MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Rudolf Steiner was a weird guy by any stretch of imagination. He was the founding father of anthroposophy, an esoteric “philosophy” that created a new dimension of obtrusiveness. Not only that, he also dabbled in farming methods, devised an educational technique and created an entire school of health care, called anthroposophical medicine. The leading product in its range of homeopathy-inspired “drugs” is a mistletoe-extract which is, according to Steiner, a cure for cancer. His idea was simple: the mistletoe plant is a parasite that lives off host trees sapping its resources until, eventually, it might even kill its host – just like cancer threatening the life of a human being!!!

So, what is more logical than to postulate that extracts from mistletoe are a cure for cancer? Medicine seems simple – particularly, if  you do not understand the first thing about it!

But here comes the odd thing: some ingredients from mistletoe do actually have anti-cancer properties. So, was the old Steiner an intuitive genius who somehow sensed that mistletoe would be a life-saver for cancer patients? Or is all this just pure luck? Or was it perhaps predictable?

Many plants produce molecules that are so toxic that they can kill (cancer) cells, and many conventional cancer drugs were originally derived from plants; the fact that mistletoe has some anti-cancer activity therefore comes as a surprise only to those who have little or no knowledge of phyto-pharmacology.

Ok, mistletoe might have some ingredients which possess pharmacological activity. But to claim that it is a cancer cure is still a huge leap of faith. This fact did not stop promoters of anthroposophical medicine to do just that.

Due to decades of clever promotion, it is now hard in many countries (including for instance Germany) to find cancer patients who have not tried mistletoe; indeed, selling mistletoe preparations to desperate cancer patients has become a mega-business.

But does it actually work?  Do these extracts achieve what proponents advertise?

The claims for mistletoe are essentially twofold:

1) Mistletoe cures cancer.

2) Mistletoe improves the quality of life (QoL) of cancer patients.

The crucial question clearly is: are these claims based on good evidence?

According to our own systematic review, the answer is NO. In 2003, we looked at all the clinical trials and demonstrated that some of the weaker studies implied benefits of mistletoe extracts, particularly in terms of quality of life. None of the methodologically stronger trials exhibited efficacy in terms of quality of life, survival or other outcome measures. The current Cochrane review (of which I am not a co-author) concluded similarly : The evidence from RCTs to support the view that the application of mistletoe extracts has impact on survival or leads to an improved ability to fight cancer or to withstand anticancer treatments is weak.

But both reviews have one major weakness: they included all of the many available extracts of mistletoe – and one cannot deny that there are considerable differences between them. The market leader in this area is Weleda (avid readers of science blogs might remember that this firm has been mentioned before); they produce ISCADOR, the mistletoe extract that has been tested more than any other such preparation.

Perhaps it would be informative to focus specifically on this product then? A German team from the “Center for Integrative Medicine, Faculty of Health, University of Witten/Herdecke” has done just that; despite the fact that these authors are not really known for their critical analyses of anthroposophical medicine, their conclusion is also cautious: The analyzed studies give some evidence that Iscador treatment might have beneficial short-time effects on QoL-associated dimensions and psychosomatic self-regulation.

So, what is the bottom line? Sceptics would say that almost a century of research without a solid proof of efficacy is well and truly enough; one should now call it a day. Proponents of mistletoe treatment, however, insist: we need more and better studies. Well, there is more! A new RCT of Iscador has just been published.

It included chemotherapy-naive advanced non-small-cell lung cancer (NSCLC) patients to assess Iscador’s influence on chemotherapy-related adverse-effects and QoL. Patients with advanced NSCLC were randomised to receive chemotherapy alone or chemotherapy plus Iscador thrice weekly until tumour progression. Chemotherapy consisted of 21-day cycles of carboplatin combined with gemcitabine or pemetrexed. Seventy-two patients were enrolled of whom 65% were in stage IV, and 62% had squamous histology. Median overall survival in both groups was 11 months. Median time to tumour progression was not significantly different between the two groups. Differences in grade 3-4 haematological toxicity were not significant, but more control patients had chemotherapy dose reductions, grade 3-4 non-haematological toxicities, and hospitalisations.

The authors’ conclusion: No effect of Iscador could be found on quality of life or total adverse events. Nevertheless, chemotherapy dose reductions, severe non-haematological side-effects and hospitalisations were less frequent in patients treated with Iscador, warranting further investigation of Iscador as a modifier of chemotherapy-related toxicity.

