just returned from the 40th annual meeting of the American Society
for Clinical Oncology (ASCO). The meeting coincided with my
30th anniversary in the cancer field, as I was hired as science writer
at Memorial Sloan-Kettering Cancer Center on June 3, 1974. And so this
trip was a very good time for me to reflect on the status of complementary
and alternative medicine (CAM) and the changes that I have witnessed
in the war on cancer over the past three decades.
The first word that comes to mind in reference to ASCO's meeting is "huge." There
were over 25,000 participants, mostly medical oncologists, and they took over
New Orleans' cavernous 1.1 million square foot Convention Center. They
came to lecture and be lectured to about the latest advances in cancer treatment.
In addition to the gargantuan plenary sessions, there were hundreds of smaller
sessions and approximately 1,500 poster and oral presentations, and 8,500 other
research summaries given as Abstracts. Oncologists swarmed around the towering
commercial exhibits, read and discussed the latest research and of course schmoozed,
dined and did whatever professionals do when they assemble for a collegial
Although I was aware of the featured papers I was more interested in gathering
information on unusual, unconventional and out-of-the mainstream treatments
than on those that grabbed the headlines. I must say that I came away disappointed.
The takeaway message of the meeting, repeated in a thousand stories, was that "little
by little, new targeted therapies are helping cancer patients live longer,
even if they do not offer miraculous cures…" (Borden 2004).
The New York Times, on its front page, featured an anecdote about a single
patient who appeared to have benefited from a new Bayer drug in a clinical
trial (Pollack 2004a). I guess I have been down this road too many times in
the last 30 years to put my faith in such anecdotes, until I see the promising
results confirmed in rigorous clinical trials. In the meantime the public is
kept from seeing the real picture which is that advanced cancer is no more
curable today than it was 30 years ago, a sobering truth that was fully examined
in a recent Fortune magazine article: Click or go here for a discussion of
the Fortune article: http://www.cancerdecisions.com/040404.html
There are a million clever ways to dance around this central fact, but none
of them can ultimately obscure this depressing truth.
You would think that in the face of this conspicuous lack of success the oncology
profession would be eager to reach out for new ideas and concepts. And, as
I have shown throughout my career, there are abundant new ideas in the world
of CAM. But instead of welcoming CAM, they react to it as if it were a competitive
challenge rather than an opportunity.
The majority of presentations at ASCO still concern cytotoxic chemotherapy,
but the new twist is to add 'targeted' drugs, such as Iressa and
Erbitux, to the mix. The existence of these new targeted drugs does raise some
interesting possibilities, but one shouldn't put all one's eggs
in one basket. The typical treatment protocol used to be based on the hypothesis 'What
happens if we add drug A to conventional drugs B and C?' Now the question
has become, 'What happens if we add targeted agent A to conventional
drugs B, C and D?' The differences in outcome are tiny. Meanwhile, the
combinations become more complicated and much more expensive — too expensive,
The New York Times even suggested, for society ultimately to bear.
Something radically new is needed. But,
once again, the number of presentations on non-toxic or alternative
treatments was meager. First, a word of caution.
Like the three blind men studying the elephant, everyone comes away from
a meeting this huge with their own distinct impression. Although I spent
three days at the meeting I readily admit that I might have missed a few
relevant presentations. (The Meeting Program itself runs to 341 pages and
the Proceedings total over 1,000.) Nevertheless, the absence of CAM was conspicuous — and
somewhat mystifying, also, in view of the fact that CAM treatments for cancer
are generally acknowledged to be extremely important to patients and to society
as a whole. For instance, a study presented at this year's ASCO meeting
showed that fully "91% of patients surveyed reported using at least
one CT [complementary therapy, ed.] since diagnosis" (Yates 2004).
Ninety-one percent! Yet despite this, I found only a single lecture (out
of many hundreds) that included a discussion of CAM. This was the Saturday
(June 5th) presentation on "Complementary and Palliative Care for the
Treatment of Pediatric Cancer." Two speakers talked at length about
palliative care as a distinct issue. Only one speaker, Kara Kelly, MD, an
Assistant Professor of Pediatrics at Columbia University, New York, and co-chair
of the Complementary Therapies Committee of the Children's Oncology
Group (COG), then spoke about complementary medicine.
Although Dr. Kelly is a reasonable voice in the field of academic CAM studies,
I found her presentation downbeat. She emphasized the negative aspects of the
topic, such as potentially adverse interactions of herbs and conventional drugs,
while de-emphasizing the positive impact that vitamins and herbs might have
for patients. At the end, however, she did concede that CAM could be useful
to mitigate the side effects of conventional treatment. She cited research
done at Columbia showing that lower blood levels of antioxidants were associated
with increased adverse effects of chemotherapy (Barclay 2004). I felt like
a single crumb had fallen off the vast ASCO banquet table.
