CAM use, but not all CAM use, is correlated with skipping chemotherapy

So-called “alternative” medicine is made up of a hodge-podge of health care practices and treatments based on beliefs that are unscientific, pre-scientific, and pseudoscientific. These modalities include practices as diverse as homeopathy, traditional Chinese medicine, reflexology, reiki and other forms of “energy medicine” based on vitalism, chiropractic, and naturopathy, and that’s a short list of the quackery that falls under the rubric of the term “alternative medicine.” Unfortunately, this unscientific, pre-scientific, and pseudoscientific hodge-podge of treatments rooted in nonsense are rapidly being “integrated” into real medicine, thanks to an unfortunately influential movement in medicine whose members have been seduced into thinking that there might be something to them and view “integrating” them into medicine as means of practicing more “holistic” and “humanistic” medicine. This “integration” started out by being called “complementary and alternative medicine” (CAM) but now among believers the preferred term is usually “integrative medicine,” largely because it eliminates the word “alternative,” which implies (correctly) that the modality is not real medicine, and “complementary,” which implies a subsidiary status, a status of being nice to have but not essential.

Particularly harmful is the hostility towards conventional medicine that often strongly correlates with use of alternative medicine. Indeed, some people even choose to rely on alternative medicine instead of real medicine to treat cancer. Unsurprisingly, the results of such a decision are generally not very good. Actually, they are almost always terrible. Very, very terrible indeed. Not surprisingly, the use of alternative medicine is associated with bad outcomes. Cancer patients who might have survived die because of it. It’s not as though it hasn’t been studied either, although the main studies I’m aware of tend to look at the bad outcomes in patients who choose alternative medicine. There is another question, and it’s one that a new study published in JAMA Oncology last week seeks to answer. It’s a study that briefly made the news, producing headlines like:

The study itself is entitled CAM Use and Chemotherapy Initiation Among Women With Invasive Non-Metastatic Breast Cancer. Interestingly enough, the first author is someone we’ve met before, Heather Greenlee, a naturopath at Columbia University. She’s the one who wrote “evidence-based” guidelines for the Society for Integrative Oncology (SIO) regarding CAM use in breast cancer patients. This time around, she’s actually doing something useful: Looking at the correlation between CAM use and chemotherapy refusal with an oncologist named Dawn L. Hershman, MD.

Basically, this study examined a cohort of 685 women with nonmetastatic breast cancer recruited from multiple sites, including Columbia University Medical Center, Kaiser Permanente Northern California, and the Henry Ford Health System. The women were all under 70 years old and part of the Breast Cancer Quality of Care (BQUAL) study, a prospective cohort study Of these women, 306 (45%) were clinically indicated to receive chemotherapy per National Comprehensive Cancer Network Guidelines. The investigators looked at factors that correlated with use or nonuse of chemotherapy in women for whom chemotherapy was indicated. Specifically, in baseline interviews they looked at the use of five different CAM types: vitamins and/or minerals; herbs and/or botanicals; other natural products; mind-body self practice; mind-body practitioner-based practice. From these interviews, each patient was defined as falling into one of three categories: any use, dietary supplement use, and mind-body use. Also, a CAM index score was developed to sum all five modalities.

When I first read the abstract, my first thought was: WTF? There’s a lot more to CAM than just vitamins, herbs, botanicals, and “mind-body” practices. It turns out, however, that the definitions were quite broad and in line with the National Center for Complementary and Integrative Health (NCCIH) definitions. For example, mind-body self practices included yoga and meditation, while practitioner-based mind-body practices included modalities as varied as acupuncture, reiki, and meditation. Special diets and multivitamins were excluded from the definition of CAM, because, according to the authors, these are commonly used and often not categorized as CAM. They justified the definition thusly in the introduction:

