"Natural" versus CAM "natural"

NOTE: I was on a lovely vacation for three days in Chicago over the weekend, where I visited old haunts. (Bathroom attendants? At one of my favorite pub hangouts when I lived in Lincoln Park, John Barleycorn? Handing out crappy brown paper towels? Plastering the walls there with endless rows of flat screen TVs turned continuously on sports and news? Really? Oh, the pain.) In any case, what that means is that I didn't write anything new for today (other than this introduction). I did, however, find a lovely post from over two and a half years ago to recycle and update. Remember: If you haven't been reading for at least two and a half years, it's new to you, and, even if it isn't, it's pretty darned good, good enough to read again, if I do say so myself.

"When I use a word," Humpty Dumpty said in rather a scornful tone, "it means just what I choose it to mean -- neither more nor less."

"The question is," said Alice, "whether you can make words mean so many different things."

"The question is," said Humpty Dumpty, "which is to be master-- that's all."

From: Through the Looking Glass, and
What Alice Found There by Lewis Carroll

"How can I help seeing what is in front of my eyes? Two and two are four."

"Sometimes, Winston. Sometimes they are five. Sometimes they are three. Sometimes they are all of them at once. You must try harder. It is not easy to become sane."

From: Nineteen Eighty-Four by George Orwell

One of the most powerful weapons in the armamentarium of advocates of the unscientific and implausible medical practices that fall under the rubric of "complementary and alternative medicine" (CAM) or, even worse, "integrative medicine" (IM), both of which seek to seamlessly "integrate" pseudoscience with science to the point that people start to be unable to tell which is which in order to "complement" effective medicine with placebo-based medicine, is their skill manupulating language. On the Science-Based Medicine blog, Wally Sampson harped on this time and time again, particularly in his masterful fictional (but all too true-sounding) response to the question, "Why would medical schools associate with quackery?" Another SBM blogger, Kimball Atwood, has even turned the--shall we say?--"plasticity" with which CAM/IM advocates manipulate language to their advantage into a humorous recurring feature.I myself have pointed out time and time again how proponents of CAM/IM co-opt diet and exercise as being somehow "alternative" and are now using that as the "foot in the door" to introduce pseudoscientific quackery like reiki and homeopathy into academic and even community medical centers.

Much of the success, both previous and current, of CAM/IM advocates depends upon language. Just like Humpty-Dumpty, to ideologues like Deepak Chopra, words mean just what they choose them to mean, and, just like the view forced on Winston Smith at the Ministry of Love, two plus two are sometimes five, no matter how much we know they are four. All it takes is viewing science as "just another narrative," as postmodernist supporters of CAM/IM would like. Once that happens, there is nothing to stop one from viewing CAM/IM as being a "narrative" just as valid as that of science-based medicine. It's the way "quackery" has been transformed into "unconventional," later into "alternative," and most recently "integrative" medicine. It's all designed to play on the natural American desire to be "fair" and the media's desire for "balance," even though it is not fair to give pseudoscience a patina of scientific respectability that it does not deserve or use "balance" to present quackery as though it has equal standing with scientific medicine.

If there is one word that has been corrupted by the CAM/IM movement more than any other, my vote would go the world "natural." Of course, it's not just the CAM/IM movement that has molded this word to mean whatever meaning is required for whatever purpose is desired. For decades, the advertising industry has done the same. However, the CAM/IM movement takes it to a new level, or "kicks it up a notch," as a certain TV chef likes to say.

I came across a perfect example of this in the form of a man named Tony Isaacs.

Tony Isaacs happened to have written an article for one of the biggest repositories of quackery on the Internet, Mike Adams' (who likes to call himself the "Health Ranger") NaturalNews.com. The article, entitled Patrick Swayze's Misguided Faith in Mainstream Medicine, was a smug broadside at Patrick Swayze. Swayze, as you may recall, was diagnosed with stage IV pancreatic cancer in early 2008. While suffering from the disease, Swayze did something that really angered a lot of CAM/IM advocates. He gave an interview to Barbara Walters. No, it wasn't giving an interview to Barbara Walters that annoyed CAM/IM purveyors. What angered them was what he actually said in that interview with Barbara Walters, which was relayed to me by one of my blogging colleagues, as well as Majikthise. This is what Swayze said:

If anybody had that cure out there, like so many people swear they do, you'd be two things. You'd be very rich, and you'd be very famous. Otherwise, shut up.

