Saudi Arabia: 60 Percent of Cancer Patients Using Alternative Medicine

The number of cancer cases in Saudi Arabia is estimated at 7,000 annually, a figure that is expected to rise to 30,000 within the next 15 years, the chairman of the Saudi Cancer Society (SCS), Dr. Abdullah al Amr, revealed to Asharq al Awsat.

Al Amr also revealed that the most common forms of cancer afflicting women in Saudi Arabia are breast and thyroid cancers, in addition to lymphoma and liver cancer, while most cancer cases among men were colon cancer. Al Amr indicated that the most challenging cancers to treat are pancreatic and liver cancers, and some types of brain cancer.

Pointing out that the world’s cancer recovery rate is estimated at 60 percent, Dr. al Amr said that the rate is lower in Saudi because a significant number of patients visit hospitals and specialized oncology centers at advanced stages of the disease.

Al Amr disclosed that random interviews conducted with patients showed that 60 percent resort to unconventional medicine and that many of them are seeking treatment using popular herbal medicines. He added that the SCS is supporting a comprehensive survey so as to ascertain the accurate figures involved.

The chairman of the SCS said that the Ministry of Health has been making steady efforts to increase public awareness and is investing in educating the community. He said, however, that it is unlikely that the SCS would resort to legal action against those selling such herbal medicines and added that the aim was to educate the people about the detriments of some herbal medicines that have obscure composition and unproven effectiveness.

The SCS issued a statement at the beginning of this week that cautioned against treatment by harmful popular medicines, affirming that it has become a common phenomenon over the past few years. Al Amr stated that the SCS, in cooperation with specialized laboratories will keep record and undertake analyses of these medicines so as to ensure the safety an efficacy of cancer treatment. He furthermore indicated that the kingdom lacked proven scientific studies on the effect of these substances on cancer patients and that outlets that sold such substances were poorly controlled.

The SCS stressed the harmful effects resultant of using these popular medicines, as some are contaminated by bacteria. Cancer patients characteristically have weakened immune systems and thus the detriments can be quite severe. The SCS stated that the side effects resulting from radiotherapy and medical drugs are worse when simultaneously combined with some herbs, all of which delays recovery.

From heresy to beneficial: Alternative therapies outlined

Not too long ago, their book would have been considered medical heresy.

But medicine has changed so much that a team of medical providers at Mayo Clinic has now produced a book about alternative therapies.

Patients often use things like herbal remedies, steeped concoctions and body-mind connections to heal their symptoms, aches and infections -- without sharing what they're doing with their health providers.

The authors of the "Mayo Clinic Book of Alternative Medicine," hope patients will instead openly discuss their non-traditional efforts with their doctors.

Alternative therapies -- anything used to treat the body not typically taught in medical school -- include today's widely accepted acupuncture and massage. The melding of traditional and alternative therapies, or "integrated medicine," has gained popularity as the doors to "integrated medicine" open.

"I think that people will have an open-minded perspective and recognize that some of the information in this book relates more to common sense than it does to esoteric new approaches to health," said Dr. Paul Limburg, one of the authors, and associate director for research in the Complementary and Integrative Medicine Program at Mayo.

General internist Dr. Larry Bergstrom said nutrition, spirituality and herbalism all come under the umbrella of integrative therapies that can be combined with traditional Western medicine.

Bergstrom said patients shouldn't keep secrets about what they're doing, because combinations of some medicines and herbal remedies can be dangerous.

Congress in 1994 passed legislation that made dietary supplements such as vitamins, minerals, herbal mixtures and amino acids a class of compounds not considered food or considered drugs.

"That really left a lot of safety implications," said general internist Dr. Mark C. Lee, one of the several authors. If the patient is doing something on his own and not telling his doctor, that sometimes works against traditional therapies, he said.

The book separates therapies into categories of green light for effective for indicated conditions, and safe; yellow for caution, studies show the therapy might be effective but there might also be risks; and red for therapies that should not be used because risks far outweigh benefits.

Beneficial alternative therapies as shown through science:

? Glucosamine and chondroitin "appear to be safe and produces fewer adverse side effects" than medications like NSAIDs against osteoarthritis. Some studies conflict, but side effects are low. People with severe symptoms were the most likely in one study to see a benefit.

? Massage "is a great complementary and alternative treatment," the authors say. "Almost everyone feels better after a massage."

? Spinal manipulation is "an effective treatment for uncomplicated low back pain, especially if the pain has been present less than four weeks."

? Peppermint "has some benefits in treating certain digestive disorders such as irritable bowel syndrome and possibly heartburn. However, its muscle-relaxing qualities could worsen hearburn symptoms associated with gastroesophageal reflux disease, so take it under a doctor's supervision."

What's not beneficial?

