Transcript WikiTox CAM Scams, EAPCCT 2008 for Wikitox

CAM Scams:
Poisons as Cancer
Cures
Lewis Nelson, MD
New York University School of Medicine
New 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
Case



A 65 year-old woman presents after a
witnessed syncopal episode.
Past medical history significant for HTN and
metastatic adenocarcinoma of the colon.
Has been seeing a naturopathic health care
provider for treatment.
Case



1 month history of loose stools
On day of presentation had witnessed
collapse without incontinence, seizure
activity or tongue biting.
Spontaneously awoke, was amnestic of the
event.
Case
Vital signs:
 BP 138/55 mmHg
 P 52/min
 Temp 36.8°C
 RR 18/min
 SpO2 95% on room air

Rapid bedside glucose 10 mmol/L
Case
Exam
 A&Ox3
 HEENT: Small contusion on forehead
 Chest: Clear
 Heart: Normal
 Abdomen: Soft, non tender
 Extremities: Normal
 Neurologic: No focal neurological findings
Medications

Naturopathic products
–
–
–
–
Unknown “herbal” powder
A tablet: Gigamax
A tablet: Multi C
A tablet: Slow K
QTc = 700 msec
Labs



K+ 2.8 mEq/L
Magnesium 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/
Naturopathy

“Cancer is a mutated cellular process which
results from high intake of refined foods,
fake foods, processed foods, including
processed white sugar products, artificial
sweeteners, white flour products, packaged
foods, food preservatives, food color and
dye additives, and foods grown with
pesticides, herbicides, antibiotics and
hormones.”
Naturopathy


“Naturopathic Medicine believes that….all
cancer is both fungal and viral in origin, and
sometimes parasitic.”
“….health disorders [including cancer] are
most likely a result of nutritional imbalances
as well as an accumulation of toxic
substances.”
Naturopathic Cancer Cures








Colloidal Silver 500 ppm
Oil of oregano P73 Physician's Strength
Garlic Kyolic Organic Liquid #10020
Aloe Vera
CoQ10 Q-Gel® With Vitamin E
Liquid Vitamins/Minerals
Calcium/Magnesium Powder
Himalayan Goji Juice
“Be careful about reading health books.
You may die of a misprint.”
Mark Twain
Herbal Cancer Treatments




CanCell
Hoxey’s Therapy
Gerson’s
Etc…..
CanCell/ProtoCel



“Lowers the voltage of the cell structure
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
Inositol
Nitric Acid
Sodium Sulfite
Potassium Hydroxide
Sulfuric Acid
Catechol
Crocinic 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 Cure





Need to detoxify
Vegetarian Diet
Vitamins
Liver injections
Coffee Enemas
Gerson Institute in Bonita, California
Laetrile

Trade name of an extract of fruit pits that
contains l -mandelonitrile-betaglucuronoside, or amygdalin
– Cyanogenic glycoside
– Acronym for laevorotatory and mandelonitrile


Used for more than a century as an active
anticancer regimen
1970 petition to study it denied by FDA
– Viewed by some as an attempt by the US
government to block cancer therapies

Multiple court cases
– Laetrile was legalized in more than 20 US states
during the 1970s.
– Must certify that the patient is “terminal”

In 1980, the US Supreme Court overturned
decisions by the lower courts
– Reaffirmed FDA’s position that drugs must be
proven to be both safe and effective before
widespread public use.
HO
O
HO
HO
O
OH
Amygdalin
O
HO
C N
HO
OH
O C
Glucosidase
H C N
HO
HO
HO
O
Hydrogen
cyanide
OH
Glucose (2)
H
C O
OH
Benzaldehyde

Administered by intravenous injection.
– Although the GI tract cells have glucosidase, the
remainder of the body’s cells do not.

Proponents claim that cancer cells, unlike
normal cells, are particularly rich in
glucosidase and they release cyanide from
amygdalin which destroys the cancer cells.


Laetrile has shown little to no anticancer
effect in laboratory studies, animal studies,
or human studies.
Not surprisingly, the adverse effects of
Laetrile are similar to those of cyanide.
The Clinical Trial (Mayo Clinic)


A prospective, open-label evaluation of
amygdalin plus "metabolic therapy“ in 178
patients with various cancers.
21 days of IV amygdalin 4.5 grams/m2
followed by 500 mg amygdalin tablets TID.
– Plus metabolic therapy consisting of vitamins,
minerals, and pancreatic enzymes.

