Thursday, December 23, 2010

Alternative Medicine: Devil's Claw for Follicular Lymphoma?

I am not a fan of alternative medicine, as my recent commentary on a German brain tumor study indicates. On the other hand, some people swear by them. Some people on "watch & wait" for indolent lymphoma credit various supplement regimens with preventing their disease from progressing. On the other hand, the scientific literature is generally lacking on this point, and there are whole blogs largely devoted to slaying the beast of pseudo-medicine. My general take is that, if pharmaceutical corporations really were the greedy, money-hungry beasts their foes think they are (and on that point I generally concur), and there really were substantial benefits to be had from alternative medicines, then said Big Pharma would be on the herbs in question like white on rice. That for conspiracy theories.

Anyhow, having said that, while "approaches" like homeopathy literally can't work according to evidence-based medicine, herbal therapies might work -- it's just that they don't deliver standardized or purified doses, so, theoretically, isolating and mass-producing the active ingredients in pill or solution form will always be more effective. Which is why I do tend to keep an eye open for interesting new research on the subject of "alternative medicine." Like, for instance, a curious study on Devil's Claw I found while searching for information about advanced follicular lymphoma.

The study in question was published in Current Oncology last year by K.S. Wilson of the B.C. Cancer Agency. Wilson presents evidence that 500 mg daily supplements of Devil's Claw may shrink lymphoma tumours, possibly to the point of inducing long-term remission. It contains an ingredient known as cox-2 which may have some role in treating arthritis and back pain, and preventing cancer, although the evidence on this point seems dubious and uncertain. Wilson vaguely suggests that cox-2 is the likely cause of the effects he observed in follicular lymphoma, as well.

This study hasn't fully convinced me. Aside from the fact that anyone with a potentially deadly disease is likely to grasp at any straw that might prove of use, Wilson's work still leaves a lot open to question. Really, this is less a "study" than a series of anecdotal observations by Wilson. It includes a writeup on all of two patients he treated since 2000. Both took Devil's Claw: one started taking it after diagnosis, and then apparently convinced at least another member of a lymphology support group to try it, as well. Both patients survive, with marked tumour regression, although one developed myeloma and needed a stem-cell transplant.

Obviously it's hard to derive a meaningful conclusion from an article like this, other than the need for further research (which Wilson does call for); despite the fact that it appears in a peer-reviewed journal, this is literally a dressed-up form of anecdotal evidence. Wilson says the chances of two randomly selected lymphoma patients undergoing simultaneous, spontaneous remission are about 2%. Of course, these two gentlemen weren't randomly selected.

Does the BC Cancer Agency have other patients taking Devil's Claw, which Wilson either is unaware of or chose not to write about -- and who did experience disease progression? And what of the myeloma case? Are we to infer that Devil's Claw carries with it a 50% risk of that, too? Obviously not.

There's a reasonable and responsible course to follow, which hopefully is now being done in this case (or not, as the case may be): analyze Devil's Claw for active ingredients, test those ingredients in the laboratory, and then develop a drug which can be used in humans, containing a purified and standardized dosage of the ingredient in question. Until then, despite the credibility of Wilson, the BC Cancer Agency, and Current Oncology, work like this still must be relegated to the long list of unproven natural remedies.

2 comments:

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