Boik on Cancer

Natural Compounds in Cancer Therapy

by John Boik

Readers awaiting the somewhat delayed publication of John Boik’s  Natural Compounds in Cancer Therapy may be neither as numerous or vociferous as Harry Potter fans, but they surely have more to shout about. Its predecessor volume, Cancer and Natural Medicine was rather like a mystery thriller, a detective story of chasing down the research literature on hundreds of herbs, combination formulae, isolated constituents and dietary compounds in a methodical attempt to gather clues about their potential anti-cancer activity and fit all the pieces of the jig saw puzzle together.  For many practitioners working with cancer patients and using natural medicines, Cancer and Natural Medicine became a valuable source of information and occasional inspiration, even if the big picture was of necessity incomplete.  In his new book,  by narrowing the breadth of the discussion to a few compounds, and increasing exponentially the depth of the analysis Boik has now generated a working version of the whole picture that is entirely original in several respects.

In essence, Boik rounded up the “most likely suspects” (i.e. the most promising anti-cancer agents) from the earlier book’s inventory of hundreds of materials. This new short list totals but thirty eight agents , over thirty of which are plants, or plant derived constituents -  the remainder being various dietary compounds including selenium, glutamine, omega 3 fatty acids and Vitamins A, C, D and E. These agents are evaluated within a comprehensive framework intended to clarify their application to cancer treatment.

This framework comprises three elements: understanding the underlying mechanisms of the cancer process; examining the effects of natural compounds on these processes; and a pharmacokinetic and pharmacodynamic analysis to establish effective therapeutic application of these compounds in synergistic combinations. Undeterred by the numerous missing pieces of  the puzzle, Boik has  innovatively filled the gaps with a variety of means, ranging from original pre-clinical research into the synergistic properties of compound combinations through to computer modeling of pharmacokinetic data on oral clearances. These latter in turn involved his developing algorithms for relating quantitative subcutaneous and intraperitoneal data to  oral clearance values, and also for interspecies extrapolations of rodent based experimental pharmacological data to humans. A cursory glance at the technical matter, much of it gathered in the burgeoning appendices, explains the delay in its publication - like topsy, [Ed. Note: jonathan—what does this mean—plain English just ain’t plain English to us here in the states!)  it just grew and grew.

The book is organized into three parts. The first deals with the molecular and cellular level of cancer mechanisms including proliferation, differentiation, apoptosis, and the role of signaling transduction and cell to cell communication in these processes. The effects of the selected natural compounds on these mechanisms are reviewed, based largely on in vitro research evidence.  In the second part, the emphasis moves to the tissue/organ/system  level, where  mechanisms of angiogenesis, invasion and metastasis are examined, with a consideration of the immune system involvement in the overall process and here the research evidence includes animal and human pre-clinical data as well as in vitro work.   The third part considers the clinical applications of the various taxonomic classes of agents, such as polysaccharides, antioxidants, flavonoids, terpenes, etc. Here incidentally, Boik’s discussion of anti-oxidants is a particularly lucid exposition of a topic rife with misconceptions. The third section concludes with an important review on the relationship between natural compounds , chemotherapy and radiotherapy. Thirteen appendices end the book, containing the details of the pharmacokinetic calculations, computer modeling and statistical analyses, and in-depth research material  supporting the first two parts of the text on the effect of compounds on the mechanisms of cancer. 

While the structure of the book is logical, at times its architecture appears almost labyrinthine, and this can be frustrating, for example, if one wishes to for example to follow a single herb or compound by reading its every entry throughout the text. My review copy sprouted dozens of post-it notes within a few days, especially in the back reference section,  and is now decorated with  highlighted text and marginal notes.  It  would have been easier, if more intimidating for some, to include all the research evidence in the appropriate chapters rather than putting it in appendices. Nonetheless the amount of information contained in the book is enormous, and an inquiring reader will find plenty of  ah-hah’s elicitated by a close reading of the dense text. To give but one of many examples ...the finding that the anthraquinone compound emodin , long known for its anti-tumor effects, is in fact specific for HER-2/neu overexpression throws new light on the inclusion of the emodin containing Rhamnus spp. in the Hoxsey formula, which is still widely used today especially by breast cancer survivors, and suggests a specific use for the invasive Japanese Knot Weed (Polygonum cuspidatum) whose roots contain large quantities of the compound (as well as rhein and resveratrol) in HER-2/neu overexpressing breast malignancy - a marker associated with worse than average prognosis.   Insights of this kind exemplify the benefits that can be obtained by integrating state of the art scientific information with clinical herbal practice, and for practitioners of such a bent, Boik’s book is worth its weight in gold. 

For clinical herbalists, some aspects of  the argument may seem excessively labored, for example -  the issue of synergy.  For herbalists, polypharmacy is the norm and synergy is inherent in the nature of herbs themselves. However Boik is writing for a wider audience, including physicians and oncologists for whom these concepts are largely unknown territory. But even herbalists have to concede that Boik is breaking entirely new ground in attempting to quantify synergistic interactions in order to establish whether therapeutically effective plasma levels of plant compounds can be attained by oral dosing in specific combinations to achieve specific anti-cancer effects. There are, perhaps inevitably, some minor inaccuracies among the plethora of data, for example Silybum is listed as a CYP450 inducer, but the weight of evidence is that it is a Phase 1 inhibitor and a Phase 2 inducer...but eagle eyed readers who personally contact the author regarding possible errors and omissions will find him keen to discuss corrections and debate the evidence of what is clearly on an ongoing work in progress.

Boik has started from the fundamental premise that the complexity of plants has a profound natural correspondence to the complexity of the human organism, and that plant medicines are inherently appropriate for the treatment of the multifactorial disturbances of healthy function that are characteristic of cancer. As he admits in his introduction, the text is open to several criticisms, including the lack of clinical studies and trials supporting natural compound use in cancer therapy, and the necessarily speculative or assumptive aspects of the pharmacokinetic modeling. If anything, in the opinion of this reviewer, Boik has erred on the side of caution, understandably  given his audience. We may have to wait for the studies and research, but for those practitioners confronted by cancer patients in their office who will not and cannot wait, this book is a valuable aid to remedy selection and dose calculations. Buy it.

© 2001 Jonathan Treasure

POSTSCRIPT

Jonathan: I am extremely pleased with your review. For me, it is more than just a positive reflection on my book, rather, it is that someone in the field really "got" what I was trying to say. Although only a few reviews have come in so far, I can already see that the message in the book was already missed or misunderstood by some. You heard me, and I am so happy to find that someone was listening. OK, now you are my friend for life. Thanks so much for the well written and thoughtful review, and for your open, inquisitive mind that allowed it.

Best,
John
John Boik
Oregon Medical Press
www.ompress.com

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