So, does Steiner’s notion based on the weirdest of intuitions contain some kernel of truth? I am not sure. But for once I do agree with the proponents of mistletoe: we need more and better research to find out.

67 Responses to Mistletoe, a cancer therapy? You must be joking!

  • Given the lack of evidence for the effectiveness of mistletoe in cancer, it is utterly perplexing to me why the Royal Society of Medicine would put not one but two speakers (one a hernia surgeon rather than a cancer expert) expounding on mistletoe in the midst of an otherwise stellar and unrelated lineup of international speakers at this conference on cancer genetics and personalised medicine: http://www.rsm.ac.uk/academ/rpd16.php
    What on earth is going on?

    • true!
      but by no means the 1st time the RSM has ventured into quackery.

    • Kat

      It’s also utterly perplexing that the NHS is buying the stuff and giving it to patients.

      Through an FOIA request, we know that Iscador is used by the Royal London Hospital for Integrated Medicine, Glasgow Homeopathic Hospital (3,020 units in 2012) and Bristol Homeopathic Hospital (value £3,558.61 in 2012).

    • It’s also utterly perplexing that the NHS is buying the stuff and giving it to patients.

      Well, why are many therapies tolerated as “complementary”, even unofficially?
      Because they are at least harmless and if effective may contribute to the very poor statistics of chemotherapy.
      Who believes that chemo-result statistics are weighed with “complementary drug treatments”?
      They may just live on their effects because they have no real value.

    • My mother was diagnosed with a rare form of ovarian cancer 15 years ago and was given 3 to 5 years to live. She took the traditional cancer treatments but also took mistletoe shots for 18 months. She has been cancer free for 15 years and still going strong. I do believe the mistletoe shots benefited her immensely and believe they work.

      • Karen Tench said:

        I do believe the mistletoe shots benefited her immensely and believe they work.

        I’m glad to hear about your mother but why do you attribute her recovery to mistletoe?

        • I had breast cancer, I had chemo radiation and took mistletoe injections, 2 of my friends also had breadt cancer..they did not take mistletoe….I am 12 years cancer free and unfortunately they both have passed away from cancer recurrences..not a coincidence….I believe!

          • @Angie
             
            Delighted you are cancer free, but your grasp of elementary statistics is not impressive. In the whole population of people with breast cancer there is a rate of recurrence which means that some individuals will experience recurrence at a given time and some won’t. The fact that two of your friends didn’t take mistletoe and both recurred is indeed pure coincidence. You can’t derive evidence for the efficacy or otherwise of a treatment on the basis of N=3.

          • Sorry to hear about your friends.

            Did you ever drink a cup of Indian tea during that time? Go for a walk at the seaside, breathing the sea air? Use a different shower gel? I hope you get the point.

          • Wow reading some comments and i cant believe people are so inconsiderate and rude…its funny how people are so quick to say it is “quackery” demanding proof while criticizing every single thing done while taking mistletoe then disregarding that persons experience saying its not effective. I have one question for all of you who say “it DOES NOT work.” well where is your proof that it DOES NOT work? There is NO SOLID PROOF it DOES NOT WORK. Therefore in actuality YOU DONT HAVE A CLUE ABOUT IT UNLESS YOU HAVE EXPERIENCED IT FIRST HAND. So dont ignorantly shoot down a persons happy hopeful experience with YOUR QUACKERY and negativity.

            Everyone is so quick to back traditional cancer treaments when they only have positive effects if the cancer is caught early enough…(the perminent damage it has on a persons ability to concentrate, memory, and dna damage are horrible) tho they may be alive which is wounderful, but what about the majority of people who dont catch it early on because most dont get symptoms until its to late?

            Every single treatment of chemotherapy or radiation on advenced stages of cancer that i know of personally, all ended within months. During thoes last few months loved ones had to as the person receiving the treatment deteriorates at a hyperspeed pace.

          • The science is practically conclusive that mistletoe doesn’t treat cancers. Though it is inconclusive whether it can help with toxicity caused by chemo. Can you speak to this anecdotally? Did you experience fewer or less severe problems than your friends?

