Hardly a day goes by without a new complementary or alternative treatment for cancer appearing in the marketplace. The task of investigating the validity of such treatments can be overwhelming. Up until the present time, it has largely fallen to individuals (especially cancer patients and their families) to evaluate the merits of proposed treatments on their own. But cancer patients are generally ill equipped to make such evaluations. First of all, they are usually rushed for time and in an emotional turmoil over the diagnosis. Secondly, most are not educated in how to evaluate the safety and effectiveness of a treatment.

Historically, the agencies that evaluate cancer treatments have been extremely prejudiced against treatments that fall outside the norm. There is no need to re-open old wounds. Some of those old treatments undoubtedly had merit; others were pure quackery. It takes wisdom and experience to tell the difference, and wisdom is a scarce commodity.

In the last few years, government agencies, such as the National Institutes of Health (US), have begun the task of evaluating such non-conventional approaches using rigorous and appropriate methods and with a fair state of mind. The fact that such work is proceeding at a snail's pace is testimony to its difficulty.

Complementary treatments for cancer form a borderland between complementary treatments and standard oncology. To evaluate them we need to know something about cancer but also about CAM treatments in general.

So we need to ask, "What is a CAM treatment?" I hope I will not insult your intelligence by asking such an elementary question.

SLIDE: WHAT IS A CAM TREATMENT?

There is no standard or agreed-upon definition of "CAM." However some of the characteristics we expect in a CAM treatment are as follows:

--It is non-toxic or significantly less toxic than standard therapies. Thus, in cancer, most CAM treatments either enhance or maintain the integrity and capacity of the immune system. Unlike radiation or chemotherapy, a CAM treatment does not damage or destroy the immune system but enhances its functioning. In general, if a treatment is non-toxic or less toxic I consider it a kind of "alternative," regardless of where it is being investigated.

--It is based on a holistic philosophy. Modern science tends to be reductionist in nature. Reductionism is defined as the analysis of something into simpler elements or oganized systems, especially with a view to explaining or understanding it. It is the great discovery of Western science. However (according to the dictionary), another synonym for reductionism is "over-simplification," which is the misguided belief that everything can be explained in simple terms.

By contrast, CAM attempts to treat the entire person, body, mind and spirit. CAM tries to harness all bodily systems, all sources of healing, against the disease. While modern scientific medicine is aggressively materialistic, many CAM systems, such as Traditional Chinese Medicine (TCM) and Ayurveda, are vitalistic and philosophically, idealistic. This gives them a "religious," "old-fashioned" or "counter-cultural" aspect. And indeed, in America there is a strong historic link between alternative medicine and non-mainstream religions (such as Christian Science, Seventh Day Adventism, Jehovah's Witnesses, etc.), as you can quickly tell if you visit the Tijuana clinics, many of which display religious iconography.

--CAM may be based on unusual mechanisms of action, some theory of health or wellness that is not recommended in medical textbooks. True, some pharmacological and biological treatments purportedly work according to well accepted and agreed-upon mechanisms. But others rely upon novel (or discarded) theories of action. For example, many CAM treatments proceed from a theory concerning cancer that was propounded by Otto Warburg in the 1930s, but that has been discarded by most of conventional medicine since then.

In some cases, the proposed mechanism may defy the common sense of received scientific opinion. It thus tends to shade off into what is called "fringe" or even "crackpot "science. In fact, a while back, a standard psychological test asked the question, "Do you believe you know the cure for cancer?" An affirmative answer was considered a sure-fire way of spotting a psychotic!

--They are generally not approved by regulatory agencies, especially the US Food and Drug Administration (FDA), and not taught in medical schools, discussed favorably in the major peer-reviewed journals, compensated by insurance companies, or accepted as mainstream treatments by the media and opinion makers or the educated public.

