Patient Services





Interviewed by Dr Jenny Mackenzie


Patients and chemotherapy concern


JM: I guess what I’d like to put before you is a scenario of an adult person who has been diagnosed with cancer and is about to have chemotherapy. The patient is really concerned about the awful side effects of chemotherapy – and wants to know how you can help?”



DW: I think this is not a straight-forward proposition; there is not one answer to that. The issue is contentious, as there is a spectrum of responses. Some medical oncologists are pretty much opposed to any use of products when you are taking chemotherapy. So even though they are quite open to integrative oncology in theory, they are very concerned, even though there is evidence of no contraindication. On the other hand you have oncologists who are very open to complementary practices – to the use of complementary medicine while taking chemo- and/or radiotherapy. I always work with medical oncologists when I can.


So the issue is not very clear. I think it’s critically important that people don’t self-prescribe – you need to see someone who has some qualifications in the area. If you go to Google, for example, and you type in ‘cancer cure’, you are going to find some millions of responses, and virtually everything on the first ten pages is rubbish and will lead people astray. You know, if patients want to do research they can go to Pubmed, for example, which is a good site for research, or even Google Scholar, which looks at peer reviewed articles or books, and they give a clear idea but again, nobody should be self-prescribing for cancer under any circumstances.


I would also like to mention Keith Block who is the editor at Integrative Cancer Therapies Journal, which is quite a well-known journal and has enormous value in looking at integrative oncology.

There is also the Journal of Society of Integrative Oncologists. Both of those journals look at evidence-based approaches to the use of complementary medicines in oncology. Keith Block several years ago wrote a major paper saying essentially that anti-oxidants are perfectly safe and are probably extremely beneficial in chemotherapy.

He said that the concerns about the anti-oxidant effects would have at most 2 or 3 percent impact on the chemotherapy, depending on the type of chemotherapy. On the other hand, it would have a significant effect on wellbeing, tolerance of the chemotherapeutic agents, protection against kidney failure, liver failure. His approach was an evidence-based one, and he pretty clearly says that most of the concerns oncologists have regarding anti-oxidants are based on a very flawed study with lung cancer where they used anti-oxidants, when men were still smoking, and in those cases only they found a reduction in efficacy. Other people in that same study who were using chemotherapy and anti-oxidants did not have that effect. So he is pretty clear in saying that anti-oxidants are useful.


Now there’s another issue with chemotherapy and that’s CYP enzymes and the effect on up regulating the de-activation or breakdown of the drug, those are of concern. But most people who are educated in the field of complementary oncology know what herbs elevate or activate CYP enzymes, so again, with an educated practitioner that shouldn’t be a problem. In specific cases there’s a difference between the synthetic supplement, that is, most vitamins that are being supplied, like vitamin C, are synthetically produced. The herbs and botanical isolates are quite different. So generally, you don’t get vitamin C from a plant; you actually construct it in the laboratory. Isolates from plants or whole herbs are quite different, they have a much broader and I guess more rounded effect in the use of chemotherapy.


The Chinese have been doing what we call integrative oncology for the last 50 years and when I go to China and I do my research in Guang ‘Anmen hospital in Beijing, there is, in a cancer hospital, a full-time laboratory to test isolates and cancer with regard to efficacy. So medical oncologists and herbal oncologists work closely together to support the patient in the process. We are seeing that I think, increasingly, in other parts of the world. Sloan-Kittering hospital in NYC, and also M.D. Anderson in Texas that has a full-time complementary staff that looks at how the patient can get the best result for their cancer. There is a significant program in the US to use complementary approaches in conjunction with chemotherapy. Most studies actually, and I could cite them, have shown that people who use some kind of botanical in conjunction with chemotherapy, are better able to tolerate the chemotherapy, are less likely to get multi-drug resistance when they use these compounds, they have better quality of life, and are able to complete the chemotherapy without as many side effects.



JM: I would be very keen to get a copy of any relevant research. At least any research regarding that.



