There are several terms consistently used in the literature relating to non conventional medicine in general and often to herbal medicine in particular, all of which both express and create a considerable amount of confusion.

1. CAM
2. HOLISM
3. SYNERGY
4. INTEGRATIVE MEDICINE

We’ll do CAM today

CAM is a useless dustbin term. It originated as bureacratic jargonese for forms of medicine that were not typically taught in medical school curricula. This was in the period of formation of the OAM (Office of Alternative Medicine), later the National Center for Complementary and Alternative Medicine (NCCAM) at the NIH in the early 1990’s. It is a hodge-podge term that includes “biological’ therapies such as herbs and nutrition; physical therapies such as massage, chirpopractic and osteopathy, and energetic therapies, ranging from acupuncture to healing touch; so called mind-body interventions such as meditation, guided imagery and prayer. The stunning idea being that somewhere between 50 and 5000 years too late, the institutions of government of conventional medicine made a fumbling attempt to acknowledge the existence of some of the diverse traditions, modalities and cultures of healing outside of the narrow and historically infant reductionist biomedical paradigm.

As we have remarked before, there is often a convergence between the views of the far right and left, compared to the muddle of the liberal center. So it is with CAM. The articulate conservative medical establishment position on CAM is that there is no such thing. I totally agree. There is indeed only “one medicine” and the point, as they say, is “whether it works” or not.

Of course, to paraphrase Bill Clinton, that all depends what you mean by “it”. Since “it” refers to mainstream social, economic and cultural institutions and accompanying philosophical underpinnings, then we have a problem. Typically in practice this is exemplified by the banal attempts to apply “evidence based medicine” methodology to individual centered therapies such as homeopathy, and hence a self-validating the circular rejection of them as “unscientific”. The vitriolic attacks in Nature journal on the BSc degrees in homeopathy (see HERBLOG March 22) represent a classic example of what can go wrong when non conventional modalities adopt the trappings of mainstream medical professionalization in the hope of being validated. It is arguable that osteopathy, chiropractic and massage all eviscerated to a greater or lesser degree their “non materialistic” core components in order to gain mainstream acceptance. Since biomedicine cannot fix back pain, these dumbed down modalities are now safe inclusions in the medical repertoire when reduced to ancillary techniques or peripatetic tool-kit extensions.

Since it is now de rigeur for mainstream medical schools to have integrative departments teaching “CAM” it seems that the original definition is now even more absurd. Amusingly, the quackbuster element still tries to exploit the CAM word to distinguish between “harmless” complementary therapies (like meditation and massage) and nasty dangerous alternative ones (like herbs). See the Sloane-Kettering Memorial Integrative medicine home page for this ludicrous attempted sleight of hand.

There is only one medicine. But there are two cultures, and two sides. CAM is a messy mainstream term of convenience that facilitates establishment co-optation (integration) of some “safe” components of non-conventional approaches while isolating and attacking others that are perceived as potentially a more fundamental threat to its dominance. Herbal medicine is not CAM, it is herbal medicine.

It is open season on alternative medicine on the UK. Nature magazine carries a special news report and editorial slamming the “unscientific” nature of BSc degrees in CAM, especially homeopathy. (full text)

Simultaneously, leading medical scientists, including a couple of nobel prize winners and of course guess who - Eddie Ernst (pops up everywhere doesn’t he) have a signed an open letter sent to 469 National Health Service Trusts ( the regional groups that administer health care delivery in the socialized medicine system in Britain) urging them to stop using bogus complementary therapies (full text of letter)

HERBLOG readers will be aware that my position is that there is an ongoing multilevel, multidimensional and multipronged attack on non conventional medicine by the mainstream. It includes both sophisticated fifth columnists, such as Ernst (Exeter University) in the UK and Cassileth (Sloan-Kettering Memorial cancer center, USA) in the US who head up “integrative” medicine departments under the banner of “evidence based medicine” - all else being unproven unscientific nonsense, as well the many fundamentalist bigots (the homeopathy and acupuncture are gobbledygook brigade)
The mainstream medical attack on “phony BSc degrees” in a leading journal like Nature is ironic for anyone who has followed developments in the UK over the last decade or more. “CAM” modalities have been giving their training courses a makeover (from diplomas etc) into “degrees” for some time, in response to the changing regulatory climate in the UK. Herbal medicine is a great example - in an attempt to become seen as more”legitimate” as a form of professional training. Prior to the sponsorship of herbal medicine BSc degrees (3 year courses). For many years the old UK School of Phytotherapy under Hein Zeylstra conducted herbal medicine training in the UK. Responding to the future need for accreditation, registration and formalization of herbal medicine as a profession (= “degrees”) Zeylstra applied for degree status to the University of Wales. His school was rejected because the course ( a 4 or 5 year training) was in excess of what could be handled by a 3 year Bachelors curriculum load. Without laboring the point, and not wanting to be controversial (who me) it is certainly arguable that the subsequent shoe-horning of herbal education into the 3 year degree format has probably lowered the bar in terms of educational level of herbalists rather than raised it. But of course, the irony is that by going for degree status in order to appear more professional and science based, rather like lambs to the slaughter, the UK CAM modalities have walked into a vicious double bind. Damned if you do, damned if you don’t.
One thing is clear. Threats to herbal medicine and many other forms of non conventional practice are increasing not decreasing globally. If you bought the ticket, you better get ready to take the ride.

Well this is the study referred to in the (jackass) Lancet editorial. Here is the deal. We have no idea what herbs were used. Each patient was examined and assessed by a practitioner of CHM, using traditional methods and approaches (presumably = no labs or mainstream diagnostics) We do not know who the practitioners were, or whether they had any experience in the specialized area of botanicals in the oncology setting. We do not know how they were briefed, or if they knew what the patients a history and current chemotherapy assignment was. We simply know that they prescribed a bunch of herbs from a list of 250, made l to them in granular powder tea format by the triallists.