Readers of Lynn Payer's outstanding book, Culture and Medicine, know that there are there are huge differences from culture to culture in what is accepted as "mainstream" medicine. In France, if you tell someone you are having trouble with your liver, they cluck their tongues sympathetically. But if you say you have a "virus" they rush you to the hospital. It is exactly the opposite in the United States. Similarly, what is considered standard, experimental, or quack medicine varies from culture to culture. Sometimes, treatments that are endorsed as standard by one regulatory agency-I am thinking of the immune-stimulating products of Germany-are rejected by agencies in other countries, such as the United States, and are regarded as either CAM or as outright "quackery." So, these categories are not writ in stone, but are culturally determined. When I visit spa towns in Germany I feel like I am in alternative medicine heaven. To Germans, this is just a normal way of viewing health and healing.

We might also mention the socio-economic dimensions of this conflict (the main subject of my first book, The Cancer Industry). Historically, conflicts have especially occurred when proponents of CAM cancer treatments were seen as attempting to substitute their innovative methods or products for established procedures. Sometimes, this entailed direct appeals to patients, encouraging them to avoid established methods, such as surgery, radiation therapy and chemotherapy, and to take a non-standard treatment instead. This either-or conflict created a great deal of friction between the "medical establishment" and proponents of the new methods.

SLIDE: MAJOR CAM TREATMENT CONTROVERSIES

In the 20th century ,the cancer field was roiled by a number of bitter controversies. Some of the most prolonged and bitterly fought were over the use of Coley's toxins (from the 1890s to the 1930s), the Hoxsey herbal and external formulas (1920s to 1950s), a proposed biological response modifier, Krebiozen (1940s to 1950s), a cyanogenic glycoside amygdalin, or Laetrile (1950s to 1980s), an inhibitor of gluconeogenesis, hydrazine sulfate (1980s and 1990s), and the Gerson diet (1940s to 1990s) and the Livingston vaccine and IAT immune treatment (1970s-present) and Burzynski's antineoplastons (1976-present).

In each case, there was resistance or refusal on the part of the medical establishment to conduct thoroughgoing or fair trials of these methods. For their part, practitioners of these methods turned in varied performances. Occasionally, they became paranoid. But their reception from the medical establishment resembled the martyrdom of Giordano Bruno at the beginning of the scientific era.

This is not to say that they were always blameless. Sometimes they fulfilled one's expectations of the back-of-the-wagon cancer quack. For instance, Harry Hoxsey, a former coal miner, often claimed that his internal mixture could cure 80 percent of cases of advanced cancer. In fact, the latest investigations confirm that very few people (at least today) are cured or even benefitted by this method.

Fundamentally, I would say that the situation has changed for the better. At one time, CAM cancer practitioners were barred from publishing in peer-reviewed medical journals, and thus from influencing their colleagues in a dispassionate forum. Today, many outlets exist for the publication of peer-reviewed articles and communications on CAM treatments. Some CAM journals, such as Alternative Therapies in Health and Medicine, are indexed in Medline. Other journals, such as Journal of the American Medical Association, the Journal of the National Cancer, and the Lancet, have begun to open their pages to non-conventional treatment cancer treatments.

SLIDE: TEN ALTERNATIVE TREATMENTS IN A CONVENTIONAL SETTING

(92nd Annual Meeting of the Amer. Assoc. for Cancer Research, 2001)

1. MGN-3, an anticancer agent made from rice bran and mushrooms
2. SPES and PC SPES, Chinese herbal mixtures used for pancreatic cancer
3. EGCG, from green tea, used as to treat pancreatic cancer cells.
4. Curcumin, derived from turmeric, and resveratrol, derived from red wine
5. Japanese butterfly alkaloids as a cytotoxic agent
6. Butyric acid, derived from butter, against ALL-leukemia
7. Squalene, from shark liver oil, to protect bone marrow during chemotherapy
8. Ascorbic acid and copper as a treatment for advanced breast cancer
9. Anvirzel, extract of the oleander bush (nerium oleander), as anticancer agent
10. Morinda citrifolia (noni) against breast and colon cancer cells

What is unusual is that all of these treatments are being discussed at the 2001 meeting of the American Association for Cancer Research (AACR) in New Orleans, LA this weekend. I ask you: is this "alternative medicine"? Or "conventional medicine"? I call them alternative treatments in a conventional setting. Anything can be subjected to scientific inquiry, even noni juice. There is a broad basis for cooperation between conventional and alternative medicine in the cancer field.

