Dr. Arunabha Sengupta_pic Dr. Arunabha Sengupta (Surgical Oncologist)




The Statesman, February 21, 2011

“Look at that weed, nurse Caisse. If people would use it, there would be little cancer in the world.” The veteran doctor’s aside halted Rene Caisse.  Could this be that secret Red Indian medicine a breast cancer patient had told her about? Her own experiments with those weeds resulted in a brew that cured her mother and aunt, who were suffering from cancer, and it became very popular and famous amongst the cancer patients. Despite stern dismissals by the Canadian authorities, cancer patients continued to try that Essiac (anagram of Caisse) tea for decades.

That paradigm of a find outside structured medical research, western or traditional, and public acceptance, even if partial, is archetypal of most popular alternative therapies in cancer medicine, it is common in societies with ambivalent attitudes. The recent tendency to euphemistically group together all such therapies as “complementary alternative medicine” or CAM, have necessitated a cautionary debate. And the tendency does not differentiate between magic and medicine and the campaign to integrate CAM in modern cancer treatment.

Apparently the most obvious reason, in a country like ours, would be poverty and inadequate infrastructure to deliver modern cancer treatment. But that is not all. Use of CAM is a universal phenomenon and is better understood with a global perspective. Even after discarding certain human propensities towards mysticism and power of black magic, there indeed are real circumstances that lead even resourceful patients to CAM – a realistic prognostication by the oncologist being the foremost. Unable to extract “guarantee” from one clinic, patients flock to others, to novelties or miracle therapies like Essiac Tea. It is an escape route from the hassles of a multi-layered treatment through modern medicine. In comparison, the CAM therapist offers an endearing one-to –one interaction and benevolent assurances. Sometimes a belief that the chosen alternative therapy is superior - one that goes beyond the mechanistic approach of knife and shots - is compelling. Many users of CAM view it as a supplementary to the ongoing allopathic treatment and thereby make the case for integrative medicine.

A look into the record of alternative cancer therapies would reveal a wide array of disparate drugs and devices. They were packaged as guaranteed to cancer course and received with considerable public enthusiasm. So intense was the ardor about one such drug “Laetrile”, researched and developed by Dr. Kerbs Jr, a failed medical student, that actor Steve McQueen trekked to Mexico in search of an unknown dental clinic selling the drug. It was by then banned in the USA. Ironically McQueen’s rapid deterioration dampened public enthusiasm about the drug. If nurse Caisse and DR. Kerbs claimed true researchers’ toil, Harry M Hoxey was simply bequeathed, passed on knowledge by his farmer grandfather. One of whose horses was said to have been cured of cancer by eating certain plants, Hoxey clinics once became thriving sanatoriums treating cancer with equine spotted herbal drugs. Citations of such therapies were widely visible. Our own city has witnessed such claims, even alluring advertisements to claim our attention. While some of them are expressions of eccentric minds treading unconventional pathways, others are fortuitous discoveries of lost prescriptions buried in traditional systems like Ayurveda or Unani or classified family heritage. The most exotic are the “inspired finds”, gifts to chosen mystics. All of them nevertheless claim too cure and cure forever.

Some would argue that it is unscientific to rubbish all CAM therapies as sham and invalid. After all it is a drug or a molecule that cures and there is nothing wrong if dedicated and altruistic men choose to engage in a side “establishment” to find that cure. Stanislaw Burzynski and Max Gerson, both trained physicians, had tried to develop alternative therapies for cancer through well-established clinics and protocols. FDA has conducted clinical trials with Burzynski’s drug antineoplastones (not to be confused with “anti-neoplastins”, a later drug from Kolkata) while Prince Charles and some elite universities have approved Gerson diet. Doctors at MD Anderson Cancer Center are examining an Indian homeopathic medicine that claims to cause regression of brain tumors. The concepts in some erstwhile CAM therapies are crude or rudimentary due to the lack of proper focus or absence of requisite technology. Some widely promoted pharmaceutical’s “latests” are actually refinements of old molecules detected in herbs and weeds by scientists or had been traditionally known to the indigenous or folk medicine. For example, the anti-cancer property of sea squirt Ecteinascidia was known for a long time but a clinically usable drug effective in advanced sarcoma has only been recently possible. The principles behind the use of immune boosting drugs like mistletoe and the logic of using shark cartilage to reduce blood supply to growing tumors are used in modern-day adoptive immunotherapy and anti-vascular drugs. The recent experiments in tumor destruction by direct needle insertion attached with a radio frequency ablator (RFA) or focused ultrasound is not much removed from the past ideas of electrotherapy or magnetic resonance used by old CAM practitioners in Europe.

The scientific community has in fact looked into many such drugs. The craze about Laetrile, for instance, led too large clinical trials and finally a senatorial investigation committee, headed by Senator E. Kennedy, conducted the test. Laetrile failed all trials and investigations, but did creditably for its investor. Most conferences of medical experts now devote separate sessions to discuss such therapies and international institutes have set up additional departments. But efforts at sifting ash to unearth hidden touchstones have largely gone unrewarded. Barring a few, which had merited clinical trails, no CAM therapy has been found suitable for clinical use to date.

What is more disquieting is that most of these therapies are offered from outside established traditional systems of alternative medicine and through publications not in indexed journals, but in lay media. The official bodies or international journals of neither the Ayrurvedic and Siddhai systems nor the Homeopathic systems make any claim to have found a radical cure for all types of cancer. But individual claims abound, typically advertising stories of despondent cases abandoned by famous hospitals and then cured after many years, often decades. Now and then such claims crop up, activating the media and thrilling the populace. Since no laid down criteria distinguishes the charlatans from the true practitioners of traditional established systems or scientists, even quacks can now don a respectable garb with the label of CAM  and come to the bourses to trade.

Another legitimate concern is the quality of CAM drugs sold in markets. No law or mechanism is in place to ensure the quality, right portions of ingredients, or genuineness of “what is in the bottle”. The purported belief about their being harmless natural products and also less costly is equally hazardous.  Their effects might be deleterious when used in conjunction with chemotherapy in weak conditions. The cost of wasted time and then carrying the burden of a maltreated disease, its incidental expenses, and loss of active life-days again offsets the seemingly low cost.

That standpoint somewhat changes if we look at the CAM therapies that depend on general health boosting practices, like yoga, mind-body control, psychotherapy ,counseling, dietary regulations, supplementations, immune boosting  and cleansing therapies, and vitamins etc. Although trials conducted so far have failed to show any survival benefit amongst breast cancer and other patients, there is also no valid scientific argument against taking a holistic view and using these measures with an aim to improve the quality of life and make patients more compliant to the rigors of cancer treatment.

Therefore, the premise for coming together of other medicines with mainstream medicine should be built with caution and guided by the canon of not putting exigency before science. It must also educate the public that cancer is a heterogeneous group of disease in a heterogeneous group of people and any therapy that claims to cure all types and forever is likely to be more a sham than shamanic.

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