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> CAM - Complementary & Alternative
Medicine
Last Update: 06/28/2009
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Evaluating medical
claims and data | The
problems with testimonials ... PDF
NEWS AACR 2009:
Oncologists Should Recommend Exercise, But Not Supplements medscape.com
there is accumulating evidence to show that it can
improve both prognosis and quality of life
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Quick Index
Chamomile
(Kamillosan oral rinse)
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CAM
stands for Complementary and Alternative medicine. It's an umbrella term for interventions and practices that are not
generally in the mainstream of medicine as practiced today in the United States and many countries.
Complementary Medicine
are practices that are sometimes integrated into mainstream medical care for
improvement of general health, and relief of symptoms, such as pain or
stress ... sometimes referred to as integrative medicine.
Alternative medicine are practices that
are used to replace mainstream medical care that are not based on evidence
from clinical trials in human subjects. The promotion of such medicine
is typically based on testimonials.
(N = ?)
There are serious dangers to delaying
proven therapy to treat cancers and choosing alternative medicine instead,
which can appeal to vulnerable cancer survivors based on pseudoscience, wishful thinking, and conspiracy theories. Evidence-based
medicine are interventions that have been proven to provide clinical
benefit for a specific medical condition. FDA (mandated by Congress) requires studies of sufficient size and a control,
capable of findings that have statistical significance as the basis for marketing
approval. The clinical findings must show that the benefits of the new
intervention outweighs the risk of the disease treated differently -- the
active control already accepted as superior to the disease untreated. (N
= many hundreds of patients and a control)
Preventative medicine: Most everyone agrees that prevention is a key to better health,
decreasing the incidence of many diseases, and lowering medical costs. Some obvious targets of such efforts would be the tobacco and food industries.
Lets be specific Much of the
confusion about CAM is based on a failure to be specific and describe the medical
condition to which the practices may be applied. For example, diet modifications
and exercise for adult-onset diabetes, versus the same to treat specific
cancers. The latter is implausible as treatment, the former could be quite
helpful. If by "integrative
medicine" we mean making good-sense modifications to diet and increasing exercise to complement the treatment of
adult-onset childhood diabetes, I think everyone would agree with integrating
such practices ... and most doctors would consider it standard practice!
- ... But cancers are a different kettle of fish. Clearly it's very wise
practice to improve our general health at any time of life and under any
circumstance, but life style
modifications are not expected to change the clinical course of most cancers - which are driven by genetic errors in the cells ... thus, diet modification,
for example, is not something to do instead of treatment. And
if by
"integrative medicine" we mean removing mercury amalgams or subjecting
ourselves to colon cleansing, then we are misusing the term, and practicing alternative
medicine: self-treatment using unproven and implausible practices, often
promoted based on unfounded personal stories and conspiracy theories about
conventional medical practices. See
Conspiracy Theory: Big
Pharma?
What's the harm?
Unrealistic expectations can interfere with good
judgment; when we fail to monitor our condition carefully enough, or when we delay or avoid effective treatment, or when we fail to
consider clinical trials, based on strong beliefs that are not arrived at by
basic and clinical research, which is subject to expert peer and regulatory review.
Prevention versus Treatment: There is also
confusion about prevention and treatment as it relates to specific medical
conditions. We may assume that since a practice reduces risk of a disease
that it will be
effective also as treatment? Sometimes yes, sometimes no. It all
depend on the medical condition.
For example, we can quit smoking to reduce risk of lung cancer, but quitting
will not reverse an existing cancer.
A pesticide-and man-made-toxin-free world could reduce the incidence of lymphomas, but changing to
an organic diet after diagnosis will not reverse it. Cancer cells (having
mutations that favor survival and growth) will grow equally well in an organic test tube
medium (if not better) than in a toxic one. If
in our lifetime we minimize unhealthful fats, we exercise, we avoid obesity, and
we don't smoke, we can significantly reduce our risk of cancer -- but switching
from fast food to a healthful diet after a diagnosis cannot be, and should not
be, called a treatment for cancer. It seems
the industry that profits from herbs and supplement sales wants to avoid making
such distinctions. And practitioners of alternative medicine will continue
to make a good living appealing to such beliefs and false hope.