      • Are you saying the mistletoe helped with the side effects of chemo treatments (a possibility) or that it was instrumental in preventing or curtailing further cancer growth?

  • …. why the Royal Society of Medicine would put not one but two speakers (one a hernia surgeon rather than a cancer expert) expounding on mistletoe……

    It would be refreshing if someone at the audience would stand up and challenge them instead of just keeping silent. We saw how an unchallenged talk about homeopathy at ASCO a few years back was used 🙁

  • If any readers of this post know the chair person “Dr Enrico Mihich” they might be able to prepare him?

  • Statistically chemotherapy improved my chances of surviving 5 years by 13%, then again chemo makes some people so ill, it probably reduces their life expectancy. I have no doubt if I believed in God and got comfort from prayer, it would also improve my chances somewhat and no side effects, which were unbelievable fatigue, loss of sensation in hands and feet and increases the risk of other cancers, to name a few. It is hardly surprising doctors and patients are searching for other treatments which MIGHT have some effect on SOME individuals who can’t face chemotherapy. Would you guys prefer cancer patients had all hope removed and suffered in silence, fortunately cancer care has moved on from assuming that each individual WILL respond as the majority have in various scientific trials.

    • I think most oncologists look for treatments that DO [not MIGHT] work. and “we guys” do certainly not want to remove hope; we want to generate hope by advancing science; and we want to prevent false hope created by irresponsible quacks who are merely interested in their financial profit.

      • “we want to generate hope by advancing science ”
        I agree. Roughly 2/3 of all cancers are said to be preventable: PREVENTION should be the priority to address.

        Gastric cancer once was leading, but steadily declined in affluent countries – why? To cut it short: the ultrachronic infection with H.pylori is the main cause, with infection prevalence steadily dropping with improving hygiene.

        Men have about twice the mortality rate compared to women, with similar H.pylori infection prevalence. This can be explained by the fact that Helicobacter needs iron, which is more available in men, resulting in more severe mucosal damage. I predict that blood donors have a much lower risk, a testable hypothesis.

        With all we know, gastric cancer could be reduced much faster by a “treat and eradicate” strategy – but no action is taken! Who profits from the current state and resists “eradication of gastric cancer”? — Limitation of space prohibits to present more examples. Just a hint: both liver and colon cancer clearly are dependent on iron storage in the body, which could easily be handeled / corrected.
        It’s not enough to clarify preventable cancer causes, when the will to prevent is missing and the available knowledge is ignored.

  • I have yet to meet an oncologist that would tell you this treatment will cure your cancer. Might and hopefully is they language they use. Anyone who guarantees a cure for cancer is an “irresponsible quack”, whether they are offering mistletoe or chemotherapy wouldn’t you agree

    • please stop mis-interpreting what I write. here is what I did post:
      I think most oncologists look for treatments that DO [not MIGHT] work.
      have you met many to whom this does not apply?
      if yes, change your oncological team as a matter of urgency.

      • My mom was diagnosed with a rare form of ovarian cancer 15 years ago with a 3 to 5 year life expectancy. She had traditional cancer treatments but she also had mistletoe shots for 18+ months. She has been cancer free for 15 years and still going strong. I believe along with her faith these shots helped her immensely.

      • During my treatment I was told by my oncologists that chemotherapy works for some not others and it is not known why! Further the adjuvant treatment to block hormones that the medical establishment does not know why this works just that statistics show more survive. However, unless there is a level playing field in research with clear data reflecting accurately the study criteria with full disclosure on who funds the research so the evidence can be comparative the arguments will rage on.
        Indeed at one time or another there has been a qualified individual arguing that the Earth was flat or that instantaneous video communication across the globe was just not possible.

  • I am not mis – interpreting what you write. You say there is no evidence to say mistletoe will cure cancer, I am in agreement with you. You seem to be disagreeing with me when I say no one has a cure for cancer. Perhaps you could enlighten me as to the evidence you have seen of a cure for cancer, or could recommend an oncologist whose “treatment works”. Perhaps I need to go private ? I have been under the Royal Marsden now since April 2011 and none of my consultants ever promised the chemo and radiation would shrink the tumour, the surgery would get rid of all the cancer cells or that six months inter-venous chemotherapy would prevent a reoccurred. Presumably thats why I am having a CT scan next week two years after the surgery, because we all “HOPE” the treatment has been successful.

