CAM Scams: CAM Scams: Poisons as Poisons as

Cancer CuresCancer Cures

Lewis Nelson, MDLewis Nelson, MD

New York University School of MedicineNew York University School of Medicine

New York City Poison Control CenterNew York City Poison Control Center

"I am glad to be among my own kind tonight. I was once a sharpshooter, but now I practice a much higher and equally as deadly a profession"

Mark Twain

Complementary and Alternative Medicine (CAM)

Complex collection of unrelated therapies– Theoretical clinical basis (relaxation)– Theoretical biological basis (herbal medicine)– Widespread acceptance (acupuncture & chiropractic)

Variable training and certification requirements for practitioners– Some feel that formal regulation would serve to

legitimize them Most have limited scientific support

– A few have a checkered history of quackery Fraudulent offering of medical skill

Cancer therapy

Current chemotherapy (possibly excluding immunotherapeutics) works by exploiting differences between normal and cancerous cells– Rate of division– Uptake of medication– Utilization of antidote

Unfortunately, scammers have used this same logic to push their products

CaseCase

A 65 year-old woman presents after a A 65 year-old woman presents after a witnessed syncopal episode.witnessed syncopal episode.

Past medical history significant for HTN Past medical history significant for HTN and metastatic adenocarcinoma of the and metastatic adenocarcinoma of the colon.colon.

Has been seeing a naturopathic health Has been seeing a naturopathic health care provider for treatment.care provider for treatment.

CaseCase

1 month history of loose stools1 month history of loose stools On day of presentation had witnessed On day of presentation had witnessed

collapse without incontinence, seizure collapse without incontinence, seizure activity or tongue biting.activity or tongue biting.

Spontaneously awoke, was amnestic of Spontaneously awoke, was amnestic of the event.the event.

CaseCase

Vital signs:Vital signs: BP 138/55 mmHgBP 138/55 mmHg P 52/minP 52/min Temp 36.8°CTemp 36.8°C RR 18/minRR 18/min SpO2 95% on room airSpO2 95% on room air

Rapid bedside glucose 10 mmol/LRapid bedside glucose 10 mmol/L

CaseCase

ExamExam A&Ox3A&Ox3 HEENT: Small contusion on foreheadHEENT: Small contusion on forehead Chest: ClearChest: Clear Heart: NormalHeart: Normal Abdomen: Soft, non tenderAbdomen: Soft, non tender Extremities: NormalExtremities: Normal Neurologic: No focal neurological findingsNeurologic: No focal neurological findings

MedicationsMedications

Naturopathic productsNaturopathic products– Unknown “herbal” powderUnknown “herbal” powder– A tablet: GigamaxA tablet: Gigamax– A tablet: Multi CA tablet: Multi C– A tablet: Slow KA tablet: Slow K

QTc = 700 msec

LabsLabs

KK++ 2.8 mEq/L 2.8 mEq/L Magnesium and calcium, normalMagnesium and calcium, normal

In the ED, the patient had 4 episodes of syncope lasting 10-20 sec each. A rhythm strip is shown:

www.naturopathic.org/

NaturopathyNaturopathy

““Cancer is a mutated cellular process Cancer is a mutated cellular process which results from high intake of refined which results from high intake of refined foods, fake foods, processed foods, foods, fake foods, processed foods, including processed white sugar including processed white sugar products, artificial sweeteners, white products, artificial sweeteners, white flour products, packaged foods, food flour products, packaged foods, food preservatives, food color and dye preservatives, food color and dye additives, and foods grown with additives, and foods grown with pesticides, herbicides, antibiotics and pesticides, herbicides, antibiotics and hormones.”hormones.”

NaturopathyNaturopathy

““Naturopathic Medicine believes Naturopathic Medicine believes that….all cancer is both fungal and that….all cancer is both fungal and viral in origin, and sometimes viral in origin, and sometimes parasitic.”parasitic.”

“…“….health disorders [including cancer] .health disorders [including cancer] are most likely a result of nutritional are most likely a result of nutritional imbalances as well as an accumulation imbalances as well as an accumulation of toxic substances.” of toxic substances.”

