Antineoplastons and the challenges of research in integrative care.
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Biomedical subjects
Publications and source records attributed to Keith I Block.
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Insomnia and other sleep disturbances are common in cancer patients. Insomnia is a multifactorial health concern that currently affects at least 1 in 3 cancer patients, and yet most insomnia sufferers do not consult their physician regarding pharmaceutical options for relief. Use of hypnotic drugs (primarily benzodiazepines) is associated with increasing tolerance, dependence, and adverse effects on the central nervous system. While hypnotic drug use declined substantially in the past decade, the use of herbal sedatives appeared to increase. Mostly self-prescribed by lay people, herbal sedatives hold widespread appeal, presumably because of their lower cost and higher margin of safety when compared to pharmaceuticals. Studies of better-known herbal sedatives, notably valerian and kava, showed moderate evidence for both safety and efficacy for valerian while revealing disturbing toxicity concerns for kava. Milder sedatives or anxiolytics in need of clinical study include German chamomile, lavender, hops, lemon balm, and passionflower; St. John's wort may have anxiolytic effects with relevance to sleep. Herb-drug interactions are a possibility for some of these species, including St. John's wort. Although sufficient evidence exists to recommend some of these agents for short-term relief of mild insomnia, long-term trials and observational studies are needed to establish the safety of prolonged use as well as overall efficacy in the context of cancer treatment and management.
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The consideration of whether to use antioxidants concomitantly with chemotherapy and radiation therapy has evolved into a heated debate. This special theme issue brings together several contributors to this debate, whose perspectives enlarge our views of the questions at hand, pointing out several very relevant ideas. First, the early hypotheses of the role of antioxidants in carcinogenesis gave a simplified and often inaccurate picture of the physiological effects of specific antioxidants. Antioxidants can have protective effects that have nothing to do with oxidation; on the other hand, they can under some circumstances develop prooxidant properties and promote carcinogenesis. During treatment, however, their role is far from clear and may be either quite positive or potentially negative. A number of clinical studies have already demonstrated beneficial effects of antioxidants in ameliorating side effects of chemotherapy. More theoretical work on the chemistry of antioxidants and chemotherapy drugs suggests that antioxidants might improve therapeutic efficacy of antineoplastics by counteracting aldehydes that impede the passage of cells through the cell cycle. However, detailed clinical study also makes it clear that we are only at the very beginning of understanding the dynamics of antioxidants and oxidant damage in the body during conventional treatment. Nevertheless, research is under way on radioprotective and chemoprotective substances, some of them rooted in traditional medicine and others in our understanding of dietary antioxidants, that may eventually lead to antioxidant-based supplements that support tolerability and efficacy of treatment, without protecting tumors through interference from antineoplastic treatment.
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Ascorbic acid is the single-nutrient supplement most commonly used by cancer patients, although in most cases this takes place without the physician's knowledge or supervision. A comprehensive review of the literature is presented on the impact of ascorbic acid on cancer survival. Findings from 6 uncontrolled studies suggest that ascorbic acid may increase survival, whereas 2 controlled trials have yielded null results. The relative strengths and limitations of these studies are discussed. A turning point occurred with the release of the 2 controlled (null) studies, which influenced many physicians to turn away from nutrition in the care of cancer patients. Controversy about these trials still persists, however, in the alternative cancer community.
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Panax ginseng is a plant that has been used in traditional medicine in China for thousands of years. It is used as a general tonic or adaptogen with chronically ill patients and is frequently featured in traditional medicine prescriptions from China, Japan, and Korea used by cancer patients. The putative active compounds are the ginsenosides, of which there are more than two dozen. These compounds are found in both Panax ginseng and in other Panax species that are used in herbal medicine. Analysis of ginsenosides is being used in developing quality control assessments for ginseng, which has frequently been adulterated due to its high cost; many currently available standardized extracts do appear to contain the amounts of ginsenosides listed on package labeling. The toxicity of ginseng appears to be low: some of the reports of toxic episodes of ginseng may actually pertain to other components of multicomponent preparations. Very low incidence of toxicity has been observed in ginseng clinical trials using well-characterized preparations. Numerous pharmacological activities of ginseng and the ginsenosides have been explored: the authors review here the activities relating to cancer. Immune system modulation, antistress activities, and antihyperglycemic activities are among the most notable features of ginseng noted in laboratory and clinical analyses. Much testing has been done in humans to explore ginseng's purported antifatigue properties, but this area remains controversial. A number of investigations point to antitumor properties and other pharmacological activities related to cancer, but no trials have yet confirmed a clinically significant anticancer activity. Cancer patients may empirically find ginseng to be useful when they are fatigued, although clinical trials should be conducted to confirm its benefits.
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