Studies often define CAM using a broad, nonspecific definition that includes any therapies or approaches that are a complement or alternative to conventional medical therapies. However, when defining clinical populations using CAM, it may be more useful to consider CAM using specific subcategories, such as dietary supplements and mind-body practices. Dietary supplements include vitamins, minerals, botanicals, and other natural products. Mind-body practices include practices such as yoga, meditation, qi gong, acupuncture, and massage. In the oncology setting, patients may use both dietary supplements and mind-body practices to relieve symptoms, for general health and wellness promotion and to increase their sense of hope and control, though the evidence base for mind-body practices is stronger than for dietary supplement use. Patient motivations and the benefits they hope to obtain may also differ between these 2 categories of CAM. It has been hypothesized that CAM use may be a risk factor for not initiating standard oncology treatments because patients may be exploring other alternative treatment approaches or because conventional oncology treatments are not congruent with patient belief systems. However, prior studies on CAM use among patients with breast cancer have not differentiated whether standard oncology treatments were indicated based on clinical characteristics of patients.

Fair enough, such as this definition is. CAM is basically vaguely defined anyway, and the number of subdivisions seems to be decreasing, so that pretty much everything that’s not dietary supplements, botanicals, or natural products falls into “mind and body” practices. If you’re going to study CAM, you have to choose a definition, and that’s not a straightforward task. Besides, when recognizing CAM, I sometimes have a hard time not invoking the old trope about pornography: I know it when I see it. In any case the authors did univariate and multivariate analyses looking for associations between current use of any CAM (yes/no), current dietary supplement use (yes/no), current mind-body use (yes/no), and number of CAM modalities currently used (range 0-5) and subsequent chemotherapy initiation. Demographic and clinical factors were tested as potential confounders. Here’s what they found:

  • Baseline CAM use was common and reported by 598 women (87%).
  • Chemotherapy was initiated by 272 women for whom chemotherapy was indicated (89%).
  • Among women for whom chemotherapy was indicated, dietary supplement use was associated with markedly less chemotherapy initiation (odds ratio: 0.16, meaning they were 84% less likely to accept chemotherapy).
  • For every one unit increase in the CAM score, the odds ratio for chemotherapy use was 0.64.
  • There was no association between mind-body practices and chemotherapy initiation.
  • There was no association between CAM use and chemotherapy use in women for whom the need for chemotherapy was judged to be discretionary.

The results are summarized below in this table:

TABLE

The authors note one surprising part of this result:

Women for whom chemotherapy is discretionary will likely have different reasons for chemotherapy initiation compared with women for whom chemotherapy is indicated. Here, we found that CAM use in the discretionary group was not associated with chemotherapy initiation. We hypothesized that CAM use would be associated with chemotherapy initiation among the discretionary group because there is more leeway in the decision making process, but we did not find that this was true. Instead, in the group with a clear clinical indication for chemotherapy, users of CAM were significantly overrepresented among the relatively small group that did not receive this indicated treatment.

That last sentence makes an important point. One of the weaknesses of this study is that the number of patients for whom chemotherapy was definitely indicated but who declined it was small, only 34 patients. It’s not clear how generalizable its results are. I, too, also found it odd that use of dietary supplement use negatively correlated with chemotherapy initiation while use of the more “woo-ey” therapies that fall under the category of mind-body treatments did not. Remember again: “Mind-body” doesn’t just encompass yoga, but also the purest quackery, such as reiki, acupuncture, other energy medicine, and the like. Unfortunately, the data aren’t granular enough to look at the use of specific “mind-body” modalities and their association with chemotherapy initiation. The same problem applies to the dietary supplement categories, because homeopathic remedies could easily be lumped under that category. With such small numbers, though, combining modalities into categories is unavoidable.

The authors do, however speculate:

By nature, dietary supplement use differs from mind-body practices. Dietary supplements are ingested substances, whereas mind-body practices include behaviors and body-work. Presumably, patients with cancer who use either type of CAM hope to achieve a health-related benefit. In the general population, users of dietary supplements often use these products to improve or maintain overall health or for organ-specific health reasons (eg, heart, joint, skin). A population-based study of patients with cancer reported that patients with cancer took dietary supplements because “it was something they could do to help themselves” to boost immune function and to improve energy. In contrast, users of mind-body practices often do so for psychological benefits (eg, stress, anxiety, depression) and pain management. Distinguishing these motivations for use may explain our findings.