SLIDE; MAIN USES OF CAM THERAPIES

There are currently five main uses to which CAM cancer treatment is put:

(1) Primary prevention: People are using diets and supplements in particular to try and ward off the occurrence of cancer in the first place, and improve their odds of not getting the disease.

(2) Secondary prevention: In the United States, there are at least eight million people who have had cancer and are now either struggling with it or hoping to prevent a recurrence. Various CAM procedures have much to offer these individuals. Many are using their local CAM-oriented practitioners to help devise such programs.

(3) Reduction of Side Effects: During the course of conventional treatment many patients suffer side effects-from the wounds of surgery, the burns of radiotherapy and the systemic poisoning effects of cytotoxic chemotherapy. CAM procedures can be used to reduce those side effects (although the usage of antioxidants concurrently with radio- or chemotherapy is controversial). Some cancer centers are incorporating these non-conventional procedures (especially mind-body techniques and acupuncture) into conventional care.

(4) Modulation of Immunity : Some forms of cancer are associated with a disruption of immunity. At the same time, conventional treatments create short-term and possibly long-term deficits in normal immunity. Many CAM treatments are associated with enhancement and modulation of immunity. Providing immune modulation may enhanced effectiveness of conventional approaches and allow for quicker healing.

(5) Treatment of Advanced Disease: Many patients first consider CAM treatments when it appears that conventional medicine has nothing further to offer them. In truth, this is what fuels the flight of many patients to offshore clinics, such as in Mexico, the Caribbean, and northern Europe as well as to some American centers that are doing non-conventional work.

SLIDE: PREVALANCE OF CAM USE AMONG CANCER PATIENTS

How prevalent is the use of CAM among cancer patients? This depends on when the question was asked and how CAM is defined.

In 1989, Lerner and Kennedy surveyed American patients for the American Cancer Society. Their report, published in 1992, found that 9 percent of patients were using one or more "questionable treatments." In the highest income and education groups, however, this use was already 13 percent. It took some fancy footwork to explain why the use of "questionable methods" went up with education and income!

In a 1998 article, Ernst and Cassileth looked at recent surveys of usage around the world. They found that estimates that varied from as little as 7 percent to as much as 64 percent. The average was 31.4 percent.

In Holland, Grootenhuis found that 31 percent of pediatric patients were being given CAM along with their conventional treatments.

In Canada, general usage was around 42 percent.

The highest estimate came from California, where 80.9 percent of breast cancer patients in one university clinic were taking food supplements. Even if we accept the Ernst-Cassileth estimate, we conclude that CAM use has increased more than three-fold in the past decade, a remarkable vote of confidence by the public worldwide.

In the United States, there has been a dramatic shift of attitude within the medical and scientific establishments. The formation of the Office of Alternative Medicine at the National Institutes of Health in 1992 was the watershed event. Because of its growing influence and acceptance, an increasing number of hospitals, medical societies and journals have become at least neutral towards the topic of CAM. Others have become more positive in their assessment. The University of Texas School of Public Health, with OAM funding, launched a major project to evaluate some of the most prominent CAM treatments. They enlisted the help and support of M.D. Anderson Cancer Institute, the top rated cancer center in the United States.

Memorial Sloan-Kettering Cancer Center in New York, with a $12 million dollar gift from the Rockefeller family, launched a center to provide complementary care to some of its patients. Similar efforts are underway at many institutions, such as Stanford University, Columbia University, and others.

The American Cancer Society, the largest health charity in America, has revised its previously negative statements on CAM treatments. It now differentiates between complementary and alternative treatments, and accepts the harmlessness and probable validity of most complementary treatments. Its statements on cancer alternatives have now come under public attack by the "quackwatch" website, as soft on quackery. The American Medical Association has devoted a special issue to CAM, in a non-hostile fashion. This was a watershed for that powerful organization. The Lancet in 2000 announced a new policy of "critical engagement" with CAM and in 2001 published three letters from researchers into CAM.