Goldenseal, for example, "has demonstrated some antibiotic and anti-inflammatory qualities. But studies about its effectiveness and safety are poor quality. Goldenseal was given a red light because "it can produce serious side effects if used for longer periods, and there's insufficient evidence that it works."

Doctor uses natural, old-fashioned medicine

Good health comes naturally to Dr. John Kule and his patients at the East Aiken Health Center.

In a small cinderblock building nestled on the edge of a sprawling horse farm between Aiken and Wagener, Kule and his staff practice medicine the old-fashioned way — with natural remedies and an emphasis on wellness.

Herbs and other vitamin supplements line the walls of the waiting room, but the exam rooms are equipped with high-tech laptop computers that gauge fitness and heart durability. According to Kule, his is "alternative medicine," to be sure, but it is first and foremost good family medicine.

"There isn't one in 100 that actually knows what alternative medicine means. So, yes, I have to do a lot more education of my patients," Kule said, sitting on the edge of one of his examination tables.

In a middle room, patients receiving intravenous treatments relax in leather recliners. In the lobby, "green-friendly" cleaning supplies and homeopathic remedies are displayed on tables surrounded by horse art prints on the walls and patient information printed simply on laserprinter paper.

"More and more, primary care is coming along my way because you see all the things about nutrition and concerns about prescription medications," Kule said. "Wouldn't it be wonderful if all the Vioxxes worked with no side effects? But they don't. That's not life. To have good health is work. It's a commitment."

Kule's education has taken him from his native Pennsylvania (where he studied biology at Pennsylvania State University) to Canada (where he explored the physical education and sports culture of Soviet Russia) to Bogota, Colombia (where he earned his medical doctorate from Pontificia Universidad Javeriana). He taught middle school science in Georgia and worked as a medical interpreter in Los Angeles before completing his residency at the Medical University of South Carolina in Charleston. He was a partner in family medical clinics in Swansea for six years until he opened East Aiken Health Center in 2000.

His patients say Kule and his staff are willing to spend hours delving into their health histories and trying to find the root causes of their maladies. "He is known to spend two hours with a patient," wrote one client, named Linda, in a letter praising her physician. "His practice is an incredible alternative to conventional health, concentrating on the body, the mind and the soul working together to create a healthy, happy individual."

Kule says that he is bucking an unfortunate trend in modern medicine — health care driven largely by insurance and Medicare reimbursements.

"I think that most doctors in primary care would like to do something like what I'm doing except that the reimbursements from the insurance companies are terrible," Kule said. "I don't think it's satisfying to see 50 patients a day and have three offices on this side and three offices on this side and the nurses come in and do most of the history-taking and you just zip in and focus on one column, write a script and go on to the next patient and drink coffee and push, push, push until you get your 50 patients in."

In fact, Kule accepts only one insurance provider, plus Medicare and Medicaid, which cover only the cost of the office visit. For the most part, his patients must pay out-of-pocket for other, less conventional procedures and natural treatments not reimbursed by the insurance industry.

First-time patients go through the traditional battery of tests — blood pressure, heart rate and the usual vital signs — but Kule and his staff also conduct high-tech tests for heart rate durability and urine and saliva chemistry. They take blood samples and read the splotches under dark-field microscopes, looking for tell-tale signs of fatigue, dysfunctional body systems and other deficiencies in the "live blood."

"All I'm doing is going one step further and saying, I would like to catch things before they get real bad and make some changes," Kule said. "When I do this kind of testing, I'm trying to figure out where they are functionally before all these things arrive at pathology. Any good doctor should be looking for that, too. I'm looking for things before they get bad. I'm also looking for things to go toward an optimal. I'm looking more at, like the Greek ideal, that there is some optimal function out there, looking at health more like what an athlete would look like."

If traditional pharmaceuticals are needed, Kule will write a prescription, of course. But he is just as likely to prescribe changes in nutrition and overall lifestyle to encourage the body to heal itself.

"When I do this kind of medicine, I'm giving people choices," Kule said. "These things make more work for me and for the patient, but it gives them a chance to allow their own natural healing mechanisms to start working again."

Kule knows that some people may scoff at the idea of holistic or "alternative" medicine, but he points to his training and experience and, more importantly, he says, to his patient successes.

"I went through a lot of training to get where I am, and I have to continue my training. I should be respected for the tools that I use," he said. "When a colleague in town is using different tools, I still respect him. As long as my patients are doing well, I don't care whether it's really alternative or conventional or whatever you want to call it.

Alternative Medicine Debated by Nevada Legislators

As more people turn to alternative practitioners for their medical needs, Nevada needs better regulation of alternative medicine to protect consumers, lawmakers were told Wednesday.

Sen. Mike Schneider, D-Las Vegas, said some doctors can't do alternative therapies because the regulatory structure isn't there. He asked the Senate Commerce and Labor committee to pass five bills affecting alternative medicine.