Perhaps. There might be something to this. It could also be that patients taking herbal remedies or dietary supplements are taking them instead of chemotherapy rather than in addition to chemotherapy. After all, herbal remedies, if they actually work to do anything, do so because they contain substances that act as drugs. Of course, there is also no good scientific evidence that any dietary supplement has an antitumor effect that decreases the risk of recurrence.

One area where this study is seriously lacking is hinted at. The authors mention that they didn’t look at genomic profiling tests that predict risk of recurrence, such as the OncoType, because such tests were not widely in use at the time subjects were being recruited for BQUAL. They wondered if perception of risk of recurrence affected the willingness of subjects to accept chemotherapy, which is not an unreasonable question. I note that the investigators had information on the single biggest determinant of risk of recurrence, stage at diagnosis, as well as other predictors, such as tumor markers. They could easily have estimated a ten year risk of recurrence based on those factors (or a range of recurrence risks, such as low, medium, or high) and then looked for a correlation, although I doubt they would have found one in this dataset because it’s too small.

I refer to this because risks versus benefits are a key consideration for any treatment. Chemotherapy is unpleasant and can result in serious side effects. If the benefit isn’t perceived as worth it, then a patient is much less likely to agree to use it. I’ve discussed adjuvant chemotherapy many times, often in the context of patients turning it down. In brief, adjuvant chemotherapy is administered after surgery in order to decrease the risk of recurrence. As is pointed out in the accompanying editorial by Robert Zachariae, adjuvant chemotherapy does decrease overall mortality and delays in chemotherapy decrease its effectiveness.

Of course, chemotherapy has different levels of benefit depending upon how high the risk of cancer recurrence is. That’s the reason why there are so many testimonials of patients who refused chemotherapy. They did, however, have primary surgery, which can be enough, particularly in earlier stage breast cancer. The motivation to undergo chemotherapy could be much less in a patient with stage I cancer, for whom the risk of recurrence might be less than 10% and the absolute benefit of chemotherapy on overall survival might only be 2-3% than it would be in a patient with stage III cancer for whom the risk of recurrence might be 50-60% or more, depending on the aggressiveness of the tumor, and the absolute survival benefit of 20% or even more, a much more convincing benefit.

Regardless if you buy the results of this study or not (and I’m not sure that I entirely do), Zachariae does use it to make an excellent point:

To provide the best evidence-based decision support regarding CAM use—including whether to use CAM as a complementary or alternative treatment to AC—oncologists need to be actively involved in discussing CAM use with their patients. Only by acknowledging that communication about CAM use is an important part of cancer care will oncologists be able to help patients to make sufficiently informed choices about CAM use. However, as shown in a systematic review of the available literature, a considerable proportion (20%-77%) of patients with cancer who use CAM do not disclose their CAM use, the main reasons for nondisclosure being the physician’s lack of inquiry; the patient’s anticipation of the physician’s disapproval, disinterest, or inability to help; and the patient’s perception that disclosure of CAM use is irrelevant to his or her conventional care.

Despite my strong opposition to CAM in general as unscientific, pre-scientific, and pseudoscientific, when it comes to CAM use in my own patients, I take a very pragmatic approach. (Believe it or not.) I will not recommend, prescribe, or encourage CAM use, and, if asked, I am honest in my assessment of any given CAM modality, but I will not tell them not to use it either, unless I have a good reason to suspect that whatever it is they are doing could interfere with science-based treatment. Of course, for me to accomplish that, I need to know a lot about CAM, and I do. Unfortunately, the vast majority of oncologists do not. This study reiterates the need for oncologists to know enough to be able to address CAM use with their patients.

Their patients’ lives could depend on it.

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Supplement use is missing an important category - legitimate orphan, lacking due early support from the medical community. Thin science, missing science has long been a hallmark of medical neglect or adversarial handling of cheap alternatives.

I don't support "emotional feel good" supplementation. "I'm sort of doing something nutritional" is an emotional crutch that is at best minor immune support.. Effect oriented supplement use for cancer should be hard hitting, often capable of making observable or measurable differences.
Nutritional supplements are usually complementary to real drugs, even if they too are off label and nicer than official chemo.

