CANCER

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A SCIENTIFIC LOOK AT ALTERNATIVE MEDICINE

Cancer and HIV/AIDS Therapies

Thomas J. Wheeler, PhD

Associate Professor (retired), Department of Biochemistry and Molecular Biology,

University of Louisville School of Medicine, Louisville KY

thomas.wheeler@louisville.edu

Revised 2017

This was originally part of a handout for an elective course given to medical students at the University of Louisville.

DISCLAIMER: The material presented here is not medical advice. It represents the author's summary of scientific evidence concerning various topics. For medical advice, see your physician.

COMPLEMENTARY AND ALTERNATIVE CANCER TREATMENTS

Introduction

This article deals primarily with methods intended to treat or cure cancer itself, rather than to deal with the symptoms of cancer and the side effects of therapy. The latter type of methods (which are often complementary to conventional treatments) are discussed in other articles (e.g., on mind-body medicine, acupuncture, and herbs).

Background

A study of Austrian cancer patients (Cancer 89, 873-880 (2000)) found that most who used CAM methods were highly compliant with conventional therapy; the seeking of alternatives was part of an active coping mechanism. However, Burstein et al. (New Engl. J. Med. 340, 1733-9 (1999)) concluded that in breast cancer patients, “new use of alternative medicine was a marker of greater psychological distress and worse quality of life.”

Earlier estimates of use among cancer patients range from 6 to 23%. More recent surveys found 43% usage in prostate cancer (but 3/4 of them did not inform their doctors!), 24% in brain tumor patients, 75% in breast cancer, and 31-84% in children with cancer. (However, some of these may be complementary methods for relief of symptoms, rather than intended as cures.)

Many Americans have gone to clinics near Tijuana, Mexico, where they can obtain treatments that are illegal in the U.S. In 2001, Mexican officials began enforcing tighter regulations, and many of these clinics were closed temporarily or permanently. Currently there appear to be about 35 in operation.

The NIH Office of Alternative Medicine (OAM) and its successor, the National Center for Complementary and Alternative Medicine (NCCAM), have funded several studies of alternative cancer methods, as well as a university-based research center at M.D. Anderson Cancer Center in Texas. The National Cancer Institute also has its own Office of Cancer Complementary and Alternative Methods. There are six NCI-designated cancer centers with major programs in researching CAM methods. Research funding has been about 100 million dollars per year for the period 2004-2014.

"OCCAM also administers the NCI Best Case Series program. Many interventions from the world of CAM have little or no associated objective research but are still sought by cancer patients hoping for a benefit they think is not possible, or likely, to come from conventional medicine. Also, some anticancer therapies develop in the context of traditional medical systems and thus become part of practice traditions or approved therapies in their native countries. The NCI Best Case Series Program was initiated in the 1990s to attempt to document cases of patients treated with these unconventional therapies in order to determine if sufficient evidence existed for NCI to initiate prospective research on a given treatment approach" (White, J. Natl. Cancer Inst. Monogr., No. 50, 286-7 (2014)).

Vickers et al. (J. Clin. Oncol. 24, 136-140 (2006)) reviewed clinical trials of unconventional cancer treatments and concluded that they “have not been subject to appropriate early-phase trial development.” “Of the 27 different agents tested in phase III, only one agent had a prior dose-finding trial, and only for three agents was the definitive study initiated after the publication of phase II data.”

Schmidt and Ernst (Annals Oncology 15, 733-742 (2004)) evaluated 32 popular web sites dealing with CAM for cancer, and concluded: “Most sites issued recommendations for a plethora of treatments, which are typically not supported by sound scientific evidence. Three sites had the potential for harming patients through the advice issued.”

Another survey of commercial websites dealing with cancer found that “92% claimed that a supplement could prevent cancer; 89% claimed that a supplement could be used to treat cancer; and 58% referred to the supplement as a cure for cancer...less than 40% recommended that users should consult their doctor” (news report by Charatan, BMJ 323, 827 (2001)). (Such claims of prevention and treatment are illegal in the U.S.) Matthews et al. (Psychosomatics 44, 100-103 (2003)) concluded that “There is a staggering amount of medical misinformation on the internet.”

In 2008 the FDA sent warning letters to 25 companies promoting cancer treatments on the Internet. In 2007-8 the FTC warned 112 web sites concerning the need to support their claims.

In an American Cancer Society survey (2005), 27% agreed (and another 14% thought it might be true) that the medical establishment was suppressing a cure for cancer.

Major categories of CAM used by patients, as classified by Wieger et al. (Ann. Intern. Med. 137, 889-903 (2002)): “dietary modification and supplementation, herbal products and other biological agents, acupuncture, massage, exercise, and psychological and mind-body therapies.” However, some of these are sought for their putative benefits in dealing with the effects of the disease or the side effects of treatments, rather than with the intent of curing the cancer.

A study of breast cancer patients found that "The most frequently cited reason for use of CAM was to reduce the symptoms of psychological distress, whereas the lowest frequency of CAM use was because of dissatisfaction with traditional medical care" (Lengacher et al., Oncol. Nurs. Forum 33, 97-104 (2006)).

Neuhousen et al. (Breast Cancer Res. Treat. 160, 539-546 (2016)) found that for breast cancer patients, "Complementary and alternative medicine use was not associated with breast cancer-specific mortality or total mortality."

Another study of breast cancer patients found that among those who do not receive standard treatment, the use of dietary supplements or other types of CAM did not affect their risk of recurrence or death (Saquib et al., Complement. Ther. Med. 20, 283-290 (2012)).

Yasueda et al. (Integr. Cancer Ther. 15, 17-39 (2016)) found that "it was difficult to determine whether antioxidants may have an impact on treatment outcomes or whether they may ameliorate adverse effects of chemotherapy and radiotherapy."

Greenlee and others (JAMA Oncol. 2, 1170-1176 (2016)) studied the association between noninitiation of recommended chemotherapy for breast cancer and the use of alternative medicine. Higher use of CAM in general (but not mind-body practices) and of dietary supplements was associated with decreased initiation of chemotherapy.

A Korean study of terminal cancer patients (Yun et al., Ann. Oncol. 24, 489-494 (2013)) found that those using CAM had no better survival and had worse quality of life (however, the study was not randomized, limiting the strength of its conclusions).

“Most patients who use CIM [complementary and integrative medicine] for cancer treatment view it as complementary rather than alternative. Even though most patients indicate that they would prefer to get a physician’s referral to use CIM, the majority do not actually consult their physician before deciding to use CIM. This is because many patients believe that their physician has limited knowledge of CIM and has no interest in discussing its use. Some believe that physicians’ emphasis on scientific studies on and evidence-based medicine, rather than patient preferences, is a barrier to openly discussing CIM. This of course can result in patients engaging in practices that may be unsafe and could diminish the efficacy of conventional treatments they may be taking for curative intent...an informed open communication about the uncertainty of the benefits and safety of a particular CIM modality will often be well received by the patient and the patient will be more likely to heed the physician advice not to use a certain CIM than if their approach to the communication is uninformed and paternalistic” (Frenkel and Cohen, J. Altern. Complement. Med. 20, 12-18 (2014)).

“Fewer than one half of oncologists are initiating discussions with patients about HS [herbs and supplements] use, and many indicate that lack of knowledge and education is a barrier to such discussions. Improving physician education about HS may facilitate more physician-patient communication about this important topic” (Lee et al., J. Clin. Oncol. 32, 4095–4101 (2014)).

“Surveys indicate that patients with cancer who use complementary approaches are younger, female, better educated and more affluent than others, representing a health-conscious segment of the population that is proactive in its healthcare, seeks health information, and has the means to pay for services that are typically not covered by insurance” (Deng and Cassileth, Am. Soc. Clin. Oncol. Educ. Book, 233-42 (2014)).

Herbs and other dietary supplements may interfere with chemotherapy drugs or increase their toxicity. Supplements may induce or inhibit cytochrome P450. Antioxidants may prevent oxidative damage needed to kill cancer cells. "The primary mechanism of action of many chemotherapy agents, such as the alkylating agents, anthracyclines, podophyllin derivatives, platinum compounds and camptothecins, is the generation of reactive oxygen species, which induces apoptosis in cancer cells. Antioxidant supplements may inhibit reactive oxygen species, thereby protecting cancer cells from death" (Smith and Steadman, Med. J. Aust. 204, 185-185e1 (2016)).

In order to avoid interactions, Seelly and Oneschuk (Curr. Oncol. 15 (Supp. 2), S81-S86 (2008)) proposed “stopping administration of the NHP [natural health product] within 3-5 half-lives before the start of chemotherapy and restarting the NHP only after 3-5 half-lives of the chemotherapy have elapsed...In the case of radiotherapy, the same basic principle can be applied, the key difference being that radiation acts within a very short period, thus allowing the rapid use of NHPS following radiotherapy if desired.”

In addition to interactions between complementary medicines and chemotherapy, the risk of interactions with drugs taken for comorbidities is a significant but neglected problem, according to a survey by Loquai et al. (Med. Oncol. 33, 52 (2016)).