The main part of Schneider's plan is SB432, which would get rid of the state Board of Homeopathic Medical Examiners and replace it with a board regulating "complementary integrative medicine," or alternative medicine. Schneider said the current board's authority is too narrow in focus.

That bill also changes the makeup and scope of several other state regulatory boards.

SB413 would mandate that insurance companies accept "ABC Codes," a new type of coding system that has more detail about alternative therapies. Using that system would make it easier for practitioners such as chiropractors, massage therapists and homeopathic doctors, said its supporters.

Using ABC codes could make it easier for massage therapists to get respect -- and money -- from insurance companies, said Billie Shea, head of Nevada's Board of Massage Therapy. But she worried that other aspects of Schneider's proposals could over-regulate some massage therapists.

Non-medical massage therapists don't make more than $40,000 or $50,000 annually, and already have to pay for multiple business and professional licenses, she said.

Larry Matheis, director of the Nevada State Medical Association, opposed all the bills. Schneider's approach wouldn't do anything to integrate alternative medicine into the existing health care system, which already is occurring, said Matheis. Rather, it would create a new state bureaucracy that could endanger patient safety, he said.

The existing medical boards offer sufficient regulation while Schneider's plan would allow unlicensed practitioners to get into the medical field, Matheis said.

"That is a dangerous step," said Matheis. "Your responsibility is patient safety, is public safety. If you're going to err, you have to err on that side."

Deborah Klein, representing the Nevada Dietetic Association, said proposed regulations for "medical nutritionists" in SB432 were vague and should be stricken. They would deceive the public into believing that nutritionists are qualified to do what dietitians do, said Klein.

"Basically, anyone can call themselves a nutritionist," said Klein. "However, they do not have the qualifications of a registered dietitian."

Some of the opposition to his bills came from traditional practitioners who "don't want to give anything up," said Schneider.

"The goal is to get more health care to more people are a more reasonable price," he said.

Should NICE evaluate complementary and alternative medicine?

Demand for complementary and alternative medicine is high despite limited evidence. In last week's BMJ, researchers go head to head over whether the National Institute for Health and Clinical Excellence (NICE) should review these therapies.

NICE was set up as an independent body by the UK government in 1999, charged with getting the best from NHS resources. It examines the value of treatments and decides whether they should be used in the NHS.

Around half of general practitioners provide access to complementary and alternative medicine, and two thirds of Scottish general practitioners prescribe herbal or homoeopathic medicines, so a thorough review by NICE would benefit the NHS and patients, argue Professor Linda Franck and colleagues.

Some people within conventional medicine remain deeply convinced that alternative medicine cannot have any possible benefit, but this is all the more reason that these therapies should be rigorously evaluated, they argue.

They believe that failure to evaluate complementary and and alternative therapies also leads to health inequalities because of uneven access and missed opportunities. For example, as complementary therapies are often relatively cheap, if shown to be effective they could save money currently spent on costly drugs.

Complementary and alternative therapies deserve a full evaluation from NICE and, if the evaluation is favourable, they should be adopted either on their own or integrated with conventional medicine, they conclude.

But Professor David Colquhoun argues that NICE cannot afford to re-examine evidence that has shown little benefit.

He points out that NICE already have alternative treatments in several of their reports and, in all these cases, they have found no good evidence for anything more than placebo effects.

And it is not necessary to take the word of sceptics about the lack of evidence. The more honest advocates of complementary and alternative medicine admit it themselves, he adds.

None of this is intended to deny the important role of supportive and palliative care for patients for whom that is the best that can be done, he says. But there is no need to subscribe to the early 19th century pseudoscientific hocus pocus of homoeopathy to treat sick patients sympathetically and holistically.

And there is no need for NICE to spend time and money coming to that conclusion when it has more important things to do, he concludes.

Head To Head: Should NICE Evaluate Complementary And Alternative Medicine?

Demand for complementary and alternative medicine is high despite limited evidence. In this week's BMJ, researchers go head to head over whether the National Institute for Health and Clinical Excellence (NICE) should review these therapies.

NICE was set up as an independent body by the UK government in 1999, charged with getting the best from NHS resources. It examines the value of treatments and decides whether they should be used in the NHS.

Around half of general practitioners provide access to complementary medicine, and two thirds of Scottish general practitioners prescribe herbal or homoeopathic medicines, so a thorough review by NICE would benefit the NHS and patients, argue Professor Linda Franck and colleagues.

Some people within conventional medicine remain deeply convinced that alternative medicine cannot have any possible benefit, but this is all the more reason that these therapies should be rigorously evaluated, they argue.

They believe that failure to evaluate complementary therapies also leads to health inequalities because of uneven access and missed opportunities. For example, as complementary therapies are often relatively cheap, if shown to be effective they could save money currently spent on costly drugs.

