Complementary and Alternative Medicine in urology

Complementary and Alternative Medicine in urology

The role of nutrition, yoga, tai chi, physical activity and herbal therapy in healing is steeped in antiquity. As one looks back on the history of healing, we recognize that in early medicine healing was the province of the priests and the religious, and in many native societies healing is still the province of shamans and tribal religious leaders.

The evolution of healing from the priest to the physician occurred in the Middle Ages when influential philosophers, such as Descartes, held there was a distinct separation between mind and body, or spirit and substance. Previously, the health of the body was directly linked to the health of the mind. But because of Descartes and similar thinkers, the Western practice of medicine veered off on a new course.

Western medicine has relied heavily on technology, leading to some spectacular breakthroughs in disease control, most notably in the area of infectious disease and vaccines. For the most part, we are one-dimensional in that we attempt to find a single answer to the cause of the disease. We are continually looking for the one antibiotic to cure the infection, the one agent to cure cancer. In other words, we tend to look for that “magic bullet.”

In contrast, Eastern medicine — commonly referred to as alternative medicine — relies on a more holistic approach in which the use of multi-therapies is the rule rather than the exception. Eastern medicine holds that disease, be it cancer, infection, or inflammation, results from a breakdown in the immune forces of the body and efforts are directed at stimulating the return of this energy, which is known by a variety of names, such as chi, pranha, and so forth, depending on the culture.

Since the entire immune system is involved, a coordinated approach is needed in order to correct the disorder and put the body back in balance. Thus, it is common for Eastern medicine to involve the use of nutrition and nutritional supplements, herbs, stress reduction in the form of yoga or tai chi, exercise, meditation and acupuncture. This global approach is reflected in traditional Chinese medicine. It is unusual for practitioners to use one herb for a specific condition.

Much more common is the use of a number of herbs, which are effective when combined, but have little or no effect used individually. This practice is in direct contrast to Western chemotherapy, which holds that unless an agent shows effect as a single agent, it will be ineffective when used in combination.

The Importance of Alternative Medicine to Physicians

Although use of alternative medicine has its strongest adherents in individuals with cardiovascular disease, asthma, arthritis and other nonmalignant conditions, Dr. Fair said he believes there is as much or more justification for the role of complementary medicine as an adjunct to the prevention and/or treatment of cancer. In a recent survey conducted by the prostate cancer survivor organization USTOO, the primary concerns of men with prostate cancer were to slow the cancer and extend life, followed closely by maintaining or improving the quality of life.

If it is possible to slow the growth of the cancer and maintain or achieve an excellent quality of life, then cancer may be considered similar to many other chronic but often incur diseases, such as cardiovascular disease, diabetes, arthritis, asthma and AIDS, where control, not cure, is paramount.

In this context, alternative medicine should be viewed as a means to compliment, but not replace, conventional therapies. However, he prefers the term “complementary medicine.” The term alternative medicine is less descriptive, since alternative implies that unconventional treatment should replace standard treatment, which Dr. Fair says he and most other physicians believe would be a serious mistake.

Many conventional practitioners, he points out, dismiss the benefits ascribed to complementary medicine as nothing more than the placebo effect–it’s “all in the mind.” But even so, one should not underestimate the impact of placebos. The placebo effect was examined in detail recently, and the evidence that the healing environment and confidence in the physician can have a major role in therapy is incontrovertible.

One recent study, for example, involved patients with angina pectoris. Some of the patients underwent sham surgery where an incision was made but no surgery was performed. Other patients underwent actual surgery where the internal mammary artery was litigated. Symptoms of chest pain improved by 76% for those who had the actual surgery but by 100% among those who underwent the sham surgery. Other placebo-related studies show similar results. So, even if some of the effects of complementary techniques can be ascribed to the placebo effect, the fact that it may improve the condition should not be dismissed. Nor should it be assumed that presumed beneficial effects of standard therapy are the result of drugs or surgical procedures. The placebo effect may also be playing a significant role.