People are thoroughly confused about levels and types of nutrition approaches. Only part of this is due to the CAM community and some marketers. I see other fingers point back to less noble, or informed, parts of the medical, pharm and dietetic communities, too.

I think it is not a surprise that the correlation is not so much with the products as with the practitioners, or that those who see practitioners with insane and counterfactual beliefs about disease, get the worst advice.

In fact the entire problem with SCAM is the fraudulent claims, not the products themselves, and this is 100% about the people.

By Guy Chapman (not verified) on 17 May 2016 #permalink

I presume this state of breast cancer always requires surgery first before chemo is recommended. That means the "total woo, no SBM" patients never made it into the cohort. The remaining "mind-body" adherents are probably less solid in their denial than your all-out believers, unlike the supplement group who wants to "stay in control" after the surgery. Never mind that the supplement route failed to begin with to protect them from the cancer, makes you wonder why they think it works the second time around.

Orac writes,

So-called “alternative” medicine is made up of a hodge-podge of health care practices and treatments based on beliefs that are unscientific, pre-scientific, and pseudoscientific.

MJD says,

Having worked with persons with intellectual and physical disabilities (e.g., brain injuries, ASD, cerebral palsy) for 25 years it is my opinion that pharmaceutical-based medicines have been underwhelming but remain hopeful.

At this moment, it is my opinion that disabled individuals and cancer patients should be encouraged to participate in the hopefulness and sensory stimulation of CAM.

Most important, let us continue to be lovingly empathetic to their situation and participate in their journey with medical interventions that do no harm.

By Michael J. Dochniak (not verified) on 17 May 2016 #permalink

Never mind that the supplement route failed to begin with to protect them from the cancer, makes you wonder why they think it works the second time around.

Because, as others have remarked, woo cannot fail, it can only be failed. If you're taking supplements (or eating "clean," or keeping your chakras clear, or whatever) and you still get cancer, then it's because you weren't taking the right supplements, or weren't taking them regularly enough, or weren't doing enough to limit your exposure to "toxins" - but fear not, the woomeister promises, you can still be saved if you repent and amend your ways. That's the harm of what people tend to think of as "casual" CAM use - as long as someone is relatively healthy they may take the occasional off-the-shelf homeopathic remedy or herbal supplement without eschewing real medicine when they're actually sick. But they're still unconsciously absorbing the CAM ideology of "purity" and "total wellness" (i.e., if you don't feel 120% great all the time you're doing something wrong,) which, like any good successful religion, is designed to create a sort of chronic, low-level sense of guilt - not enough to make the person so uncomfortable that they start examining their beliefs the beliefs you've created for them, but just uncomfortable enough to make them susceptible to manipulation by someone who can alleviate that mental tension. So when something really bad happens, that vague sense of guilt suddenly becomes a very concrete sense of guilt, along the lines of, "if only I'd eaten better/avoided toxins/taken supplement X, I wouldn't have gotten cancer." So now, like the nominal Christian who "gets religion" after a painful confrontation with their own mortality, the newly-diagnosed cancer patient is powerfully motivated to dedicate (and potentially sacrifice) their lives for the fantasy of immortality that CAM offers.

"the first author is someone we’ve met before, Heather Greenlee"

Yes we have and she just won. This study will be cited by the alts and will be mostly cherry picked. Same tactic as used by the creationists - create the controversy, create a modicum of legitimacy and then demand that it be taught.

It is a typical loaded design with broad definitions to be virtually meaningless or grouping something of some value. From the study : http://oncology.jamanetwork.com/article.aspx?articleid=2521357#ArticleI… which is open access " At baseline, participants were asked whether they were currently using 7 different types of CAM modalities. Dichotomous (yes/no) variables were created to indicate current use of dietary supplements (including vitamins, minerals, herbal and/or botanical supplements, and other over-the-counter natural products) and mind-body practices (including self-practices such as yoga and practitioner-based approaches such as acupuncture). We computed a CAM use index summarizing the number of CAM types used (range 0 to 5) including vitamin and/or mineral supplements, herbal and/or botanical supplements, other over-the-counter natural products (eg, fish oil, glucosamine, melatonin), mind-body self-practices (eg, yoga and meditation) and practitioner-based mind-body practices (eg, acupuncture, massage, reiki). For this analysis, special diets and multivitamins were excluded from the definition of CAM, as these are very commonly used and often are not categorized as CAM." Then going to the supplementary materials there is no sign of the questionnaire, so we dear readers either trust or guess or call it nonsense. Being a recalcitrant, at least by an American definition, the lead author hoodwinked JAMA and others for the advancement of altie.

