Cancer Decisions - Free Newsletter -September 5, 2003

AN INFORMED READER COMMENTS ON GRAVIOLA

Roger DeLong runs the www.paudarco.com website and knows a thing or two about South American herbs. He recently wrote, "You hit the nail on the head in your speculations about the much hyped herb called Graviola….I found nothing to substantiate any claims relating to the herb as an alternative cancer treatment in my searches on the Internet. I have had several inquiries about the herb from past customers and reply that I have to speculate that the whole Graviola campaign has been instigated…to promote…sales of the herb."

"I am glad that you have finally published your recent article on this subject. Hopefully, many will become aware of the disreputable opportunists that prey on the uninformed... and many thanks for your efforts to educate the many victims looking for viable information and assistance in this age of pharmaceutical looting of the American public."

If you share Mr. DeLong's feelings, won't you please take a moment and forward copies of this newsletter to friends who are also interested in cancer, urging them to subscribe? It costs nothing, yet could be of great importance to their future well-being. Thank you.

A FRIENDLY SKEPTIC LOOKS AT ARTEMISININ

Artemisinin is a chemical derived from the common herb Artemisia annua, known in the West as "sweet wormwood" or more poetically as "sweet Annie." This plant (known as Qinghao) has been used in China to treat fevers for over 2,000 years. The chemical artemisinin, known in Chinese as qinghaosu (QHS), was first isolated in 1972 and synthesized in 1983. Its usefulness as a relatively nontoxic antimalarial drug was confirmed in clinical trials in the 1980s. Derivatives (metabolites) of artemisinin, such as artesunate, are also used against malaria. For example, artesunate rectal capsules are used in Africa by the World Health Organization (WHO) for the initial management of acute malaria in patients who cannot take medication by mouth and for whom injectable treatment is not available. The therapeutic value of artemisinin and artesunate as antimalarial agents is thus well established.

However, some doctors have also begun using artemisinin and artesunate in a less conventional way - as a treatment for cancer. This practice seems to have begun around 30 years ago in China and Vietnam and has now spread to the United States and other countries. What is the scientific basis, if any, for such usage?

There are over 800 articles in PubMed, the National Library of Medicine's database, on the topic of artemisinin but only 29 of these relate to cancer. There is some laboratory evidence pointing to artemisinin's potential value against cancer, but, like all test tube studies, it has major limitations and cannot be automatically extrapolated to clinical situations.

The published articles are largely positive, even enthusiastic, in tone and indicate that artemisinin and its metabolites do indeed kill cancer cells in the test tube and inhibit new blood vessel formation (a process called 'neoangiogenesis'). They thus can be reasonably considered "promising novel candidates for cancer chemotherapy" (Chen 2003). But it is important to note that of the 29 PubMed articles on artemisinin and cancer, the number of actual clinical studies (in humans or domesticated animals) is zero.

Turning to the Web, we find 8,000 sites referencing artemisinin, over 1,700 of which also relate to cancer in some way. There are quite a number of websites selling artemisinin to cancer patients. Many of the statements appearing on these websites were inspired by an article by Robert Jay Rowen, MD, of Santa Rosa, California, in his medical newsletter for laypeople, "Second Opinion". A version of that same article was also published in the Townsend Letter in December, 2002 and is available online.

Rowan article:
http://www.townsendletter.com/Dec2002/artemisinin1202.htm

Dr. Rowen is obviously enthusiastic about artemisinin, yet despite the admirably measured way he addresses this controversial topic we need to look very carefully at the claims in his article.

"For the past ten years," he says, "the Hoang medical family…ha[s] used artemisinin in combination with several other herbs to treat cancer, and eliminate necrosis material from the body...." Members of this same family indicated that they have achieved a 50-60 percent long-term remission rate in over 400 cancer patients utilizing artemisinin together with a comprehensive cancer strategy, and with no observed toxicity.

Need for Further Documentation

First of all, we know next to nothing about the Hoang family. The assertion that they have been practicing medicine in Vietnam for three generations tells us very little about their honesty, probity or scientific acumen. They may be great pioneers…or something else entirely. In actuality, the only reference to them on the Internet is that contained in Dr. Rowen's newsletter.

Rowen says that "the efficacy of the artemisinin compound is very impressive for the treatment of breast cancer and possibly to prevent it." These are generalizations which demand substantiation. Talk of giving 300 milligrams of this chemical compound along with other herbs as a preventative to symptom-free people raises ethical questions similar to those posed by clinical trials that give potentially toxic drugs to patients who have no visible signs of cancer.

Dr. Rowen also states that "artemisinin is appealing for oral use in that the pharmacodynamics, dosage and toxicity have been well studied for use in relationship to the treatment of malaria. Artemisinin is relatively safe with little side-effects even at high dosages (70 mg/kg per day) in short term malaria use."

While the clinical experience with malaria is undoubtedly valuable, it hardly predicts what will necessarily happen when people with advanced cancer take artemisinin, either on its own or along with other treatments. Drugs can interact with other agents in unpredictable ways in the bodies of cancer patients. Shouldn't there be laboratory and Phase I studies performed in cancer patients to make sure that such therapeutic doses of artemisinin are really without side effects, as claimed? And shouldn't an Institutional Review Board (IRB) oversee such studies to safeguard the fundamental interests of patients?

Artemisinin is also said to "balance the hormones in the human body". This is another big claim - but an imprecise one. Exactly which hormones need balancing in cancer? The footnote on the topic in the Townsend Letter article turned out to be simply a personal communication between Dr. Rowen and Dr. Hoang. In other words, Dr Rowen reports that artemisinin works in a certain way because Dr. Hoang told him so. While personal communications are sometimes useful in scientific research, one cannot base treatment decisions on them. They have the lowest standing as sources of objective facts, since they depend on the non-peer reviewed observations of individuals.

Dr. Rowen next cites three articles on cell line research on artemisinin and cancer. I think we can all agree that artemisinin kills various kinds of cancer cells in the test tube. But it is an overstatement to say that "artemisinin may be a most effective method, and certainly one of the easiest, of delivering a knockout oxidative stress to cancer cells." This is purely speculative, since to my knowledge the issue has never been tested in a formal study in living patients.

That is the full extent of the scientific documentation of artemisinin's proposed anticancer effects. It is all based on promising, yet limited, cell line research. No human or veterinary studies have been done, nor any in vivo animal research in the laboratory. While laboratory experiments with cell lines may be a necessary and useful first step in research, cell lines are not directly equivalent to actual cancer tissue found in patients. (See Gerald B. Dermer's book The Immortal Cell for corroboration of this point of view.)

TO BE CONCLUDED NEXT WEEK (WITH REFERENCES)

--Ralph W. Moss, Ph.D.

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IMPORTANT DISCLAIMER

The news and other items in this newsletter are intended for informational purposes only. Nothing in this newsletter is intended to be a substitute for professional medical advice.