Some prominent types of treatment and their promoters

ALKALINE or pH DIET - “the belief here is that acidity promotes cancer, and that cancer cells cannot survive in an alkaline environment. By drinking ‘alkaline water’ from an expensive device hooked up to a faucet and eating ‘alkaline foods,’ which happen to be mainly fresh vegetables, fruits, legumes, and nuts, purveyors claim cures for cancer, arthritis, obesity, and more. Another approach is to use cesium chloride [see below]. Patients commonly are unaware that the body maintains a tight pH range and eliminates excess acid or alkaline to preserve proper pH balance and that the ‘treated’ water has little buffering capacity, and that drinking ‘alkaline water’ will not significantly affect blood pH levels” (Deng and Cassileth, Am. Soc. Clin. Oncol. Educ. Book, 233-42 (2014)).

"A systematic review of the literature revealed a lack of evidence of an association between a diet acid load or alkaline water for cancer risk and no studies [of] alkaline treatment for cancer. Promotion of alkaline diet and alkaline water to the public for cancer prevention or treatment is not justified" (Fenton and Huang, BMJ Open 6, e010438 (2016)).

Promoted by Robert O. Young, who treats patients at his pH Miracle Ranch.

ANTINEOPLASTONS (promoted by Stanislaw Burzynski) - substances which allegedly "normalize" cancer cells. It was proposed that they act as part of a surveillance system that can switch cancer cells back to their normal pathways; cancer patients allegedly are deficient in antineoplastons. There is no published evidence in support of this proposal. Other mechanisms of action have also been proposed.

Antineoplastons are synthetic or extracted from urine. They are usually administered orally or by injection. However, their chemical properties are inconsistent with Burzynski's description. "What Burzynski calls antineoplastons are nothing more than the byproducts of the body's metabolism of the orphan drug sodium phenylbutyrate...what is probably one active metabolite (phenylacetate) was already being researched in the 1950s, and the other probable active metabolite, phenylacetylglutamine, was investigated in the urine of cancer patients in 1958. Burzynski didn't 'discover' these two chemicals. All he did was to purify them from urine, then throw them at patients in extremely high doses. This he did for decades until, sometime in the last several years, he apparently discovered that these chemicals are metabolites of sodium phenylbutyrate, so he switched to that" (Gorski, Science-Based Medicine blog, Dec. 12, 2011).

The Office of Alternative Medicine funded a major study of antineoplastons, as well as small exploratory grants for shark cartilage, Revici therapy, magnets, and macrobiotics. However, earlier reviews of patients treated with antineoplastons had found no evidence of effectiveness. Phase II clinical trials were carried out from 1991 to 1995. They were closed prematurely in 1995, with only nine patients having been enrolled. In 2000, the Mayo Clinic concluded, based on a small study, that Burzynski’s method was useless and potentially harmful.

More recently he enrolled hundreds of patients, but other researchers felt that the trials were so poorly designed that they were unlikely to yield any useful information. FDA approval of these clinical trials appears to be a result of political pressure from a Texas congressman.

An FDA warning letter in 2009 cited the Burzynski Institute for serious deficiencies. Another warning letter (2012) concerned his promotion of antineoplastons as safe and effective, whereas they are investigational new drugs whose safety and effectiveness are unknown.

"In fact, the FDA hasn't had a chance to approve Burzynski's drugs. He has never officially asked. Although Burzynski said he has completed 14 intermediate-phase studies, he has yet to file a new drug application" (Szabo, USA Today, Nov. 18, 2013). "To date, although Burzynski has published occasional case studies and partial results of two phase 2 trials, he has not published the complete results of any of his phase 2 trials. Of the sixty-one clinical trails registered on ClinicalTrials.gov with Burzynski as the principal investigator, only one has been completed, but it has not been published. Of the remaining sixty trials, the status of fifty are unknown; seven were withdrawn; two have been terminated; and one has not yet been opened to accrual (ClinicalTrials.gov 2013), and the phase 3 trial has never accrued a single patient" (Gorski, Skeptical Inquirer 38(2), 36-43 (2014)).

Burzynski "is charging huge sums of money for his special cocktail of targeted therapies and sodium phenylbutyrate under the guise of clinical trials and forcing patients to bear the cost, while enticing them to bear that cost by making extravagant promises and wrapping his selling of antineoplastons up as part of 'personalized gene-targeted therapy'...What cancer patients considering going to the Burzynski Clinic need to know is that antineoplastons...appear to be no better than many experimental therapies at a very early stage of development" (Gorski, Science-Based Medicine blog, Dec. 12, 2011). Patients are told that expenses may be as high as $100,000, mostly out of pocket.

"Burzynski's drugs pose a risk of serious harm, including coma, swelling near the drain, and death...While Burzynski has touted his treatments as an alternative to chemotherapy, a 1999 NCI study found that antineoplastons can cause many of the same side effects as conventional chemo: nausea, vomiting, headaches, muscle pain, confusion, and seizures" (Szabo, USA Today, Nov. 18, 2013).

After the 2012 death of a six-year-old patient with a lethal degree of hypernatria (one of the side effects of antineoplastons), Burzynski was forbidden to treat any more children. This was later extended to adults. However, in 2014 the FDA announced that Burzynski had fixed some problems and allowed his trials to resume.

A Newsweek story by T. Wilner (Feb. 22, 2016) quoted oncologist Joseph Paul Eder: "'Typically, whoever’s funding [the trial], the institution, NIH, or somebody else, would say, "You’re not meeting your goals. We’re going to need to stop the study",’ Eder says. Since Burzynski funds his own trials—at least in part through patient fees— and hasn’t established a partnership with any institution, there’s never been anyone to apply the brakes."

The Texas Medical Board unsuccessfully tried to have Burzynski's license revoked in 1993 and 2012. New charges were brought in 2014, resulting in penalties (announced in 2017) including probation, a public reprimand, and a fine. Burzynski was acquitted in 1997 on charges of using an unapproved drug in interstate commerce.

Since he had been forbidden to enroll new patients in antineoplaston therapy, Burzynski turned to treating patients with "personalized gene-targeted therapy," using combinations of conventional chemotherapeutic drugs. However, the choices of these combinations have not been validated in clinical trials.

Skeptics have created a website, The OTHER Burzynski Patient Group, to publicize stories of Burzynski's treatment failures and other problems with his claims.

Some of the "seemingly miraculous responses to ANP therapy in brain cancers could come from a phenomenon known as pseudoprogression in which late effects of radiation therapy can produce enhancing lesions that mimic tumor recurrence on brain MRI (Stuplich 2012) and which can occur as much as 28 percent of the time after radiation therapy (Brandes et al. 2008). Such pseudoprogression 'tumors' regress over the course of weeks to months..." (Gorski, Skeptical Inquirer 38(2), 36-43 (2014)).

BLOODROOT - see CORROSIVE SALVES below.

3-BROMOPYRUVATE - in vitro studies indicate that this compound preferentially kills tumor cells, by inhibition of glycolysis or other effects. Has not yet been shown to be safe and effective in clinical trials. Deaths of two patients at a German clinic in 2016 have been attributed to 3-bromopyruvate.

BURZYNSKI, STANISLAW - see ANTINEOPLASTONS above.

CANCELL and similar formulas (Entelev, "Jim's Juice," Cantron, Protocel, Sheridan’s Formula, JS-114, JS-101) - claimed to inhibit the aerobic metabolism of cancer cells, causing them to reach a "primitive state" that is recognized by the body and destroyed. Composed of inositol, catechol, and inorganic chemicals. "Jim Sheridan, of Roseville, Mich., made the original formula Cantron is based on. He called it Entelev or Jim's Juice and cooked it up on a hot plate in his pantry, using a method he said was sent to him by God in a dream that took the form of a rainbow. Sheridan gave the mixture away to terminal cancer patients for free - until the U.S. Food and Drug Administration ordered him to stop in 1983. Cancell, a similar product based on the Entelev formula, also got slapped with an order to cease distribution in1989, with the FDA labeling it an unapproved drug" (Brownell, Windsor Star, Apr. 28, 2012). Some products had been distributed free (with patients donating to offset costs); currently Cancell-like products are sold for about $50 to $100 per one month supply. Tests by the National Cancer Institute (animal studies, 1978, 1980; in vitro studies, 1990, 1991) were negative. The products are claimed to be powerful antioxidants; thus, they could interfere with chemotherapy. They are also promoted for AIDS and many other diseases.

CANNABIS, CANNABINOIDS - being investigated in animal models, but appears to be very little evidence from clinical trials.

CARCTOL - an herbal mixture developed by Nandlal Tiwari, an Ayurvedic doctor from India. Supposedly creates a more alkaline pH to kill cancer cells. No published studies in support (Ernst, Breast Cancer 4, 31-35 (2009)).

CAT'S CLAW - prepared from bark of a Peruvian vine (Uncaria tomentosa). It is also promoted for AIDS, arthritis, other conditions. It was tested by National Cancer Institute, but its activity in initial screening was insufficient to merit more detailed study.

