My Family and I have always Loved Camping.
‘Canoe camping’ actually. You ‘put in’ just at the end of a root-crossed path leading from a cottage trail or logging road down to the water. Load the canoe. Paddle in. Portage the gear, food, canoe, kids. Find a great site hidden away on an oil-black lake in the Muskoka’s. Get the tents up. Fire started. Wake early to the call of a loon. Swim. Eggs, oatmeal, and coffee. Trail mix and apples. Stay a day or two. Paddle and portage to another camp site a following day. Do it again. Portage and paddle back out. Everyone coming out smelling a little more woodsy. Everyone different. Refreshed.
Old Gear
I’ve never been the type to update my camping gear each year. We use the same green canoe, same pots & utensils, and the very same un-ergonomic backpacks that my parents used when they did the same with my sister and me, when I was a little boy. I’ve always just poached the gear from the back of my Dad’s garage whenever we headed into the lakes and coves of Georgian Bay each summer.
The beauty of old gear is the nostalgia and memories that are soaked into them. A grainy sped-up film of past trips you had as a kid can start to roll through your mind, taking you somewhere else, somewhere good, different times and places that somehow all connect, as you begin to boil water over the fire you just built.
The Crap Thing about Old Gear is that it’s Old.
Using old gear is fine when all things are as they should be. Good weather. Calm water. But the thing about camping is that you are intentionally exposing yourself to ‘the elements”. Weather. Waves. Rapids. Bears. Dark. Deep waters. Now I’ve never gone out unprepared. By ‘unprepared’, I mean without the necessary equipment. It’s just that it has always been old.
Now when gear fails you out on a lake you simply have to come up with another way of doing things. You have to think on it. Come up with the best plan. Improvise, and do it. And if the scenario is a critical one, the pressure and urgency placed upon the ‘thinking’, ‘improvising’, and ‘doing’ becomes all-the-more intense. A hole or crack in the hull of your only mode of transportation back to civilization needs to be mended quickly, made functional, and often it is patchwork with anything that makes the best sense. It may not be the ultimate solution but, considering the predicament, if it can be reasonably thought of as a fix to get you home than you do it. Beggars can’t be choosers at the end of the day.
Oncology & the Crack that Needs Fixing.
The ‘crack in a canoe’ image is, in some ways, and unfortunately, a fitting analogy for the field of oncology and the war on cancer. We are in some deep waters, we’re paddling hard, we can make out the shoreline in the distance, but we‘re taking on some serious water. We can see (though we prefer not mentioning it) that we may not make it to shore.
So how do we get home with a cracked canoe?
To Fix a Canoe: Common Sense (vs.) Proof, Proof, Proof
Common sense and proof. These elements of problem-solving are fantastic allies. They shouldn’t really be set up in opposition against each other. In one area of clinical oncology, however, it seems we have set the table as such. [Either/Or] mindsets versus a [Both/And] approach.
The ‘I’ve got a hole in my canoe’ scenario is always a ‘Both/And’ scenario.
You’re out in the wild. Whatever you can use with a reasonable chance of working, you’ll employ it. To fix your ride you can go for the more trust-worthy fixes (patch kits, etc.) or the make-shift maybe’s (duct tape, epoxy, plastic sheets, pine resin, etc). You may need to use both. Both/And. You wouldn’t comb the latest research to come to a hardened stance that only patch kits (which we know can work) should be used. You would never be heard to utter (as you bail water from your vessel), “Pine resin and duct tape will never touch the underside of my precious canoe!… because research hasn’t definitively shown… damn thing that I forgot my patch kit though”… Bail, Bail, Bail…
Cancer: the sinking ship we’ve found ourselves in.
With all of the clinical trials, all of the money raised and spent for research, all of the Kaplan-Meier survival curves, all the decades of trying to find the next magic bullet to save our loved ones and communities, we are still taking on water. With all of the exciting news that has come from the world of ‘targeted’ drugs, immunotherapy, and personalized genomic medicine, the improvements that have been gained in response rates, progression-free survival, and dare we even mention overall survival, have been fractional, primary due to the improved detection of early stage disease, and continue begging us for more.
And certainly patients are. Begging for more, that is.
So, follow my logic…
Firstly, if medical oncology, radiation oncology, and surgery were hitting it out of the park with, let’s say, a batting average of .800 (the best major league baseball players bat around .300) then this next discourse would be a waste of everyone’s time. We’d be doing well on the ol’ cancer front. We wouldn’t be needing to speak of adding anything new to the arsenal. Anything more to patch the hole. But, of course all of the noble fund-raising efforts and research going on around the world declare to us that we are still desperately searching for another strategy to make a more profound push-back against the disease.
