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CAM Scams: Poisons as Cancer Cures Lewis Nelson, MD New York University School of Medicine New York City Poison Control Center "I am glad to be among my own kind tonight. I was once a sharpshooter, but now I practice a much higher and equally as deadly a profession" Mark Twain Complementary and Alternative Medicine (CAM) Complex collection of unrelated therapies – Theoretical clinical basis (relaxation) – Theoretical biological basis (herbal medicine) – Widespread acceptance (acupuncture & chiropractic) Variable training and certification requirements for practitioners – Some feel that formal regulation would serve to legitimize them Most have limited scientific support – A few have a checkered history of quackery Fraudulent offering of medical skill Cancer therapy Current chemotherapy (possibly excluding immunotherapeutics) works by exploiting differences between normal and cancerous cells – Rate of division – Uptake of medication – Utilization of antidote Unfortunately, scammers have used this same logic to push their products Case A 65 year-old woman presents after a witnessed syncopal episode. Past medical history significant for HTN and metastatic adenocarcinoma of the colon. Has been seeing a naturopathic health care provider for treatment. Case 1 month history of loose stools On day of presentation had witnessed collapse without incontinence, seizure activity or tongue biting. Spontaneously awoke, was amnestic of the event. Case Vital signs: BP 138/55 mmHg P 52/min Temp 36.8°C RR 18/min SpO2 95% on room air Rapid bedside glucose 10 mmol/L Case Exam A&Ox3 HEENT: Small contusion on forehead Chest: Clear Heart: Normal Abdomen: Soft, non tender Extremities: Normal Neurologic: No focal neurological findings Medications Naturopathic products – – – – Unknown “herbal” powder A tablet: Gigamax A tablet: Multi C A tablet: Slow K QTc = 700 msec Labs K+ 2.8 mEq/L Magnesium and calcium, normal In the ED, the patient had 4 episodes of syncope lasting 10-20 sec each. A rhythm strip is shown: www.naturopathic.org/ Naturopathy “Cancer is a mutated cellular process which results from high intake of refined foods, fake foods, processed foods, including processed white sugar products, artificial sweeteners, white flour products, packaged foods, food preservatives, food color and dye additives, and foods grown with pesticides, herbicides, antibiotics and hormones.” Naturopathy “Naturopathic Medicine believes that….all cancer is both fungal and viral in origin, and sometimes parasitic.” “….health disorders [including cancer] are most likely a result of nutritional imbalances as well as an accumulation of toxic substances.” Naturopathic Cancer Cures Colloidal Silver 500 ppm Oil of oregano P73 Physician's Strength Garlic Kyolic Organic Liquid #10020 Aloe Vera CoQ10 Q-Gel® With Vitamin E Liquid Vitamins/Minerals Calcium/Magnesium Powder Himalayan Goji Juice “Be careful about reading health books. You may die of a misprint.” Mark Twain Herbal Cancer Treatments CanCell Hoxey’s Therapy Gerson’s Etc….. CanCell/ProtoCel “Lowers the voltage of the cell structure by about 20%...so they ‘self digest’” Warn that bottles of CanCell should not be allowed to touch each other Claim that CanCell cannot be analyzed because it varies with atmospheric vibrations Inositol Nitric Acid Sodium Sulfite Potassium Hydroxide Sulfuric Acid Catechol Crocinic Acid National Cancer Institute states, “The nature and origin of this chemical has not been provided, and it does not appear to be a known compound.” Gerson’s Cure Need to detoxify Vegetarian Diet Vitamins Liver injections Coffee Enemas Gerson Institute in Bonita, California Laetrile Trade name of an extract of fruit pits that contains l -mandelonitrile-betaglucuronoside, or amygdalin – Cyanogenic glycoside – Acronym for laevorotatory and mandelonitrile Used for more than a century as an active anticancer regimen 1970 petition to study it denied by FDA – Viewed by some as an attempt by the US government to block cancer therapies Multiple court cases – Laetrile was legalized in more than 20 US states during the 1970s. – Must certify that the patient is “terminal” In 1980, the US Supreme Court overturned decisions by the lower courts – Reaffirmed FDA’s position that drugs must be proven to be both safe and effective before widespread public use. HO O HO HO O OH Amygdalin O HO C N HO OH O C Glucosidase H C N HO HO HO O Hydrogen cyanide OH Glucose (2) H C O OH Benzaldehyde Administered by intravenous injection. – Although the GI tract cells have glucosidase, the remainder of the body’s cells do not. Proponents claim that cancer cells, unlike normal cells, are particularly rich in glucosidase and they release cyanide from amygdalin which destroys the cancer cells. Laetrile has shown little to no anticancer effect in laboratory studies, animal studies, or human studies. Not surprisingly, the adverse effects of Laetrile are similar to those of cyanide. The Clinical Trial (Mayo Clinic) A prospective, open-label evaluation of amygdalin plus "metabolic therapy“ in 178 patients with various cancers. 