    • …and where exactly did I claim that there are some conventional oncology “guys” who have a cure. this, I fear, is the domain of people like Gonzalez (see subsequent post).

  • I have just been alerted to the fact that NICE have published a statement on this [https://www.evidence.nhs.uk/document?ci=http%3A%2F%2Fwww.medicinesresources.nhs.uk%2Fupload%2Fdocuments%2FEvidence%2FMedicines%20Q%20%26%20A%2FQA%20415%201%20final.doc%3Ffromsource%3Dnelm&q=mistletoe&ReturnUrl=%2Fsearch%3Fq%3Dmistletoe%26rf%3DFalse]:
    Whilst in vitro testing has been promising, showing a number of mechanisms by which mistletoe may be helpful in cancer treatment, clinical evidence of the effectiveness of mistletoe preparations is lacking. There are no licensed mistletoe products available in the UK. Until more high quality evidence is available, there is currently no compelling evidence to support the use of mistletoe extracts in cancer therapy. Currently available positive evidence is confounded by poor study design, with more high quality trial data suggesting little or no difference in those treated with mistletoe

  • Edzard, just FYI – Johns Hopkins Hospital, where I worked for a long time and now a retired stage 4 cancer patient, is preparing for the clinical trial with Mistletoe subcut injections. Swiss manufacturer agreed to supply the vials for free, funding is underway, etc. We have stage 4 colon cancer patient here who is alive for 4 years, she is on Mistletoe (an expert Baltimorian physician trained abroad and not affiliated with Hopkins is her “Mistletoe” doctor). Again, her story does not prove anything, of course, but her Hopkins oncologist and her “Mistletoe” physician managed to get an acceptance from such a conventional institution like Hopkins – there must be enough evidence in other trials to make this endeavor.

  • Dr. Steiner did NOT say mistletoe is a “cure” for cancer. He was specific and emphatic about this. Since his death in 1925 he has been misquoted, and his statements taken out of context. What he said is that it can help keep many cancers from metastasizing. There are no serious side effects and compared to prescription drugs it’s not super expensive. The therapy is to be used in addition to other appropriate treatment.

  • I suggest you go onto the sites for some additional information. If Hopkins can see the light re: MT injections and then so will the public. We need good studies that are well funded, well founded. We have one finally. Hopkins is going to do the job and do it right. Let’s see. I’m putting my money on MT. How about you?
    This is the u-tube presentation of Dr. Luis Diaz, Hopkins Oncologist http://youtu.be/7stGJAFpa00
    And here is the video of my neighbor Frank Ridgeway. http://youtu.be/9DR0EET7rg8
    please check out this orgainization- http://www.believebig.org

    Stacey Warther, RN
    Local Care Coordinator
    Patient-Centered Medical Home

    7055 Samuel Morse Drive, Suite 200
    Columbia, MD 21046
    c. 443 542 7562
    efax: 1-443-276-6537
    stacey.warther@healthways.com

    Learn about PCMH: http://www.carefirst.com/pcmhinfo

  • Not very sensible to put one’s money on a horse that >a href=”http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/herbsvitaminsandminerals/mistletoe”>never finished a race

  • stacey

    After-dinner speeches? Really?

  • Q – How do you maintain repeat business in oncology?
    A – Make sure you put down anything that you can’t understand or seems to offer a cost-effective/improved treatment, deride the word ‘cure’ (even though it is the holy grail of any treatment) & then dress it up with the pseudo-sophistry & old-school right-brain language & impoverished thinking. ie stay inside the co$y co$y box & while you at it shove in a bit of ad-hominem character assassination. You poor miserable saps/loosers – just admit it – the Germans have developed a process that you are simply jealous of.

    Finally – for all your ranting, the arguments you raise could just as easily be turned against most if not ALL the ‘conventional’ cancer treatment$ that you hold so preciou$.

    C’mon guys – fess up now… Whose ‘paytroll’ are you really on? Don’t worry I’m just mirroring your behaviour… just incase you didn’t get it 🙂

  • I suppose that the main problem with mistletoes is that they are parasites, so quite a lot depends on the host plant, which grows in similar, but not exactly the same environment. And cancer therapy must be very specific and efficient, because you have no time to waste!