Some 60 years ago high-dose IV vitamin C was started and there is yet one well designed study that states it works, but the "Not a Doctor" crowd still uses it, claiming efficacy. This is going to be spun in much the same way.

By Ross Miles (not verified) on 17 May 2016 #permalink

I don't know which hypocrisy is worse in MJD's case: that he pretends to support real medicine, or that he pretends to support disabled kids and worse, works with them, so they can see his disdain for them up close and personal.

MJD:At this moment, it is my opinion that disabled individuals and cancer patients should be encouraged to participate in the hopefulness and sensory stimulation of CAM.

You mean the 'false hope" of CAM, and I don't know what you're talking about when it comes to sensory stimulation..... Do you mean the overwhelming awareness of food, when the caretakers of disabled kids force them to fast, according to the directions of their Rasputin of choice? Or the sensory stimulation of having to choke down wheatgrass?

By Politicalguineapig (not verified) on 17 May 2016 #permalink

I'm surprised and disappointed they didn't include a 5 year survival figure for their patients, since they were enrolled over 5 years ago.
I'd suspect that the study's "uses dietary supplements" group (which excluded simple multivitamin use) is a proxy for contact with naturopathy and similar ideas, which are actively hostile to chemotherapy, where as yoga, massage, and acupuncture used for side effect relief are not hostile. That makes me unsurprised that dietary supplements users were much more likely to refuse chemotherapy.

Politicalguineapig #7

*upvote*

MJD's comments are often meandering and lacking coherency, and this one is a corker. The idea that cancer patients should be encouraged to participate in the hopefulness of CAM is... fucking flabbergasting.

By Can't remember… (not verified) on 17 May 2016 #permalink

Can't remember my nym says (#8),

The idea that cancer patients should be encouraged to participate in the hopefulness of CAM is… fucking flabbergasting.

MJD says,

The American Massage Therapy Association
communicates that massage therapy is a clinically proven method of relief for symptoms related to breast cancer and/or the side effects of treatment:

@Orac,

Would you agree?

By Michael J. Dochniak (not verified) on 18 May 2016 #permalink

"worse, works with them"

That is the real problem. Although his "work" probably consists of doing nothing, hence his support of woo.

After all, herbal remedies, if they actually work to do anything, do so because they contain substances that act as drugs. Of course, there is also no good scientific evidence that any dietary supplement has an antitumor effect that decreases the risk of recurrence.

Herbal remedies can most definitely have an effect on humans, and many plants have thousands of active substances in them that can either be beneficial, or of course, even deadly. We have known that drugs come from plants a long time before we even know to call them drugs. Thinking your 'true medicine' is separated from plant 'drugs' is very narrow-minded, as is the sense I have from your article that you seem to believe that chemo is the only effective way to treat cancer.
Science is very important, but don't you think it is also the responsibility of 'science' to discover the potential to cure from as many sources as close to nature as possible? And possibly entertain the very plausible THEORY that there are some plants that have developed along with humans to help correct things that may go wrong with our health? There is no proof yet of the efficaciousness of this ancient traditional way of healing (which has been stamped out of western culture for hundreds of years), because we don't see them being studied as there is no money in it for big Pharma. There have been plenty of in vitro studies of many herbs having anti cancer properties, but science unfortunately doesn't pay for itself to prove things through all of its rigorous testing methods does it, so further studies are yet to be done. Perhaps one day the herbal medicine sector will be as big as pharma... And you still have more variables that must be considered to obtain your scientific proof, such as if the plant was grown with pesticides, if it was picked at the correct time etc. Dismissing it as you have is ignorant.
While we are talking about science and CAM, perhaps it is a good moment to bring up the very well documented scientifically proven phenomenon of the PLACEBO effect. That's some proper WOOOO right there in over in your lofty medical science corner! Watch out! Or perhaps you have an explanation... wooooooo perhaps it could be similar to the state of mind that you can achieve with some meditation practises.... Wooooo.... Your opinions are a little small minded for my taste, especially after you concede to the fact the study was flawed. Thanks for a real good waste of time.

