Moss Report

[Guest guest]

THE CASE OF THE MYSTERIOUS HERBS

One sometimes hears stories of people who are cured of cancer by

unorthodox means, without the intervention of surgery, radiation or

chemotherapy. The medical profession is usually quick to label such

cases `spontaneous remissions,' or else to dismiss them as having

been the result of mistaken diagnosis or even outright fraud.

That is why the publication last year of an article describing a case

of complete remission of chronic lymphocytic leukemia (CLL) caught my

eye. The patient in question had had no conventional treatment

whatsoever, yet had brought his disease under control – over ten

years in complete remission when last contacted by the authors of the

article – solely through the use of a mysterious Chinese herbal

mixture.

Unlike most such anecdotal accounts, in this case the patient's

disease was carefully diagnosed and his medical records were

available for analysis. The article appeared in a respected journal,

Leukemia Research, published by Elsevier, the world's largest

science, technology and medical publisher. The authors of the

article, Dr. Traci E. Battle and colleagues, are oncologists at the

Dana-Farber Cancer Institute in Boston and Memorial Sloan-Kettering

Cancer Center in New York, two of the world's top cancer centers.

CLL is a malignancy that results in the accumulation of immature

white cells (predominantly lymphocytes) in the blood, bone marrow,

and lymphatic tissues. According to the American Cancer Society,

there will be approximately 8,190 new cases of CLL in the US this

year and 4,800 deaths. Although patients can survive for a long time

with their disease, and there are treatments available, there is

presently no cure.

The patient described in the article was a 57-year-old man who was

first seen with enlarged lymph nodes (lymphadenopathy) and flu-like

symptoms. His doctor found that his overall white blood cell count

was 39,400 per microliter (normal: 4,000-11,000), with greater than

90 percent of these being lymphocytes (normal: 25-35 percent). His

hemoglobin was 13.1 g/dL (normal: 14-18) and his platelet count was

280,000 (normal: 150,000-350,000 per microliter). A bone marrow

biopsy and other sophisticated diagnostic tests were then performed

and in December 1990 the patient was formally diagnosed with chronic

lymphocytic leukemia. As is often the case with CLL, the patient

opted for no immediate treatment.

By July 1991, however, his white cell count had risen to 60,000. At

that time, he consulted with a practitioner of traditional Chinese

medicine (TCM), who provided him with a mixture of what the patient

described as " twigs, roots and bark. " The practitioner instructed the

patient to boil these in water, allow the mixture to cool and

concentrate by evaporation before straining off the liquid and

drinking it.

According to the article, the patient's white cell count (WBC) and

absolute lymphocyte count (ALC) began to decline dramatically as soon

as he began this unusual treatment. His blood values returned to

normal and have remained normal for at least ten years. His lymph

node enlargement also resolved, and the authors state that by 1993

tests " no longer revealed a clonal population of lymphocytes

consistent with chronic lymphocytic leukemia. "

Since the patient traveled extensively for his job he was not always

able to get the mysterious herbs nor to sustain a consistent dosage

schedule. A notation in his medical record indicated that when he was

unable to get the mixture for a period of two months his WBC count

again rose. By March 1997, however, he was again taking the mixture

once per week and once again maintaining normal blood counts. He paid

his last visit to his American doctors in September 2000, after which

time he left the country.

A Tiny Sample

At that last visit he presented his doctors with just 10 milliliters

(one third of an ounce) of the still-unnamed herbal decoction. It was

a thick, dark brown, cloudy liquid with little odor. His doctors

decided to test this liquid by isolating leukemic cells from two

untreated CLL patients and then culturing (growing) the cells in the

presence of the herbal extract. They also cultured CLL cells with

black and green tea, both of which independently are thought to have

anticancer activity. The number of viable cells (cell density) was

counted at the beginning of the experiment and then every 24 hours

thereafter.

The goal of this experiment was to see if this extract affected the

survival of CLL cells. And, indeed, cells cultured in the presence of

the Chinese herbal extract showed decreased survival (viability) at

24 and 48 hours. (Green and black tea, by contrast, had only minimal

effect on the viability of CLL cells in this test.) The scientists

then focused on three biochemical mediators that are thought to play

a crucial role in the natural history and progression of CLL (STAT1,

P13K/Akt, and Mek/MAP kinase), but the mixture had no effect on any

of these three.

Searching further for an explanation of their patient's remarkable

remission, the scientists considered the various mechanisms by which

the Chinese herbs may have had an effect. For instance, the immune

system might have become activated by one or more of the herbs in the

mixture. But the cumulative evidence in this case indicated that this

was unlikely. Immune-mediated remissions are usually very gradual and

take months to achieve. Besides, CLL cells are considered relatively

unresponsive to immune signals. In this patient's case, the decrease

in both the total white cell and lymphocyte counts " occurred almost

concurrently with the initiation of the herbal extract, " according to

the authors. Furthermore, the fact that the therapeutic effect

stopped as soon as the mixture was temporarily discontinued argued

against an immune-based response, since such responses are slower to

disappear as well.

Activating Apoptosis

More likely, they speculated, the therapeutic effect was due to

increased apoptosis (programmed cell death) of the CLL cells.

Apoptosis is a natural and desirable way of killing cancer cells. It

has been shown that there are proteins (for example, members of the

bax and bcl-2 families) that regulate survival and apoptosis in CLL

cells. High levels of the bcl-2 protein protect the cells from death

by apoptosis. The bcl-2 protein suppresses apoptosis by preventing

the activation of certain protein-digesting enzymes (called caspases)

that carry out the process. In fact, the standard chemotherapy drug

docetaxel (Taxotere) kills cancer cells by targeting members of the

bcl-2 family. (It is interesting in this context to note that

docetaxel also has `herbal' ancestry, being ultimately derived from

the needles of the English yew tree.)