CESIUM THERAPY - “patients ingest cesium chloride (CsCl) to alkalinize the body, which proponents claim will kill the cancer cells because ‘cancer cells cannot survive in an alkaline environment.’ Unfortunately ingestion of CsCl can lead to torsade de pointes, a potentially lethal cardiac arrhythmia. This ‘treatment’ also may include an elaborate regimen of special diets, detoxification techniques, and large doses of natural products” (Deng and Cassileth, Am. Soc. Clin. Oncol. Educ. Book, 233-242 (2014)). Although cesium is classified as an alkali metal, cesium chloride is a neutral salt, not alkaline.

CLARK, HULDA (died 2009), in The Cure for All Cancers, claimed that cancer (and AIDS) is caused by an intestinal parasite, and can be cured with plant materials within three weeks. She also promoted a device called the “Zapper” that is claimed to kill parasites, viruses, and bacteria with radio waves tuned to the correct frequencies. Another device, the “Syncrometer,” is used in diagnosis. In 2001 and 2003 the FTC took action against promoters of these devices for claims related to cancer and other diseases; a 2004 settlement forbids the companies from making unsubstantiated health claims.

CONTRERAS METHOD (Ernesto Contreras (died 2003), Tijuana, Mexico). Metabolic therapy (see below) with laetrile, coffee enemas, colonic irrigation, proteolytic enzymes. Live cell therapy, oxygen therapy, shark cartilage, herbs. There are also spiritual and psychological components, with worship and Bible study, humor and laughter, etc.

CORROSIVE SALVES (black salve, escharotics) - "...applied directly to tumors with the hope of burning them away. Zinc oxide, bloodroot, and several other herbs are common ingredients...often referred to as 'escharotics' because they produce a thick, dry scab called an 'eschar' in the skin" (Barrett, "Don't Use Corrosive Cancer Salves (Escharotics)," Quackwatch (2010)). Employed in the Hoxsey method (see below). Marketers may label as intended for animal use in order to avoid regulation. While cancer tissue may be destroyed, it is possible that not all of the cells will be eliminated, and necessary treatment will be delayed.

DICHLOROACETATE (DCA) - according to Wikipedia, "Although preliminary studies have shown DCA can slow the growth of certain tumors in animal studies and in vitro studies, the American Cancer Society stated that 'available evidence does not support the use of DCA for cancer treatment at this time [2012]'."

DIETS: The MACROBIOTIC DIET (George Ohsawa (died 1996), Michio Kushi (died 2014)) - based on Eastern yin-yang philosophical principles. Foods (yin or yang) are used to balance the yin or yang of the cancer. Includes whole grains, vegetables, fruits, miso; almost no animal foods. Advocates have recommended avoiding conventional treatment except in emergency. Users risk malnutrition due to low levels of protein, vitamins, and iron. The diet may be too bulky to meet high caloric needs of cancer patients. There are invalid diagnoses based on external appearances. Possible side effect is guilt, as the patient and/or family feels that a poor diet was responsible for the cancer.

Other diets include the grape diet (grapes and other "raw foods") (Johanna Brandt (died 1964)), and diets including plant materials with chlorophyll (an alleged "detoxifying" agent). However, there is no known role of chlorophyll in human metabolism. In general, special diets may lack essential nutrients that are especially important to patients with cancer, as well as sufficient calories.

Huebner and others (Anticancer Res. 34, 39-48 (2014)) reviewed 13 cancer diets, concluding, "We did not find clinical evidence supporting any of the diets." Moreover, "Some diets are based on hypotheses of carcinogenesis which are not compatible with modern scientific concepts..."

DONSBACH, KURT - operated a Mexican hospital for cancer and other diseases. This was shut down in 2006 after the death there of Coretta Scott King. Apparently the hospital later reopened illegally. In 2010 Donsbach pleaded guilty to practicing medicine without a license and other charges.

ELECTRONIC DEVICES - various devices are alleged to diagnose and treat cancer. See the handout dealing with miscellaneous topics.

ESSIAC - herbal remedy promoted by Canadian nurse Rene Caisse (died 1978). It has also been promoted for many other conditions, such as diabetes and AIDS. Essiac is a propriety mixture of four herbs. Another mixture, Flor Essence, contains the same four plus four other “potentiating” herbs. Essiac is administered in the form of herbal tea. Some recent studies have found 5 to 10% of cancer patients using Essiac in addition to their usual treatments.

No controlled studies showing safety and effectiveness for cancer or any other condition have been published. The Canadian federal health department reviewed data from 86 patients and found no benefit. Essiac has shown no anticancer activity in animal tests. A pilot study by NCCAM indicated it might be harmful, insofar as it promoted the growth of breast cancer cells in culture. Zick et al. (J. Altern. Complement. Med. 12, 971-980 (2006)): a retrospective study found no benefit for quality of life.

“Today, more than 25 products purport to derive from the original Essiac formula, including ready-made brewed tea, powdered tea, tinctures, salves, capsules, and tea bags. The products are available online and from naturopaths and health food stores. Buying a year’s supply of the tea in powdered form can cost up to $1,000. A year’s supply of ready-brewed liquid Flor-Essence, a popular brand produced by Flora Inc., from Whole Foods costs more than $4,800. Others buy herbs and, following the published recipe, make their own tea” (Kindergan, OA Online, Feb. 13, 2006).

FRESH CELL THERAPY (Live cell therapy) (Paul Niehans, Switzerland (died 1971)). Involves intramuscular or subdural injection of fresh embryonic animal cells from the organ which, in patient, is cancerous. The cells are said to be transported to target organ, where they repair function. Side effects include infections, allergic reactions, anaphylactic shock (with some deaths), and chronic progressive neurological damage. Animal cells would be rejected, and would be unlikely to reach a target organ and provide any function.

GcMAF (Gc protein-derived macrophage activity factor) - promoted for treatment of cancer and many other diseases. However, according to an article at www.anticancerfund.org, “no proper clinical research involving GcMAF has been performed. Laboratory findings still need to be confirmed by independent groups.”

GERSON THERAPY (Max Gerson (died 1959); Charlotte Gerson Straus). Metabolic therapy (see below) featuring large amounts of fresh fruit and vegetable juices, vitamins, minerals, other supplements, laetrile, coffee enemas, pancreatic enzymes, and intravenous glucose-potassium-insulin. Some of these treatments are discussed elsewhere in this handout. A strict vegetarian diet is employed for at least six weeks. Diets are high in potassium and low in sodium. The therapy may also include treatment with ozone or hydrogen peroxide and Staphage lysate (a supposed “immune booster”). The goals include "detoxification," enhancing the immune system, and raising intracellular potassium. It is felt that the liver is overburdened in dealing with the toxic materials produced in cancer, and must be given support. Coffee enemas are thought to stimulate the liver and gallbladder, but there is no evidence for this. Side effects of Gerson therapy include infections from raw liver.

Cases were reviewed by National Cancer Institute in 1959; no evidence of effectiveness was found. The American Cancer Society gave a negative assessment in 1971. A study of 21 patients identified in 1983 found that all but one were dead by 1988 (Barrett, The Health Robbers, p. 88).

Charlotte Gerson Straus and Norman Fritz founded the Gerson Institute to continue Gerson's work. It authorized the use of the methods in some Mexican clinics.

GONZALEZ, NICHOLAS - see Kelly Metabolic Therapy below.

GREEK CANCER CURE (Hariton Alivizatos, Athens (died 1991)). Uses secret blood tests to measure severity of cancer. Treatment with intravenous injection of "serum"; said to contain "a combination of organic substances such as sugars, vitamins, amino acids, and other factors" to boost immune system. Diet low in salt and acids. Analysis of a sample of "serum" revealed it to be a solution of nicotinic acid.

HERBAL TEAS (e.g., pau d'arco). May contain toxic compounds.

HOXSEY METHOD (Harry Hoxsey (died 1974); Mildred Nelson (died 1999)). Includes tonics with herbal components to stimulate elimination of toxins, balance pH of body, bring DNA "back to its more normal state," etc. Key component is potassium iodide. Also uses external powders, pastes and solutions (see corrosive salves above) and a special diet. Side effects include toxic effects of excess iodide and corrosive, disfiguring effects of external agents. A University of British Columbia study of Hoxsey patients (1957) revealed no benefit.

HYDRAZINE SULFATE - developed by Joseph Gold. Supposedly blocks liver gluconeogenesis (via inhibition of phosphoenolpyruvate carboxykinase), depriving tumors of glucose (needed for anaerobic glycolysis). However, glucose is needed for the brain and other tissues, and normally is tightly controlled; thus, patients suffer many side effects. Another proposed mechanism relates to inhibition of tumor necrosis factor alpha. Hydrazine sulfate has also been studied for dealing with cancer-related anorexia and cachexia.

Some animal studies indicated that it actually can increase the incidence of tumors. The U.S. government listed it as reasonably anticipated to be a human carcinogen. As a result of preclinical studies in the 1980s, the National Cancer Institute recommended against further studies of hydrazine sulfate as an anticancer agent.

A series of Russian trials were said to provide support for the use of hydrazine sulfate. However, these studies were uncontrolled and had several other weaknesses. In contrast, four placebo-controlled clinical trials found no evidence of effectiveness in treating cancer.

HYPEROXYGENATION THERAPY - rationale based on the Warburg effect (see below). HYDROGEN PEROXIDE, GERMANIUM sesquioxide, and OZONE are used as oxygenating agents. Hyperoxygenation is also claimed to be effective for many other diseases. Side effects include possible damage from free radicals.