Naturopathic Cancer CuresNaturopathic Cancer Cures

Colloidal Silver 500 ppmColloidal Silver 500 ppm Oil of oregano P73 Physician's Strength Oil of oregano P73 Physician's Strength Garlic Kyolic Organic Liquid #10020 Garlic Kyolic Organic Liquid #10020 Aloe Vera Aloe Vera CoQ10 Q-Gel® With Vitamin ECoQ10 Q-Gel® With Vitamin E Liquid Vitamins/MineralsLiquid Vitamins/Minerals Calcium/Magnesium Powder Calcium/Magnesium Powder Himalayan Goji Juice Himalayan Goji Juice

“Be careful about reading health books. You may die of a misprint.”

Mark Twain

Herbal Cancer TreatmentsHerbal Cancer Treatments

CanCellCanCell Hoxey’s TherapyHoxey’s Therapy Gerson’sGerson’s Etc…..Etc…..

CanCell/ProtoCelCanCell/ProtoCel ““Lowers the voltage of the cell structure Lowers the voltage of the cell structure

by about 20%...so they ‘self digest’”by about 20%...so they ‘self digest’” Warn that bottles of CanCell should not

be allowed to touch each other Claim that CanCell cannot be analyzed

because it varies with atmospheric vibrations

InositolInositolNitric AcidNitric AcidSodium SulfiteSodium SulfitePotassium Potassium HydroxideHydroxideSulfuric AcidSulfuric AcidCatecholCatecholCrocinic AcidCrocinic Acid

National Cancer Institute states, “The nature and origin of this chemical has not been provided, and it does not appear to be a known compound.”

Gerson’s CureGerson’s Cure

Need to detoxifyNeed to detoxify Vegetarian DietVegetarian Diet VitaminsVitamins Liver injectionsLiver injections Coffee EnemasCoffee Enemas

Gerson Institute in Bonita, California

LaetrileLaetrile

Trade name of an extract of fruit pits that Trade name of an extract of fruit pits that contains contains l l -mandelonitrile-beta--mandelonitrile-beta-glucuronoside, or amygdalinglucuronoside, or amygdalin– Cyanogenic glycosideCyanogenic glycoside– Acronym for laevorotatory and mandelonitrile Acronym for laevorotatory and mandelonitrile

Used for more than a century as an active Used for more than a century as an active anticancer regimenanticancer regimen

1970 petition to study it denied by FDA 1970 petition to study it denied by FDA – Viewed by some as an attempt by the US Viewed by some as an attempt by the US

government to block cancer therapiesgovernment to block cancer therapies

Multiple court casesMultiple court cases– Laetrile was legalized in more than 20 US Laetrile was legalized in more than 20 US

states during the 1970s. states during the 1970s. – Must certify that the patient is “terminal”Must certify that the patient is “terminal”

In 1980, the US Supreme Court In 1980, the US Supreme Court overturned decisions by the lower overturned decisions by the lower courtscourts– Reaffirmed FDA’s position that drugs must Reaffirmed FDA’s position that drugs must

be proven to be both safe and effective be proven to be both safe and effective before widespread public use. before widespread public use.

C O

H

Amygdalin

Hydrogen cyanide

BenzaldehydeGlucose (2)

OHO

HO

HO

OH O

OHO

HO OH O CC N

C NH

OHO

HO

HO

OH OH

Glucosidase

Administered by intravenous injection. Administered by intravenous injection. – Although the GI tract cells have Although the GI tract cells have

glucosidase, the remainder of the body’s glucosidase, the remainder of the body’s cells do not.cells do not.

Proponents claim that cancer cells, Proponents claim that cancer cells, unlike normal cells, are particularly unlike normal cells, are particularly rich in glucosidase and they release rich in glucosidase and they release cyanide from amygdalin which cyanide from amygdalin which destroys the cancer cells.destroys the cancer cells.

Laetrile has shown little to no Laetrile has shown little to no anticancer effect in laboratory studies, anticancer effect in laboratory studies, animal studies, or human studies.animal studies, or human studies.

Not surprisingly, the adverse effects of Not surprisingly, the adverse effects of Laetrile are similar to those of cyanide. Laetrile are similar to those of cyanide.

The Clinical Trial (Mayo The Clinical Trial (Mayo Clinic) Clinic)

A prospective, open-label evaluation of A prospective, open-label evaluation of amygdalin plus "metabolic therapy“ in amygdalin plus "metabolic therapy“ in 178 patients with various cancers. 178 patients with various cancers.

21 days of IV amygdalin 4.5 grams/m21 days of IV amygdalin 4.5 grams/m22 followed by 500 mg amygdalin tablets followed by 500 mg amygdalin tablets TID. TID. – Plus metabolic therapy consisting of vitamins, Plus metabolic therapy consisting of vitamins,

minerals, and pancreatic enzymes.minerals, and pancreatic enzymes. Primary outcomes measured were tumor Primary outcomes measured were tumor

response and survival. response and survival.