The attitude of the National Cancer Institute and the National Institutes of Health have undergone positive changes over the last decade. In August, 1997 the National Cancer Institute and the Office of Alternative Medicine hosted an international conference on Practices Outcomes and Monitoring Evaluation System, or POMES. This historic meeting brought together approximately 100 experts on the evaluation of non-conventional cancer treatments. With a little help from Congress, in October, 1998, this led to the creation of the Cancer Advisory Panel on Complementary and Alternative Medicine (CAP-CAM). This advisory group has responsibility for advising the government on the testing of such methods.

In October, 1998, the Congress passed legislation changing the Office of Alternative Medicine into a National Center for Complementary and Alternative Medicine. The purpose of this new Center will be to "conduct and support" complementary and alternative research, with an emphasis on the integration of CAM with conventional medicine. The new office will have its own funding authority and will have an initial budget of $50 million. In 2001, the alternative medicine budget at NIH totalled $99 million (of which $89 went to NCCAM). This is a small amount compared to the overall NIH budget, but it is almost fifty times the initial OAM budget in 1992.

SLIDE: ORGANIZATIONS STILL HOSTILE TO CAM

Despite all this, a number of organizations and individuals maintain old attitudes and remain hostile to CAM treatments for cancer. Some years ago, the New England Journal of Medicine launched a campaign against CAM in general, and CAM cancer treatments in particular. That campaign has fizzled, but the New England Journal maintains its hostility.

The enforcement wing of the Food and Drug Administration continues to harass practitioners of alternative methods (although many FDA scientists are more friendly). In particular, FDA has recently rekindled the "laetrile wars" of the 1970s and 1980s, and has indicted a distributor of the unconventional drug, hydrazine sulfate. A non-substantial article in the Annals of Internal Medicine in 2000 supported the FDA's contention that hydrazine sulfate is a toxic drug.

Unfair critics of CAM cancer treatments are the "quackbusters" centered around the website, Quackwatch.com, the American Council Against Health Fraud and a number of "skeptical" magazines, which keep up a steady barrage of one-sided criticism and propaganda. The Quackwatch.com website, organized by Stephen Barrett, MD, takes a critical view of almost every CAM treatment for cancer. It has nearly nothing positive to say about any treatments but the orthodox triad of surgery-radiation-chemotherapy. The rise of the Internet not only revived many once nearly-dead cancer theories and treatments, but also has been a shot in the arm to the unreasonable critics of CAM.

In general, the mainstream media have not done much better on CAM and cancer issues. It is hard to point to a single writer at a major journal who is friendly towards CAM, although individually favorable articles do occasionally appear. Some science writers at the New York Times (the so-called "newspaper of record") have not reconciled themselves to the new atmosphere.

In addition, despite changes at the top, many physicians and scientists (especially those educated in the old atmosphere) maintain a hostile attitude. Since such hostility had deep, historical roots dating back over a century, it is by no means an easy task to promote the acceptance or even the fair testing of CAM cancer treatments against such ingrained hostility.

The answer to both unfounded advocacy and undue skepticism is good science. This means appropriately designed and funded clinical trials. At the present time, the National Cancer Institute is funding a randomized clinical trial (RCT) of the Gonzalez (Kelley) method. The study population is made up of patients with biopsy-confirmed adenocarcinomas of the pancreas. Half of the group will receive the chemotherapeutic agent Gemzar (gemcitabine). The other half will be treated by an innovative and controversial physician, Nicholas Gonzalez, MD of New York City, using a combination of an individualized diet, high-dose pancreatic extracts, and detoxification (primarily coffee enemas), usually called the "Kelley method." This study is taking place at the comprehensive cancer center of Columbia University in New York City, under the direction of Karen Antman, MD, past president of the American Society for Clinical Oncology (ASCO). It has received favorable coverage in the New Yorker magazine and damaging attacks in the Washington Post. The results are bound to be extremely controversial.