MJD: First of all, that's way off topic, since Orac's article had nothing about either massage or cerebral palsy. Secondly, massage is not CAM in any way- it's regulated and usually is classified as part of the therapeutic field. Orac's talking about reiki, acupuncture and supplements- the far out woo-woo. Massage is, unfortunately, deeply infected with woo, but there are some benefits to it, unlike the other things I listed. Yoga also has some benefits, (I mean, it is technically exercise) but it's drowned out by the woo and the beliefs of the people who practice it.

Also, dude, a little clarity would be appreciated. You can't blame people for being confused when most of your posts are more muddled than a mojito. (Friendly advice, talking about yourself in the third person doesn't help.

By Politicalguineapig (not verified) on 18 May 2016 #permalink

Massage, when applied correctly is not woo nor is alternative. It is unfortunately one of those modalities that attracts woo-lovers and is used as touchy-feely bullshite.

By Science Mom (not verified) on 18 May 2016 #permalink

Politicalguineapig says (#12),

"Secondly, massage is not CAM in any way."

Reference:

The U.S. Department of Health and Human Services:

In the United States, massage therapy is often considered part of complementary and alternative medicine (CAM), although it does have some conventional uses.

https://nccih.nih.gov/sites/nccam.nih.gov/files/D327.pdf

Message therapy is CAM and may be useful for some cancer patients.

PGP says,

"Friendly advice, talking about yourself in the third person doesn’t help."

MJD says,

Friendly advice from one of Orac's minions is like swallowing a spoonful of pureed wheatgrass sprinkled with monosodium glutamate.

By Michael J. Dochniak (not verified) on 18 May 2016 #permalink

Science Mom says,

...is used as touchy-feely bullshite.

MJD says,

Sir Orac has written about massage therapy and stated:

If there’s one form of so-called “complementary and alternative medicine” (CAM) that I find more tolerable than most, it’s massage therapy.

http://scienceblogs.com/insolence/2012/02/13/a-study-that-oversells-mas…

Embrace the healing effects of massage!

By Michael J. Dochniak (not verified) on 18 May 2016 #permalink

Julia @12: What you are talking about is pharmacognosy, a well, respected field of scientific research that has produced many, many widely used drugs. Like pseudoephedrine.
It is not 'dismissed' by anyone in the scientific or medical community.

By JustaTech (not verified) on 18 May 2016 #permalink

MJD: Friendly advice from one of Orac’s minions is like swallowing a spoonful of pureed wheatgrass sprinkled with monosodium glutamate.

That might actually improve the taste of the wheatgrass. Fine then, but don't blame me when no one will publish your tripe.

Julia: There have been plenty of in vitro studies of many herbs having anti cancer properties, but science unfortunately doesn’t pay for itself to prove things through all of its rigorous testing methods does it, so further studies are yet to be done. Perhaps one day the herbal medicine sector will be as big as pharma.

Well here's the thing: people are already combing the rainforests for the next big cure. How do you think we got taxol, if it wasn't for people investigating old healing lore? Heck, we wouldn't have digitalis if it weren't for people taking another look at folk medicine. The thing is, with herbs, there's no standard dose, and it's really easy to overdose. (Also, plants don't really care when they're picked, unless the harvesting time affects the taste, like tea or wine.)

By Politicalguineapig (not verified) on 18 May 2016 #permalink

#6 Ross Miles
Some 60 years ago high-dose IV vitamin C was started and there is yet one well designed study that states it works, but the “Not a Doctor” crowd still uses it, claiming efficacy.
The maimstream lost credibility on IV vitamin C trials long ago, denying funding, never running trials where they had the funds and a nominal mission, attacking despite strongly hypothesis generating material, doing meaningless tests clearly designed to fail. Their moment without obvious partiality would have been in the 50s or 60s.