Moertel CG. N Engl J Med 1982;306:201-206

1 partial response1 partial response 79% had progression at 2 months 79% had progression at 2 months

– 91% by 3 months. 91% by 3 months. – Median survival: 4.8 months from initiation Median survival: 4.8 months from initiation

Adverse effects: HA, N/V, dizziness, Adverse effects: HA, N/V, dizziness, obtundation.obtundation.

Significantly elevated blood cyanide Significantly elevated blood cyanide concentrations. concentrations.

Moertel CG. N Engl J Med 1982;306:201-206

The results suggest that amygdalin is The results suggest that amygdalin is ineffective in the treatment of cancer.ineffective in the treatment of cancer.

Claims for Laetrile’s effectiveness Claims for Laetrile’s effectiveness shifted from a cancer cure, to a cancer shifted from a cancer cure, to a cancer “control” agent, to a "vitamin” (called “control” agent, to a "vitamin” (called B17) purported to prevent cancer. B17) purported to prevent cancer.

Moertel CG. N Engl J Med 1982;306:201-206

The Internet The Internet search found search found several websites several websites still selling still selling Laetrile or Laetrile or offering related offering related clinical services.clinical services.

All in MexicoAll in Mexico ““Oasis of Hope”Oasis of Hope”

http://www.amygdalin.co.uk

Elements and simple Elements and simple molecules molecules

Widely touted as cancer curesWidely touted as cancer cures ““Hyperoxygenation therapy” Hyperoxygenation therapy”

– It is claimed by proponents that intravenous It is claimed by proponents that intravenous ozone can “dissolve” malignant tissues due to ozone can “dissolve” malignant tissues due to their deficiency of the protective enzyme their deficiency of the protective enzyme catalase. catalase.

““Autohemotransfusion” of ozoneAutohemotransfusion” of ozone– Blood mixed with ozone and retransfused. Blood mixed with ozone and retransfused. – In one case, clinical and postmortem studies In one case, clinical and postmortem studies

revealed gas embolism and patent foramen revealed gas embolism and patent foramen ovale.ovale.

The Role of pHThe Role of pH

In a seminal In a seminal paper, Dr. A. K. paper, Dr. A. K. Brewer, a Brewer, a physicist, physicist, describes two pH describes two pH therapies therapies available for available for treating cancer:treating cancer:– Low pH TherapyLow pH Therapy– High pH TherapyHigh pH Therapy

Low pH TherapyLow pH Therapy

“…“….glucose is injected into the blood stream. .glucose is injected into the blood stream. As a consequence, the cancer cell pH will As a consequence, the cancer cell pH will drop eventually to the 5.5 range.”drop eventually to the 5.5 range.”

““The patient is then placed in a furnace The patient is then placed in a furnace heated to 104 degrees Fahrenheit (40C) for a heated to 104 degrees Fahrenheit (40C) for a matter of hours.”matter of hours.”

““At these high temperatures and in the acid At these high temperatures and in the acid medium, the life of cancer cells is very medium, the life of cancer cells is very short.”short.”

““The only drawback is that severe toxemia The only drawback is that severe toxemia may result from the out-leakage of the acid may result from the out-leakage of the acid toxins within the tumor masses.” toxins within the tumor masses.”

High pH TherapyHigh pH Therapy

“…“….consists of .consists of feeding the patient feeding the patient about 6 gm of CsCl about 6 gm of CsCl per day in per day in conjunction with conjunction with Vitamins A and C, Vitamins A and C, which upon which upon absorption by the absorption by the tumor cells will give tumor cells will give rise to the pH to 8 rise to the pH to 8 or above…”or above…”

High pH TherapyHigh pH Therapy

Cancer cells undergo anaerobic metabolism– Produces lactic acid

This alters DNA to allow uncontrolled growth Also causes pain

Cesium is an alkaline earth metal– Highly electropositive, generates alkaline solution– Though given as the chloride salt

Follows sodium pathway into cells Purportedly raises intracellular pH to 8

– Stops mitosis– Ends pain

High pH TherapyHigh pH Therapy

““Two side effects have been observed Two side effects have been observed in some of the patients. These are first in some of the patients. These are first nausea, and the second diarrhea.”nausea, and the second diarrhea.”

