NEWS Journal of the National Cancer Institute, Vol. 92, No. 24, December 20, 2000 White House Commission Examines Research on Complementary Cancer Therapies By Matthew Fritts "Within 5 to 10 years, complementary therapies will be a part of the care in every major hospital and clinic across the country," predicted James Gordon, M.D., clinical professor of psychiatry at the Georgetown University School of Medicine in Washington, D.C. Gordon is chair of the White House Commission on Complementary and Alternative Medicine Policy. The 19-member commission is charged with developing legislative, administrative, and public policy recommendations to maximize the benefits of complementary and alternative medicine for Americans. "If we are going to hold complementary and alternative therapies to an appropriate standard of accountability, we need to invest in research so health care professionals and consumers can make informed judgments about the appropriate use of these services," President Clinton stated upon appointing the chair and first 10 commissioners. At a recent commission meeting to review the latest research in complementary and alternative medicine, Jeffrey D. White, M.D., director of the National Cancer Institute's Office of Cancer Complementary and Alternative Medicine, highlighted two NCI-coordinated phase III clinical trials. Both trials are funded by the National Institutes of Health's National Center for Complementary and Alternative Medicine. One trial at New York's Columbia University is comparing the Kelley/Gonzalez protocol, a nutritional program with oral pancreatic enzymes and a detoxification regimen, with conventional chemotherapy for advanced pancreatic cancer (see News, Oct. 4, p. 1558). The other is a multicenter trial coordinated by the University of Texas M. D. Anderson Cancer Center in Houston. This trial is examining the efficacy of shark cartilage versus placebo, both in combination with platinum-based chemotherapy and radiation therapy. A total of 756 stage III lung cancer patients are being randomly assigned to receive either shark cartilage extract or placebo. Patients also receive infusions of cisplatin plus vinorelbine over a 12-week period or carboplatin plus paclitaxel over a 3-week period, plus radiation therapy beginning at week 8 and continuing for 6 weeks. Patients will be evaluated every 8 weeks for 2 years. A third study sponsored by NCI at Memorial Sloan-Kettering Cancer Center, New York, is investigating whether dietary changes can slow or halt increases in prostate-specific antigen levels in prostate cancer patients who have undergone prostatectomy or radiation therapy. Patients are randomly assigned to a diet low in fat and high in soy, fruits, vegetables, green tea, vitamin E, and fiber, or to a standard healthy diet. PSA levels will be tested at baseline, 1 and 3 months into the study, and then quarterly thereafter. Dietary modification is also the theme of the Prostate Cancer Lifestyle Trial, directed by Dean Ornish, M.D., clinical professor of medicine at the University of California at San Francisco, president and director of the nonprofit Preventive Medicine Research Institute in Sausalito, Calif., and a member of the commission. Ornish began his prostate cancer trial 31/2 years ago at PMRI in conjunction with UCSF and Memorial Sloan-Kettering Cancer Center. At the meeting, Ornish reported that 85 of 120 patients with biopsy-proven prostate cancer who have elected to undergo "watchful waiting" have been randomly assigned to an experimental group that is asked to make comprehensive lifestyle changes or to a control group that is not. These changes include a very low-fat vegetarian diet, moderate exercise, stress management training, and group support sessions. Participants undergo quarterly PSA testing and MRI and MR spectroscopy scans of the prostate to determine tumor size and activity. "While it would be premature and unwise to draw any definitive conclusions from a study that is still in progress, our preliminary data are encouraging," Ornish said. "Whatever we find, the data will be important, because many people in the general public are making changes in diet and lifestyle without conclusive scientific evidence to support these changes." Researchers from the federal, private, and not-for-profit sectors addressed illnesses from heart disease to arthritis and therapies from herbal medicine to chiropractic manipulation. The commission also discussed research priority setting, regulatory challenges, and outcomes research and heard public comments on how public policy changes might be used to help disseminate research findings to medical practitioners and the general public. "At this early stage, it is difficult to see how the diverse presentations and discussions with the commission will be crystallized into specific policy recommendations," commented White. "There are some difficult issues in advancing CAM research, some of which we're only beginning to uncover. Their solutions are likely to require intensive efforts." The commission has planned a series of town hall and public meetings to address these issues. It will prepare an interim report next summer and a final report to the president in March 2002. The Future Gordon is optimistic about the work of the commission and the future of CAM in the United States. "Our definition of medicine will be far larger than it is today," said Gordon, who is the president of the Center for Mind-Body Medicine, Washington, D.C. "The questions are not 'if' or even 'when' this will happen. The questions that must be answered, and the ones the commission will address, are how we can find out which of these therapies are truly effective; how clinicians can be trained in using them and the public educated about them; and how therapies that do prove effective will be safely integrated into a truly comprehensive and humane care for all Americans." More information about the commission is available at its Web site: http://www.whccamp.hhs.gov. CAM speakers from New York metropolitan area Ann's Talk to WHCCAM Peter Chowka's Talk 2/25/02 Healthscout News Remember we are NOT Doctors and have NO medical training. 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