Important First Step

This amazing case study " may provide an important first step towards

the development of a new class of agents for use in this otherwise

incurable disease, " the authors of the article write.

But now comes the bad news. The authors don't have any knowledge of

the ingredients of this Chinese herbal mixture. The patient in

question did not give them a large enough sample to permit them to

analyze it nor were they able to identify any potentially active

components. There are therefore no clinical trials currently planned

or underway. In fact, they do not even know the compound's name.

In an email, Dr. Battle wrote me: " Our motivation in publishing these

data was to communicate to other researchers the potential use of

alternative therapies in the treatment of CLL. We are currently

focusing our research on other natural compounds that have potent

anti-leukemic effects " (Battle 2004).

Readers may wonder how prominent scientists could apparently allow

such a promising treatment for CLL to slip through their fingers,

without identifying, naming or sourcing it for further research.

I received some insight on this question from , MD, PhD, a

co-author of the paper, who actually cared for the patient in

question during his brief sojourn in Boston.

" Upon first hearing his story, " Dr. wrote, " I naturally

requested information about the source of the material and I asked

him for a sample to be analyzed. He told me that he received an

unmarked bag of what looked like twigs and bark from a Chinese herbal

practitioner in Manhattan named Kit Tong. Despite repeated requests,

he never provided us with an address for this person " ( 2004).

A search of the Internet uncovers no herbalist or practitioner by the

name of Kit Tong in Manhattan. Dr. himself says he asked

numerous people in New York to see if they could find this

practitioner, but none has been able to do so as of yet.

Dr. repeatedly asked his patient to provide him with some of

the material to analyze, giving him a sterile container for it, and

even offering to go to his home to obtain it. It was only on his

final visit that he prevailed on the patient to provide him with the

small amount of material that he did. The patient then left the

country, and despite several attempts on Dr. 's part, both by e-

mail and post, he never heard from the patient again.

One of his other former physicians did hear from him once, and

provided the brief follow-up information included in the article. " I

have sent him copies of the manuscript both electronically and by

mail to try to solicit additional information, " Dr. told me, "

but I have had no reply. " Dr. wanted readers to understand

that " every attempt possible was made to follow-up on this case. "

Dr. and his colleagues wrestled with the question of whether it

was beneficial to report this case at all. In the end, they felt

that publishing this manuscript " might stimulate others to consider

the potential therapeutic benefits of these kinds of natural

preparations in CLL. We certainly did not wish to instill a false

sense of hope or undue frustration in anyone. "

Since it simply is not possible to identify the particular herbs

involved in this remarkable case, nor the whereabouts of the patient

or the identity of the practitioner who prescribed the mixture, what

sort of practical advice could be offered to patients who might be

interested in exploring herbal treatment for CLL?

Providing such treatment were administered by a skilled practitioner

in close consultation with the patient's medical advisers, it would

very likely be a fruitful avenue to explore. However, while the

patient described in the article appeared to suffer no ill-effects

whatever from taking the herbal decoction it is important to be aware

of the possibility of toxicity when using herbal remedies of this

sort since there are no official standards of purity or potency. Then

there is the question of expense. Although there are many reputable

herbalists and practitioners of traditional Chinese medicine, there

are also plenty of unscrupulous operators, and it is not uncommon for

people to end up spending a great deal of money on ineffective

treatments.

Perhaps the most often cited danger in turning first to CAM

treatments for cancer rather than initially taking standard treatment

is the potential loss of crucial time. Cancer as a rule requires

prompt and definitive action. Yet CLL may be an exception to this

rule. The conventional treatment for almost all stages of CLL can,

and often does, include " watchful waiting. " This means closely

monitoring a patient's condition but withholding treatment until

symptoms appear or change. Unlike most cancers, CLL is characterized

by long periods of latency, during which patients and their doctors

could experiment with unusual treatments. Therefore the `loss of

precious time' argument is not so convincing when applied to CLL (NCI

2004).

Herbal Treatments

On the Internet there are discussions of various TCM products that

are advocated for the treatment of leukemia. Here is a representative

sample:

http://www.herbchina2000.com/therapies/CLK.shtml

http://www.pulsemed.org/leukemiaherbs.htm

http://www.atihealthnet.com/pages/leukemia.html

I am not recommending these companies or products, as I know very

little about them or their reliability. If I were researching the

field, however, this is where I would start. It would be imperative

to work with an experienced health care practitioner, who could

monitor one's progress and see if the treatments in question are

really having a desirable effect.

Who knows? Perhaps the reader will have as fortunate an experience as

the unnamed patient in this astonishing article.

Note: Any readers having knowledge of the whereabouts of Kit Tong,

the practitioner who prescribed the herbal mixture to the patient

whose case was described in the article, or who have any knowledge of

the herbal mixture that was used to treat him, are encouraged to come

forward. Please write to me at ralph@.... As always,

confidentiality will be maintained.

--Ralph W. Moss, PhD

=======================

References:

Battle TE, Castro-Malaspina H, Gribben JG, DA. Sustained

complete remission of CLL associated with the use of a Chinese herbal

extract: case report and mechanistic analysis. Leuk Res. 2003 Sep;27

(9):859-63.

Battle Traci E, personal communications, August 2, 2004.

,, personal communication, August 3, 2004.

NCI: For the National Cancer Institute's latest statement on the

appropriate treatment of CLL click or go to:

http://www.cancer.gov/cancertopics/pdq/treatment/CLL/Patient/page5

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