Oh yeah….Oh yeah….

Cesium ChlorideCesium Chloride

Why do people fall for quackery?

Proponents almost never keep score or reveal what percentage of their cases end in failure.– How good is the diagnosis

The patient never had cancer

– If the patients die, “they were too late to be cured”

Proponents are very convincing, charismatic– Cancer patients are particularly vulnerable

Thank you

ReferencesReferences

National Cancer Institute. National Cancer Institute. http://www.cancer.gov/cancertopics/treatment/cam. Accessed 2/25/08. Accessed 2/25/08

Goldfrank L et al. Goldfrank’s Toxicologic Emergencies. 7th Ed, McGraw Goldfrank L et al. Goldfrank’s Toxicologic Emergencies. 7th Ed, McGraw Hill, New York. 2002: pp. 1-15, 1183-119, 1498-1504.Hill, New York. 2002: pp. 1-15, 1183-119, 1498-1504.

Soignet SL et al. Complete remission after treatment of acute Soignet SL et al. Complete remission after treatment of acute promyelocytic leukemia with arsenic trioxide. NEJM 1998;339:1341-promyelocytic leukemia with arsenic trioxide. NEJM 1998;339:1341-1348.1348.

Brewer AK. The high pH therapy for cancer tests on mice and humans. Brewer AK. The high pH therapy for cancer tests on mice and humans. Pharmacol Biochem Behav 21: Suppl. 1, 1-5. 1984.Pharmacol Biochem Behav 21: Suppl. 1, 1-5. 1984.

Dalal AK, Harding JD, Verdino RJ. Acquired long QT syndrome and Dalal AK, Harding JD, Verdino RJ. Acquired long QT syndrome and monomorphic ventricular tachycardia after alternative treatment with monomorphic ventricular tachycardia after alternative treatment with cesium chloride for brain cancer. Mayo Clin Proc 2004; 79(8):1065-1069. cesium chloride for brain cancer. Mayo Clin Proc 2004; 79(8):1065-1069.

Jones DL, Petrie JP, Li HG. Spontaneous, electrically, and cesium chloride Jones DL, Petrie JP, Li HG. Spontaneous, electrically, and cesium chloride induced arrhythmia and afterdepolarizations in the rapidly paced dog induced arrhythmia and afterdepolarizations in the rapidly paced dog heart. Pacing Clin Electrophysiol 2001; 24(4 Pt 1):474-485. heart. Pacing Clin Electrophysiol 2001; 24(4 Pt 1):474-485.

Pinter A, Dorian P, Newman D. Cesium-Induced Torsades de Pointes. Pinter A, Dorian P, Newman D. Cesium-Induced Torsades de Pointes. NEJM 2002 346: 383-384 NEJM 2002 346: 383-384

ReferencesReferences

Moertel CG, Fleming TR, Rubin J, Moertel CG, Fleming TR, Rubin J, et al. et al. A clinical trial of amygdalin A clinical trial of amygdalin (Laetrile) in the treatment of human cancer. (Laetrile) in the treatment of human cancer. N Engl J Med N Engl J Med 1982;306:201-2061982;306:201-206

Chlebowski RT, Bulcavage L, Grosvenor M, Chlebowski RT, Bulcavage L, Grosvenor M, et al. Hydrazine sulfateet al. Hydrazine sulfate influence on nutritional status and survival in non-small-cell lung influence on nutritional status and survival in non-small-cell lung

cancer. cancer. J Clin Oncol 1990;8:9-J Clin Oncol 1990;8:9-15. 15. Marchetti D, La Monaca G. An unexpected death during oxygen-Marchetti D, La Monaca G. An unexpected death during oxygen-

ozone therapy. ozone therapy. Am J Forensic Med Pathol 2000;21:144-147. Am J Forensic Med Pathol 2000;21:144-147. See KA, Lavercombe PS, Dillon J, Ginsberg R. See KA, Lavercombe PS, Dillon J, Ginsberg R. Accidental death from Accidental death from

acute selenium poisoning. acute selenium poisoning. Med J Aust 2006;185:388-9. Med J Aust 2006;185:388-9. Lyon AW, Lyon AW, Mayhew WJ. Cesium toxicity: a case of self-treatment by Mayhew WJ. Cesium toxicity: a case of self-treatment by

alternate therapy gone awry. alternate therapy gone awry. Ther Drug Monit 2003; 25:114-116.Ther Drug Monit 2003; 25:114-116.