  • Regarding an anticancer effect from mistletoe, just enter ‘Viscum album cancer’ into PubMed to see the many scientific studies on this plant attributing a positive effect on malignant cells. Since the ‘Nixon war on cancer’ has admittedly been lost – and most cancers are lifestyle-linked – maybe mistletoe has a major role in prevention, as a prophylactic. Would the good professor please consider this?

  • My husband had Prostate Cancer. His cancer was very aggressive and big the surgeon told him. He injected himself with Mistletoe for three weeks before having the Prostate removed. The surgeon was amazed and told him the Cancer was nowhere near as big as it had been. He wished afterwards that he had continued with the injections for longer and not rushed into having the operation.

  • Regards Escador, I have to say that I am aware of a case where a patient had multiple metastases in the lungs, and had months to live. A GP working in the UK prescribed mistletoe therapy only – it was used routinely in his own country – weekly injections for a significant length of time, and a few months later, the chest x-ray revealed all the tumours were no longer visible. In addition, palpably enlarged metastatic lymph nodes also reduced to normal size. The lady in question lived several years, not months, good quality life, with little or no side effects to note.
    I know from experience that this can only be attributable to the Mistletoe therapy. The effects may be different for different people, but this case was extremely successful.

    • @Sarah

      If all you post is a link, readers are left totally clueless as to what you intend to be its significance in context. Taken at face value, you seem to have linked to a site the reinforces the title and sentiment of the original post. Sample quotes…

      “Mistletoe extract has been shown to kill cancer cells in the laboratory and to affect the immune system. However, there is limited evidence that mistletoe’s effects on the immune system help the body fight cancer.”

      “A large number of human studies using mistletoe to treat cancer have been done since the early 1960s, but major weaknesses in many of these have raised doubts about their findings.”

      “The U.S. Food and Drug Administration (FDA) has not approved mistletoe as a treatment for cancer or any other medical condition.”

      “The FDA does not allow injectable mistletoe to be imported, sold, or used except for clinical research.”

    • @Sarah

      I don’t know whether you intend your link to support the use of mistletoe or not, but from your link, this is germane:

      A large number of human studies using mistletoe to treat cancer have been done since the early 1960s, but major weaknesses in many of these have raised doubts about their findings

      The U.S. Food and Drug Administration (FDA) has not approved mistletoe as a treatment for cancer or any other medical condition.

      The FDA does not allow injectable mistletoe to be imported, sold, or used except for clinical research

      Anything you want to add to that?

    • Hi Sarah

      Do you have any conflicts of interest that might be relevant to this discussion we should be aware of?

      Thanks.

  • Steiner was a genius and offered a “depth” of thinking that took science out of its helpless box. To call him a “weird guy” when so many people have found his ideas to be useful and effective is a poor way to begin a clinical discussion. Researches who need to mock the giants of the past to get attention, are not worth reading

  • I had stage 4 Appendix cancer! Rare! Aggressive and fast growing . You look up the survival rate! Had surgery and decided to do Chemo. But..I also did and still am using Mistletoe! I committed to take it for 3 years. 3 shots a week. It definitely helped me through chemo and I am 2 years cancer free! While 7 friends of mine have died in those 2 years of cancer. They did not use Mistletoe. Don’t be so ignorant people. If you have cancer, use it! I’m living proof it works! I am spreading the word!

    • no you are not!
      proof requires a different approach.

    • Are you quite sure Phil, that it was not the water you have drunk during this time that works? According to your logic you are living proof it does.

      Have you thanked your surgeon and your oncologist yet, for their part in you having lived for two years after diagnosis? And all the hard working doctors/scientists who worked on developing the surgical techniques and the tough-stuff-chemotherapy that may have saved your life, or at least made it a bit longer than if you had done nothing or just taken the mistletoe nostrum? A two year survival in this situation is nothing remarkable nowadays, even without the mistletoe juice, which by the way has never been shown to be of use when proper methods have been used in researching it.
      http://edzardernst.com/category/iscador/

    • Hello Phil we would like to try a mistletoe injection for my sister with stage 4 thyroid cancer agressive and fast growing. It spread on different parts of her body. It metastesis in her brain and the doctor told is that she has a tumor in her head. She doesn’t recognize us we are so upset. We don’t have any option we want to inject rhe mistletoe without consent of her doctor but we want to try because the doctors want us to have a chemo therapy but we think my sister can’t survive in chemo she is so weak.she taking lot of pills and antibiotic. I’m not sure if any other side effects injecting mistletoe while taking medicine pr antibiotics? Base in your experience. I hope you can help us regarding in this matter. Thank you.