21 days of IV amygdalin 4.5 grams/m2 followed by 500 mg amygdalin tablets TID. – Plus metabolic therapy consisting of vitamins, minerals, and pancreatic enzymes. Primary outcomes measured were tumor response and survival. Moertel CG. N Engl J Med 1982;306:201-206 1 partial response 79% had progression at 2 months – 91% by 3 months. – Median survival: 4.8 months from initiation Adverse effects: HA, N/V, dizziness, obtundation. Significantly elevated blood cyanide concentrations. Moertel CG. N Engl J Med 1982;306:201-206 The results suggest that amygdalin is ineffective in the treatment of cancer. Claims for Laetrile’s effectiveness shifted from a cancer cure, to a cancer “control” agent, to a "vitamin” (called B17) purported to prevent cancer. Moertel CG. N Engl J Med 1982;306:201-206 The Internet search found several websites still selling Laetrile or offering related clinical services. All in Mexico “Oasis of Hope” http://www.amygdalin.co.uk Elements and simple molecules Widely touted as cancer cures “Hyperoxygenation therapy” – It is claimed by proponents that intravenous ozone can “dissolve” malignant tissues due to their deficiency of the protective enzyme catalase. “Autohemotransfusion” of ozone – Blood mixed with ozone and retransfused. – In one case, clinical and postmortem studies revealed gas embolism and patent foramen ovale. The Role of pH In a seminal paper, Dr. A. K. Brewer, a physicist, describes two pH therapies available for treating cancer: – Low pH Therapy – High pH Therapy Low pH Therapy “….glucose is injected into the blood stream. As a consequence, the cancer cell pH will drop eventually to the 5.5 range.” “The patient is then placed in a furnace heated to 104 degrees Fahrenheit (40C) for a matter of hours.” “At these high temperatures and in the acid medium, the life of cancer cells is very short.” “The only drawback is that severe toxemia may result from the out-leakage of the acid toxins within the tumor masses.” High pH Therapy “….consists of feeding the patient about 6 gm of CsCl per day in conjunction with Vitamins A and C, which upon absorption by the tumor cells will give rise to the pH to 8 or above…” High pH Therapy Cancer cells undergo anaerobic metabolism – Produces lactic acid This alters DNA to allow uncontrolled growth Also causes pain Cesium is an alkaline earth metal – Highly electropositive, generates alkaline solution – Though given as the chloride salt Follows sodium pathway into cells Purportedly raises intracellular pH to 8 – Stops mitosis – Ends pain High pH Therapy “Two side effects have been observed in some of the patients. These are first nausea, and the second diarrhea.” Oh yeah…. Cesium Chloride Why do people fall for quackery? Proponents almost never keep score or reveal what percentage of their cases end in failure. – How good is the diagnosis The patient never had cancer – If the patients die, “they were too late to be cured” Proponents are very convincing, charismatic – Cancer patients are particularly vulnerable Thank you References National Cancer Institute. http://www.cancer.gov/cancertopics/treatment/cam. Accessed 2/25/08 Goldfrank L et al. Goldfrank’s Toxicologic Emergencies. 7th Ed, McGraw Hill, New York. 2002: pp. 1-15, 1183-119, 1498-1504. Soignet SL et al. Complete remission after treatment of acute promyelocytic leukemia with arsenic trioxide. NEJM 1998;339:1341-1348. Brewer AK. The high pH therapy for cancer tests on mice and humans. Pharmacol Biochem Behav 21: Suppl. 1, 1-5. 1984. Dalal AK, Harding JD, Verdino RJ. Acquired long QT syndrome and monomorphic ventricular tachycardia after alternative treatment with cesium chloride for brain cancer. Mayo Clin Proc 2004; 79(8):1065-1069. Jones DL, Petrie JP, Li HG. Spontaneous, electrically, and cesium chloride induced arrhythmia and afterdepolarizations in the rapidly paced dog heart. Pacing Clin Electrophysiol 2001; 24(4 Pt 1):474-485. Pinter A, Dorian P, Newman D. Cesium-Induced Torsades de Pointes. NEJM 2002 346: 383-384 References Moertel CG, Fleming TR, Rubin J, et al. A clinical trial of amygdalin (Laetrile) in the treatment of human cancer. N Engl J Med 1982;306:201-206 Chlebowski RT, Bulcavage L, Grosvenor M, et al. Hydrazine sulfate influence on nutritional status and survival in non-small-cell lung cancer. J Clin Oncol 1990;8:9-15. Marchetti D, La Monaca G. An unexpected death during oxygen-ozone therapy. Am J Forensic Med Pathol 2000;21:144-147. See KA, Lavercombe PS, Dillon J, Ginsberg R. Accidental death from acute selenium poisoning. Med J Aust 2006;185:388-9. Lyon AW, Mayhew WJ. Cesium toxicity: a case of self-treatment by alternate therapy gone awry. Ther Drug Monit 2003; 25:114-116.