Complementary and alternative therapies deserve a full evaluation from NICE and, if the evaluation is favourable, they should be adopted either on their own or integrated with conventional medicine, they conclude.

But Professor David Colquhoun argues that NICE cannot afford to re-examine evidence that has shown little benefit.

He points out that NICE already have alternative treatments in several of their reports and, in all these cases, they have found no good evidence for anything more than placebo effects.

And it is not necessary to take the word of sceptics about the lack of evidence. The more honest advocates of complementary and alternative medicine admit it themselves, he adds.

None of this is intended to deny the important role of supportive and palliative care for patients for whom that is the best that can be done, he says. But there is no need to subscribe to the early 19th century pseudoscientific hocus pocus of homoeopathy to treat sick patients sympathetically and holistically.

And there is no need for NICE to spend time and money coming to that conclusion when it has more important things to do, he concludes.

Garlic

Sutidies have concluded that garlic doesn't lower cholesterol.

But advocates of herbal and nutritional remedies are responding to the news with this advice: Keep eating the onion-like herb because what befouls one's breath may befriend one's health.

Garlic, the longtime folk remedy for various conditions and ailments -- heart disease, cancer and bacterial infections included -- still has sizable support in scientific literature. But anyone using garlic to lower his or her cholesterol might consider seeking an alternative approach.

"I do recommend that people eat garlic, especially through the winter," said Dr. Sharon Plank of the Center for Integrative Medicine at UPMC Shadyside, noting its antibiotic effects. "We tend to see better health in people who eat nutritionally and the Mediterranean diet, which uses garlic and spices."

Previous studies about garlic's impact on cholesterol were mixed, despite many alternative medicine publications suggesting a positive impact on cholesterol.

But a study that appeared yesterday in Archives of Internal Medicine concluded that garlic consumed almost daily for six months had no appreciable effect on cholesterol.

Dr. Christopher Gardner, assistant professor of medicine at Stanford University, told The Associated Press that he and colleagues were initially optimistic that garlic would reduce cholesterol.

Their study included 192 adults about 50 years old who had moderately elevated LDL or bad cholesterol levels. They were assigned to eat an average clove of garlic in raw form, or take garlic pills, six days a week for six months. In the double-blind study, part of the group was given dummy pills.

While more than half of the participants reported bad breath and body odor and some reported flatulence, there were no major side effects from eating garlic. But the study found virtually no effect on cholesterol levels in either group.

Calling the results disappointing, Dr. Gardner said it's still possible garlic might lower cholesterol when eaten in larger doses or by people with severe cholesterol problems. It also might have other characteristics that benefit heart health.

An Archives editorial said "the jury is still out" on whether garlic prevents cardiovascular diseases.

But advocates of herbal and nutritional remedies said people should continue consuming the herb.

Dr. Plank recommends consuming two cloves of raw garlic daily. She questioned whether the study's use of garlic pills, rather than raw garlic, accounts for the lack of impact on cholesterol. She said garlic thins the blood, which benefits heart health.

Other studies have concluded that garlic prevents prostate and gastric cancers, kills bacteria and even can alleviate mosquito bites.

Dr. Shivendra Singh, director of basic research, professor of pharmacology and urology, and leader of the Biochemoprevention Program at the University of Pittsburgh Cancer Institute, has been studying diallyl trisulfate, a chemical found in garlic that kills gastric and prostate cancer cells in dish cultures and animal models without affecting healthy cells.

He said he's developing the chemical as a cancer prevention, and soon will seek U.S. Food and Drug Administration approval to conduct human clinical trials on its safety and effectiveness.

Dr. Singh said research proves garlic consumption has beneficial effects on prostate cancer.

Diallyl trisulfate, he said, is just one of many chemicals in garlic that benefits health. Allicin, the chemical released when garlic is chopped, was purported to be the agent that reduced cholesterol.

Garlic's health benefits have been documented since 1400 B.C. Hippocrates, the famed Greek doctor, advocated its use for abnormal growth, which Dr. Singh said probably referred to cancer. Egyptian and Indian cultures also recommended garlic consumption to solve various ailments including growths.

Dr. Singh, who eats a clove of garlic daily, said the evidence is clear: "In terms of cancer, we know which chemical it is, how it works and how it inhibits cancer in animals."

He recommended eating a clove of garlic a day, which can be chopped, microwaved a brief period or mixed with honey.

Dr. Robert A. Schulman, author of "Solve It With Supplements" that recommends using herbal and nutritional supplements to help prevent and heal more than 100 common health problems, praised garlic, but warned that no herb or nutritional supplement is "a magic bullet."

"Herbs work in concert with other things," Dr. Schulman said. "Eating well, not eating junk food, exercising and getting a lot of sleep will make you live longer."