      • @Pinkrose
        I feel for you and your family, and I respect your desperation. But mistletoe is not going to work. Phil is mistaken in attributing it to mistletoe injections and not the chemotherapy that he as survived for two years. Appendix cancer is usually slow growing and can be delayed with chemotherapy.
        It sounds like ther is nothing more to offer your sister. It is better to accept the fact than let charlatans or delusional naturopaths take your money for useless nostrums like mistletoe extract that has never been shown to help anyone for real.

        My best advice to you is to read these articles, especially number 6, 7 and 8
        http://scienceblog.cancerresearchuk.org/2014/03/24/dont-believe-the-hype-10-persistent-cancer-myths-debunked/

  • Let me remind you Pinkrose, that mistletoe almost certainly does not work. You do have an option, you should trust the doctors, not the internet. Your judgement is totally compromised, as you are more fond of the comments than the content of the present post. You shouldn’t do anything without the doctor’s consent. I hope your sister improves, but it won’t be the mistletoe.

    Remember, this is your choice, if you reject chemotherapy and use mistletoe, you make a judgement call that is not based on evidence and you will have to live with that. Cancer therapy options must be based on evidence, not on word of mouth and personal egoism. Your compromised judgement is not dependable at the moment.

    Good luck. I really wish your sister gets better!

  • Yes the different ampule extracts are based on good evidence based scientific proof of concepts — unless one is looking at it purely from an MHRA, Health Canada, FDA, WTO, etc. (Big Business under UN’s Food and Agriculture Organization and UNDCP). If you are under the impression that clinical trials via those organizations are the only true science, then unfortunately you have been misled. A huge populous in the science and medical fields now are calling them criminal trials because they have led so many people’s current beliefs astray. To the point though, if one uses his/her biomedical and genomic databases correctly (there are free classes on the internet by US college professors how to do this) scripting/filtering out said trials from said organizations – you will infact conclude that Yes the different ampule extracts are based on good evidence based scientific proof of concepts.

    The problem is that in most cases the extracts would not (and should not) be the only method used in the treatment and also they do not work for everyone in every situation. Patients should seek out Low Dose Chemo options in addition to Holistic coaching and adjunct therapies in addition to the mistletoe options.

  • Mistletoe is also big business. I don’t see why health providers would not want to make big money from mistletoe if it provided any benefit. But, since they operate under ethical obligations, this piece of the cake is left to Big Falsehope.

  • @TASP

    You must be joking.

  • I am a Clinical Oncologist, now myself suffering from an advanced malignancy which has led to my recent retirement from practice. Today a nurse advised me (“person-to-person, not officially”) that mistletoe had helped her through cancer treatment and that I should try it myself; she also recommended a practitioner whose name I recognised as somebody that one of my own patients had once consulted. Curiousity led to an Internet search, bringing me to this thread.

    I have often asked myself why people believe things for which there is no evidence. I think it is because people like (and remember) stories rather than data and numbers; because our intuitions about statistics and probability are highly misleading; because we trust our family, friends and casual acquaintances more than we trust experts whom we have not met personally; because our opinions tend to be strongest regarding subjects we know the least about; because we cannot accept that some things are simply not known. The Internet and social media reinforce misguided beliefs and bombard us with opinions and information at the expense of wisdom. Our education system is not very good at teaching us how to weigh evidence objectively, and there isn’t enough cross-fertilisation between the sciences and the humanities (many science students are simply not interested in the arts, and non-scientists tend to be scientifically completely illiterate).

    Is this why there are persistent beliefs such as the cancer-prevention properties of antioxidants, when there have been large, prospective, double-blind, randomised controlled trials showing that some of them at least (including high-dose vitamin C and vitamin E) are strongly carcinogenic?