By KarlS
Recommended: Discussing CAM with your doctor - scienceblogs.com:80/terrasig
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On Levels of Evidence |
Credible Resources |
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Tools |
Studies |
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Drug/Supplement
Interaction Checker drugreax.epnet
This tool
doesn't include every possible interaction or account for
individual responses to medicines. |
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Complementary
and Alternative Medicine Online Continuing Education Series Video
Lectures |
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To
avoid potential adverse interactions, be
sure to let your health care provider know
if you use supplements when receiving therapy.
Given the limitations
described, it would be beneficial to find reliable data and conduct
additional research to determine how specific supplements and some life style
practices might do the following:
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Enhance or inhibit drug
efficacy.
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| Reduce or increase side effects and
damage to normal cells during treatment, or when monitoring disease. Towards
this goal we provide the following:
Radio-protective?
- practices that may or may not reduce treatment side effects or reduce risks
associated with repeated x-ray imaging. Chemo-protective
& enhancement? - practices that may
or may not reduce treatment side effects and/or
enhance treatment efficacy.
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Increase or decrease drug accumulation
or drug resistance.
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Help restore health
to patients after receiving chemotherapy or radiotherapy.
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| Inhibit or promote tumor growth for
individuals in watchful waiting status. |
BC Cancer Agency: Guidance on unconventional
therapies .bccancer.bc.cam
For unconventional therapies that are taken by
mouth or put into the body: Do not take any of these during
chemotherapy, hormonal therapy or immunotherapy. Do not take any
them in conjunction with any other medications without checking with
the BCCA Patient Education Pharmacist about possible drug
interactions.
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Tell your oncologist about supplements and
alternative therapies
you may be using.
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When you use herbs, do so only for short periods,
and in
moderation.
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Check to see if the therapy has been proven to be
harmful.
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Do not use alternative therapies to replace
prescribed treatment.
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Purchase from established and reputable
suppliers.
Some herbs and supplements have been found to contain toxins, such as heavy metals. Ask about what you are buying: Are the Latin names of herbs, the quantities and uses listed?
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Do not give children under age two herbal teas.
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Be cautious in using very concentrated oils and
teas.
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Perspective: How
Quackery Harms Cancer Patients quackwatch.com
There is an old saying: "The highwayman demands 'your
money OR your life,' but quacks demand 'your money AND your
life!'" This statement is particularly true when it comes to
dubious cancer treatment. The harm done by quackery may be categorized
as economic, direct, indirect, psychological and societal.
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Dietary Supplements in Patients With Cancer: Risks and Key Concepts
Laura Boehnke Michaud; Julie Phillips Karpinski; Kellie L. Jones; Janet Espirito
Am J Health-Syst Pharm. 2007;64(4):369-381. ©2007 American Society of Health-System Pharmacists
Purpose: The risks and key concepts regarding the use of dietary supplements in patients with cancer are described.
Summary: There are six common characteristics of dietary supplements that must be addressed when used by patients with cancer.
Clinicians must establish if the supplement:
is an antioxidant,
is an anticoagulant or procoagulant,
has immunosuppressive or
immunomodulating properties,
has hormonal properties,
has known safety issues,
and has known or theoretical drug interactions.
These six characteristics of the dietary supplements commonly used by patients with cancer are reviewed to aid in the analysis of the scientific data and communication of the results with the patient or family members.
A framework upon which clinicians can adequately help patients make informed decisions regarding the use of complimentary and alternative medicine and dietary supplements is also described.
When evaluating the appropriateness of a supplement for use by a patient with cancer, clinicians must conduct a safety review (evaluate the six characteristics). If the supplement is considered safe, an efficacy review must be conducted, after which the clinicians can recommend the supplement’s use, accept the patient’s decision to use the supplement if no or inconclusive evidence exists, or discourage use if there is conclusive evidence supporting inefficacy.
Available resources for locating information regarding dietary supplements are also discussed.
Conclusion: Counseling patients with cancer about dietary supplements requires a systematic thought process that considers the available theories and data, as well as the patients’ views about the agents.
I: http://www.medscape.com/viewarticle/553692_print
II: http://www.medscape.com/viewarticle/553699_print
Caveats of Supplements As Treatment Modalities
Doses of supplements may
not be significant a normal doses:
Information
about effective doses for specific conditions, and also the bioavailablity of natural products
is rarely
known or provided by promotions of herbs and vitamins as cancer therapy.