The Warburg effect - In most cells, glucose is completely oxidized by the pathways of glycolysis, the citric acid cycle, and oxidative phosphorylation. However, when oxygen is limiting, glucose can be metabolized by glycolysis only, with lactic acid as a final product, a process that results in a much lower yield of ATP energy. In the 1920s, Otto Warburg discovered that many tumor cells carry out glycolysis to lactate even in the presence of oxygen. The advantages of this for the tumor cell are still not clear.

Oxygenating cancer therapies are based on a misunderstanding of the Warburg effect, reasoning that since cancer cells carry out a form of metabolism typically seen under anaerobic conditions, they would be poisoned by oxygen. This is not true; tumor cells carry out glycolysis to lactate even under well oxygenated conditions. (Some therapies based on the Warburg effect aim at inhibiting glycolysis rather than providing oxygen. These include 3-bromopyruvate and dichloroacetate.)

HYPERTHERMIA - the body is heated (to as high as 113̊F).

IMMUNE SYSTEM MANAGEMENT (formerly CANADIAN CANCER RESEARCH GROUP (CCRG)) - promoted by William P. O'Neill (died 2013). Using analysis of plasma amino acids (Aminomics™), dietary supplements are recommended to correct supposed abnormalities.

IMMUNOAUGMENTATIVE THERAPY (IAT) (Lawrence Burton - clinic in Bahamas) - uses proteins prepared from blood of cancer patients or healthy donors; these are injected into patients. However, the stated preparative procedure is inconsistent with purification of the proteins. Risks have included spread of HIV and hepatitis.

KELLEY METABOLIC THERAPY/GONZALEZ REGIMEN (William Kelley, Nicholas Gonzalez (died 2015)). Includes the use of pancreatic enzymes, colonic irrigation or coffee enemas, diet, and supplements. See Metabolic Therapy below for discussion of colonic irrigation. It was proposed that the pancreas plays a role in detoxification, and provision of pancreatic enzymes (obtained from pigs) could assist in this. However, enzymes taken orally would be degraded in the stomach and intestine.

The Office of Technology Assessment reviewed 50 "best cases" of Kelley (compiled by Gonzalez) and found no evidence of effectiveness. “At least 41 of the patients had been treated with surgery, radiation, and/or chemotherapy that could have been responsible for the length of their survival. The rest lacked biopsy evidence and/or had cancers that typically have long survival times” (Moran and Lubetkin, “Book Review: One Man Alone: An Investigation of Nutrition, Cancer, and William Donald Kelley,“ Cancer Treatment Watch (2015)).

Nicholas Gonzalez obtained promising results in a pilot study of 11 pancreatic cancer patients, but there was no control group. This led to a study of 55 patients funded by NCCAM and the National Cancer Institute. There was a median survival time of 4.3 months for the Gonzalez regimen patients vs. 14 months for conventional therapy. The Gonzalez group also had a poorer quality of life (Chabot et al., J. Clin. Oncol. 28, 2058-2063 (2010)).

A network television story on Gonzalez revealed that he followed the progress of patients’ cancer using hair analysis, and was unable to explain the basis of the test (which involved an invalid method, radionics).

LAETRILE is derived from amygdalin, a compound found in plants such as apricots and bitter almonds. Cyanide released from the compound is said to kill cancer cells in preference to normal cells. Laetrile has been referred to as "Vitamin B17," but it is not a vitamin. There is a risk of cyanide toxicity. Laetrile can be administered orally or by injection.

Because of widespread interest (tens of thousands of users) and public pressure (resulting in legalization in many states in the 1970s), laetrile has been subjected to many scientific investigations. Numerous studies of laetrile with cell culture and animal models have been published, with nearly all showing a lack of effectiveness. A clinical trial of 178 patients found no benefit (Moertel et al., N. Eng. J. Med. 306, 201-206 (1982)).

In 2000 the FDA took action against several laetrile marketers, including three Internet sites selling “Vitamin B17.” One leading promoter was convicted in 2003 of violating a court order against selling or promoting laetrile.

LIVINGSTON VACCINE (Virginia Livingston-Wheeler (died 1990)). The therapy attributes cancer to a bacterial infection, and uses vaccines prepared from cultures from patient. It also includes a special diet, supplements, and visualization. However, there is no evidence of the postulated bacterium. The University of Pennsylvania Cancer Center, studying patients with advanced untreatable cancer, found no evidence that the therapy improved survival.

MEDICINAL MUSHROOMS (Ganoderma lucidum (reishi), Lentinus edodes (shiitake)). These are used in Asian herbal remedies, and contain polysaccharides and triterpenes thought to enhance immune system. They have also been used in treatments for HIV. A Cochrane review on reishi mushrooms (Jin et al., Cochrane Database Syst Rev., CD007731 (2016)) "did not find sufficient evidence to justify the use of G. lucidum as a first-line treatment for cancer. It remains uncertain whether G. lucidum helps prolong long-term cancer survival."

MEGAVITAMINS - to enhance body's capacity to destroy malignant cells. Most prominent is the use of VITAMIN C, as promoted by Linus Pauling (see below). Possible side effects include toxic levels of vitamins. Antioxidant vitamins may interfere with chemotherapy by increasing resistance of tumor cells to oxidative damage.

MENTAL IMAGERY; SIMONTON METHOD (O. Carl Simonton (died 2009)). Uses relaxation, stress reduction, and mental imagery (visualize destruction of cancer cells). A possible side effect is guilt from thinking a stressful lifestyle was responsible for the cancer.

METABOLIC THERAPY (Harold Manner (died 1988)): "the use of natural food products and vitamins to prevent and treat disease by building a strong immune system" (Manner, quoted in Barrett, Health Schemes, Scams and Frauds). The immune system is thought to be weakened by toxins, stress, or poor nutrition. Includes vegetable juices, natural foods, laetrile (see above), coffee enemas, high colonic irrigation, vitamins, minerals, enzymes, glandulars. Colonic irrigation has led to deaths from electrolyte imbalance, bowel necrosis or perforation, toxic colitis, amebiasis, hypokalemia, and sepsis. Dehydration and renal failure have also been produced. Enzymes and glandular given in diet are digested rather than reaching target organs or cells.

MILK THISTLE (active ingredient SILYMARIN) - conflicting results have been reported for some small clinical studies.

MISTLETOE (marketed as ISCADOR and other products) has been of special interest in Germany. Popularized by Rudolf Steiner, founder of anthroposophical medicine. Research studies and reviews have come to conflicting conclusions as to whether there is evidence of effectiveness. Ziegler and Grossarth-Maticek (Evid. Based Complement. Alternat. Med. 7, 157-166 (2010)): meta-analysis indicated increase in survival. Lectins and polysaccharides are among the possible active agents. Mistletoe drugs are not available in the U.S.

NEWCASTLE DISEASE VIRUS - an avian virus that can also infect human cells. Because it preferentially attacks cancer cells rather than normal cells, it is being explored as a cancer therapeutic agent.

PATIENT-DERIVED XENOGRAFTS (PDX) MODELS - in order to provide individualized treatment, xenografts are made in mice and tested for response to drugs. While this is an important strategy in research, its marketing to individual patients is questionable. "One scientific shortcoming of PDX mice is that the animals lack a functioning immune system. This precludes trying immunologic therapies; it may also give misleading information about how drugs will behave in a person" (Couzin-Frankel, Science 346, 28-29 (2014)).

PC-SPES is a mixture of Chinese herbs; it had shown some promise as a treatment for prostate cancer. However, in 2002 it was discovered that the product was adulterated with several conventional drugs. One of these, diethylstilbestrol, is known to have antitumor effects, which could account for the apparent benefits of PC-SPES. It has been suggested that there are additional effects not due to estrogen-like actions. According to Rackley et al. (Urol. Clin. N. Am. 33, 237-246 (2006)), "the United States Food and Drug Administration advised the discontinuation of this product by all users, and the manufacturer is no longer in business." However, similar products are currently available.

PHOSPHOETHANOLAMINE (known as "fosfo" in Brazil) - Some studies found it inhibited tumor cell growth in vitro, but others did not. Despite the lack of clinical studies showing its effectiveness, the Brazilian congress voted in 2016 to legalize its production and distribution.

PSYCHOSOCIAL INTERVENTION - see the handout on mind-body medicine.

REVICI SYSTEM (lipid therapy, "biologically guided chemotherapy") (Emanuel Revici (died 1998)). Treatment is guided by analysis of single sample of patient's urine for acidity and specific gravity. It then attempts to correct "imbalances" with: lipid alcohols, zinc, iron, and caffeine ("anabolic"); or fatty acids, sulfur, selenium, and magnesium ("catabolic"). However, acidity and specific gravity of urine are too variable to be meaningful. The biochemical rationale is dubious.