In the Question and Answer session that followed, one angry doctor assailed
parents who expressed a desire to use CAM for their children. These people,
he claimed, were actually suffering from a psychopathology (a fancy word for
mental disease), and had what he called "control issues" vis-à-vis
their doctors. (The topic is sensitive since doctors in the US have the legal
ability to force pediatric patients to submit to chemo and other conventional
treatments.) He also said that doctors who offered alternative treatments were
motivated by greed (a charge I considered hypocritical considering the intimate
ties of ASCO and many of its members with the pharmaceutical industry). There
was embarrassed silence at the podium, and none of the three speakers — good
people all — saw fit to challenge these intemperate remarks.
Posters No Better
The poster sessions filled one section of the vast convention hall. I thought
for sure I would find some interesting and unusual presentations there. But
this was not the case. On two consecutive days I squeezed my way past most
of the posters. Whenever appropriate, I spoke to the presenters.
One of the first was Catriona McNeil, MD, a young doctor from New South Wales,
Australia whose poster presentation warned against the "delay in conventional
breast cancer treatment associated with alternative therapy usage" (Abstract
#593). This poster contained some of the most grisly pictures of untreated
breast cancers I have ever seen. Really in-your-face stuff. Her presentation
concerned six patients who had been treated at two Sydney hospitals, and who
had delayed conventional treatment in order to try alternatives. Three of them
died while the other three were still alive and possibly cured by conventional
Now, I happen to believe that women who have curable breast cancers should
accept conventional treatment and use alternative treatments only as adjuncts.
And I certainly have known a few women over the years who I think made tragic
choices in this regard, some of whom lost their lives in the process. So I
would be the last person to say that this is not a potential problem. But exactly
how big a problem is it?
According to the impression given by these Australian doctors, it is a huge
one. "Alternative therapies," the presentation cautioned, "are
used by between 28% and 83% of women with breast cancer, but their impact is
causing deleterious delay in commencing empirically validated conventional
This young doctor, thinking I was a fellow oncologist, began to confide in
me on what she presumed was our shared desire to limit the use of CAM treatments!
I corrected her misunderstanding and explained my position. I then asked how
frequently this problem actually occurred. She didn't know, but volunteered
that there were at least 6 oncologists involved and each of them saw about
200 new patients per year. So they see about 1,200 new patients per year. Since
the study ranged over a four-year period, the patient base from which these
six cases were drawn was approximately 4,800 patients. Thus, the "deleterious
delay" affected 0.125 percent of the total patient population. This is
obviously a miniscule proportion of the total number of women treated, a fact
not pointed out in the presentation. Quite the opposite, the authors drew global
conclusions about "a medico-political climate that favors accommodation
of non-traditional adjuncts to cancer therapy." Dr. McNeil indicated
that alternative medicine was so popular that many oncologists feared to criticize
What amazed me was that Dr. McNeil and her colleagues considered this problem
serious enough to do a study, create a grisly poster, and then travel 10,000
miles to warn their American and international colleagues about this imminent
danger. This more or less set the tone for the other CAM-related presentations
that I saw and read.
One researcher at Massachusetts General Hospital, Brian D. Lawenda, MD, did
present an interesting and objective poster (Abstract #9601) on how vitamin
E and EGCG (an antioxidant compound in green tea) might modify the effects
of radiation. The premise of the study was, however, a negative one, i.e. that "dietary
antioxidants may play an antagonistic role during radiation treatment (RT)" In
fact, the opposite is true. As I explained in my book, Antioxidants
most studies show not an antagonistic but a harmless or synergistic interaction
when antioxidants are given concurrently with conventional treatment.
Be that as it may, Dr. Lawenda and his Boston colleagues implanted cancer cells
into the legs of mice, and then gave them either vitamin E or EGCG. There was
a small and statistically non-significant 4 percent increase in the radiation
dose necessary to control 50% of the tumors locally (the so-called TCD50).
But EGCG by itself significantly decreased the tumor growth rate by 10 percent.
There was also less general toxicity when animals were administered these nutrients:
less than half of the EGCG-treated mice had to have their limbs removed after
radiation treatment (9.8 percent vs. 23.8 percent in the control animals).
For patients, this could translate into a rather significant benefit from a
simple and non-toxic regimen involving taking the equivalent of 2-3 cups of
green tea per day. (This was an animal study and so the usual limitations of
such studies apply.)
