The Olive Branch Bears Fruit

I just returned from the Feb. 26 meeting of the Cancer Advisory Panel on Complementary and Alternative Medicine (CAPCAM), of which I am a founding member. The creation of CAPCAM was the fulfillment of one of my dreams: representatives from both alternative and conventional medicine, who could meet regularly under government auspices to fairly evaluate the claims of unusual cancer treatments.

Until the formation of CAPCAM, conventional and alternative medicine usually met in battle. After the Office of Alternative Medicine (OAM) was founded in 1991, these skirmishes became more pitched. In time, the National Cancer Institute (NCI) asked for a truce and invited members of the two communities to a conference in August, 1997. This led to the formation of CAPCAM. Initially, I was among the skeptics. I had been fighting NCI so long that it was hard to accept the idea of cooperation, much less friendship. But Glenn Warner, MD, who had lost his medical license the year before through the machinations of government officials, passionately urged me to accept the olive branch that NCI extended. I thought to myself, "If Glenn Warner, who has suffered so much, can accept this offer, why can't I?" And so, I fought hard to create this panel.

NCI simultaneously established the Office of Complementary Cancer and Alternative Medicine (OCCAM) to direct its own participation in the process. Jeffrey White, MD, was made head of OCCAM and also serves on CAPCAM. Over the last few years, CAPCAM members, under the chairmanship of Michael Hawkins, MD, a Washington oncologist, have tried to evaluate new and promising cancer treatments that come from non-conventional sources.

The members of the panel have displayed an extraordinary degree of expertise in their respective fields. Some are top experts in cancer treatment, diagnostic radiology, tumor pathology and statistics. I know that CAPCAM has been attacked for not doing enough. Some people in alternative medicine scorn us because we have not yet validated any nonconventional treatments, while the self-declared "quackbusters" hate us because our existence validates the idea that there might be useful alternatives to surgery, radiation and chemotherapy.

Why has progress been so slow? Rigorously validating a new treatment inevitably takes time. Not all of the blame rests with government inertia. For the last few years, NCI has been asking alternative practitioners to submit their best cases for evaluation. This could lead to a full-scale clinical trial, such as in the case of Nicholas Gonzalez, MD. Yet surprisingly few alternative practitioners have taken up this challenge.

Macrobiotics

At this week's session, one group did. This was macrobiotics, promoted by the Kushi Institute of Becket, Mass. Macrobiotics is more than a diet. It is a philosophical system based on the idea of achieving a balance between Yin and Yang in one's life and diet. Michio Kushi and his many followers believe that most cancers are caused by an excess of either "yin" or of "yang." Patients are treated according to the type of cancer they have and what food imbalances supposedly caused it. The emphasis is on the intake of foods that are available in groceries, and not on medicine, not even medicinal herbs. It is, in essence, a simple and inexpensive approach to advanced disease. The biggest expenses are for the initial consultation with a counselor and to purchase specialized equipment, such as a pressure cooker.

Most patients are put on a diet high in whole grains, beans and cooked vegetables that avoids sugar, stimulatory beverages and most meat. From the standard American perspective it sounds like Dullsville. I have had some excellent meals at macrobiotic restaurants, but those were, so to speak, one-night stands. I don't know what it would be like to be wedded to this diet for life. The rigorous food regimen is accompanied by many and varied recommendations about life style, some of which would be onerous for me. For example, followers are supposed to strictly limit their use of computers because of the alleged danger from electromagnetism.

Does It Work?

Of course, the question on everyone's mind is, "Does macrobiotics work?" Can it really cure cancer or other intractable diseases? Opinions are sharply divided. At yesterday's afternoon session, there was a devoted group of believers who overflowed the small meeting room. Some had perfect faith in this all-embracing system. There are also skeptics who think that macrobiotics is a kind of cult. Between these two extremes are those of us who want to know if there is something that might be beneficial to patients in this system.

The session brought forth strong testimony that sometimes the adoption of a macrobiotic diet is followed by the dramatic regression of advanced cancers. A nurse told how, in 1995, she was diagnosed with lung cancer that had spread all over her body. She received no effective conventional therapy, and reluctantly went on the macrobiotics diet. ("I have cancer, and now I have to eat this s**t," is how she graphically put it at the time.) What makes this case so extraordinary is that her progress was monitored weekly by a sympathetic physician colleague. The shrinkage, and finally the disappearance, of her tumors was documented millimeter by millimeter! She has now been disease-free for over five years. It is the kind of story that renews one's faith in the power of natural medicine to sometimes conquer this awful disease.

The trouble is that such well-documented cases are very rare. Usually you get cases that are muddled by confounding treatments, by missing records (films are often melted down for their silver after just a few years), or by scans that are technologically outdated and uninterpretable. A stellar case history, or even a case series, cannot answer the ultimate question of how often such cures are likely to occur. We have to remember that the people who testified are precisely those who responded and who lived long enough to extol the virtues of the method in question. Those who did not respond did not get to testify.

The Gold Rush

There is promise here but also some danger. To make an analogy: back in the 19th century, someone would find a lump of worthless "fool's gold," which would trigger the migration of thousands of desperate people. At other times, people would find genuine gold, but it would not be abundant enough to warrant a gold rush. Those people were also disappointed. Only rarely was gold discovered that could be extracted consistently and profitably and that justified extraordinary efforts.

After this week's meeting I could definitely say there is real gold in macrobiotics. But whether these herald a genuine strike, a Sutter's Mill, or just a few stray nuggets, I cannot yet say. What is needed now is a serious clinical study in patients, using all the resources the NIH can muster. The Kushi Institute deserves credit for having taken these first steps towards documenting its methods and results. An influential government panel is at last listening. Let's hope that a productive clinical trial will come of this encounter.

Remarkably, Dr. Warner's "olive branch" is starting to bear fruit.

--Ralph W. Moss, Ph.D.