Dr. Fair’s report concentrates on the complementary techniques in which there is some definitive scientific evidence of benefit. Included are nutrition, exercise, stress reduction, group support acupuncture, herbs and aroma therapy either alone or as an adjunct to standard therapy.

Nutrition

What and how much we eat can play an important role in the prevention and treatment of cancer. Perhaps nowhere is this potentially of more value than prostate cancer therapy. Dr. Fair points to a recent rather disconcerting study from Wayne State University, which showed evidence that approximately one third of the men older than 30 years have microscopic evidence of prostate cancer. While it is an astonishing number, clearly, he says, a third of males do not die with prostate cancer. What is it that prevents the development of this microscopic latent cancer, into killing cancer?

A number of studies strongly suggest that environmental factors may be involved, chiefly nutrition. For example, the incidence of prostate cancer among first generation Japanese and Chinese Americans living in the San Francisco Bay area increased 3 to 7 fold compared to those whose parents had not migrated to the United States. Obviously, this marked increase does not reflect a genetic effect as the men who migrate bring their genes with them!

Compelling experimental and clinical data exist suggesting a relationship between diet and the incidence of prostate cancer. Dr. Fair states that his laboratory studied the effect of substances on the growth of human tumor (LNCaP) implanted in mice. In those animals receiving a 40% fat diet throughout the experiment tumor growth was as expected. However, in those animals where the fat diet was reduced to 20% or less after the tumor was established, there was a marked reduction in tumor growth.

The relationship between a high percentage fat diet and prostate cancer is clearly seen in a study conducted by Carroll, K.K. and Khor. It showed that the Pacific Rim countries (Japan, Taiwan, Sri Lanka, etc.) with the lowest per capita fat intake also had the lowest death rate from prostate cancer. The populations with the highest death rate are in the United States and Western Europe, which also have the highest dietary fat intake. Experimental and clinical data suggest that for the normal individual, an optimal prostate cancer retarding diet is one where no more than 20% of the daily calorie intake is in the form of fat.

Dr. Fair says that in addition to dietary fat reduction there are nutritional supplements that may be helpful in reducing the likelihood of prostate cancer: Vitamin E, for example. There is strong suggestion of a beneficial relationship between vitamin E and prostate cancer from a Finnish trial of 29,000 men, which was primarily designed to assess the value of vitamin A in preventing lung cancer among male smokers. One group of men were given vitamin A, a second group received vitamin E, and a third group was given a combination of vitamins A and E. The men were followed for several years. The study was terminated after an interim analysis revealed that among the vitamin A recipients there was an 18% increase in the incidence of lung cancer. However, it was observed that the men in the other two groups had a 32% decrease in the incidence of prostate cancer.

Dr. Fair notes that the study conducted in his laboratory using LNCaP implanted mice also showed that vitamin E retarded the growth of cancer. Two groups of mice were used. Both were on a 40% fat diet, but the control group was also given vitamin E. The mice receiving vitamin E had a marked reduction in the growth of the LNCaP tumor.

Exercise Therapy

In addition to nutritional intervention and dietary supplements, Dr. Fair discussed the value of exercise in the management of chronic disease. He refers to a number of studies that show the role of physical activity in decreasing death from chronic disease. In one study (Kushi et al.) more than 40,000 postmenopausal women were involved. Those women who exercised moderately for at least 30 minutes four times a week had an overall death rate that was approximately half the of women who rarely or never exercised. Another study (Hakim et al.) demonstrated the beneficial effect of walking more than two miles a day on the overall, as well as cancer specific, death rate. Two groups of men — one walked on average less than one mile a day and the other walked two or more miles daily — were followed for 12 years. The overall death rate for those who walked more than two miles a day decreased by 50% and cancer deaths decreased by two-thirds compared to the non-walkers.