DW: The Keith Block one is pretty central to that, I can email that to you later. Then of course in Germany there are some very good clinics – Dr Ursula Jacobs has got a large hospital in the Black Forest and she works with medical oncology and herbs and supplements. She looks particularly at circulating cancer stem cells and how to treat them. Her treatment is largely in the post-chemotherapy recovery area. There are also a significant number of people who are working in Germany in looking at chemotherapy. One of the things I teach and support in people is looking at a lot of testing which is important in how you prescribe. For example, looking at inflammatory
markers like high sensitivity CRP and serum amyloid A levels gives you an idea of the activity, and how aggressive the tumors will be. Looking at inflammatory cytokines; interleukin 1 and 6, and their ratio to non-inflammatory cytokines like interleukin 2 are important tests to take. Also the T-helper 2 : T-helper 1 (Th2:Th1) ratio is another factor.



JM: So you would recommend having these tests done before prescribing any herbal medicine or supplements?



DW: Oh, absolutely! You have to – you can track the

efficacy of your treatment, otherwise you are just operating blind. Just reading that something is good for some condition is really not science it’s just superstition.



JM: So are any of these tests done routinely by the oncologists?



DW: I don’t know, I don’t think so. Not in Australia anyway. I think probably in the US there are quite a lot of sites; for example there’s a site where you can do tissue samples and you can look at the Th1:Th2:Th17 ratio, so you can look at some of the other factors that are associated with inflammation.
One of the things that is true in most tumors is that the ratio between cellular and humeral immunity is skewed; humeral immunity is quite high, that why you are getting all these increased readings in inflammatory cytokines. But cellular immunity is depressed, so people talk about ‘tonifying’ or activating the immune system, that’s a meaningless statement, you actually have to know exactly what you’re going to stimulate. They’re kind of yin and yang, so one is high and one is low, and if cell-mediated immunity is low, there are certain kinds of compounds (for example astragalus, and some of the medical mushrooms like ganoderma), that increase cellular immunity.
There are others that increase humeral immunity, and they may not be appropriate in these cases. So there are laboratories in the US that do the Eliza testing kits for Th1:Th2:Th17.



JM: Can these tests be done by naturopaths and Traditional Chinese Medicine practitioners, or only by medical practitioners?



DW: Oh, no, anybody can do that, I do tests all the time, for example the erythrocyte sedimentation rate (ESR) is critical, so I’ll always do that. I have somebody with prostate cancer and I always look at the ESR because it shows how inflammatory it is. Now one of the things I find, particularly in older men with prostate cancer, is that the sedimentation rate is not critical, so there is not a highly aggressive inflammatory state that is driving it, and therefore certain kinds of androgen-supporting herbs are effective.
On the other hand, with younger men, there is clearly an inflammation factor involved and we use different, what are called in Chinese medicine heat-clearing or toxin-clearing herbs.
In general I always use a herb called Genistein with prostate cancer, it is particularly effective in managing both types of prostate cancer.



JM: Are there any kind of general tests that you would perform for most patients? Are there any particular considerations, for example the age and health of the patient, the type of cancer, are these things crucial?



DW: Absolutely, there are upwards of about 200 plus kinds of cancer, and every cancer has to be treated differently. For example, I often find in younger women, the estrogen negative tumors, they tend to be inflammatory, and so they are treated differently than somebody who’s got an estrogen positive tumor, and so there is a whole different approach in the treatment therapy. Different herbs, different supplements will be used in those cases. I think medical oncology also makes a distinction in terms of the therapeutic agents involved in some of these different kinds of tumors. I’m particularly interested in younger women – there seems to be an increase, statistically. The vast majority of breast cancer happens after the age of 70. That’s not popularly understood, people think about breast cancer, they think about Kylie Minogue, or Jane McGrath, these ones in their 30’s and 40’s. It’s entirely a different type of cancer than what occurs in older women, so the approach has to be different. Some of these tests actually give you a key to the approach that you will give. You can use them to monitor, redo the tests in 3 months to see if you are making an impact.



JM: Daniel, the focus of my book is really more on the side effects of chemotherapy.



DW: Yeah, I think they are connected. How can you just treat the side effects of chemotherapy without actually impacting on the whole tumor micro-environment?



JM: The chemo agent itself would also be crucial in what side effects you would expect, and what you would be planning on treating, I would think.



DW: For example, very specifically, with cisplatin, and I’m looking here at supplements, vitamin E reduces neurotoxicity, vitamin A increases the anti-cancer effect. A lot of people use black cohosh for cisplatin, and it reduces its efficacy, I think via CYP enzymes. And N-acetyl-cystine interferes with the anticancer effect of cisplatin. Cyclophosphamide, for example is not to be used with curcumin. The medical herb astragalus is very effective in many a decrease in cell counts. So again, that’s the kind of research that’s already done, and I can send you some of the papers associated with that.