So, we need more. What we have currently is saving some, but clearly not getting the job done to the degree that too many families ache for.
Natural Cancer ‘Cures’: Can they lend a hand?
Now, some practical advice before we jump in on this one…
If you come across a website, any web-based personality, or natural medicine ‘healer’/’practitioner’ in your town using the word ‘cure’, turn away and never look back. They are disconnected from the realities of the fight. They’re either deluded or selling to you. ‘Cure’ is a special word. It should never be used loosely or lightly. Cancer is truly a beast of a foe. There are no easy decisions, no ‘one size fits all’ answers, and certainly no guaranteed cures.
Not to Burst Bubbles, but…
I have never, in the 10’s of thousands of patient interactions I’ve had, seen a single natural compound ‘cure’ cancer. If some of you have, beautiful. I celebrate with you. But you are an anomaly and not the norm. I have seen combinations of multiple natural compounds used at high, high doses, heroically halt a rapidly progressing disease for many years when conventional treatment was getting nowhere. The stuff can work, but let’s all calm down with the ‘cure’ verbiage. The fantastic medical oncologists I’ve worked with don’t spout off such promises, and nobody has the right to. It’s misleading and unfair.
And Yet…
We do know from a wealth of published research that there is a short list of natural compounds with some serious potential to be honestly considered in this fight. They truly rise above the fads and gimmicks. They’ve empirically been shown to impact tumors. It would be great to have larger clinical trials to validate their survival impact. Yes, sure. But very few institutions are seriously setting up these trials. Validating them to the level that chemotherapies have been is a long ways off.
My 3-Tiered System (Prioritizing Natural Cancer Compounds)
Colleagues and patients will often ask me which natural compounds have good scientific support, and how many are there. I often break it down and prioritize it into a 3-tiered bucket system. These buckets help create a framework for patients to follow my reasoning and to see what an objective critique of anti-cancer compound claims looks like.
This categorization is just my own, and it changes for me as more literature is published, but here’s how it goes.
First Tier: (approx. 5-10 compounds could be considered at this level)
– compounds that have at least 100+ published studies displaying an anti-cancer effect (mostly at the pre-clinical level, but many of these also have a few well-designed clinical trials under their belts as well). The impact observed in these studies is not generalized or vague either. The effects I’m speaking of pertain to the ‘nuts n’ bolts’ mechanisms (i.e. genetic, molecular, etc.) of how these compounds sabotage cancer cell growth and division. The compounds in this first tier all have been seen in the research to shut down multiple/dozens of cellular functions that are necessary for cancer to thrive, thereby choking out these malignant cells.
To be placed in this tier they also need to have sufficient Phase I trials (determining safety parameters & proper dosing ranges). We know how to use them safely.
So, First Tier = large volume of published research (preclinical + clinical/with patients), cellular mechanisms of sabotage confirmed and measured. Not supported by mere anecdotal reports of success or historically accepted use. Safety concerns established.
Second Tier: (approx. 15-20 natural compounds)
– has the same criteria for me as the first tier but with less studies in the bank. This group of compounds will have dozens (not hundreds) of studies. Again, this tier dwells far beyond anecdotal claims.
Third Tier: (numerous products and claims)
– minimal-to-no published research to support them. The public interest in this list is largely based on bold claims about them being miracle cures per anecdotal reports.
Because we lack the scientific exploration of them we have no molecular or genetic understanding of what they do, or if they do anything at all. This is of critical importance clinically. When I get pathology reports and genomic test results back for my patients and it is revealed which specific molecular and genetic abnormalities are driving their disease it allows me to then select which natural compound is the most likely to succeed against their individual cancer. I can only work this way for my patients by turning to the Tier 1 & 2 compounds.
Also with Tier 3 compounds there is most often no safety profiles established for them, so I am left in a place of uncertainty as to how safe they are when used with conventional treatment, and therefore, I can’t ethically use them.
So, there’s a decision pyramid that we can start to see. Wisdom would direct us to pull from the fewer options at the top of the pyramid over selecting from the many unfounded approaches at the bottom.
The take-away, though, is that there are legitimate natural compounds with a very compelling rationale, supported by a large amount of detailed mechanistic research to back their use.
And here’s my main point… Ready?
We do NOT need phase III trials to begin using natural compounds with patients.