He's also fairly realistic about his chances:

"Five years is pretty wishful thinking," the 'Dirty Dancing' star told Walters, who had been pressing the heavy question. "Two years seems likely if you're going to believe statistics."

Here we have a man facing death, a man who is highly unlikely to survive much longer than a year, in essence telling the CAM/IM crowd to stick it where the sun don't shine. If ever there were a situation where the temptation to try something--anything--different, even the rankest forms of quackery, Swayze's situation is it. After all, other celebrities facing death from cancer have succumbed to the temptation to try quackery, celebrities such as Steve McQueen, Coretta Scott King, and possibly even Michael Landon. That Swayze hasn't followed that siren song shows that he not only realizes CAM/IM has nothing that will save his live but also that his best hope for palliation and possible extension of the time he has left rests with science- and evidence-based medicine, as small and weak as that hope may currently seem.

Tony Isaacs was displeased:

The mainstream medicine group that has failed to conquer cancer for half a century has clearly gotten into Swayze's head. These are the same MD's and oncologist who will more often than not advise a person to not take antioxidants when having chemo, though there have been no reliable studies to support such advice and many which dispute it. The mainstream chemo theory is to weaken and destroy the cancer cells with chemical poison which also weakens and destroys the rest of the body's cells and organs in the often misplaced hope that the symptoms of cancer (tumors and cancer cell masses) will somehow be eliminated before the treatment itself kills the patient. It is a desperate gamble that fails more often than not. Even when most or all of the symptoms are eliminated by chemo (or radiation), the damage to the body's natural immune system, major organs and overall health is so great that the way is paved for the return and unabated growth of cancer in a body whose natural defenses have been rendered virtually useless.

So far, nothing different than the usual tropes. Yes, differential toxicity towards cancer cells compared to normal cells is how chemotherapy works. However, the immune system is far more resiliant than woo-philes like Isaacs can conceive. They seem to think that the immune system can't ever recover from the insult of chemotherapy. It can. It is also true that chemotherapy can increase the risk of secondary malignancies, as can radiation. However, the benefits of chemotherapy and radiation usually outweigh the risks of secondary malignancies. Indeed, if a cancer patient lives long enough to get a secondary malignancy, usually many years, isn't that better than dying within months of the first cancer? Moreover, it's not as though "conventional" doctors are not aware of this problem and researchers aren't trying to find treatments that either don't produce this complication or have a lower chance of producing it. Here, however, is where we see how the word "natural" means something different in CAM-speak than it does everywhere else:

While addressing the underlying causes of cancer is the ultimate key to long term cancer survival, one cannot ignore the symptoms of cancer which may well kill you in the short term before you are able to restore you body and immune system to optimum health. Here too, the right herbs and supplements can play a vital role in attacking tumors and cancer cells to arrest their growth and eliminate them to give the body the time it often needs to become restored and keep cancer at bay in the future. Though pancreatic cancer is a very aggressive and difficult cancer to beat, two natural items featured here at Natural News have been particularly successful against pancreatic cancer: oleander and black cumin seed oil.

Elsewhere, Isaacs drives his point home:

In contrast to at least 6000 years of the practice of natural medicine, Western medicine treats the body as a collection of parts instead of as a synergistic organism. When it comes to treating broken bones and injured body parts, mainstream Western medicine is unequaled. When this same approach is used to treat illness and disease - fixing or repairing the parts where the symptoms of underlying illnesses manifest themselves, modern medicine fails miserably

In the instance of cancer, instead of addressing the causes of cancer - toxins, pathogens and a weakened immune system - we see instead treatments that either slash, burn or poison away the tumors and cancer cells, which further weakens an immune system cancer has already defeated and only worsens the conditions that led to cancer to begin with.

[...]

And so, when we go to an oncologist and are diagnosed with cancer what is the prescribed treatment? Does it incorporate ANY of the above elements? No, sadly it does not. Our doctor prescribes what he or she has been taught: cut out, radiate or poison the symptom and do nothing to address the underlying causes and natural imbalances that led to the symptom.

As a result, the way is paved for the return of the cancer or the introduction of another cancer or serious condition. Even worse, the road to further illness is often made easier due to the damage to the immune system and major organs caused by the treatment of the symptom.

Nature, on the other hand, enables us to address virtually every area of knowledge and concern. In a future installment, we will take a look at a suggested protocol based on what nature has to offer.