JM: That would be great. Are there any general recommendations that you tend to give across the board? For anyone who’s about to have chemotherapy and wants to get through it as easily as possible?



DW: I go back to what I said earlier: it’s not good idea to treat yourself, you know, and I speak regularly with oncologists, and they are eminently interested in what’s happening in the complementary field.



JM: That’s encouraging!



DW: Well, I think some of them are quite suspicious and are suspect about what’s going on because I think there’s been a lot of poor treatment in regards to complementary medicine and cancer, and people have been taken advantage of. Most oncologists do recognize many patients do get some kind alternative or complementary medicines and they are concerned about it, and rightly so. We do need to supply evidence to medical oncologists as to the efficacy of what we are doing. But they, like most professionals may read their own journals, possibly a lot of articles here and there and they are not looking in the complementary field, as they don’t have particular interest in it. So it’s part of our responsibility, in the field of complementary oncology to write the articles and to put those things forward in peer-reviewed journals.
So there is a sense of co-operation and a feeling that we can work together. Medical oncologists I’ve spoken to say their concern about any non-standard or non-orthodox approaches is that the patient will actually not get the full benefit of the medicine and they don’t really have good communication with responsible and trained people in the complementary field. So they see this as a way that undermines their best treatment, and statistically you would be a fool not to use medical oncology. Statistically, people who try alternatives alone will die sooner and have much greater recurrence of cancer. That doesn’t mean that it can’t be enhanced, that you can’t get better results. Just don’t do it yourself.



JM: That seems to be your main message: there is a lot you can do, but don’t treat yourself with limited knowledge and resources.



DW: Well look, if you have rheumatoid arthritis you can try something different; I mean what’s going to happen? You lose nothing, even if you have cardiovascular disease. With cancer you die. So the responsibility with us in the complementary field is to be able to supply the information to oncologists so that they can encourage their patients to use some kind of supplement compound or similar which can help them terms of their chemotherapy. Chemo is so complex you can’t really make a generalization. I always insist that patients who come to me tell their oncologist what they are doing. And I will supply what I am doing to the oncologist, with some evidence as to why I am doing it, if they so desire. I will not treat a patient who does not want to go with mainstream oncology, unless they are in a terminal state where oncology has done everything it can. People come to me and they say “look I don’t want to go through surgery and chemotherapy. I want alternatives.” I say, “I’m sorry, I won’t treat you”, and I think that’s the ethical approach. So this is a life and death thing, and if you get it right you can enhance quality of life, you can make the chemotherapy more effective, you can reduce the side effects of the chemotherapy, you can avoid multi-drug resistance and all the other problems that go with that. You can protect the healthy cells, and you can keep somebody in remission! So, we’re not talking about a cure, and I never use the word cure, but I think you can be of enormous benefit to the patient, but it has to happen from an informed position.



JM: That sounds fantastic, actually, a really balanced approach. I agree that we need to be working with our mainstream colleagues and oncologists and providing evidence to back up our claims, so they don’t think that patients are just treating themselves from Google and inventing their own management plans. Are there any interesting case histories you’d like to share?



DW: I’m not one for case histories, and I’ll tell you why. I think case histories tend to be so subjective – I choose the case history, I choose what I’m trying to do, I decide on only the successes and don’t talk about the one who die. So while anecdotal evidence is maybe useful, I don’t know that it proves anything. Having said that, I can say, for example, if somebody has prostate cancer. Go to Pubmed, Google prostate cancer, and do a Google Scholar search, and see ‘genistein’. You can get lots and lots of good information. Genistein is not contraindicated in any kind of chemotherapy protocols because it doesn’t have a particularly antioxidant effect or CYP enzyme effect. You are going to get a positive benefit from that. Ursolic acid is another compound that I use often with chemotherapy because it doesn’t have any side effect that affects the chemotherapy. It’s just an isolate that’s found in no other herbs and fruits.
Berberine is another isolate that I use quite a lot with chemotherapy, it’s an extract of a number of herbs. Tests show that if there is an inflammatory component of the tumor, then berberine goes very well with chemotherapy, it supports the chemotherapy. One of the things that is important to do as a practitioner is to ensure that the oncologist understands that you are giving them something that is making their chemotherapeutic agent more effective, so they may need to reduce its dosage. Otherwise the doses may be higher than necessary to be effective. It actually helps the patients tolerate the chemotherapeutic agents so they can complete full doses and protocols, so this is a very important fact to communicate to the oncologists.



