Choices in Healing, by Michael Lerner (1994)                   www.commonweal.org

 

Comments about the book

!         It is written by a political scientist who has studied cancer therapies for over a decade.

!         The author is an educator who works with people facing life-threatening illness; he is not a scientist.

!         The author because of his background has not analyzed methodological problems with the cited studies.

!         The book is designed for the cancer patient who wants to have a comprehensive overview of his/her choices regarding treatment and also living with cancer.

!         In the preface, the author advises against recommending complementary therapies to patients disinclined to use them, because we know so little about these therapies.

!         The book overall provides a critical appraisal of complementary therapies, combined with a hopeful approach.

!         The book is a map -   material is mostly factual; few recommendations are made.

!         There are excellent "conclusion" sections in many of the chapters.

!         There are very many references to original material.

 

Cancer Therapy from a historical and cross-cultural perspective

!         If America is compared with Japan, Britain, Germany, and France, we note that

o       Medical culture is most aggressive in the United States.

o       No other culture has separated biomedicine from other healing practices to the extent that the United States did in the early 1900s.                        

!         President Nixon - war on cancer - $20 billion - not much to show for it.

!         Other than childhood cancers, improvement associated with chemotherapy is usually minimal.

!         Significant differences in recommendations from surgeons, oncologists, and radiation therapy specialists.

!         A central problem is that society and the medical profession have not yet recognized the need for systemic education and training for cancer patients who are often overwhelmed by the diagnosis and the choices.

!         The AIDS community has done a commendable job at reshaping health care to fit its needs - activists have expanded treatment options, accelerated research, built support systems, and made public health institutions more responsive to people's suffering. (This could serve as a model for the cancer community).

!         There is very little scientific evidence in favor of unconventional cancer treatments.

!         Surveys show that most unconventional cancer treatment is delivered by licensed physicians or credentialed health care providers at a reasonable cost.

 

Classification of unconventional approaches

!         Adjunctive psychological approaches

!         Macrobiotics - a nutritional plus spiritual approach

!         Nutrition - metabolic programs

!         Traditional Chinese medicine (TCM)

!         Unconventional pharmacologic approaches

!         Healers

!         Miscellaneous (Laetrile)


 

Evaluation

!         Plausibility of therapy

!         Credibility and character of practitioner

!         Quality of service delivery

 

Psychological Approaches

!         We know that psychological approaches can greatly enhance quality of life (example: relief of anticipatory nausea and emesis), but we do not know much about whether psychological approaches extend life.

!         Acute stress is known to enhance tumor growth in many animal experiments, so elimination of major negative life stressors, and also general stress reduction techniques such as meditation or progressive relaxation, are likely to be helpful.

!         Whether there is a "cancer personality" remains debatable.

!         The Simonton’s have associated better outcomes with a capacity for vivid visualization of a strong immune system overcoming a weaker cancer. Most people can learn this skill.

!         Social support seems to be enormously important in terns of improving quality of life and maybe even increasing longevity.

!         David Spiegel, MD - Stanford psychiatrist - in a randomized study involving 86 women with metastatic breast cancer, Dr. David Spiegel, a Stanford psychiatrist, showed that those who participated in weekly discussion groups in which they shared their feelings and learned simple techniques to reduce stress not only had a better quality of life, but nearly doubled their survival to a mean survival of 37 months (Spiegel D, Bloom, JR, Kraemer HC, et al. Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet 1989; 2:888-891).  

 

Spiritual Approaches

!         No definitive studies in cancer patients.

!         Byrd showed statistically significant benefits from intercessory prayer for a group of myocardial infarction patients in the CCU at San Francisco General Hospital (Byrd RC.  Positive therapeutic effects of intercessory prayer in a coronary care unit population Southern Med J 1988; 81[7]:826-829).

 

Nutrition and Cancer

!         Scientific literature - cautious optimism regarding role of nutrition in cancer prevention and treatment.

!         Alternative literature is often highly inaccurate.

!         There is significant evidence that nutritional support can decrease the side effect of conventional treatment of cancer.

!         Good resource is chapter on cancer in Modern Nutrition in Health & Disease by Shils and Young.

!         Just like cancer is more responsive to chemotherapy than healthy tissue, it may be more responsive to calorie restriction and/or mineral restriction, but this is unproven.

!         Vitamin C in pharmacologic doses may prolong survival, except in leukemia where it may worsen the prognosis.

!         Vitamin C does seem to decrease side effects from chemotherapy and radiation therapy.

!         Vitamin E in animals protects against hair loss and heart damage from Doxorubicin.

!         Selenium is correlated with decreased colon cancer rates.

!         Zinc antagonizes selenium and may promote tumor growth.


!         B12 can promote some tumors and inhibit others.

!         Beta carotene: clinical trials show opposite effects compared to epidemiologic data.

!         Food allergies may play a role in some cancers (i.e. celiac syndrome - gluten allergy - associated with lymphoma).

 

Unconventional nutritional approaches

!         Commonalities include fresh, whole foods eaten in balanced combinations, and emphasis on a predominantly vegetarian diet.

!         Differences amongst the approaches are multiple, as are direct contradictions from one diet to the next.

!         Beware that programs with selective nutrient restrictions have the potential for harm.

!         Beware that a "healing crisis" can result in death.

!         As a rule of thumb, if weight does not stabilize at high school weight, but continues to drop on an unconventional diet, the diet is nutritionally inadequate.

!         Gerson Diet

o       Radical - raw vegetarian diet, juices hourly, including calf liver juice, and four types of "cleansing enemas".

o       First used in 1928.

o       Full time project for two people to comply with this diet.

o       There is some evidence for the role of coffee enemas in detoxification.

o       There is some support for this diet from basic and clinical research.

o       Gerson lost his license in the 1940s after testifying before the Senate.