This is nonsense on many, many levels. Science-based physicians have been studying nature for centuries trying to find the cause of and cure for cancer. Indeed, science has also been studying natural compounds for centuries, and many of our most potent drugs against cancer. Examples include the class of drugs known as taxanes or the class of drugs known as the vinca alcaloids, which were originally isolated and/or modified from plants. Indeed, existing happily within science- and evidence-based medicine is a discipline dedicated to finding natural products that can treat or cure disease. It's called pharmacognosy, and is the area of study that my blog bud David Kroll specializes in. What Isaacs is presenting is a false dichotomy: Either accept his pseudoscientific representations of what herbs, supplements, and "natural products" can do or die from cancer.

Isaacs is not even consistent, either. He refers to chemotherapy as "poison," but he sells oleander plant extracts and an "oleander soup" as a treatment for various cancers and other diseases. In some places, he likes to brag about how the UT-M.D. Anderson Cancer Center is supposedly studying oleander as a treatment for cancer. However, the M.D. Anderson website itself describes just how toxic oleander is:

Side Effects and Warnings:

Common oleander contains a strychnine-like toxin and a heart-active cardiac glycoside substance (similar to the prescription drug digoxin) that may cause the heart to beat rapidly or abnormally, or to stop beating. Common oleander has been used as rat poison, insecticide and fish poison and is toxic to mammals including humans. Animals (sheep) have died after eating as little as two to three leaves of Nerium oleander (common oleander). Children may die after eating a single leaf of common oleander. Eating the leaves, flowers or bark of common oleander may cause nausea, vomiting, stomach cramps, pain, fatigue, drowsiness, unsteadiness, bloody diarrhea, abnormal heart rhythms, seizures, liver or kidney damage or unconsciousness. Death may occur within one day. Reports of toxicity and deaths in children and adults have been reported for decades in Australia, India, Sri Lanka and the United States.

Fruits of Thevetin peruviana (yellow oleander) are thought to be even more toxic to mammals, including humans. Based on human studies of intentional overdose (suicide attempts), eating eight or more seeds of yellow oleander may be fatal. Additional side effects of oleander ingestion include irritation and redness of lips, gums and tongue, nausea, vomiting, depression, irritability, fast breathing, sweating, stomach pain, diarrhea, headache, confusion, visual disturbances and constricted pupils. Abnormal blood tests, including tests of liver and kidney function (potassium, bilirubin, creatinine and blood urea), have been reported in humans. It is possible that plants grown in the same soil as oleander plants or in soil exposed to oleander may contain trace amounts of oleander.

That's some seriously toxic stuff, isn't it? In fact, it sounds a lot like...chemotherapy!

Yes, that's exactly what it sounds like. Actually, it sounds like some of the most toxic chemotherapy currently used--maybe even more toxic. Worse, unlike many chemotherapeutic agents, it's unclear if oleander extracts have any actual benefit against pancreatic cancer--or any other cancer, for that matter. It's possible that they might, as might any natural product with biologically active agents with the appropriate chemical activity, but the evidence isn't there in the form of randomized trials showing a definite benefit. Such evidence may be found someday, but it is not there yet. Certainly Isaacs' anecdotes do not qualify as any sort of convincing evidence. Indeed, he brags about pancreatic cancer patients living five months using a specific oleander extract called Anvirzel, but in retort I point out that, as of his interview, Patrick Swayze had lived nearly a year since his diagnosis using science-based medical therapies and ultimately survived 20 months after diagnosis. Of course, the example of Patrick Swayze tells us no more than the example of patients taking Anvirzel. One year survival rates for patients with advanced pancreatic cancer range from 20-30%. That's why randomized clinical trials are needed. Moreover, even if oleander is effective against pancreatic cancer, it is clear that it is unlikely to be much more effective than current chemotherapy, if it is even as effective.

So what makes chemotherapy "unnatural" and oleander "natural"? In fact, Isaacs' hypocrisy goes beyond that, because the oleander extract he is touting is not any sort of raw plant extract. It's a natural product isolated by--horror of horrors!--an actual biotech startup company! It's a pharmaceutical company, and it's not studying these extracts because of any commitment to "natural" therapies. It's studying them because its scientists hope that they will form the basis of effective chemotherapy against various cancers and, above all else, to make money. That's what companies exist for, to make money for their investors and shareholders. In other words, it's just like the big pharmaceutical giants Merck and Bristol-Myers-Squibb except that it's not that big. But it hopes to be someday.