Hence the report title in the Lancet? The validity of Chinese herbal medicine questioned? Why?
Worse still - the conclusion of Ernst? “Individualized herbal prescriptions in general” are invalid. What?

When these sort of cheap attacks are made, the perpetrators demean themselves, keep the clock firmly set on neanderthal time, and do nothing but disservice to patients. Ernst, for reasons that are largely obscure to many is seen as an expert on CAM. He persistently uses this “expert status” to make pronouncements that are nothing more than his own bigoted opinions. The whole thing stinks, but is just one more example of the feeble attempts of the status quo to maintain its hegemonic “authority”.

Mok, T., W. Yeo, et al. (2007). “A double-blind placebo-controlled randomized study of Chinese herbal medicine as complementary therapy for reduction of chemotherapy-induced toxicity.” Ann Oncol. epub ahead of print

BACKGROUND: Chinese herbal medicine (CHM) is a common complementary therapy used by patients with cancer for reduction of chemotherapy-induced toxic effects. This study applied the highest standard of clinical trial methodology to examine the role of CHM in reducing chemotherapy-induced toxicity, while maintaining a tailored approach to therapy. PATIENTS AND METHODS: Patients with early-stage breast or colon cancer who required postoperative adjuvant chemotherapy were eligible for the study. Enrolled patients were randomly assigned to one of three Chinese herbalists who evaluated and prescribed a combination of single-item packaged herbal extract granules. Patients received either CHM or placebo packages with a corresponding serial number. The placebo package contained nontherapeutic herbs with an artificial smell and taste similar to a typical herbal tea. The primary end points were hematologic and non-hematologic toxicity according to the National Cancer Institute Common Toxicity Criteria Version 2. RESULTS: One hundred and twenty patients were accrued at the time of premature study termination. Patient characteristics of the two groups were similar. The incidence of grade 3/4 anemia, leukopenia, neutropenia, and thrombocytopenia for the CHM and placebo groups were 5.4%, 47.3%, 52.7%, and 1.8% and 1.8%, 32.2%, 44.7%, and 3.6%, respectively (P = 0.27, 0.37, 0.63, and 0.13, respectively). Incidence of grade 2 nausea was the only non-hematologic toxicity that was significantly reduced in the CHM group (14.6% versus 35.7%, P = 0.04). CONCLUSIONS: Traditional CHM does not reduce the hematologic toxicity associated with chemotherapy. CHM, however, does have a significant impact on control of nausea.

This jackass headline accompanies a piece by Angela Paolino reporting to Lancet Oncology readers (current issue) on a study by Mok et al, (from Annals of Oncology earlier this year January 17th) that is typical of the anti-herb propaganda and garbage that mainstream medicine endlessly serves up….it is almost beyond the point of being funny it so stupidly transparent. Are the readers of Lancet oncology really this dumb? Will all Chinese medicine practitioners kindly see the light and stop what they have been doing ( for the last few thousand years) now that Lancet Oncology has spoken in its profound wisdom, especially since the execrable Ernst endorses this headline, and indeed extends it to ALL of herbal medicine….
FWIW - the study in question compares two groups of cancer patients (resected breast and colon) undergoing chemotherapy (adriamycin/cytoxan) and 5FU/leucovorin) repsectively, with and without concomitant CHM (Chinese herbal medicine) Total n=111 for both groups. The verum groups were assigned to one of three “experienced Chinese herbalists” who assessed each patient on day 1 and day 14 of each cycle of chemo. The assessments were apparently “traditional”. The subjects were then prescribed “individualized herbal teas”. After the cycles of chemotherapy were completed the patients were evaluated for a range of chemotherapy induced toxicities compared to those that had received “placebo herbal teas” No significant differences were found between the control and herbal Rx groups of patients with respect to hematological toxicity (neutropenia and leukopenia) nor any other toxicity except nausea and vomiting for which the herbal treatment groups did better than controls.

We shall report the gory details of this study in the following post since it is bound to get a lot of attention but trust me for now, the study is flawed to the point of absurdity - but the point here, even if it were an intelligent study design, is that how come one negative finding calls ALL of Chinese herbal medicine into question??

The author of this piece and the Editor of the journal should apologize for such a low life attempt to rubbish something they know nothing about. But instead, the reporter wheels out our old friend Eddie Ernst, champion of evidence based CAM who says , this one study actually “questions the validity of all of individualized herbal treatment in general” .

Ernst is a fatuous fool for making such a remark, and the Editors of Lancet Oncology are moronic to print it.

The bigger and deeper tragedy is, that for the countless people with cancer facing the daunting prospect of toxic chemotherapy for advanced disease despite its pathetic cure rate, as well as the few herbal practitioners ( Chinese or Western) dedicated, thick skinned, or perhaps foolish enough to persist in attempting to help forge a more inclusive, integrative multidimensional model of cancer care, these kind of comments are not merely egregiously retarded, but they arguably harm patients as well as the emerging integrative approach which will inevitably supercede the current reductionist/materialist/toxic/and banalized model of cancer care promoted by pharmaceutical companies and the majority of mainstream oncology. Shame on you Lancet Oncology.

Just a quick note for Herblog subscribers - you may have noticed. we took a vacation! (What a concept) Two weeks in Belize, a killer combo of jungle/rainforest, medicinal plants and Mayan spiritual healing work with a couple of days on the islands to recover from scorpions etc. Having re-landed in the contiguous 48 we are now changing servers and testing the new system. Normal service will be resumed as soon as possible - actually later today.

Check back soon for Lancet Oncology and Chinese medicine jackass of the week award.