Doses of otherwise safe
supplements may be toxic at high doses. When
you give vitamins or herbs at very high doses, the compounds can have
drug-like effects, which may have risks that are not known or understood.
There is no clinical
evidence that supplements can improve survival in cancer patients. Theories
and testimonials may be persuasive, but should not be regarded as
evidence. See for many limitations
of testimonials
Mixed and unexpected effects may
occur in the human body
when supplements are used in high doses, particularly if used during
treatment.
Mouse studies
(the basis for some herbal promotions) do not
reliably predict effects in the body. "A mouse is not a man (or woman). The behavior of a drug in a mouse need not be the same as in a human. Meaning, the drug may distribute differently, proportional differences per blood and organs and tumor, in mouse
vs. man. Drug exposures ( the amount of drug and for how long) in different body parts , including tumor, may be quite different
... " Full text
Petri dish experiments
(the basis for some herbal promotions) do
not predict effects in the complex environment
of the human body.
To have clinical effects the active
ingredients must get to the cells you want to influence in sufficient
concentrations. Often, natural products are promoted based on cell culture
activity that fail to take into account how the compound is affected by
digestion, and other metabolic processes - so called
bioavailability.
(Other terms for petri dish experiments: in-vitro / cell
culture experiments)
In vitro refers to experiments on cells that are done outside the
body in test tubes or cell cultures. It's known that cancer cells
are changed significantly when removed from
the host environment - the cells may die spontaneously when removed from
the body. Thus,
evidence of activity of a herb or vitamin in a cell culutre is only a starting point for additional
experiments and studies.
For Open-source background: wikipedia.org
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Why Petri dish studies don't always translate into benefit
for patients -
Part I: scienceblogs.com/
| Part II: scienceblogs.com
"To understand the translation of cell culture studies
to the whole person, we must first consider all of the systems
operating in the human body that are not present when human cells are
grown in plastic Petri dishes. ....
(1) drug absorption, (2) distribution,
(3) metabolism, and (4) excretion"
It is rare for a herbal or dietary supplement company to conduct, much
less publish, the results of the bioavailability of their products.
For dietary supplements, these studies are not required by the US Food
and Drug Administration or by any federal regulatory authority in the
world.
By "bioavailability," we mean a study as to what
fraction of a given oral dose actually makes it into the bloodstream.
While measuring bioavailability, scientists also conduct more
sophisticated calculations to determine the peak blood concentrations,
when they occur, and how quickly the body clears the substance.
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Drug
interactions may be harmful. Supplements may
interfere with treatment or with how a drug is metabolized. Therefore, we
believe it's prudent to avoid taking any supplements the same day you are receiving
treatment medications.
Purity of supplements are
unknown. Natural products and supplements are not regulated by an
independent agency, and the risk or ingesting inferior or contaminated
herbal products is significant and well documented.
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NEWS:
Final Rule Promotes Safe Use of Dietary Supplements fda.gov
Under the final rule, manufacturers are required to evaluate the
identity, purity, quality, strength, and composition of dietary
supplements. |
Natural does not mean not
toxic. It's common
to associate "natural" with safety. But many plants and
animals produce poisons in order to avoid being eaten by animals and
insects, or to kill off competing plants. Consider how many common house plants are toxic to
our pets.
See Herbs or Natural Products That May Cause Cancer and Harm Part Four of a Four-Part Series Muriel J.
Montbriand, PhD, RN - ons.org
Data Sources: Natural Medicines Comprehensive Database
and Lawrence Review of Natural Products–Monograph System.
Information about these herbs has been found in evidence-based
studies cited in the references.
So why with the uncertainties
stated here should we provide information about CAM ? The
answer is that patients are using vitamins and herbs
and therefore need reputable and objective sources of information on this
topic. Please note that the
data here is definitely not complete, but we are making an
honest effort to provide this information in a balanced way - by avoiding
commercial sources and seeking information from published scientific
papers when possible.
-KarlS
Anonymous & Confidential
4-question CAM SURVEY
for lymphoma survivors or caregivers
 Purpose:
To can better meet needs when we understand the community we serve - details
After you complete the survey you
will see a list of what you selected.
When you return to this
form, you are done.
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Evidence-based?
