on antioxidants and chemotherapy. He excluded all in vitro and animal experimental data, something that is rarely done when considering new chemotherapeutic approaches. Instead, he focused on the clinical data for vitamins A, C, and E; glutathione; CoQ10; and the synthetic antioxidants dexrazoxane (also called ICRF-187) and amifostine. Dr. Hawkins mainly had positive things to say about the concurrent use of antioxidants and chemotherapy, and there was no doubt from his data that most antioxidants do not interfere with the efficacy of chemotherapy. In fact, most have been shown to decrease toxicity. There is some concern about the potential decrease of effectiveness of the drug Adriamycin with the synthetic antioxidant dexrazoxane. For that reason, said Dr. Hawkins, the package insert for the latter drug indicates that it is reserved for patients who receive at least 300 mg of Adriamycin. Dr. Hawkins ended his presentation, certainly the most fair-minded of the symposium, with a call for large-scale randomized trials. Given the number of researchers around the world doing serious work in CAM, it was hard to ignore the infuriating lack of balance on the panel. Real experts on the use of CAM in cancer were not asked to speak. I myself sat between E. Dieter Hager, MD, PhD, director of the BioMed clinics of Germany, and Ann Fonfa, a breast cancer activist who directs the innovative Annie Appleseed Project. Neither of them was asked to participate. I saw a number of other CAM clinic directors in the audience, some of whom had traveled thousands of miles to attend the symposium. How ironic that the audience wound up listening to non-CAM practitioners while genuine experts, who administer these treatments every day, sat unacknowledged in their midst. To be sure, this meeting was free of the cant of outright enemies of alternative medicine, such as the one who had announced at the 2000 meeting that vitamin C supplements would result in the explosive growth of tumors. There was no such nonsense at this meeting and, in that sense, some progress was made. In particular, Dr. Hawkins’ carefully worded appraisal of antioxidants and chemotherapy was the most balanced presentation on the subject I have heard at ASCO. But when, I wonder, will ASCO allow its members to hear from those who have a profound knowledge of this subject, as physicians, patients and health advocates, instead of from those who have never personally used the therapies they talk about? When they do that, it will be a meeting that makes history. ---Ralph W. Moss cancerdecisions.com Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.