(Phase III Trials‘, for those that are not familiar with them, are the trials that all cancer drugs need to be tested at to see if they produce better survival outcomes than the current best treatment, and therefore get approval for use or not).
And by ‘begin’, I mean right now. We should be routinely using select natural compounds with our patients to potentially improve their outcomes. Now.
Yes, even though they do not have clinical trials quantifying their survival benefit. This statement will most likely not compute, at least not immediately, for those in conventional clinical oncology, but it is correct.
What I am saying is that logically, and as a reasonable response to the urgent sinking ship dilemma we find ourselves in, we don’t need to hold natural compounds to the rigors of phase III clinical trials before we approve their use.
“At this time, [they] do not have enough evidence (meaning double-blind, randomized, placebo-controlled phase III clinical trials) to support their use”, is a confused and miscalculated position. It’s an unnecessary vetting.
And here’s why.
The reason trials are needed for chemotherapy.
The reason phase III trials are need for pharmaceuticals is, obviously, to pick out the best drugs with the best results. However, it’s important to understand that we do these fine-tuned comparison studies because we are working with really toxic agents. These drugs can 1) kill patients, and 2) can’t be given all at once to a human being, so, ethically, we have to prioritize the order in which we give them. Essentially, if we are going to poison you, we’ll give you the courtesy of finding out which one works best.
Truly, it is a matter of, ‘These things are toxic… we can’t throw them all at a patient at once… Therefore, ethically, we need to compare them & assess which one has the best chance of working before we give them’.
The reason trials are not needed for natural compounds.
With safe compounds, this demand for scrutiny and head-to-head comparison to elucidate clinical priorities, and the sequencing of delivery, is misplaced.
We can deliver them all together without side-effects (again, we have the phase I safety trials assuring this already).
I’m not against running phase III trials for the sake of seeing which natural compound seems to out-perform the others, but to leave them totally off the clinical table until we do so is ludicrous.
Remember, we are in a canoe with a serious crack, that, in spite of all our efforts, is still taking on water and we may not make it home. And by ‘we’, I particularly mean the next individual patient to sit in front of an oncologist today.
‘Alternative’ cancer therapies shouldn’t be used as an Alternative.
One clarifying clause for what I’m declaring…
If any alternative approaches to clinically assist a cancer patient are being offered to patients in lieu of conventional treatment then they need to be strictly scrutinized with phase III double-blind RCT’s. If that’s how they are being touted then they need to prove it in a head-to-head showdown against the current first-line standard of treatment. If anyone claims to be able to upstage the thoroughly tested & approved front-runner from medical oncology than they must prove it. Otherwise we are in the camp of the reckless, irrational, and foolish.
I, by default therefore, am an advocate for conventional cancer treatments. I will always respect a patient’s right to choose, but factually there are no trials in existence that show an alternative treatment can be reasonably promoted over standard conventional therapy.
So, when the context is fighting for one’s life, I think you’ve got to ‘put your best foot forward’. You must. But I also like the idea that we have two feet! I’m ‘Both/And’ on the matter.
Natural compounds promoted as substitutes for conventional treatment?… Prove it or sit down.
But if natural compounds are being suggested as safe adjuncts to conventional therapies for better outcomes then they do not need to pass through phase III trials.
Logical? Check. Proof? Not too shabby either.
Truly, these targeted natural compounds have proven themselves valid and efficacious at every level they have been tested. Genetic. Molecular. Cellular. Apoptotic studies. Xenograft animal models. Early phase trials.
They just haven’t been the recipients of acceptance for larger phase III trials. No one is offering their patients en masse to enter studies testing them. Aside from a handful IV vitamin C clinical trials, other therapies (far more promising than IVC) haven’t even been given a spot in the batting order to see a single pitch.
“Get Ready for the Throw Down.”
(Maybe over-dramatic for a section heading, but sometimes a little hype works.)
It is disingenuous in 2017 to continually insist that natural compounds, proposed for an anti-cancer impact, have ‘no evidence’ (which always means from phase III trials specifically, yet it’s most commonly uttered as an overarching verdict of no evidence ‘at all’), when they have never been tested to that level.
It’s kinda like my 4-year old telling me that green beans are disgusting and that she will never consider having them on her dinner plate. She says this, not because she has ever actually tried them before, or has had them clearly fail her taste buds on that occasion. Rather, it’s because they look nothing like the food that she is used to, nothing like her favorites; that please her, and that she’s comfortable with (which by the way is goat yogurt with blueberries and a touch of maple syrup. Can’t blame her).