The National Cancer Institute is also testing several other non-conventional treatments. These include various shark cartilage products and green tea. A low-fat diet is being evaluated as a form of prevention for breast cancer at the American Health Foundation. Johns Hopkins has received $8 million from the NIH for research into CAM treatments for cancer. These include the use of sour cherries to relieve pain and of intercessionary prayer among African-American women with breast cancer.

There is talk of clinical trials with PC SPES, a Chinese-American formulation for prostate cancer. In addition, efforts continue to bring about independent confirmation of the claims made for Burzynski's Antineoplaston peptides and Csatáry's MTH-68, a non-pathogenic form of Newcastle Disease Virus.

SLIDE: NEW TREATMENTS OF INTEREST

There are literally hundreds of complementary and alternative treatments that are in use around the world and that could be scientifically studied. Needless to say, deciding on which ones should work their way up the research ladder till they reach full-scale RCTs is an arduous task. Ideally, RCTs should be based upon extensive in vitro and in vivo tests in the laboratory. Let me categorize the various CAM treatments that are currently in use and indicate the rationale for further study:

Some of the treatments that appear worthy of further investigation include the following:

Paracure: Otherwise known as Arglabene, it is a compound derived from a form of wormwood, Artemesia glabella, which seems to have anticancer activity in human hepatoma and some other forms of cancer. It is a product of plant-derived drug development in Khazakstan, in the former Soviet Union.

Digitoxin: In 1967, O. Shiratori noted that cardiac glycosides as well as aglycones had a growth inhibiting effect on cancer cells both in the test tube and in laboratory animals. Independently, in the 1970s, Björn Stenkvist, M.D., of University Hospital in Uppsala, Sweden noticed that there seemed to be fewer breast cancer recurrences among patients who also had heart disease. At that time, most cardiac patients received digitoxin, and so it occurred to him that "digitalis in itself had some kind of modifying influence on the course of the disease." In a retrospective study he found that the rate of recurrence was 9.6 times lower in the digitalis group than in controls. This work has now been revived and expanded by a young oncologist, Johan Haux, MD of Trondheim, Norway.

Carcagel: This is a traditional American treatment for skin cancers composed of a mixture of zinc chloride, bloodroot (Sanguinaria canadensis), and galangal (Alpinia officinarum). It is an escharotic, which is a burning paste. Although such treatments are dangerous in lay hands, they have a scientific usefulness when other methods involve unacceptable side effects. Dr. Jose Gonçalves, a dermatologist of Santarém, Portugal.

--PolyMVA: This is a mixture of palladium and lipoic acid, as well as trace amounts of other vitamins, developed by Merrill Garnett, DDS of the State University of New York in Stony Brook. There is strong anecdotal data for a number of cancers and a study on brain cancer is being contemplated at the Neurological Institute of Columbia University.

--IP6 (Cell Forte): This is a mixture of the B vitamin inositol and its derivative, inositol hexaphosphate, otherwise known as phytate, phytic acid or IP6. This was first identified in 1855, but its possible use as a cancer treatment was not known until the 1980s. During that time, AbulKalam M. Shamsuddin, MD, PhD, a professor of pathology at the University of Maryland School of Medicine in Baltimore performed experiments in rodents showing that IP6 could decrease the elevated rates of cell division that occur during cancer formation, but does not affect the normal rate of division in otherwise healthy animals. There is intriguing data on its ability to prevent the number of size of tumors in rats. IP6 is currently sold as a food supplement called Cell Forte.

--MGN-3: This is an arabinoxylane derived from rice bran conjugated with certain chemicals derived from Asian mushrooms. It has been proposed as a cancer treatment by M. Ghoneum of Drew University, Los Angeles.

Some Dietary Treatments:

-The Gerson Diet has been in widespread use for nearly 70 years. It is intensively practiced at three Tijuana clinics (Oasis, Meridien and CHIPSA). Retrospective reviews by Gar and Christeene Hildenbrand showed that stage III and stage IVA melanoma patients who used the Gerson diet had substantially better outcomes than average patients.

