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Blogging against alternative cancer treatments

Mistletoe Just For Kissing, Not For Curing Cancer, Says Edzard Ernst

Read what Edzard Ernst, professor of complementary medicine at the universities of Exeter and Plymouth, has to tell us about mistletoe.

Most people will be surprised to learn from a case reported in this week’s British Medical Journal (BMJ) of a use for mistletoe (Viscum album) that has nothing to do with Christmas. Some patients with cancer inject themselves with extract of mistletoe in the hope of improving their condition. In continental Europe, at least 30 different mistletoe preparations are available. In Europe, most cancer patients use such extracts, at a total expense of about £30m (€45m; $59m) each year, and in Germany the insurance system pays for this treatment.

A Google search (20 November 2006) showed that 145 000 websites promote or mention mistletoe as a treatment for cancer. This much publicity may mean that many cancer patients in the UK will try mistletoe in the future or ask their doctor about it. It is therefore timely to discuss the value of mistletoe as an anticancer drug.

A century ago, Rudolf Steiner developed anthroposophy, a school of thought that led to innovations such as the Waldorf schools, biodynamic farming, and anthroposophic medicine. This approach to healthcare is based on intuitive thinking about assumed associations between four postulated dimensions of the human body (physical body, etheric body, astral body, and ego), plants, minerals, and the cosmos.

Anthroposophic medicine includes drugs, art therapy, rhythmic massages, special exercises, external applications, counselling, and anthroposophic nursing. These treatments are used “partly as adjuncts to and partly as substitutes for conventional medicine.” Anthroposophic drugs are based on ancient alchemistic and homeopathic notions, far removed from the concepts of pharmacology. Many of these drugs are produced in unusual ways—some mistletoe preparations are fermented while other anthroposophic drugs are highly diluted according to homeopathic principles.

Steiner’s intuition that mistletoe might help treat cancer is based on the fact that, like cancer, mistletoe is a parasitic growth that eventually kills its host. Inspired by Hahnemann’s “like cures like” principle, he believed that an extract of mistletoe would cure cancer. Despite the implausibility of this idea, about 1000 in vitro studies have shown that mistletoe or its main constituents (alkaloids, lectins, and viscotoxins) do have anticancer activity.  However, many plants have some sort of anticancer activity. Occasionally, this is useful therapeutically—vinblastine and vincristine are derived from the common periwinkle and Taxol comes from the yew tree. In most cases though, toxicity or lack of bioavailability prohibit the use of these compounds.

Proponents of anthroposophic medicine make two claims about mistletoe. Firstly, they claim that regular injections of mistletoe extract improve the natural course of cancer by slowing down or stopping tumour growth.
Secondly, they say that such extracts improve the quality of life in patients with cancer.

Many clinical studies of mistletoe exist, but their findings are inconsistent. Most of them are methodologically weak, and the less rigorous they are the greater the likelihood of a positive result. The conclusions of systematic reviews are therefore contradictory. Anthroposophical doctors, who tend to include unreliable primary studies, arrive at positive conclusions. In contrast, independent reviewers tend to focus on the most reliable evidence and regularly find that neither of the above two claims is supported by good evidence.

In this week’s BMJ, Finall and colleagues report a case of subcutaneous inflammation mimicking metastatic malignancy induced by injection of mistletoe. So how safe is this treatment? A wide range of serious adverse reactions have been noted, such as local reactions at the site of injection, anaphylaxis, dyspnoea, haemorrhagic colitis, herpes simplex, herpes zoster, joint pain, kidney failure, lymphangiitis, parasthesias, sarcoidosis, ulceration, and vertigo (Saller R. Zu den unerwuenschten Nebenwirkungen von Mistelpraeparaten. Drittens Mistelsymposium Otzenhausen, 20-22 November 2003).

Findings from in vitro studies suggest that mistletoe extract may enhance the proliferation of some cancers. In addition, some patients with cancer may use mistletoe as an alternative to conventional treatments for cancer, rather than just a complementary treatment.

The claim frequently voiced by proponents of anthroposophic medicine—that mistletoe injections have no serious risks—is therefore misleading.

Thus, mistletoe has been tested extensively as a treatment for cancer, but the most reliable randomised controlled trials fail to show benefit, and some reports show considerable potential for harm. The costs of regular mistletoe injections are high. I therefore recommend mistletoe as a Christmas decoration and for kissing under but not as an anticancer drug.
At the risk of upsetting many proponents of alternative medicine, I also contend that intuition is no substitute for evidence.