JM: Yes, for sure. Can you give us a general indication of how many patients you have been able to help, overall, with reducing the side effects of chemotherapy using Traditional Chinese Medicine and nutritional medicine?



DW: Off the top of my head, I’d say about 80% of patients have benefited from the use of these kinds of botanical agents. You know, it’s multifaceted in everything, so there are things like quality of life; people feel better. Again, it’s subjective because this patient may have been more tolerant of chemo, because everybody responds to varying degrees to chemotherapy. So, quality of life is one, reduction of side effects… in a number of cases where there is incipient kidney failure, we’ve actually been able to avoid the kidney failure by using herbs while they’re under chemotherapy. Again, subjective anecdotally, I believe that more of the patients can complete the same course of chemotherapy because they’ve been using some kind of botanical.



JM: Which is obviously in the interests of everyone, the patient and the treating oncologist, and everyone wins, really.



DW: Yeah.

JM: Now Daniel, is there anything else, in your experience, that you think might be helpful, that you would like to add?



DW: I think we tend to be, all of us, excessively reductionist in the multifaceted nature of cancer and remission rates. For example, though I don’t recall the references, women who do nothing for breast cancer, either during or after chemotherapy but exercise, have a 33% reduction in recurrence, so exercise is important.
Social relationships, if you have good, solid social relationships, the recovery rates are higher and recurrence rates are lower. So, it isn’t just one factor.
One of the things that I do as a practitioner, for the first session, I spend at least an hour or an hour and a half, I get all of their medical papers in advance so I can review them. Then I basically explain to them what I do – oncologists are very busy, and I tell them why they are using this agent, what the side effects will be, what we can do to help them. And I hope then that in a sense that they feel that they’ve got a professional who understands their condition and is working with them to support them. I think this is also part of the healing process. It isn’t just the application of a remedy; it’s the application of a remedy within a context of a relationship, and I’m not being critical of oncologists, because they are extraordinarily busy, but they do live in the ‘pantheon of the gods’, along with psychiatrists and surgeons. They are not people given to patient education. And that may be unfair to a lot of oncologists, but they do tend to be extremely busy, so I do think that a good complementary practitioner or medical doctor who’s working in the complementary field is able to supply enormous benefit to the patient, not only in the remedies, but also in the way in which these alternatives are delivered. That’s not placebo, it’s actually been pretty clearly demonstrated that a trusting, supportive relationship is a very healing process.



JM: So searching for a practitioner who can give you that could actually be of enormous benefit.



DW: Exactly. I encourage more and more medical doctors to get into complementary medicine because I think they are able to hold the respect of the patient, and also they have the scientific background to be able to discern what is valuable and what’s just nonsense, while the lay person doesn’t. You, know, things have to have some evidence of efficacy before they can be applied.



JM: Well, I thinks that reasonable and I think that a lot of the training that occurs now for doctors In the field of complementary medicine is far more evidence-based than perhaps it used to be, say 20 years ago.



DW: Yeah. Can I give you another name of a book which I think is probably very useful? It’s call “Supportive Cancer Care With Chinese Medicine”, it’s published by Springer, and William Cho is the editor, and that’s been published this year, Dr Cho works out of Melbourne as well as Hong Kong, and he has written a number of books on cancer and Chinese medicine, and all of those on evidence-based research. I think I mentioned some journals earlier that might be useful.
Oh, one more source; a journal called “Nutrition and Cancer”. It’s very, very good, of course all peer-reviewed and really, very, very useful, particularly looking at isolates and their impact on cancer at various levels.



JM: That’s great, this will give people at least a place to start searching for what they need. Well, I think that’s about it. Thank you so much, Daniel, for your contribution, and I wish you good luck what all your future endeavors.



DW: Yes, I’m just completing my second doctorate in integrative oncology or complementary oncology, and in the midst of a research project. I’ll send you a whole group of articles.



JM: Thank you, and thanks again for the interview.