    Now consider the newly-diagnosed cancer patient, who feels completely out of control. Their life is taken over by hospital appointments for consultations, tests, scans, treatment, unexpected complications, leaving little time for anything else (I know this from experience). They are subjected to unpleasant procedures and treatments which they feel they have to accept so as not to let their family down, or because they are scared of the consequences of not agreeing to them. They don’t even feel in control of their own body, which isrebelling against them. Then somebody (a friend, a magazine article) recommends an alternative approach. The practitioner (which the patient may well feel that they have in some way chosen themselves) takes an interest in them and with his promises of the effects of the treatment on offer and how they choose to participate in it, restores their feeling of control. Whatever good things happen to them after that are easily ascribed to the treatment rather than coincidence.

    What puzzles me is why so many alternative practitioners prey on people who are at their most vulnerable. Some of them are clearly charlatans who are simply interested in personal gain; I think the rest must be well-meaning but misguided, and when they find themselves making money out of grateful patients it reinforces their belief in what they are doing. After all, with a complex system such as homeopathy or Chinese traditional medicine it is possible to explain anything if you think about it hard enough.

    Then there is the patient who thinks to themselves “I know they haven’t proved that this works, but it just might, so what is the harm in trying”. The harm, of course, follows from the continued failure to subject the treatment to a proper clinical trial, so that we will know whether to incorporate it into evidence-based medicine or to throw it out. This is the only way that medicine moves forward, and is why doctors are no longer treating people with leeches, charging them up with static electricity, poisoning them with mercury, or for that matter carrying out mutilating and debilitating surgery where small operations or medical treatment can work better. It is why the survival from cancer is steadily improving.

    As for anecdotal evidence for miracle cures, over the course of my career I have had about half a dozen patients with aggressive advanced cancers who have done much better than I ever expected, for no reason that I have been able to discern (amazing responses to chemotherapy, failure of cancer to recur after palliative treatment, tumours suddenly halting in their progression). Every oncologist has seen this, and we have no idea why. Personally I used to refer them to a colleague who is collecting their tumour samples for genetic analysis; I didn’t take credit for anything other than giving them the best treatment available on the basis of current evidence.

    Then there is the difficult situation of using treatment that works, but not for everybody. Adjuvant chemotherapy, for instance, which might give (say) an 8% increase in absolute survival. This means that on average, for every 12 patients treated, you would expect 11 of them to see no benefit, either because they will be cured without it, or they will die regardless. But one of them will be cured because of the chemotherapy, and go on to live a long and healthy life, rather than dying within a year or two of their cancer. All of them will suffer the disruption and side-effects of treatment, and nobody can predict who will be the one to gain, or even know afterwards which is the one who was saved, and only statistical analysis can show an effect at all. By comparison the anecdotes about alternative treatments are much more memorable and appealing.

    Coming back to mistletoe – I marvel at the way it grows on an apple tree near my home. I am intrigued by recent research concerning its lack of many of the fundamental metabolic mechanisms whereby almost all multicellular organisms burn glucose to generate energy (biology is so much more complex than anybody ever gives it credit for). I might snatch a kiss under a sprig of it at Christmas. I have no intention of taking it myself, however. But if a well-designed clinical trial produces statistically valid results in favour of a beneficial effect that might be relevant to my condition then I would have to change my mind in the light of new evidence. After all, I have always found that if I am treating my patients the same way that I did last year then I am not keeping up with research.

    I apologise for such a long and rambling post, only tangentially relating to mistletoe, prompted by a well-meaning nurse whose professional judgement was completely thrown by her own reaction to a cancer diagnosis. I hope it has been of some interest nevertheless.

    • many thanks for sharing your story and thoughts.
      AND GOOD LUCK WITH YOU OWN CANCER.

    • No apologies necessary. This beautiful post deserves to be read and digested by every fan of pseudo-medicine.

    • Apology not accepted, because apology not needed! This comment is a service to medicine and rationality and wonderfully compensates another large bit for the endless number of irrational, and sometimes aggressive, comments typically arriving on many of the blog posts of Dr. Ernst here.

      Thank you for the time to share your experiences.
      Another wish for all the best with your condition!

  • Thank-you for your well-wishes. I appreciate your kind thoughts and comments, but of course what I really need is more research.

    At the moment I am reasonably well and stable on established treatment. But when the time comes, I wonder whether I will have the strength to be as brave and selfless as those of my own patients who have signed up to Phase I clinical trials, knowing that they are very unlikely to benefit, but also aware of the service they are giving to those who will come after them.

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