-The Kelley method. This diet-supplement-detoxification regimen was developed by William D. Kelley, DDS. It is based in part on the Gerson diet, with a heavier emphasis on food supplements. It is currently under review at Columbia University.

--Macrobiotic diet. The subject of many books and articles. It could be scientifically studied, as has been proposed by Lawrence Kushi, PhD, also of Columbia University, and son of the Michio Kushi, leader of macrobiotics.

Supplement Programs

--The use of high-dose intravenous vitamin C and other nutrients should be re-examined. The negative Mayo Clinic studies of the early 1980s only used orally administered vitamin C. There is some interest in reviving studies using IV drips.

--Specific antioxidants have generated interest as potential therapeutic agents. We might mention the success of vitamin A analogs in the treatment of head and neck cancer. A small and non-rigorous study seemed to show that coenzyme Q10 had therapeutic effects in advanced breast cancer. There is intense interest in alpha-lipoic acid, the tocotrienols, gamma-tocopherol, selenium, limonene, etc. But probably a group of antioxidants should be studied together for the maximum synergistic effect.

--The use of antioxidants as an adjuvant treatment to chemotherapy and/or radiation therapy in cancer. The prevailing prejudice among oncologists is that antioxidants will interfere with conventional methods. Yet research by Kedar Prasad, PhD of the University of Colorado, shows exactly the opposite. Antioxidants are highly synergistic with conventional treatments. This question is ripe for some good RCTs

Energy Medicine

There are various forms of energy medicine that are being used against cancer. These include:

Hyperthermia, local, regional and whole body;
Galvano therapy;
Infrared sauna

This is related to Coley's toxins and fever therapy.

Immunotherapies

There are various kinds of immunotherapy that are currently being practiced:

Autologous cancer vaccines
Coley's toxins
Non-specific immune stimulators
Dendritic cell vaccines
Immuno-augmentative therapy

SLIDE: POORLY DOCUMENTED TREATMENT

At the same time, we recognize that the problem of poorly documented, and even outright fraudulent, treatments continues to exist. There are, unfortunately, many of these. In my book, Herbs Against Cancer, I discuss a number of purported cancer treatments for which there is little factual basis.

Aveloz: This is a Brazilian herbal treatment publicized through "supermarket tabloid" newspapers. Dr. James Duke, Ph.D., formerly of the United States Department of Agriculture, is often quoted in support of this product. Actually, Dr. Duke states that this product is more likely to cause cancer than to cure it.

Colloidal minerals: The proponent of this treatment has made a fortune with an audio tape claiming that medical doctors in the United States die at any early age. In fact, American doctors die at the same age as the rest of the population. The colloidal minerals he sells are potentially dangerous because of heavy metal contamination.

Grape cure: There is an extraordinary lack of scientific data to support the exaggerated claims made for this old treatment.

HANSI: A sensation in Argentina, this is an injectable form of "homoeopathic" cactus preparation. There is little data--as of yet--to support a curative role for this treatment, although proponents have evinced some interest in scientific tests.

Hulda Clark: This "cure for all cancers" is based on the erroneous premise that a parasitical worm, called Fasciolopsis buski, is responsible for all cases of cancer, and most other diseases as well. The proponent suggests that a mixture of wormwood, cloves, and tincture of green walnut hulls can cure cancer. Actually, wormwood in particular is potentially dangerous because of the presence of thujone.

Noni juice: There is virtually no data to support the use of this compound as a treatment for cancer. It is aggressively marketed through a multi-level marketing scheme.

Vitae Elixxir: An American herbal mixture that seems to have considerable toxicity and virtual no data to support its effectiveness.