The effects of high IV vitamin C are so obvious for many viral cases, it would take a very strong stomach or obtuseness to maintain "scientific equanimity" with deadly illnesses that generate a hard end point. You know executioners often used to be alcoholics.

#12 Julia
Of course, there is also no good scientific evidence that any dietary supplement has an antitumor effect that decreases the risk of recurrence.
Trivially, leucovorin (a vitamin B9) shows that's not correct. To the extent you may be right about specific supplements, that may say more about the "scientists" and their institutions than the supplement.

#13 PGP
Orac’s talking about.... and supplements- the far out woo-woo.
You may not have broken code correctly.

prn #20:

"The effects of high IV vitamin C are so obvious for many viral cases..."

I treat patients with viral infections on a daily basis.

These range from trivial, self-limiting infections (eg rhinovirus, enterovirus) to chronic, controllable +/- curable infections (eg HIV/HBC/HCV) to acute, life-threatening disseminated infections in severely immunocompromised hosts (eg CMV, HHV-6).

I have never witnessed a single instance where vitamin C therapy has changed the anticipated clinical course of a viral infection, and I am not aware of any published evidence that demonstrates its efficacy in these settings.

Happy to stand corrected though.

#21 DrRJM re prn #20
DrRJM: I treat patients with viral infections on a daily basis....These range from trivial, self-limiting infections (eg rhinovirus, enterovirus) to chronic, controllable +/- curable infections (eg HIV/HBC/HCV) to acute, life-threatening disseminated infections in severely immunocompromised hosts (eg CMV, HHV-6).

I have never witnessed a single instance where vitamin C therapy has changed the anticipated clinical course of a viral infection, and I am not aware of any published evidence that demonstrates its efficacy in these settings.

You (MSM) define out what experience base there is. e.g. the Levy and McCracken books as "no (high quality) evidence". We've all heard that corruption of EBM that ignores data of a lesser god.

Likewise, as the IV vitamin C crowd sees it, you all - our RI friends, your journal group, your hospital, etc, all combined, have never witnessed any real vitamin C therapy. Ever. Not by 1-2 orders of magnitude. So, of course you "haven't seen C change a virus' course", because you've never remotely met the threshold conditions. MSM drs are still XX and XXX homeopathic for the prompt therapeutic conditions of IV vitamin C for viruses to occur. Also remember, profound chemical changes quickly begin with IV C.

You guys are the ones with flow cytometers etc that could bring more measured clarity with even a few patients' closely spaced longitudinal samples.

In all that incoherent diatribe about reality-based medicine not using IV vitamins, you neglected to give a single even remotely plausible reason why doctors would not use it if it worked. All you do is repeat your statement of faith followed by a variety of fallacious reasons why people deny your faith, the while ignoring the most obvious and likely one: That your faith is not based on fact, but on belief.

By Guy Chapman (not verified) on 19 May 2016 #permalink

In reply to by prn (not verified)

prn @22:

1. Define "real vitamin C therapy".

2. Show me the in vitro studies, the animal studies, and the phase 1,2 and 3 trial data that supports you claim that "real vitamin C therapy" is effective for any viral infection.

3. "MSM drs are still XX and XXX homeopathic for the prompt therapeutic conditions of IV vitamin C for viruses to occur"

I have absolutely no idea what this sentence means.

Lastly: why would I need my lab's flow cytometer to measure the in vitro/in vivo antiviral activity of vitamin C?

prn @22: "never witnessed any real Vit C therpay" - that is venturing rather close to "no true Scotsman" territory.

On the subject of flow cytometry: what markers are we looking for? CD8? CD4? CD40? Co-stimulation? Antigen presentation? Are we talking single-color, multi-color? Sorted or unsorted? Extracellular or intra-cellular staining?
How "closely spaced" will these samples be? (That's important given that staining can take upwards of 5 hours, plus time on the instrument.) What kind of samples? Whole blood? (Gonna need a lot!)