SHARK CARTILAGE, SHARK OIL - based on presence of angiogenesis inhibitors in shark cartilage, and the allegation that sharks don't get cancer. However, sharks do get cancer - even in their cartilage. Their lower incidence of cancer is likely due to their immune system, not the anti-angiogenesis factor. Bovine cartilage has also been used. Taken as a supplement, only negligible amounts of anti-angiogenesis factors would be ingested, and these would be broken down in digestion. It is also claimed that alkylglycerols in shark oil will kill tumor cells, stimulate the immune system, and reduce side effects of conventional treatments. At one time annual sales were $50 million.

Two studies of powdered shark cartilage products with advanced cancer patients found no benefit (Miller et al. (1998) J. Clin. Oncol. 16, 3649-55; Loprinzi et al. (2005) Cancer 104, 176-182). Lu et al. (J. Natl. Cancer Inst. 102, 859-865 (2010)) tested a shark cartilage extract (AE-941, Neovastat) in a trial with lung cancer patients; no benefit was found.

The FDA and FTC acted against shark cartilage products in 1999-2000. In 2005 Lane Labs agreed to refund millions of dollars to customers who bought shark cartilage products for cancer treatment.

UKRAIN - developed by Wassil Nowicky (Vasyl Novytskyi), who was from Ukraine. Contains alkaloids and thiophosphoric acid from the weed Chelidonium majus (greater celandine). Some preliminary studies in support, but convincing evidence of effectiveness is lacking.

VITAMIN C - Megadoses of intravenous and oral vitamin C (ascorbate) were promoted by Linus Pauling as a cancer cure. However, in the late 1970's and mid 1980's two double-blind studies of oral vitamin C were performed on patients at the Mayo Clinic. These found no benefit. More recently, there has been renewed interest in high dose intravenous vitamin C, with some support from animal and cell culture studies. Much higher levels of vitamin C can be achieved through intravenous administration than orally. "Base on survey results and industry sales, more than 10 000 patients in the US each year were treated with i.v. ascorbate, at an average of...20 treatments per patient" (Chen et al., Can. J. Physiol. Pharmacol. 93, 1055-1063 (2015)).

One proposed mechanism relates to the uptake of the oxidized form (dehydroascorbate) by the passive glucose transporter GLUT1, which is expressed in high levels in some cancer cells. Inside the cells, dehydroascorbate is reconverted to ascorbate, depleting the cells of the reductants NADPH and glutathione. This in turn makes the cells more susceptible to DNA damage by reactive oxygen species. Another proposal is that vitamin C leads to production of ascorbate radical and hydrogen peroxide in the extracellular fluid.

714-X - Developed by Gaston Naessens. Claimed to help the immune system fight cancer. "7 is for G, the 7th letter of the alphabet, 14 for N and X for the alphabet's 24th letter, corresponding to Mr. Naessens' birth in 1924" (Blackwell, "Opening Doors to Unproven Treatments," Canada.com, Oct. 21, 2006). "Mr. Naessens was educated as a biologist in France, where he says he invented a highly powerful microscope, called a somatoscope. With it, he claims to have discovered 'somatids,' microscopic particles that he says are key to human life and can lead to cancer if traumatized by something like pollution or radiation. 714-X - which is mostly composed of water but also contains camphor, ammonium chloride and nitrate, sodium chloride and ethanol - is designed to return the somatids to a normal state. The substance is injected into lymph glands in the groin [nasal administration is also used]...In almost 30 years of supplying the drug, Gaston Naessens has not conducted any clinical trials or sought approval for the drug."

No animal or human studies in support of 714-X have been published in the peer-reviewed scientific literature. The FDA banned its import. It is produced in Canada, and is legally available there under a special access program.

Characteristics of pseudoscience

Claims of proponents to be visionaries (ahead of their time) or persecuted

Claim burden of proof is on opponents to show that therapies don't work

May employ dubious diagnostic methods (e.g., iridology) - "cured" patients may not have had cancer

Lack of documentation: improper or inadequate diagnosis; lack of followup studies. Reliance on patients to report back with claims of success. Survival estimates based on subjective evaluation of departing clinic patients.

Anecdotal evidence of success. "Cured" patients may be in remission or having progressive cancer.

Use of secret formulas (Hoxsey, Greek Cancer Cure).

Declare test protocol invalid after completion of study

Rationale for use is changed when previous rationale shown to be invalid

Nonscientific (yin-yang) or nonmeasurable (detoxification) concepts

Attribute failures to effects of previous conventional therapy in poisoning body, or to mixing protocols, or to not following the protocols exactly.

Wide-ranging claims to heal all cancer, whereas there are many types of cancer with different characteristics and sensitivities to established therapies.

"They frighten patients away from proper therapy by referring to surgery as cutting, to radiation as burning, and to chemotherapy as poisoning.” (S. Bertolone, (1991), Louisville Medicine 10(5), 40-42)

If condition worsens, patient told this is a "healing crisis" due to removal of toxins

David Gorski (Nature Rev. Cancer 14, 692-700 (2014)) has criticized the concept of "integrative oncology": it "integrates unscientific practices into science-based medicine, and, worse, the pseudoscience at the heart of so many of the non-biologically based subdivisions of CAM is so pervasive, so embedded in the very fabric of integrative oncology, that it opens the door to clinical trials of dubious efficacy and the wasting of time and resources."

Groups that promote questionable methods

Barrett, in Barrett, S. and Jarvis, W.T., The Health Robbers, pp. 97-98 (1993), listed several organizations under the category "Promoters of Questionable Methods." Those that still appear to be active include International Association of Cancer Victors and Friends, Cancer Control Society, National Health Federation, Foundation for Alternative Cancer Therapies, and Project Cure. World Research Foundation and CANHELP were described as providing information on both conventional and alternative methods.

According to an analysis by W. London (Committee for Skeptical Inquiry site, 2015), the Cancer Control Society "enthusiastically promotes approaches to health care that are based on simplistic and/or discredited theories and treatments that either (1) haven’t been shown to be safe and effective for an intended purpose, or (2) have failed under proper testing."

Cancer Treatment Centers of America use some questionable methods, including acupuncture, chiropractic, naturopathy, homeopathy, reflexology, and reiki. The accuracy of its survival data has also been challenged. D. Gorski (Science-Based Medicine, Oct. 7, 2013) wrote, "One thing becomes clear as you peruse the treatment options offered at CTCA for virtually any cancer, and that’s that naturopathic treatments are deeply embedded (or 'integrated') into everything that is done at CTCA." Recently it has started using personalized treatments based on genetic testing, even though the methods have yet to be validated clinically.

Psychological aspects

Holland (“Why Patients Seek Unproven Cancer Remedies: A Psychological Perspective,” American Cancer Society (1982)): "Psychologically, the patient with cancer is apt to feel the worst when it becomes clear that medical treatment can no longer control his disease. As soon as traditional medicine is perceived as being unable to offer either control or cure, both patient and family are likely to begin considering unorthodox and unproven methods for curing cancer...Well-meaning friends and colleagues exert enormous pressure...to 'leave no stone unturned' and to explore all known unproven methods of cancer therapy...The result, however, is a barrage of information that the patient hears at a time of great personal anxiety and uncertainty."

Appeal to patients to take control over dealing with illness.

"Poor doctor-patient communication, the emotional impact of the cancer diagnosis, perceived severity of conventional treatment side effects, a high need for decision-making control, and strong beliefs in holistic healing appear to affect the decision by patients to decline some or all conventional cancer treatments...a tendency by doctors to dichotomize the patient decisions as rational or irrational may interfere with the ability of the doctors to respond with sensitivity and understanding...Numerous motivations for this decision [to decline conventional treatment] were reported, including a negative experience with mainstream medicine, loss of family members or friends to cancer while on conventional treatment, CAM use before diagnosis, and a strong belief system in favour of whole-person (holistic) healing" (Verhoef et al., Curr. Oncol. 15(Supp.2), S101-S106 (2008)).

Other points

In “Book Review: One Man Alone: An Investigation of Nutrition, Cancer, and William Donald Kelley“ (Cancer Treatment Watch (2015)), Moran and Lubetkin wrote: “Promoters of nonstandard cancer treatments often claim that mainstream medicine’s rejections are governed by unjustified biases or ignoble motives. However, if a treatment actually works, it should be fairly easy to demonstrate effectiveness by accumulating appropriate data. To be compelling, cases intended to demonstrate a cure would require:

• A firm diagnosis of invasive cancer of a type that has predictable behavior. This usually requires biopsy evidence, but some diagnoses can be reliably based on imaging and/or laboratory tests.

• That all signs of cancer abate with the use of the treatment being assessed, with that treatment alone, and within a time frame consistent with a causal relationship

• That the patient stays cancer-free long enough to conclude that a cure has occurred or the tumor is unlikely to recur. For example, because colorectal cancer usually recurs within 5 years of treatment if it has not been eradicated, colorectal cancer patients who remain cancer-free for 5 years are likely to have been cured. But some cancers require much longer follow-up time to judge.

“Even a few well-documented and confirmable cases with these specific qualities within the recent experience of a single practitioner or clinic would suggest that a cancer treatment is worth pursuing. If the type of cancer is known to regularly undergo spontaneous remission—as are certain lymphomas, renal cell cancer, melanoma, chronic lymphocytic leukemia, and childhood neuroblastoma—more cases would be needed, but the required evidence would be similar."

No drug that has failed lab tests has been demonstrated to be effective against cancer.

