Dr. Markman spoke about "Safety Issues in Using Cam" and made the point that the intent is not to indict since the evidence overall is that (CAM therapies) are remarkably safe. The potential concerns include: Direct toxic effects Interactions with other medications Problems with methods of administration Reduced effectiveness of 'standard therapy' Toxicity not specifically related to cancer Impairment in overall 'quality of life' Delay in obtaining known effective therapy He also mentioned several reports of the direct toxicity of CAM therapies such as laetrile (cyanide toxicity), shark cartilage (nausea, vomiting, constipation, hepatitis), hydrazine sulfate (hepatorenal failure), macrobiotic diets (nutritional deficiency), antineoplastons-Burzynski's therapy in glioma patients (neurocortical toxicity-transient insomnolence, confusion, worsening of seizure activity), green tea-at 6 g/day (nausea, vomiting, insomnia, fatigue, diarrhea, abdominal pain, confusion). Ann's NOTE: This is a complicated issue. Laetrile may be active because it has cyanide. In the UK, cyanide is being examined as a cancer therapy. Nausea and vomiting, constipation-what can I say? Not unknown in cancer therapy? Hepatitis, a real problem for those with weakened immune systems. Hepatorenal failure-I read this report on one patient. It is difficult to know (and I queried the author) if this patient knew that hydrazine sulfate is an MAO inhibitor and requires avoidance of certain foods and drugs. We report extensively on this therapy on our site (see Treatment section). Further direct toxicity included herbal medicines with contamination, crop variability, wrong plant species, and fraud, all very real problems which need to be addressed by FDA. Chiropractic was faulted for the possibility of (admittedly rare) cerebrovascular accidents and acupuncture (again admittedly rare incidence of forgotten needles, transient hypotension, pneumothorax ecchymosis, minor hemorrhage, transmission of infection). Ann's NOTE: I have used acupuncture since 1991 as a very close friend graduated from the New England School of Acupuncture at that time. All of the criticisms, at least those I understood, are quite minor. Transmission of infection is extremely unlikely in the U.S. as practitioners use disposable needles. Minor hemorrhage sounds a bit scary but it is just a blood 'spot' after needle is removed. Dr. Markman then mentioned the basic group of herbs that everyone can criticize, including ephedra for cardiovascular effects, garlic, ginkgo and ginseng for bleeding (not good enough reasons to avoid these extremely useful herbs, however ginseng is estrogenic so those with breast cancer SHOULD avoid it), Ginseng and hypoglycemia was mentioned and the sedative effects of kava versus anesthesia. St. John's Wort and increased metabolism was also listed (Ang-Lee, MK et al.JAMA 2001;286:208) The problems with administration refer to some information about enemas, including dehydration, serious infections, electrolyte loss/hypotension. Ann's NOTE: When this type of report is looked at, it is often one foolish patient who figures out that if once is good, ten must be wonderful. This can be blamed on the lack of useful studies. Where are they? Surely our tax dollars could fund some of them. Yes we have NCCAM and NCI OCCAM and I just hope they get started producing some information we can use to make more informed choices. There has been a recent study demonstrating that St. John's Wort can interfere with Irinotecan (Mathijssen, RHJ et al. Proc AACR 2002; 43:492). There has also been a report of Cyclosporin and St. John's Wort reducing plasma concentrations and leading to rejection of transplanted organs. (Breidenbach, TH et al. The Lancet 2000;355:1912) Of course, said Dr. Markman, toxicity of CAM use is not limited to cancer, and there are some reports of complications with herbs. (Ernst E. Ann Intern Med 2002;136:42) Perhaps as the dialogue becomes more common these reports will increase. Norman Farnsworth, PhD (University of Illinois) and a later speaker stated that the researcher who reported on these complications publishes too many reviews in one year for them to contain good research. Dr. Markman also cautioned against those 'alternative' practitioners who require patients to stop all other therapies, including pain meds. He further criticized the use of 'alternatives' as potentially delaying known effective therapy. And he made the important point that it is a medical practice issue if a doctor does NOT know what else a patient is taking. So doctors must ask. 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.