By JustaTech (not verified) on 19 May 2016 #permalink

#23 DrRJM re prn @22:
1. Define “real vitamin C therapy”.
In this context, complete IV vitamin C treatments in the higher dose forms without slipping off early to oral tx. High dose would be 0.7 to 1 gram IVC per kg per infusion, infusions every 6-8 hrs for up to 72 hrs. (Most viruses succumb far, far sooner) One thought is that recent deterioration in blood sugar levels, diabetes and vitamin D levels might alter this slightly higher. Vitamin C via GLUT transporters into the cells differs in diabetes and possible allowance for the equilibria effects from Klenner's younger psof the 1950s, say ~75-80 mg/dL blood glucose vs older pts now, at 110+ mg/dL (ie, average 4.4 vs 6.1 mmmol/L).

2. Show me the in vitro studies, the animal studies, and the phase 1,2 and 3 trial data that supports you claim that “real vitamin C therapy” is effective for any viral infection.
Beyond the old literature in the Levy and McCracken, I would suggest others like the Riorden Clinic for better, more up to date references. There is always the open question of freaks like TB for antibiotics, to the general claim for acute viruses. Perhaps some of the chronic viruses are less susceptible even in the acute phase.

Since the 1940s, actual human experience has been far easier to achieve than difficult lab capabilities for individul experimenters. Klenner's papers and the Riordan clinic infusion protocol establish the criteria for IV vitamin C safety.

3. “MSM drs are still XX and XXX homeopathic for the prompt therapeutic conditions of IV vitamin C for viruses to occur”
"Mainstream drs are almost homeopaths in their failures to achieve viral MIC with infused sodium ascorbate"

You're new here. Orac constantly razzes the homeopaths, whose products are marked in dilutions, most commonly X for 10x and C for 100x. So laugh at MSM for being 99% - 99.9% of the way to homeopathic tx with IV vit C, failing to hit treatment threshold criteria. Usually tx duration, infusions until clearance or immune control is a logistics problem.

Lastly: why would I need my lab’s flow cytometer to measure the in vitro/in vivo antiviral activity of vitamin C?
Direct measurement of tiime dependent, in vivo virus viability as one possible data set to increase medical understanding and confidence.

JustaTech@25
prn @22: “never witnessed any real Vit C therpay” – that is venturing rather close to “no true Scotsman” territory.
Actually the "real IV vitamin C" criteria can be pretty well quantified, bounded by minimum tx at 0.7 to 1 gram C per kg per 6-8 hrs, and the upper limits set by electrolytes for a continuous IV.

I'll be very surprised if anyone here can say they have been around even two serial infusions within this range, much less 72 hrs. Probably most infusion series stop at 2-3.

On the subject of flow cytometry: what markers are we looking for? Sampling every 2 hrs might be a reasonable fit, once before and after infusion and every 2 hours. Viral analysis time would only be limited by viability changes; if liq N2 storage works, fine. Figure some basic blood work (CBC, ESR, CRP, electrolytes...) and what ever viable particle sensitivity can be achieved with smaller blood volumes in different ranges. Beyond blood - pustules, urine- what else? Rashes and pustules will probably be hard and brown in 8-12 hours.

prn @27: To the best of my knowledge flow cytometry does not show viruses. They are too small. Flow cytometry uses fluorsecently labeled antibodies to identify expression of markers (either intra-cellular or more commonly extra-cellular) on cells. In immunology one looks at immune cells (T-cells, B-cells, granulocytes, monocytes, lymphocytes, etc).

For humans flow cytometry is most often performed on PBMCs (peripheral blood mononuclear cells), with bone marrow the next most likely. In animal studies you might also take immune cells from the lymph nodes, Peyer's patches, spleen, thyroid, etc.

Basically, flow cytometry is used to look at cells and how they respond to stimuli, such as viral infection. But you can't look at the virus itself. (Also, most of the changes in marker presentation take days not hours, although some are pretty fast.)

By JustaTech (not verified) on 19 May 2016 #permalink