!         Macrobiotics - Michio Kushi

o       This is a diet plus a spiritual philosophy of life.

o       Kushi's initial goal was to support a movement toward world peace through health - he shifted focus in 1976 to a cancer prevention diet.

o       Little research support for his concepts.

o       Problems with macrobiotics include 1) blames the patient for causing disease, and 2) inconsistent and inaccurate citations of scientific literature.

!         Livingston diet (San Diego)

o       Theory is that a microbe causes cancer and therefore a vaccine is needed.

o       Collection of data at the San Diego clinic is sparse.

o       This is a whole program - nutrition is just one part of it.

!         Keith Block diet (Evanston, Illinois)

o       This diet is less radical - it is derived from macrobiotics.

o       The approach includes biomedical, psychosocial, biochemical, and biomechanical profiles, then individualization of recommendations.

o       Dietary approach is integrated with fitness and psychological support.

!         IN SUMMARY, many supporters of nutritional therapy for cancer have made excessive claims for the efficacy of nutritional therapy, but there is enough data from animal studies and uncontrolled human studies that controlled studies are needed.

!         We do not know if nutritional therapies will function in the same way across a wide variety of cancers, or whether they will prove helpful only in some cancers, and even counterproductive in others.


 

Unconventional Pharmacologic Therapies

!         Largest, most diverse field of unconventional approaches.

!         More media attention than for spiritual, psychological, physical, and nutritional approaches.

!         In contrast with spiritual, psychological, or nutritional approaches, there is no obvious, intrinsic health-promoting benefit.                                                                                                             

!         Scientific study of unconventional pharmacologic therapies is easier to accomplish than for "lifestyle therapies".

!         At a psychological level, there tends to be an inverse relationship between the openness (versus degree of secrecy) of an alternative treatment and the level of public interest.

!         In contrast with spiritual, psychological, or nutritional approaches, quackery and excessive costs are much more common.

                                                                                                                        

Stanislaw Burzynski - antineoplastins "urine therapy"

!         Plausibility

o       The theory is that peptides in the blood and in small quantities in the urine have activity against cancer, and some people are deficient in these. Purification of these peptides from the urine of healthy, non-deficient volunteers, and administration of these purified peptides to cancer patients, will improve survival.

o       Antineoplastins are considered species-specific, so animal experimentation is not valid.

o       Therapy holds promise based on the theory and initial studies.

o       Effectiveness seems to be inversely related to the effectiveness of chemotherapy.

prostate > brain> non-Hodgkin’s > pancreas > breast > lung > colon

It is hypothesized that the natural product concentrated from urine is more effective than synthetic.

!         Practitioner

o       A brilliant man with a genuine interest in open, controlled trials of his ideas. Obtained MD and PhD degrees by age 25.

o       Choice to leave academia at Baylor University in 1977 and work outside of mainstream institutions may have been influenced by his past -- refugee from Poland who was drafted into the army as a penalty for not joining the communist party.

!         Service delivery

o       Suboptimal

o       Expensive: $3,000-$5,000/month of therapy.

o       Ethical issue of doing research based on patient finances.

o       Cultural gap - European system allows physicians to conduct extended programs of human experimentation with new cancer therapies.

o       Burzynski does tell patients who he does not think that he can help that his therapy is not worth the cost.

 

Joseph Gold - hydrazine sulfate

!         Plausibility

o       Hydrazine sulfate blocks conversion of lactic acid to glucose (it is an MAO inhibitor).


o       Cancer only partially metabolizes glucose, to lactic acid.

o       The body then expends much energy reconverting lactic acid to glucose, and this contributes to cancer cachexia.

o       Gold published a study in 1975 showing benefits, but based on three negative studies by other researches, hydrazine was placed in 1976 on the ACS unproven methods list, and funding for research in the United States disappeared.

o       Hydrazine was removed from the unproven list in 1982.

o       Benefit has been documented in one small (65 patients) randomized, controlled study published 1/90 in Journal of Clinical Oncology.

o       Toxicity is minimal -- mild nausea and light-headedness.

o       Multi-center trials are currently underway (NCI-sponsored).

!         Practitioner

o       Gold stayed inside the cancer establishment and played by the rules.

o       He is Director of Syracuse Cancer Research Institute in Syracuse, New York.

!         Service delivery

o       Syracuse Cancer Research Institute will send promotional literature.

o       There is "black market" availability, with the product available very inexpensively.

 

Emanuel Revici - complex biochemical theory

!         Plausibility - Theory is so complex that it is difficult to assess, and few others have even attempted to study it systematically.

!         Practitioner - MD, brilliant, unconventional, born in Romania, MD degree at Bucharest, practices in New York City.

!         Service delivery - not well organized.

 

Traditional Chinese Medicine (TCM)

!         Considerable evidence for its benefit in pain control and alleviating side effects from chemotherapy.

 

Living with Cancer

!         Pain is what people with cancer tend to fear the most.

!         Psychological approaches to pain control, especially visualization, are complementary.

!         Hospice physicians tend to do best at pain control.

!         Pain is a great spiritual teacher if it is not overwhelming.

!         The fact that near-death experiences are also simultaneously out-of-body experiences tends to indicate that near-death is not a hallucination of the dying brain, which in turn supports survival of the soul.

!         It is important to support survivors who are grieving, especially spouses.

!         Fear of recurrence is often significant in cancer survivors.

!         Recognize that cancer is not always the most difficult part of a person's life.

!         Challenges

o       Financial/work related

o       Changes in relationships

o       Process of rapid inner growth and re-evaluation of what is important in life.


 

 


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