It’s a child-like stubbornness, which is fine for a 4-year old. Not, however, for medical professionals that should be accurately and objectively commenting on the level of evidence that exists, the degree that is still lacking, and why it is lacking to said degree.
I suggest changing our vernacular from “there’s just no evidence to support their use” (again, dismissively stated as a definitive reason to not waste one second longer on the topic) to a more precise statement such as, “we haven’t tested them in phase III trials yet, so we don’t know the clinical impact they could be having”. Just a slight difference, but the latter keeps a door open to the possibility that they may be having a clinic impact, and perhaps we could give them a go.
Why should they be given this courtesy?
Good question. Because of the research.
May I present the findings from a mountain of pre-clinical studies (primarily cellular & xenograft animal models), which have also been confirmed, by the way, in the few novel clinical studies that explored their impact on tumor biology in patients. The following list is for just a small number of natural compounds such as curcumin, green tea extract, and indole-3-carbinol. These findings will hopefully have the effect of our interests and curiosity being peaked, rather than a common trait in all of us to dismiss things unfamiliar.
(For those that aren’t familiar with these genes, gene products & molecular pathways that are involved in cancer growth and metastasis you can quickly skip this, but know that these are the bits and pieces that either drive aggressive disease from within a cancer cell, or sabotage it)
Increased gene expression of, or molecular activity of:
(wild type p53 allele, p21, p27, p38, BAX, PTEN, caspases (3/9), TIMP 1/2, FOXO3a, apoptotic signaling/Apaf-1, HIF1, IGFBP, apoptosome & DNA fragmentation rates, miRNAs 22/34/181b [involved in cell cycle arrest], histone acetylation/HAT expression, depolarization of mitochondrial out membrane & cytochrome-C release, telomerase, BRCA 1/2, PARP cleavage, etc.)
Down regulated gene expression of, or molecular activity of:
(mTOR, PI3K, Kras, BRAF, Bcl2, metalloproteinases [MMP-2/3/9], EMMPRIN, ABCB1 & pGP efflux pumps & MDRP-1 transporters, PDGF(R), EGF(R), VEGF(R), HER2/neu, ER expression, NFkB, IL6, JNK, Akt, ERK/MEK, Stat3, MAPK, IGF1(R), CDKs [4/6] & cyclins, CXCL1/2, TNF-alpha, c-jun, c-fos, integrin alpha6-beta4, HSP 70/90, Aromatase, DHT, Ki67, miRNAs 186a/199a [involved in progression], CpG island methylation, stem cell self-renewal via inhibition of STAT-3 & NFkB, Notch pathway, Wnt, telomerase hTERT, microtubule formation & activity)
* One could also add numerous studies displaying chemotherapy and radiation therapy augmentation by natural compounds when used concurrently.
* If you wish for more references, please ask and I’d be happy to provide them.
So, here’s my Train of Thought/Logic, in summary…
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There is a short-list of natural compounds that have the science behind them. This is not some dreamed up wishful thought. This call-out is not being fueled by mere anecdotal stories. They repeatedly work when used against cancer in every pre-clinical research model.
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Our canoe has a hole in it and the standard patch kit being used, though helping to some degree, isn’t getting the job done.
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We need to employ any reasonable strategy to get us closer to shore.
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Considering these natural compounds is reasonable (see point #1)
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These compounds are safe to use in combination with each other, and (in most cases) concurrently with conventional oncology treatments (seek out an ND/FABNO for guidance).
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Due to their negligible toxicities, we are not challenged with the burden, nor encumbered with the non-negotiable demand that medical ethics would otherwise hold us to, to trial them against each other to see which should be used first.
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This immediate call-to-use is only valid if natural compounds are being promoted as adjuncts, not substitutes, to conventional treatment.
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I am not saying that rigorous clinical trials should not be designed to see if these natural patch kits are truly making a difference. These need to be done so we can optimize their administration, determine if a certain compound betters another in augmenting a particular conventional treatment, or perhaps to discard one if it proves ineffective. This would naturally be the expected future course to follow.
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BUT, to be left to watch the water level rise because we have granted clinical trials a misplaced power of approval over natural agents, sidelining them, is nonsensical. This medicinal strategy, having the potential to give us another little push towards the shore, should have its day… now.
… and, an Algorithm to Make the Case for my Unconventional Reasoning.
Dr. David Karl Oster is a licensed Naturopathic Doctor (ND/FABNO), and founder of www.OsterOncology.com, a video consultation-based medical practice exclusively focused on supporting cancer patients moving through active treatment anywhere in North America, with the use of Naturopathic Oncology.