Primary outcomes measured were tumor
response and survival.
Moertel CG. N Engl J Med 1982;306:201-206


1 partial response
79% had progression at 2 months
– 91% by 3 months.
– Median survival: 4.8 months from initiation


Adverse effects: HA, N/V, dizziness,
obtundation.
Significantly elevated blood cyanide
concentrations.
Moertel CG. N Engl J Med 1982;306:201-206


The results suggest that amygdalin is
ineffective in the treatment of cancer.
Claims for Laetrile’s effectiveness shifted
from a cancer cure, to a cancer “control”
agent, to a "vitamin” (called B17) purported
to prevent cancer.
Moertel CG. N Engl J Med 1982;306:201-206



The Internet search
found several
websites still selling
Laetrile or offering
related clinical
services.
All in Mexico
“Oasis of Hope”
http://www.amygdalin.co.uk
Elements and simple molecules


Widely touted as cancer cures
“Hyperoxygenation therapy”
– It is claimed by proponents that intravenous
ozone can “dissolve” malignant tissues due to
their deficiency of the protective enzyme
catalase.

“Autohemotransfusion” of ozone
– Blood mixed with ozone and retransfused.
– In one case, clinical and postmortem studies
revealed gas embolism and patent foramen
ovale.
The Role of pH

In a seminal paper,
Dr. A. K. Brewer, a
physicist, describes
two pH therapies
available for
treating cancer:
– Low pH Therapy
– High pH Therapy
Low pH Therapy




“….glucose is injected into the blood stream. As a
consequence, the cancer cell pH will drop
eventually to the 5.5 range.”
“The patient is then placed in a furnace heated to
104 degrees Fahrenheit (40C) for a matter of
hours.”
“At these high temperatures and in the acid
medium, the life of cancer cells is very short.”
“The only drawback is that severe toxemia may
result from the out-leakage of the acid toxins within
the tumor masses.”
High pH Therapy

“….consists of feeding
the patient about 6 gm
of CsCl per day in
conjunction with
Vitamins A and C,
which upon absorption
by the tumor cells will
give rise to the pH to 8
or above…”
High 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 Therapy
“Two side effects have been observed in
some of the patients. These are first
nausea, and the second diarrhea.”
Oh yeah….
Cesium 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
References







National Cancer Institute.
http://www.cancer.gov/cancertopics/treatment/cam. Accessed 2/25/08
Goldfrank L et al. Goldfrank’s Toxicologic Emergencies. 7th Ed, McGraw Hill,
New York. 2002: pp. 1-15, 1183-119, 1498-1504.
Soignet SL et al. Complete remission after treatment of acute promyelocytic
leukemia with arsenic trioxide. NEJM 1998;339:1341-1348.
Brewer AK. The high pH therapy for cancer tests on mice and humans.
Pharmacol Biochem Behav 21: Suppl. 1, 1-5. 1984.
Dalal AK, Harding JD, Verdino RJ. Acquired long QT syndrome and
monomorphic ventricular tachycardia after alternative treatment with cesium
chloride for brain cancer. Mayo Clin Proc 2004; 79(8):1065-1069.
Jones DL, Petrie JP, Li HG. Spontaneous, electrically, and cesium chloride
induced arrhythmia and afterdepolarizations in the rapidly paced dog heart.
Pacing Clin Electrophysiol 2001; 24(4 Pt 1):474-485.
Pinter A, Dorian P, Newman D. Cesium-Induced Torsades de Pointes. NEJM
2002 346: 383-384
References






Moertel CG, Fleming TR, Rubin J, et al. A clinical trial of amygdalin (Laetrile)
in the treatment of human cancer. N Engl J Med 1982;306:201-206
Chlebowski RT, Bulcavage L, Grosvenor M, et al. Hydrazine sulfate
influence on nutritional status and survival in non-small-cell lung cancer. J Clin
Oncol 1990;8:9-15.
Marchetti D, La Monaca G. An unexpected death during oxygen-ozone
therapy. Am J Forensic Med Pathol 2000;21:144-147.
See KA, Lavercombe PS, Dillon J, Ginsberg R. Accidental death from acute
selenium poisoning. Med J Aust 2006;185:388-9.
Lyon AW, Mayhew WJ. Cesium toxicity: a case of self-treatment by alternate
therapy gone awry. Ther Drug Monit 2003; 25:114-116.