The paper concluded that "adverse [radiation therapy]-related soft tissue
reactions occurred less frequently with antioxidant supplementation…." Although
Dr. Lawenda seemed especially eager to explore the issue of antioxidants' possibly
negative impact on the TCD50, he was clear that the takeaway message was the
dramatic lowering of the toxicity of the treatment. This was the most positive
thing I heard about any CAM treatment at the convention. Sadly, while some
of the 'targeted' treatment posters were so crowded that you had
to fight your way in, New York subway-style, just to read them, Lawenda's
study was completely unattended during the time I visited it.
On the exhibit floor the picture got even
worse. One booth bore the provocative title, "Remission Accomplished!" (I hope the "remission" quote
that it accomplished lasts somewhat longer than the "mission" that
Pres. Bush celebrated last May.)
This whole conference floor was a paean to the surging profitability of the
new cancer medicine. As Andrew Pollack of The New York Times made
clear, the ASCO meeting has become the new trading floor of the whole biotech
(Pollack 2004b). "Analysts, many of them with medical or science degrees,
pack the meeting rooms and photograph the presentation posters with digital
According to the May 2004 issue of Hem/Onc Today magazine,
there are now over 500 indications being explored in hematology/oncology using
new drugs. In five
years the "hem/onc's pipeline grew by 43 percent." In other
words, business is booming. On the floor, huge corporations jostled with one
another for control of the best space, each with its two or three-story high
triumphalist display. More than once, beautiful young women tried to entice
me into their carpeted booths to receive information on their company's
products. (A similar thing happened to me in the evening as I strolled with
a colleague down the French Quarter's raucous Bourbon Street.)
Overall, the actual amount of serious research into CAM presented at ASCO is
so small as to be nearly non-existent. Readers can check this for themselves
by accessing the ASCO Knowledge Center search engine (accessible at http://asco.org/ac/1,1003,_12-002577,00.asp).
I entered some popular CAM-related topics in the search engine and here is
what I came up with:
|Cartilage (any kind)
|Insulin potentiated chemotherapy
|Vitamins (in general)
As you can see, many popular topics in CAM are unmentioned among
the 10,000 Abstracts. These include hyperbaric oxygen, lycopene, melatonin,
Coley's toxins, the therapeutic use of cartilage extracts, and
so forth. And forget about the more controversial topics of laetrile,
Essiac tea, Hoxsey herbs, Rife machines, noni, mangosteen, etc. The
public can expect no help from the cancer establishment in making difficult
treatment decisions in these matters. It seems that as far as the oncology
profession is concerned, such treatments are simply beneath their contempt.
And yet, even the numbers on the above list, scanty though they are, give a
falsely positive impression of how much work is going on. Many of these citations
actually refer to the same few papers. Plus, many of these are not original
research but once-over-quickly surveys that mention a treatment only in passing.
Thus, the number of genuine, original studies of the safety and effectiveness
of CAM treatments is very small.
If we put the term "complementary medicine" into the same search
engine (for the body of the text), we come up with the following numbers:
So I guess we're making some
progress. In fact, if this were 30 years ago, I would know exactly
how to spin
the story on behalf
of the cancer establishment. "This year saw a 50% increase in
CAM-related papers over last year." And technically I would be
right! At the rate of an increased three extra papers per year, I can
confidently predict that in a mere 300 years from now, CAM will have
become a significant minority interest at ASCO meetings.
So, let's see. On the one hand, we know that between 60 to 90% of all
cancer patients are now using some form of CAM, and interest continues to grow.
One paper, reviewed by Dr. Kara Kelly, showed that 86% of patients reported
satisfaction with their alternative treatments. But on the other hand, we have
the painful spectacle of 25,000 oncologists with their heads in the sand, diligently
avoiding serious study of those very topics that are of the greatest interest
to their patients.
When the public and Congress rise up against this intolerable situation — and
they will — short-sighted oncologists will have no one to blame but themselves.
Barclay, Laura, MD. Many children with ALL
deficient in antioxidant vitamins. Medscape
June 7, 2004. Accessed June 8, 2004 from: http://www.medscape.com/viewarticle/480092?src=mp
Borden, Bill and Pierson, Ransdell. New drugs chip away at cancer,
Reuters, June 6, 2004. Accessed June 8, 2004 from: http://www.reuters.co.uk/newsArticle.jhtml?type=healthNews&storyID=5354434
& section=news (2/20/05: Link not viable.)
Pollack, Andrew. Drugs may turn cancer into manageable disease. The
New York Times, June 6, 2004. Accessed June
8, 2004 from: http://www.nytimes.com/2004/06/06/health/06CANC.html (citedas 2004a)
Pollack, Andrew. Annual Cancer Conference Becomes Laboratory for Stocks.
The New York Times, June 8, 2004.
Accessed June 8, 2004 from:
ace.html (cited as