NEWS

Alternative Medicines Gain in Popularity, Merit Closer Scrutiny

Katherine Arnold

Therapies that fall under the rubric of complementary and alternative medicine are popping up with greater frequency these days as nonstandard therapies gain more attention from the media and popularity with the public. According to a study published in the Journal of the American Medical Association last year, 42% of Americans used some form of alternative therapy in 1997, and about 39 million people sought treatment or advice from an alternative medicine practitioner, up from 22 million in 1990.

This trend has captured the attention of medical researchers and increased efforts to understand and validate these therapies.

"Just because a tradition is 3,000 years old, however, does not make its health claims correct," cautioned Robert Wittes, M.D., director of the Division of Cancer Treatment and Diagnosis at the National Cancer Institute and one of several speakers at a joint symposium on alternative and complementary therapies and oncology care at the 35th annual meeting of the American Society of Clinical Oncology in Atlanta this past May. The forum brought together scientists as well as proponents and critics of alternative therapies to discuss current research and upcoming studies.Go



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Cancer survivors at the ASCO annual meeting discuss their alternative therapy.

 
What Is CAM?

The National Center for Complementary and Alternative Medicine at the National Institutes of Health defines complementary and alternative medicine as those treatments and healthcare practices not taught widely in medical schools, not generally used in hospitals, and not usually reimbursed by medical insurance companies. The boundaries of this definition, however, have become increasingly vague as more CAM therapies enter mainstream medicine.

NCCAM, which was established as the Office of Alternative Medicine in 1991, gained its status as a center last fall. NCCAM supports 13 clinical research centers to examine the efficacy, safety, and validity of complementary and alternative therapies and to support basic, preclinical, clinical, and epidemiologic studies of these therapies.

Researchers hope these studies will provide some scientific answers to which of these therapies work and their mechanisms of action.

"The quality of evidence is everything," Wittes said. "It's more important than a hypothesis or the weight of tradition. It's incumbent upon people who make a claim to make it with hard evidence."

Complementary and alternative medicines are not usually promoted as cures for cancer, said Barrie Cassileth, Ph.D., recently named the first chief of the Integrative Medicine Service at Memorial Sloan-Kettering Cancer Center, New York. Rather, these therapies are used to enhance a patient's quality of life, and may be used to slow tumor progression.



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Dr. Barrie Cassileth

 
"These alternatives are seen as more avant garde, and people believe these therapies are safer than the standard treatments," said Cassileth, adding that the most popular of these are mental imagery, herbal cures, antineoplastons (a medicine made of chemicals found in the urine of people who do not have cancer), bioresonance (a theory that electromagnetic energy can be used to restimulate p53 genes in tumor cells), and high-dose vitamin therapy. The JAMA study estimates that Americans spent an estimated $21.2 billion in 1997 on alternative medicine therapies.

Complementary therapies, such as massage, accupressure, or counseling are used to ease symptoms of disease or treatment, Cassileth said. Patients might use these therapies to enhance well-being, increase the quality of life, provide strength, reduce side effects, or reduce fear and anxiety.

The National Cancer Institute recently formed the Office of Cancer Complementary and Alternative Medicine, which works directly with NCCAM. The NCI office will help support alternative medicine studies of interest to cancer research. The office is currently supporting a phase III trial that is testing a special dietary regimen for advanced pancreatic cancer patients, and will also be involved in a study of shark cartilage as an antiangiogenic agent in the treatment of lung cancer.

Each of the 13 centers NCCAM supports has a specialty area of research, such as pain, aging, or women's health. While all the centers cross disciplines of research, the University of Texas Center for Alternative Medicine Research (UT-CAM) specializes in alternative therapies and prevention for cancer.

Some of the natural therapies that are being studied for use in cancer prevention and treatment are green tea, ginseng, mistletoe, oleander, and Chinese herbal medicine. UT-CAM is studying melatonin for toxicity reduction in lymphoma patients; mistletoe to improve the quality of life in esophageal cancer; the herbal extract Flor-Essence for quality of life in colorectal cancer patients; and 714-X, a liquid medicine made from camphor, for patients who have refused or failed conventional cancer treatment.Go



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Shark cartilage is under study as an alternative therapy for lung cancer.

 
"The most reasonable approach to alternative medicine is to keep an open mind, encourage more studies, and respect the placebo effect," said Mary Ann Richardson, Ph.D., principal investigator at UT-CAM.

Dietary studies are also on the list of priorities for CAM researchers. Daniel Nixon, M.D., associate director for prevention and control at the Hollings Cancer Center at the Medical University of South Carolina and recently appointed president of the American Health Foundation, is researching the effects of phytochemicals — non-nutritive components of plants — specifically an acid found in raspberries, strawberries, walnuts, figs, grapes, and olives.

Ellagic acid seems to induce apoptosis, Nixon said. The study is examining whether eating a small handful of raspberries a day decreases the risk of developing certain types of cancers. Results are expected late this year, he said.

Awaiting Results

As the results of these studies trickle in, it will be important to evaluate CAM's place in standard medicine. One study, published recently in The New England Journal of Medicine, shed doubt on the role of CAM in helping patients. It found that women who used alternative medicine therapies, such as high-dose vitamins or relaxation therapies, after treatment for early stage breast cancer experienced greater psychosocial distress and a worse quality of life than a comparison group who did not seek alternative therapies after cancer treatment.

Researchers and the public will no doubt anxiously await the results of other CAM studies. Their importance is emphasized by the fact that many of these treatments are already used without solid scientific evidence to support them.

"If these methods have positive effects, they will probably ultimately be understandable in scientific terms," Wittes said. "We are all in this for the patient's good."



             
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