Edzard Ernst, professor of complementary medicine, Department of Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, Exeter EX2 4NT


Finall AI, McIntosh SA, Thompson WD. Subcutaneous inflammation mimicking metastatic malignancy induced by injection of mistletoe extract. BMJ 2006 doi: 10.1136/bmj.39044.460023.BE[Free Full Text]
Steuer-Vogt MK, Bonkowsky V, Scholz M, Arnold W. Plattenepithelkarzinome des Kopf-Hals-Bereichs. Mistellektin-1-normierte Viscumtherapie. Deutsches Arzteblatt 2001;98:3036-46.
Ernst E. Anthroposophische Medizin: Geheimwissenschaft oder Heilmethode? Perfusion 2006;19:344-8.
Kienle GS, Kiene H, Albonico HU. Anthroposophische Medizin: HealthTechnology Assessment Bericht-Kurzfassung. Forsch Komplementarmed2006;13(suppl 2):7-18.
Mansky PJ. Mistletoe and cancer: controversies and perspectives. Semin Oncol 2002;29:589 94.[CrossRef][ISI][Medline]
Kintzios SE, Barberaki MG. Plants that fight cancer. Boca Raton, FL: CRC Press, 2004.
Kleijnen J, Knipschild P. Mistletoe treatment for cancer: review of controlled trials in humans. Phytomedicine 1994;1:255-60.
Stauder H, Kreuser E-D. Mistletoe extracts standardised in terms of mistletoe lectins (ML I) in oncology: current state of clinical research. Onkologie 2002;25:374-80.[Medline]
Ernst E, Schmidt K, Steuer-Vogt MK. Mistletoe for cancer? A systematic review of randomised controlled trials. Int J Cancer 2003;107:262-7.[CrossRef][ISI][Medline]
Huber R, Klein R, Berg PA, Luedtke R, Werner M. Effects of a lectin- and a viscotoxin-rich mistletoe preparation on clinical and hematologic parameters: a placebo-controlled evaluation in healthy subjects. J Altern Complement Med 2002;8:857-66.[CrossRef][ISI][Medline]
Gabius S, Gabius H-J. Lektinbezogene Mistelanwendung: experimentelle Therapieform mit praeklinisch belegtem Risikopotenzial. Dtsch Med Wochenschr 2002;127:457-9.[Medline]

See also:
Who is Edzard Ernst
Interview with Edzard Ernst in The Guardian


9 responses to “Mistletoe Just For Kissing, Not For Curing Cancer, Says Edzard Ernst

  1. Pingback: Mistletoe just for kissing, says Edzard Ernst « Anax blog

  2. natalie March 8, 2009 at 9:42 pm

    “In 2004, over $72 billion dollars in the US alone was spent on cancer treatment” seems easy enough to see why big medicine goes to such lengths to destroy “quacks” ,those who proft from toxic therapies like chemotherapy and radiation might be out of business..”

  3. beatis March 9, 2009 at 6:06 am

    Up to now, not one alternative therapy claiming to be able to cure cancer has come up with one single validated case to support their claims. All they have to do is to give us just one patient who was cured of proven, incurable cancer by alternative therapy only.

    When they claim they can do better than standard medicine, they have to give us something to go by.

    As for the money thing, fot both standard and alternative medicine, there will be information on this blog shortly.

  4. natalie March 9, 2009 at 7:24 pm

    It’s impossible to beacuse any valid evidence is ALWAYS surpressed see

    or a doctor is accused of quackery and has their licence revoked….
    despite whether these alternative treatments work or not can’t deny the fact that the cancer industry is a big money making industry!

  5. beatis March 9, 2009 at 8:38 pm

    any valid evidence is ALWAYS surpressed

    No, it isn’t. See my other comment about scientific research into CAM-therapies.

    Furthermore, this confuses me. Cancer tutor and others say that the evidence of the efficacy of CAM is surpressed. So apparently, there is evidence. We all know the internet is free. So why not just post this evidence on the internet? Perhaps big pharma won’t like it, but the scientific community will love it.

    And when they have trouble getting research into their theories funded, why not apply for a grant at the NCCAM? They will love to fund grants that may generate a cure for cancer and they have the money.

  6. Melissa March 18, 2009 at 6:05 am

    “Up to now, not one alternative therapy claiming to be able to cure cancer has come up with one single validated case to support their claims.”

    I don’t believe there is any “one” alternative cure, though I definitely believe in alternative cures. But I think one has to use different mechanisms of action, that work synergistically together to get good results. There are no magic bullets … not even in conventional medicine. And believe me, I have done all the conventional cancer treatment there is … it still metastasized. Never again … now I’m using a little conventional and mostly alternative and I’m 2 years post peritoneal carcinomatosis dx and that’s a real nasty dx. Though I don’t have total control of it, I must be doing something right in that I’m feeling good, staying active, and looking great. 😉 Sure couldn’t say that if I were doing chemo this time around.

  7. beatis March 18, 2009 at 7:58 am

    Hi Melissa, good to see you here. Great that you are feeling so well, we’ll keep our thumbs up for you!

  8. evenarsenicisnatural March 18, 2009 at 7:41 pm

    Fixed for natalie:

    It’s impossible to beacuse any ‘valid’ evidence is ALWAYS blown out of proprtion and spun to cover-up it’s actual worthlessness.

    or a doctor is accused of quackery continues to peddle ‘cures’, often out of the country….
    despite whether these alternative treatments never work as shilled, can’t deny the fact that the cancer industry is a big money making industry for the quacks!

  9. natalie March 18, 2009 at 8:49 pm

    Hi Melissa,

    I too hope you stay well, your story sounds promising and gives hope 🙂

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