There have been cases of claimed cures who later died of cancer.

Credit may be given to unorthodox therapy when conventional therapy was also being employed.

"The reason breast cancer testimonials sound so convincing is that most lay people don't know a lot about the disease, particularly that surgery alone 'cures' many breast cancers. Early stage cancers are cured by surgery alone more often than not, and a significant minority of patients with even large tumors and multiple positive lymph nodes still have a not insignificant chance of long term survival with surgery alone...These facts help explain breast cancer survivors who have undergone surgery but decided to forego chemotherapy and/or radiation therapy in favor of 'alternative' medicine..." (Gorski, Science-Based Medicine blog, Jan. 14, 2008)

Variability in survival times may lead to credit being attributed to unorthodox treatment. Some studies have found that prognoses for survival tend to be too pessimistic. Some patients have long survival times with no treatment.

Spontaneous remissions occur in nearly all types of cancer and at all stages. The overall incidence is estimated to be between 1 in 10,000 and 1 in 100,000. These cases can lead to stories of miraculous cures, attributed to whatever treatment the patient was receiving. A study by Zahl et al. (Arch. Intern. Med. 168, 2311-2316 (2008)) found evidence for unexpectedly high levels of spontaneous remission of invasive breast cancer.

Study of Cassileth et al. (N. Engl. J. Med. 324, 1180-1185 (1991): patients with advanced cancer had poorer quality of life when treated with unorthodox methods.

If patient feels a need to go beyond conventional therapy, an option is to participate in a clinical trial of an investigative therapy.

"...Pursuit of questionable remedies can deprive the patient of the time and resources needed to adjust to the realities of the situation...Reinforcing the illusion of the denial stage prevents the normal psychological adjustments from taking place and thus removes the potential for some satisfaction in the final days." (Jarvis, CA 36, 293-301 (1986))

D. Gorsky ("Orac") wrote, "...it might seem 'empowering' for people to think that they can cure their cancer with magic herbs, shooting coffee up their butts, thinking positive thoughts, or doing yoga, but it’s not. It tells people battling cancer and losing that they didn’t do enough, that they could have prevented this if only they had wanted it badly enough and had a positive enough attitude, that their impending death is at least partially their own fault" (Respectful Insolence blog, March 31, 2016).

Freedom of choice: can patients make informed decisions based on misinformation provided in much of the literature for the lay public?

Ethical/legal considerations: what are the rights of minors and their parents to choose unorthodox treatment? In general, courts may protect the rights of children to conventional treatment if there is a reasonable chance for a cure. A mature, well-informed older adolescent may be given more rights to choose an alternative.

Undisclosed use of CAM methods by participants in clinical trials is widespread and may complicate research findings.

COMPLEMENTARY AND ALTERNATIVE HIV/AIDS THERAPIES

(This section is based partly on a talk by Ardis Hoven, M.D., of Lexington, at the Kentucky Health Fraud Conference, Nov. 18, 1994, and on an article by William Templeton, M.D., in Louisville Medicine.)

General points

In the first years of the HIV epidemic, HIV patients were desperate, vulnerable, and willing to take risks. Some wished to avoid unpleasant side effects of conventional therapy, and want to try more "natural" remedies. With new therapies increasing survival times dramatically, the attraction of unconventional therapies would seemingly be diminished (although a 2003 survey found no decrease had occurred as of that year).

Studies in the mid- to late-1990s reported CAM usage of 30% to 68% among HIV patients. One study (based on 1996-7 surveys) found that “One quarter of patients used CAM with the potential for adverse effects, and one-third had not discussed such used with their health care provider...Three percent of patients substituted CAM for conventional HIV therapy” (Hsiao et al., J. Acquir. Immune Defic. Syndr. 33, 157-165 (2003)).

Some alternative therapies for cancer and other diseases have been promoted as AIDS therapies. Some of the Mexican cancer clinics (see p. 1) treat AIDS as well.

In the early stages of the epidemic, many HIV patients were highly organized, with self-help groups, buyers' clubs, and other sources of information, leading to the dissemination of information on obtaining unorthodox therapies. By 1988 there were over 200 "alternatives" being promoted. One company listed 120 mail order items.

With increasing effectiveness of conventional treatments, much of the use of CAM now is for improved quality of life while standard drugs are being taken. St. John’s wort, garlic, and vitamin C can potentially reduce the effectiveness of conventional drugs.

Clinical studies of conventional therapies may be compromised if patients are secretly taking other agents.

Alternative therapies used for treating HIV (* = see above in the cancer section)

ACUPUNCTURE

(ALLEGED) ANTIVIRAL COMPOUNDS - compound Q, AL727, St. John's wort, ribovirin, shark cartilage, dextran sulfate, hypericin, DHEA, aloe vera juice

*CANCELL

CHACHOUA, SAMIR - operates a Mexican clinic. Injects vaccines based on viral diseases; these are supposed to destroy existing viruses ("Nemesis theory"). In the case of HIV, he has used milk from goats infected with Caprine Arthritis Encephalitis Virus. Received publicity in 2016 with appearance on Bill Maher's TV show and treatment of Charlie Sheen. Chachoua claims to have eradicated HIV from the nation of Comoros, but this is false.

CHIROPRACTIC

CRYSTALS (to stimulate chakras related to AIDS)

DIETS - Immune Power Diet (avoids cow's milk, wheat, corn, yeast, soy products), macrobiotic diet, yeast-controlled diet (avoids yeast, sugar, food additives)

*FRESH CELL THERAPY

GREGORY METHOD - hydrotherapy, saunas, sunshine, colonic irrigation, etc.

HERBS - a 2005 Cochrane review found "insufficient evidence to support the use of herbal medicines in HIV-infected individuals and AIDS patients" (Liu et al., Cochrane Database Syst. Rev., CD003937 (2005)).

HOMEOPATHY

HYPEROXYGENATION THERAPY. OZONE administered to blood (after removal from patient), rectally, IM, or IV. Treatments in Germany may cost thousands of dollars per week.

HYPERTHERMIA - body temperature raised to 108̊ (potentially serious complications)

(ALLEGED) IMMUNE ENHANCERS - vitamins A, C, E; fatty acids, iron, zinc, selenium, amino acids, bee pollen, garlic, blue-green algae, Immunex (low-dose α-interferon), PCM4 (pig spleen protein plus Siberian ginseng), other Chinese herbal remedies, "immunity soup" (major component is from mushrooms), Cat's Claw

MAGNETS

MALARIAL THERAPY - inject with malarial parasites; fever allegedly kills HIV. Promoted by Henry Heimlich. However, as noted by Paul Farmer, areas where malaria is endemic have especially high incidence of HIV.

MASSAGE

MEDITATION, IMAGERY

*METABOLIC THERAPY

SECOMET V - promoted by Girish Kotwal in South Africa. Extract of red clover (Trifollium pratense).

THERAPEUTIC TOUCH

YOGA

READING

Cancer therapies - complementary and integrative approaches

Gorski DH. 2014. Integrative oncology: really the best of both worlds? Nature Rev Cancer. 14(Oct):692-700. (abstract)

Wesa K, Gubili J, Cassileth B. 2008. Integrative oncology: complementary therapies for cancer survivors. Hematol Oncol Clin North Am. 22(2):343-53. (abstract)

Cassileth BR, Keefe FJ. 2010. Integrative and behavioral approaches to the treatment of cancer-related neuropathic pain. Oncologist. 15 Suppl 2:19-23.

Truant TL, Porcino AJ, Ross BC, Wong ME, Hilario CT. 2013. Complementary and alternative medicine (CAM) use in advanced cancer: a systematic review. J Support Oncol. 11(3):105-13. (abstract)

Deng G, Cassileth B. 2014. Integrative oncology: an overview. Am Soc Clin Oncol Educ Book. 233-42.

White JD. 2014. National Cancer Institute's support of research to further integrative oncology practice. J Natl Cancer Inst Monogr. 2014(50):286-7.

Greenlee H, Balneaves LG, Carlson LE, Cohen M, Deng G, Hershman D, Mumber M, Perlmutter J, Seely D, Sen A, Zick SM, Tripathy D; Society for Integrative Oncology. 2014. Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. J Natl Cancer Inst Monogr. 2014(50):346-58.

Greenlee H, Neugut AI, Falci L, Hillyer GC, Buono D, Mandelblatt JS, Roh JM, Ergas IJ, Kwan ML, Lee M, Tsai WY, Shi Z, Lamerato L, Kushi LH, Hershman DL. 2016. Association between complementary and alternative medicine use and breast cancer chemotherapy initiation: The Breast Cancer Quality of Care (BQUAL) Study. JAMA Oncol. 2(9):1170-6. (abstract)

Cancer therapies - effects on survival and quality of life

Saquib J, Parker BA, Natarajan L, Madlensky L, Saquib N, Patterson RE, Newman VA, Pierce JP. 2012. Prognosis following the use of complementary and alternative medicine in women diagnosed with breast cancer. Complement Ther Med. 20(5):283-90.