Also, apparently one of the clinical trials using oleander is for another experimental agent dubbed testing an agent dubbed PBI-05204. It is a phase I trial, which means that it is not testing efficacy, but rather maximum tolerated dose and pharmacokinetics. In any case, get a load of what Isaacs said about it:

I realize that oleander in raw form is highly toxic - but not so when processed into the medicine and supplement form (which is itself now made by a pharmaceutical manufacturing company to exact standards) and the FDA phase I trials found no doseage limit for toxicity, but rather stopped because the dose reached a size that was impractical to exceed.

As a point of interest, the very latest oleander medicine that has entered phase I FDA testing at MD Anderson clinic has no name yet, but is known simply as PBI-05204 (the PBI stands for Phoenix Biotechnology Inc).

Taking raw plant compounds and then processing them and modifying them to make them less toxic and (hopefully) more effective is exactly what the science-based medical science of pharmacognosy has been doing for centuries and, yes, those evil pharmaceutical companies have been doing for many decades, if not over a century. More than that, PBI-05204 is a drug. Not only is it a drug, but it's a drug made by a pharmaceutical company, a startup biotechnology company that's raising cash from investors just like any other biotech company and, presumably, hopes someday to make a tidy profit and grow into something much bigger. Moreover, the oleander product PBI-05204 is a purified (and possibly modified) natural product, just like lots of other experimental compounds isolated, purified, chemically modified, and manufactured by pharmaceutical companies, both large and small. The only difference is that this particular patented natural product is derived from a plant something that Isaacs likes, extracts of which promotes in the form of oleander soup.

Now do you understand what I am talking about? As was the case with Humpty Dumpty, to Isaacs, "natural" means exactly what he chooses it to mean, neither more nor less. The list of cancer chemotherapeutics derived from natural products is long: taxol (derived from the bark of the Pacific yew tree), vincristine and vinblastine (derived from Catharanthus roseus, commonly known as the Madagascar periwinkle), campothecin and irinotecan (discovered in the barks of the Chinese camptotheca tree and the Asian nothapodytes tree), anthracycline chemotherapy agents such as doxorubicin (derived from the bacteria Streptomyces peucetius), and etoposide (derived from the mayapple), among others. To Isaacs and other advocates of so-called "natural" therapies, these chemotherapeutic agents are purest evil, the tool of the Devil himself, given that they are used by oncologists to "poison" cancer. In contrast, it doesn't matter to him that the oleander plant is extremely toxic and that extracts from it can similarly be very toxic. To Isaacs, it's "natural." That means it must be good; it must be holy; it must be right. It must cure cancer, HIV, and other diseases.

Here's another example. On Tony Isaacs' website, a man named Chris Beckett writes:

The human body is self-preserving, self-maintaining, and self-healing. All that is required from us is to remove the causes of the problem, rest (go to bed) and preferably stop eating (fast), since the body will use the energy saved from not having to digest food, for the incredibly powerful healing & cleansing processes of the body to be initiated.

Yet on his very website, he is selling colloidal gold, all manner of supplements, various "oxygen-saturated" gels (trust me, you don't need extra oxygen on your skin, even if the oxygen doesn't diffuse away almost as soon as the gel is applied), and even collodal silver! Never mind that colloidal silver is no more "natural" than metallic silver forged into a ring or other jewelry. It has to be isolated, synthesized, and made into a colloidal suspension. It's also funny how Isaacs fails to mention that chronic usage of colloidal silver can produce what I've occasionally termed the "Smurf syndrome," a.k.a. agyria.

Come to think of it, there's one other therapy that is frequently touted as "natural," and that's "detoxification" therapies, such as the regimens popularized by Max Gerson or Nicholas Gonzalez. After all, the colon is a finely tuned organ that naturally eliminates waste and does it quite effectively. Yet, if we are to believe "alternative" medicine practioners, the colon can't do its job and needs to be "cleansed." In fact, I find it hard to imagine anything more unnatural than the "colon cleansing" therapies, variants of which have been espoused and popularized by Gerson, Kelly, and Gonzalez. After all, they involve pumping large quantities of fluids into one's rectum to fill the colon and flush out the feces and supposedly somehow "detoxify" the liver, coupled with the ingestion of all sorts of supplements and juices to the point where the carrot juice can turn patients orange. What's so "natural" about shooting coffee (or anything other liquid) up your butt and taking up to 100 supplement pills a day? Yet, what do we find on Tony Isaac's page?