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Evaluating medical claims and data
- Lymphomation.org
Spontaneous Remission and the Placebo Effect,
Stephen Barrett, M.D. - quackwatch.org
Recovery from illness, whether it follows self-medication,
treatment by a scientific practitioner, or treatment by an
unscientific practitioner, may lead individuals to conclude that
the treatment received was the cause of the return to good health.
Alternative Therapies for Curing Cancer: What Do
Patients Want? What Do Patients Need?
Wendy S. Harpham, MD (NHL survivor) amcancersoc.org
"Patients who don’t understand the difference
between information based on theory, anecdote, historical
analysis, or double-blind placebo controlled studies are making
ill-informed decisions, believing alternative therapies are safer
or more effective when they are not. Even patients who presume
that alternative therapies are ineffective may use them. Why?
When faced with a life-threatening disease requiring highly toxic
treatments with no guarantees, or when dying because there are no
effective conventional treatments, it takes guts to reject
something or someone claiming to be able to save you, just in
case you might be wrong."
Facts & Myths about Cancer - cansa.co.za
Cancer information and the Internet: Benefits and Risks - journeyofhearts.org
By Maurie Markman, MD
The Alternative Universe, By Wallace Sampson, MD - geomag.gfdi.fsu.edu
... "modern medicine's integrity is being eroded by New
Age mysticism, cult-like schemes, ideologies, and classical quackery, all
known as "alternative medicine." Using obscure language and
misleading claims, they promote changes that would propel medicine back five
centuries or more. They would supplant objectivity and reason with myths,
feelings, hunches and sophistry. NCCAM is being presented as a scientific
vehicle to study alternative medicine's anomalous methods. But NCCAM
actually promotes the movement by assuming that false and implausible claims
are legitimate things to study."
Debunking cancer myths: An interview with a Mayo Clinic specialist - mayoclinic.com/
Medical myths not only mislead but also may hamper proper treatment.
Find out why these common cancer myths are wrong. Highly recommended
reading.
Consumer Health Digest - ncahf.org
"NCAHF is a private nonprofit, voluntary
health agency that focuses upon health misinformation, fraud, and quackery
as public health problems. Our positions are based upon the principles of
science that underlie consumer protection law. We advocate: (a) adequate
disclosure in labeling and other warranties to enable consumers to make
truly informed choices; (b) premarketing proof of safety and effectiveness
for products and services claimed to prevent, alleviate, or cure any health
problem; and, (c) accountability for those who violate the law."
2006
Archive | 2005
Archive | 2004
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Archive | 2002
Archive | 2001 Archive
Subscribe to CH Digest | NCAHF
Home Page | Search All
of Our Affiliated Sites
Caring (Really) for Patients Who Use Alternative Therapies
for Cancer - jco.org
"The reasons why people seek alternative therapies
for cancer are broad. Many seek out alternative therapy when
options for conventional therapy have been exhausted. There is
also the recognition that, for some tumor systems, conventional
therapy is of limited effectiveness and that the side effects of
chemotherapy, surgery, and radiation are feared. For some tumor
systems, no conventional therapy exists and the standard therapy
is participation in phase I or phase II trials. Many patients
perceive that the conventional approach is emotionally or
spiritually empty and provides neither comfort nor solace."
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Other Resources & Research
News
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BC Cancer Agency: Guidance on unconventional
therapies - .bccancer.bc.cam
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Cancer patients conceal alternative meds - nlm.nih.gov
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Ethical considerations of complementary and
alternative medical therapies
in conventional medical settings.
Ann Intern Med. 2002 Oct 15;137(8):660-4. PMID: 12379066 - PubMed
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| Facts About Dietary Supplement - NIH
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| Facts and
Myths about Attitude and Cancer- cansa.co.za
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INTEGRATING
COMPLEMENTARY AND ALTERNATIVE
THERAPIES FOR CANCER PATIENTS
A Cancer Patient’s Guide to Complementary and Alternative Medicine
Heather L. Morein University of California San Diego School of
Medicine
Independent Study Project, April 2002 (Large 168 pg document) PDF
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Use of Complementary/Integrative Nutritional Therapies During
Cancer Treatment: Implications in Clinical Practice - Medscape
2002 H. Lee Moffitt Cancer Center and Research Institute, Inc.
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