Yun YH, Lee MK, Park SM, Kim YA, Lee WJ, Lee KS, Choi JS, Jung KH, Do YR, Kim SY, Heo DS, Kim HT, Park SR. 2013. Effect of complementary and alternative medicine on the survival and health-related quality of life among terminally ill cancer patients: a prospective cohort study. Ann Oncol. 24(2):489-94.

Leggett S, Koczwara B, Miller M. 2015. The impact of complementary and alternative medicines on cancer symptoms, treatment side effects, quality of life, and survival in women with breast cancer - a systematic review. Nutr Cancer. 67(3):373-91. (abstract)

Neuhouser ML, Smith AW, George SM, Gibson JT, Baumgartner KB, Baumgartner R, Duggan C, Bernstein L, McTiernan A, Ballard R. 2016. Use of complementary and alternative medicine and breast cancer survival in the Health, Eating, Activity, and Lifestyle Study. Breast Cancer Res Treat. 160(3):539-546. (abstract)

Use of supplements

Michaud LB, Karpinski JP, Jones KL, Espirito J. 2007. Dietary supplements in patients with cancer: risks and key concepts, part 1. Am J Health Syst Pharm. 64(4):369-81. (abstract)

Michaud LB, Karpinski JP, Jones KL, Espirito J. 2007. Dietary supplements in patients with cancer: risks and key concepts, part 2. Am J Health Syst Pharm. 64(5):467-80.Am J Health Syst Pharm. 64(5):467-80. (abstract)

Lawenda BD, Kelly KM, Ladas EJ, Sagar SM, Vickers A, Blumberg JB. 2008. Should supplemental antioxidant administration be avoided during chemotherapy and radiation therapy? J Natl Cancer Inst. 100(11):773-83.

Seely D, Oneschuk D. 2008. Interactions of natural health products with biomedical cancer treatments. Curr Oncol.15 Suppl 2:s109.es81-s10.es6. (abstract with link to pdf file)

Lee RT, Barbo A, Lopez G, Melhem-Bertrandt A, Lin H, Olopade OI, Curlin FA. 2014. National survey of US oncologists' knowledge, attitudes, and practice patterns regarding herb and supplement use by patients with cancer.J Clin Oncol. 32(36):4095-101.

Smith PJ, Steadman KJ. 2016. Antioxidant supplementation and cancer patients receiving curative-intent chemotherapy. Med J Aust. 204(5):185-185e1.

Yasueda A, Urushima H, Ito T. 2016. Efficacy and interaction of antioxidant supplements as adjuvant therapy in cancer treatment: a systematic review. Integr Cancer Ther. 15(1):17-39.

Loquai C, Dechent D, Garzarolli M, Kaatz M, Kaehler KC, Kurschat P, Meiss F, Stein A, Nashan D, Micke O, et al. 2016. Risk of interactions between complementary and alternative medicine and medication for comorbidities in patients with melanoma. Med Oncol. 33(5):52. (abstract).

Cancer centers and organizations

Salzberg S. 2012. Making a profit from offering ineffective therapies to cancer patients. Forbes Dec 31. [Cancer Treatment Centers of America]

Begley S, Respaut R. 2013 Mar 7. Special report: Behind a cancer-treatment firm's rosy survival claims. Reuters.

Gorski D. 2013 Mar 7. The Cancer Treatment Centers of America: Cherry picked patients and survival data used to sell “integrative” oncology to the masses. Respectful Insolence.

Gorski D. 2013 Oct 7. Cancer Treatment Centers of America: Revisiting the epitome of "integrative" cancer care. Science-Based Medicine.

London WM. 2015 Nov 9. Continuing education in the toxin haunted world of the Cancer Control Society. Committee for Skeptical Inquiry.

Cancer therapies - critiques and reviews (general)

Barrett S, Moran P. 2017. Cancer Treatment Watch.

Barrett S. 2008. 125 fake cancer 'cures' consumers should avoid. Cancer Treatment Watch.

Barrett S. 2015. Questionable cancer therapies. Quackwatch.

National Cancer Institute. 2015 Apr 10. Complementary and alternative medicine.

National Cancer Institute. PDQ® cancer information summaries: integrative, alternative, and complementary therapies. (Individual pages are listed below under "types of treatments.")

American Cancer Society. Complementary and alternative methods and cancer.

Moran P. Alternative medicine and cancer. (includes link to "What's so hard about showing that a cancer cure works?" and other articles)

Vickers A. 2004. Alternative cancer cures: "unproven" or "disproven"? CA Cancer J Clin. 54(2):110-8.

Hall, H. 2012. CAM for Cancer. Skeptic 17(4):24-28

Cassileth BR. 1999. Evaluating complementary and alternative therapies for cancer patients. CA Cancer J Clin. 49(6):362-75.

Vickers AJ, Kuo J, Cassileth BR. 2006. Unconventional anticancer agents: a systematic review of clinical trials. J Clin Oncol. 24(1):136-40. (abstract)

Nahin, R.L. 2002. Use of the best case series to evaluate complementary and alternative therapies for cancer: a systematic review. Semin Oncol. 29(6):552-62. (abstract)

Weiger WA, Smith M, Boon H, Richardson MA, Kaptchuk TJ, Eisenberg DM. 2002. Advising patients who seek complementary and alternative medical therapies for cancer. Ann Intern Med. 137(11):889-903. (abstract)

Poppy C. 2017 Feb 2. Tijuana's alternative cancer treatments: warnings and side effects. Committee for Skeptical Inquiry.

Matthews SC, Camacho A, Mills PJ, Dimsdale JE. 2003. The internet for medical information about cancer: help or hindrance? Psychosomatics. 44(2):100-3. (abstract) (“There is a staggering amount of medical misinformation on the Internet.”)

Schmidt K, Ernst E. 2004. Assessing websites on complementary and alternative medicine for cancer. Ann Oncol. 15(5):733-42.

Ross K. 2008. Crackdown on unproven cancer treatments focuses on internet marketers. J Natl Cancer Inst.100(17):1200-2.

BC Cancer Agency 2017. Complementary/alternative therapies websites.

Federal Trade Commission. 2008. Cancer treatment scams.

Gorski D. 2008 Jan 14. On the nature of "alternative" medicine cancer cure testimonials. Science-Based Medicine.

Cancer therapies - types of treatments

Fenton TR, Huang T. 2016. Systematic review of the association between dietary acid load, alkaline water and cancer. BMJ Open. 6(6):e010438.

Yeo G, Quinn T. 2017 Jan 19. The dying officer treated for cancer with baking soda. BBC News.

Green S. 2013. Stanislaw Burzynski and "antineoplastons." Quackwatch.

National Cancer Institute. 2016. Antineoplastons.

Gorski D. 2011 Dec 12. Dr. Stanislaw Burzynski, antineoplastons, and the selling of an orphan drug as a cancer cure. Science-Based Medicine.

Gorski D. 2012 Nov 7. Stanislaw Burzynski: Slapped down by the FDA once again. Respectful Insolence.

Szabo L. 2013 Nov 18. Doctor accused of selling false hope to families. USA Today.

Gorski DH 2014. Stanislaw Burzynski: Four decades of an unproven cancer cure. Skeptical Inquirer 38(2):36-43.

Blaskiewicz R. 2014. Skeptic activists fighting for Burzynski's cancer patients. Skeptical Inquirer 38(2):44-47.

Barrett S, Blaskiewica R, De Dora M, Forrest B, Frazier K, French C, Gorski D, Hall H, Karr B, Lindsay RA, London WM, Scott EC, Segal B, Singh S, Stubblefield S. 2014 Apr 16. Re: Stanislaw Burzynski and antineoplastons. Letter to The Honorable Margaret A. Hamburg, MD, Commissioner, Food and Drug Administration. (pdf file)

Szabo L. 2014 July 24. Texas medical board charges controversial cancer doctor. USA Today.

Blaskiewicz R. 2014. Burzynski update: Publications, clinical trials, and more charges. Skeptical Inquirer 38(6):5-6

Wilner T. 2016 Feb 22. Cancer "Visionary" Stanislaw Burzynski stands trial for unprecedented medical malfeasance. Newsweek.

Ernst E. 2016 Aug 6. Fatalites in a German alternative medicine clinic caused by 3BP? Edzard Ernst. (3-bromopyruvate)

National Cancer Institute. 2016. Cancell/Cantron/Protocel.

Brownell C. 2012. "Cure" embraced by some, eschewed by MDs. Windsor Star Apr 28 [Cantron]

Cancer Research UK. 2015 Oct 1. Cannabis, cannabinoids and cancer - the evidence so far.

Ernst E. 2009. Carctol: profit before patients? Breast Care (Basel) 4(1):31-33.

Barrett S. 2003. Cellular therapy. Quackwatch.

Chen X, Deng L, Jiang X, Wu T. 2016. Chinese herbal medicine for oesophageal cancer. Cochrane Database Syst Rev. (1):CD004520.

Barrett S. 2009. The bizarre claims of Hulda Clark. Quackwatch.

Chavez P. 2007. How Hulda Clark victimized my parents. Cancer Treatment Watch.