That's right, all sorts of "intestinal detox" and colon cleansing products that the human body does not need and that may even be harmful. In fact, the body does quite a good job of "cleansing" itself of "toxins" without all these unnatural interventions. Apparently, these advocates of "natural hygiene" don't trust the body's natural ability to detoxify itself. I realize that they claim that the "modern world" is so full of "toxins" that the body supposedly never evolved to eliminate, but in reality much about our world is actually cleaner than it was, say, 100 years ago. More importantly, these toxins are always unnamed or their identities only vaguely alluded to; there is never any compelling evidence presented that they cause the chronic health problems attributed to them; and there is never any evidence from basic science or clinical studies to show that these "detox regimens" actually "detoxify" anything, much less cure the diseases or relieve the symptoms for which they are advocated.

The bottom line is that the belief that "natural" is better than the products of big pharma is far more akin to religion than to science, and it is this belief that drives so much of the "alternative" medicine movement. Mr. Isaacs himself epitomizes this double standard through his hawking of various oleander extracts, even though oleander is extremely toxic, and his ability to see no conflict at all between his support of using purified components from oleander made by a profit-driven startup biotech company and his disparaging of chemotherapy and "mainstream" medicine as not being "natural." Those of us advocating science-based oncology, in contrast, perceive no difference. Oleander extracts, if they end up being shown to be effective against cancer, will be correctly considered chemotherapy. Oncologists will happily add them to their armamentarium of chemotherapy and use them based solely on their ratio of efficacy to toxicity.

Just like any other new cancer therapy that is shown to be effective.

Also, these oleander extracts are being tested and marketed by institutions that are firmly part of the "conventional" biomedical industrial complex, with clinical trials being done at a major cancer center. Actually that's not entirely correct. There is one difference between Isaac's oleander and chemotherapy. Specifically, there has to be hard scientific evidence that chemotherapy is effectve against various cancers before it can be marketed. Oleander extracts have not yet passed that hurdle. They may, but they have not yet. Yet that doesn't stop Isaacs from making unsupported claims for their efficacy, especially given that there is no evidence that I can find that oleander extracts are any more effective against, for example, pancreatic cancer than currently used chemotherapy regimens. Certainly there is no evidence that Isaacs can present of any miraculous-seeming "cures" that would make his bold admonition that Patrick Swayze would do much better with "natural" therapies like oleander than he is currently doing using the fruits scientific oncology to fight his cancer. In fact, even the M.D. Anderson website doesn't say much new about its trials on oleander, which makes me think that they haven't gone as far as Isaacs would like us to think. All I could find more recent than when I wrote the original version of this post two and a half years ago was a link to a PowerPoint presentation that mentioned an upcoming trial entitled "A Phase I Study of Sublingual Anvirzel (Nerium Oleander) in Advanced Non-small Cell Lung Cancer."

Mark Crislip once characterized CAM/IM in a frighteningly accurate way, one that I will likely appropriate when I have the opportunity:

Much of alternative medicine where it overlaps with real medicine is the art of making therapeutic mountains out of clinical molehills.

That's exactly what Isaacs is doing here. He takes the results of cell culture studies and preliminary phase I clinical trials for various oleander extracts and, because he perceives them as being more "natural" than chemotherapy, ignores just how toxic oleander is, and arrogantly argues that his "natural" therapies are so much better than conventional chemotherapy that poor Patrick Swayze was hopelessly deluded to choose science-based medicine instead of his so-called "natural" cures.

Two and two equal three or five indeed depending the need, and words mean exactly what CAM/IM advocates choose them to mean, neither more nor less. Especially the word "natural." In any case, I can't help but ask: If nature is so effective at preventing and healing illness, then why does God allow so many people to become so sick and even to die of horrible diseases like AIDS and cancer? Oh, wait. I bet I know. It's the person's fault for not living "naturally" enough. Yes, that does appear to be the implication, as it is for so much woo, that disease is almost completely preventable or curable if only you eat the right foods, do the right exercises, take the right supplements, and believe the right stuff hard enough, so that if you get sick, it's almost always because of a failing on your part, not because nature's a bitch.

Perhaps Tony would clarify that point for me.