Stress Reduction

While the benefits of exercise seem rather clear, Dr. Fair says the role that stress plays has been controversial. Specifically, does stress cause cancer or might it stimulate the growth of cancer are questions that remain unanswered. However, he says there is increasing evidence that stress can alter the immune system as well as documented evidence that alterations in the immune system can regulate tumor growth. In a recent study described by Dr. Fair, 93 men who were HIV positive but did not have AIDS were given standard medical and psychological assessments every 6 months for 42 months. The study documented that men subjected to higher stress levels had an increased risk of disease progression and the group with the most severe stress level had a four-fold increase in the severity of progression from HIV positive to clinical AIDS. Although the study involved AIDS cases, Dr. Fair feels that by extrapolation the results may be applicable to individuals with other forms of malignancy.

Social Interaction, and Group Support

Next Dr. Fair looks at the role played by social interaction and group support in disease control. The impact of social isolation and disease progression, he says, is particularly striking. In the years 1979 to 1994 a number of large studies from widely spaced geographical areas showed a two to five times increase in the risk of premature death of those who were socially isolated.

In the area of group support, Dr. Fair says the most striking example of the value of group support is a 10-year study involving women with breast cancer (Spiegel et al.) The women were divided into a control group and a treatment group. Both groups received standard treatment with the only difference being that the patients in the treatment group participated in a weekly support group for a year. While all patients in the control group died within four years, almost 40% of the patients in the support group were alive at five years and 8% were alive at 10 years.

Acupuncture, Herbs and Aroma therapy

Acupuncture, which for years, Dr. Fair notes, was disdained by the medical community, has been shown to be very effective in the control of pain from a variety of sources. He notes that some orthopedic surgeons are now routinely using acupuncture as part of their office practice; and that acupuncture has also been shown to be effective in the control of nausea and vomiting, which are brought on by chemotherapy.

Herbal therapy has been used in the treatment of various diseases since the days of the Old Testament, but does not have many proponents among Western practitioners This, Dr. Fair says, is due primarily to the lack of controlled studies on the effectiveness of herbs. However, he notes there have been some recent studies which have shown that saw palmetto may be effective for the treatment of benign prostate hyperplasia and that Saint-Johns-wort is effective for the treatment of moderate depression The recent introduction of the herbal mixture PC-SPES , he says, has shown to have some inhibiting effect on prostate cancer. Although many of the herbal remedies have not been subjected to controlled studies, Dr. Fair does point out that herbs have been used by Chinese and other Asian cultures for more than 3,000 years by intelligent people with a strong history of an interest in healing.

Finally, a discussion of aroma therapy: the effect of smell on the body and its processes. While this is still a relatively new area, Dr. Fair says some recent studies have indicated smells can have a profound effect. In an experiment known as the “Bruce Effect,” a male and a female rat are placed in the same cage, a pregnancy ensues, and the female eventually delivers rat pups. The pregnancy will also continue if the stud male rat is separated from the female by a wire cage.

However, if the stud male is replaced by another male or if the stud male is separated from the female by a glass partition, which permits visualization but no touching or smelling, the fetus will be reabsorbed. This dramatic example of the influence the sense of smell has on the body processes, says Dr. Fair is unexplained but is thought to involve pheromones, which are odorless airborne chemical signals, released into the environment with the ability to effect the body processes or behavior of other members of the same species.

Conclusion

Dr. Fair expects that the role of complementary medicine in the treatment of patients with malignant disease is likely to increase in the future. While recognizing the need for more controlled studies of complementary techniques, he feels claims that all complementary medicine is without merit because these studies have not been done is unjustified and erroneous.

He concludes by saying that the use of complementary therapy techniques, not as an alternative to conventional therapy, but as a complement, providing nutritional, physical, mental and spiritual help to individuals suffering from cancer or other chronic diseases, may have a definite and significant role in therapy, while at the same time minimize the mental and psychological stresses associated with chronic diseases.

Dr. Fair stresses that the relief of illness, not necessarily the cure of disease, and expanding life, even if extending life is not possible, should be the primary goals in the care of cancer patients.

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