Federal Trade Commission. 2003 Jan 27. Swiss company charged by FTC with making unsubstantiated health claims. (actions against companies associated with Hulda Clark)

Green S. 1992. A critique of the rationale for cancer treatment with coffee enemas and diet. JAMA 268(22):3224-7. (abstract)

Eastman KL, McFarland LV, Raugi GJ. 2014. A review of topical corrosive black salve. J Altern Complement Med. 20(4):284-9. (abstract)

Barrett S. 2014. Don't use corrosive cancer salves (escharotics). Quackwatch.

Barrett S. 2013. Stay away from Dr. Lorraine Day. Quackwatch.

Bertelli G. 2006. DiBella therapy was worthless. Quackwatch.

Ernst E, Boddy K. 2006. CAM cancer diets. Focus Alternative Complement. Therapies 11(2):91–95.

Huebner J, Marienfeld S, Abbenhardt C, Ulrich C, Muenstedt K, Micke O, Muecke R, Loeser C. 2014. Counseling patients on cancer diets: a review of the literature and recommendations for clinical practice. Anticancer Res. 34(1):39-48.

Barrett S. 2011. The shady activities of Kurt Donsbach. Quackwatch.

National Cancer Institute. 2016. Essiac/Flor Essence.

Kindergan A. 2005 Sept 5. Brewing up a cure? Cancer patients increasingly turning to Essiac tea to supplement treatment. Colorado Springs Gazette.

Anticancer Fund. 2015. GCMAF.

National Cancer Institute. 2016. Gerson therapy.

Moran P. Dr Max Gerson and his fifty cases.

Green S. 2000. Nicholas Gonzalez treatment for cancer: gland extracts, coffee enemas, vitamin megadoses, and diets. Quackwatch.

National Cancer Institute. 2016. Gonzalez regimen.

Atwood K. 2008 Nov 28. The "Gonzalez Trial" for pancreatic cancer: outcome revealed. Science-Based Medicine.

Chabot JA, Tsai WY, Fine RL, Chen C, Kumah CK, Antman KA, Grann VR. 2010. Pancreatic proteolytic enzyme therapy compared with gemcitabine-based chemotherapy for the treatment of pancreatic cancer. J Clin Oncol. 28(12):2058-63.

Green S. 2001. Hydrazine sulfate: is it an anticancer agent? Quackwatch.

National Cancer Institute. 2016. Hydrazine sulfate.

Barrett S. 2013. A critical look at William P. O'Neill, CCRG, and Immune System Management (ISM). Quackwatch.

Baratz R. 2013. Why you should stay away from insulin potentiation therapy (IPT). Quackwatch.

Moran PJ, Lubetkin L. 2015. Book review: One man alone: an investigation of nutrition, cancer, and William Donald Kelley. Cancer Treatment Watch.

Wilson B. 2014. The rise and fall of laetrile. Quackwatch.

Milazzo S, Horneber M. 2015. Laetrile treatment for cancer. Cochrane Database Syst Rev.(4):CD005476.

National Cancer Institute. 2017. Laetrile/amygdalin.

Bromley J, Hughes BG, Leong DC, Buckley NA. 2005. Life-threatening interaction between complementary medicines: cyanide toxicity following ingestion of amygdalin and vitamin C. Ann Pharmacother. 39(9):1566-9. (abstract)

Barrett S. 2001. Manner metabolic therapy. Quackwatch.

National Center for Complementary and Integrative Health. 2016. European mistletoe.

National Cancer Institute. 2016. Milk thistle.

Mansky PJ. 2002. Mistletoe and cancer: controversies and perspectives. Semin Oncol. 29(6):589-94. (abstract)

National Cancer Institute. 2017. Mistletoe extracts.

Ziegler R, Grossarth-Maticek R. 2010. Individual patient data meta-analysis of survival and psychosomatic self-regulation from published prospective controlled cohort studies for long-term therapy of breast cancer patients with a mistletoe preparation (Iscador). Evid Based Complement Alternat Med. 7(2):157-66. (abstract with link to full text (pdf file))

National Cancer Institute. 2017. Medicinal mushrooms.

Jin X, Ruiz Beguerie J, Sze DM, Chan GC. 2016. Ganoderma lucidum (Reishi mushroom) for cancer treatment. Cochrane Database Syst Rev. 4:CD007731.

National Cancer Institute. 2016. Newcastle disease virus.

Green, S. 2001. Oxygenation therapy: unproven treatments for cancer and AIDS. Quackwatch.

National Cancer Institute. 2016. PC-SPES.

Escobar H. 2016. Brazil bill would legalize renegade cancer pill. Science 352(6281):18. (summary) ("fosfo" = phosphoethanolamine)

National Cancer Institute. 2017. Prostate cancer, nutrition, and dietary supplements.

Barrett S. 2005. Matthias Rath's cancer treatment criticized. Quackwatch.

National Cancer Institute. 2016. Cartilage (bovine and shark).

Miller DR, Anderson GT, Stark JJ, Granick JL, Richardson D.J. 1998. Phase I/II trial of the safety and efficacy of shark cartilage in the treatment of advanced cancer. J Clin Oncol. 16(11):3649-55. (abstract)

Ostrander GK, Cheng KC, Wolf JC, Wolfe MJ. 2004. Shark cartilage, cancer and the growing threat of pseudoscience. Cancer Res. 64(23):8485-91.

Loprinzi CL, Levitt R, Barton DL, Sloan JA, Atherton PJ, Smith DJ, Dakhil SR, Moore DF Jr, Krook JE, Rowland KM Jr, Mazurczak MA, Berg AR, Kim GP. 2005. Evaluation of shark cartilage in patients with advanced cancer: a North Central Cancer Treatment Group trial. Cancer. 104(1):176-82.

MD Anderson News Release. 2010 May 26. Shark cartilage shows no benefit as therapeutic agent for lung cancer.

Lu C, Lee JJ, Komaki R, Herbst RS, Feng L, Evans WK, Choy H, Desjardins P, Esparaz BT, Truong MT, Saxman S, Kelaghan J, Bleyer A, Fisch MJ. 2010. Chemoradiotherapy with or without AE-941 in stage III non-small cell lung cancer: a randomized phase III trial. J Natl Cancer Inst. 102(12):859-65. (shark cartilage)

White J. 2010. The challenge of rational development of complex natural products as cancer therapeutics. J Natl Cancer Inst. 102(12):834-5. (comment on preceding paper)

National Cancer Institute. 2016. Selected Vegetables/Sun's Soup.

Barrett S. 2005. Some notes on "Two Feathers Healing Formula." Quackwatch

Ernst E. 2012 Oct 14. A telling story about "alternative" cancer cures and their purveyors. Edzard Ernst. (Ukrain)

National Cancer Institute. 2017. High-Dose Vitamin C.

Frei B, Lawson S. 2008. Vitamin C and cancer revisited. Proc Natl Acad Sci U S A. 105(32):11037-8.

Kaiser J. 2015. Vitamin C could target some common cancers. Science 350(6261):619. (summary)

Chen Q, Polireddy K, Chen P, Dong R. 2015. The unpaved journey of vitamin C in cancer treatment. Can J Physiol Pharmacol. 93(12):1055-63. (abstract)

Hsu PP, Sabatini DM. 2008. Cancer cell metabolism: Warburg and beyond. Cell. 134(5):703-7.

National Cancer Institute. 2015. 714-X.

Blackwell T. 2006 Oct. 21. Opening doors to unproven treatments. Canada.com (714X)

Cancer therapies - psychological and legal issues

Holland JC. 1982. Why patients seek unproven cancer remedies: a psychological perspective. CA Cancer J Clin. 32(1):10-4. (abstract with link to full text (pdf file))

Söllner W, Maislinger S, DeVries A, Steixner E, Rumpold G, Lukas P. 2000. Use of complementary and alternative medicine by cancer patients is not associated with perceived distress or poor compliance with standard treatment but with active coping behavior: a survey. Cancer. 89(4):873-80.

Verhoef MJ, Rose MS, White M, Balneaves LG. 2008. Declining conventional cancer treatment and using complementary and alternative medicine: a problem or a challenge? Curr Oncol 15 Suppl 2:s101-6. (abstract with link to full text (pdf file))

Lengacher CA, Bennett MP, Kip KE, Gonzalez L, Jacobsen P, Cox CE. 2006. Relief of symptoms, side effects, and psychological distress through use of complementary and alternative medicine in women with breast cancer. Oncol Nurs Forum. 2006 Jan 1;33(1):97-104. (abstract)

Gorski D. 2016 Mar 31. Cancer patients do not need or want suggestions for alternative cancer cures. Respectful Insolence.

HIV/AIDS therapies

Barrett S. 2001. AIDS-related quackery and fraud. Quackwatch.

Mills E, Wu P, Ernst E. 2005. Complementary therapies for the treatment of HIV: in search of the evidence. Int J STD AIDS. 16(6):395-403. (abstract)

Gorski D. 2016 Feb 3. Same as it ever was: Antivaccine crank Bill Maher loves him some HIV/AIDS quackery. Respectful Insolence. (Sam Chachoua)

Liu JP, Manheimer E, Yang M. 2005. Herbal medicines for treating HIV infection and AIDS. Cochrane Database Syst Rev. (3):CD003937. (abstract)

Bolognesi N. 2006. Bad medicine. Nat Med.12(7):723-4. (abstract) (Secomet V)

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