SLIDE: LEADING INTERNATIONAL ALTERNATIVE CANCER CLINICS

Name of Clinic Main Location Principal Director Main Treatments

1. Advanced Alternatives,Reno, Nevada Philip Minton RA Therapy
2. Aeskulap Brunnen, Switzerland Marcel Brander Eclectic
3. Aidan Clinic Tempe, Arizona Neil Riodran Dendritic cells
4. Amer. Metabolic Inst. Tijuana, Mexico Geronimo Rubio Eclectic
5. American Biologics Tijuana, Mexico Robert Bradford Eclectic
6. Benediktusquelle Selters-Ortenberg, G Alexander Herzog Hyperthermia/chemo
7. BioMed Bad Bergzabern, G E. Dieter Hager Hyperthermia/chemo
8. BioPulse Tijuana, Mexico Loran Swensen IHT/Dendritic
9. Block Medical Center Evanston, Illinois Keith Block Mind-body/diet
10. Brody, Douglas Reno, Nevada Douglas Brody Eclectic/laetrile
11. Burzynski Res. Inst Houston, Texas Stan. Burzynski Antineoplastons
12. C.S.C.T. Tijuana, Mexico John Armstrong Magnetic therapy
13. CHIPSA Tijuana, Mexico Dan Rodgers Eclectic/Coley/HBO
14. Clark, Hulda Tijuana, Mexico Hulda Clark, Detoxification
15. Gonzalez center New York City Nicholas Gonzalez Kelley Method
16. Hufeland Bad Mergentheim, G Wolfgang Woeppel Issels
17. Humlegaarden Humlebaek, Denmark Finn Andersen Hyperthermia/eclectic
18. Immuno-Augmentative Th. Freeport, Bahamas John Clement Immunotherapy
19. Immune Institute Huntington Beach Darryl See Immunotherapy
20. International BioCare Tijuana, Mexico Rodrigo Rodriquez Eclectic/laetrile
21. Livingston Foundation San Diego, Ca Immunotherapy
22. Lukas Klinik Arlesheim, Switz. Mistletoe
23. Neue Wicker Bad Nauheim, G W.W. Wicker Eclectic
24. Oasis of Hope Tijuana, Mexico Contreras family Eclectic/Gerson
25. Paracelsus Klinik Switzerland Thomas Rau Eclectic/dental
26. San Diego Intl Tijuana, Mexico Filiberto Muñoz Eclectic
27. Schachter Center Rockland Cty., NY Michael Schachter Eclectic/laetrile
28. Scheef, Wolfgang Bonn, Germany Wolfgang Scheef Chemotherapy
29. St. Georg Klinik Bad Aibling, G Friedrich Douwes Eclectic/hyperthermia
30. Valley Cancer Institute Los Angeles, CA Haim Bicher Hyperthermia/radiation

SLIDE: CONCLUSIONS

The field of complementary and alternative medical (CAM) treatments for cancer is a very exciting and promising source of new therapeutic ideas. In the past, this field has been contaminated by many fraudulent claims and bogus "patent medicines." While such practices are not unknown today, there is a general consensus that claims need to be verified through the highest level of scientific evaluation, particularly randomized clinical trials (RCTs).

CAM treatments today are most properly used as adjuncts to conventional treatments, such as surgery, radiation therapy and chemotherapy (where these have been proven to extend life). Although the medical profession has in the past blindly opposed all such treatments, there is a new openness today. Patients all over the world are demanding the integration of such treatments into their overall care. Worldwide, between 30 and 40 percent of patients are already using such adjuvant treatments.

There is a need for intensive, appropriately designed studies to evaluate the safety and effectiveness of such treatments. This can take the form of outcomes research and investigations, epidemiological studies, health services research, basic science research, clinical trials, and other appropriate research and investigational activities.

The formation of the Cancer Advisory Panel of the National Institutes of Health will speed this process. So too will the conversion of the Office of Alternative Medicine (OAM) into the new National Center for Complementary and Alternative Medicine, with annual funding of nearly US $100 million.

Especially important is the on-going cooperation and collaboration between cancer investigators in the United States and those in Germany and elsewhere, who have long struggled for the scientific evaluation of non-conventional treatments.

THE END