For Ingrid Schorr, 36, an actor and writer who lives in Arlington, the bomb dropped last September: a totally unexpected diagnosis of breast cancer.
The diagnosis was traumatic enough, she says, but she also felt “desperate and sad” about having to undergo chemotherapy. She knew it would leave her weak and drained.
Her instincts were clear. She agreed to fight cancer with the harsh tools of Western medicine, the so-called “slash, burn and poison” approach of surgery, radiation and chemo.
But she also vowed to try to protect her body against that onslaught with what she hoped would be the gentler, more supportive tools of ancient herbs and modern nutrition as well.
And she didn’t want some do-it-yourself, East-meets-West patchwork of ideas culled from books, friends and herbalists who didn’t consult with oncologists. What she wanted, she says, was “a complete program of nutritional support and detoxification with herbs, and I wanted it from an oncologist.”
That proved a tall order, at least in this medical mecca.
So Schorr commutes monthly to Evanston, Ill., where she sees Dr. Keith Block, an internist who has put together a staff of oncologists, herbal chemists, dieticians and others who offer a combined program of chemotherapy, herbs, diet, psychological support, exercise and stress management.
Schorr may be unusual in the lengths to which she went to find a good blend of Eastern and Western medicine. But her inclination to augment – not replace – Western medicine with reputable alternatives is anything but unusual.
Cancer patients today, like AIDS patients a decade ago, are pushing outside the traditional frontiers of medicine, demanding that doctors take seriously their desire to combine Western medicine with other remedies, especially medicinal herbs used for millenia in China.
To be sure, even Block warns that there is more art than science in blending of the two traditions.
“There simply haven’t been enough carefully-controlled human studies to know how much good many of these traditional herbs can do,” he says. “But most of evidence to date, which is admittedly anecdotal, suggests there is little to no harm in herbs prescribed by practitioners who know what they’re doing.”
Good, bad or indifferent, herbs are clearly in demand.
“In the past, doctors would have tried to discourage patients from using anything alternative while undergoing cancer treatment. But today, you don’t see discouragement. You see some indifference and some interest,” says Alexandra Todd, a Suffolk University medical sociologist. That’s “because the public is doing it, not because the medical profession wants to.”
Indeed, many cancer patients do not tell their oncologists when they take herbs on the side, though they should. But “the more you ask, the more you find out that people do it,” adds Dr. Karen Krag, an oncologist at the Dana Farber Cancer Institute. “There’s more of it out there than oncologists would like to believe.”
And although Americans don’t equal the Germans, the leaders among Western nations in using and studying herbs, we now spend $ 2 billion on them yearly, and the market is growing 20 to 30 percent a year, says Mark Blumenthal, executive director of the American Botanical Council, a nonprofit research group.
“Business is booming,” adds acupuncturist-herbalist Michael Broffman of the Pine Street Chinese Benevolent Association in San Anselmo, Calif.
“When we first came to Marin County in 1983, there were only three of us practicing Chinese medicine. Now there are 100 in this county alone, and about 6,000 nationwide,” says Broffman, a leader in the art of trying to tailor herb use to the various types and stages of standard chemotherapy.
It is no easy task.
There are dozens of types of cancers, thousands of herbs and thousands upon thousands of herbal combinations. Patients also vary in gender, age, stage of disease and susceptibility to the effects – good and bad – of herbs. And, practitioners say, an herb that seems to work at one stage – such as in the middle of chemotherapy – may be useless when the patient is in remission.
For example, one chemotherapy regimen often used for breast cancer is CMF – cytoxan, methotrexate and 5-fluorouracil. To go with this regimen, Broffman often uses herbs like astragalus and a Japanese formula called JT-48, JTT or Juzentaihoto.
But that’s just the beginning. Because CMF is given in 21-day cycles, some herbs are given on days 1 through 4, in hopes they will enhance circulation and boost the effects of chemo. Others are given on days 5 through 10, the idea being to clean up dead cells, and others on days 11 through 21, to build strength and immunity.
For other cancers, the recommended remedies are different. For non-Hodgkins’ lymphoma, Block uses the Chinese herb Dan Shen, also called red-rooted sage or salvia miltiorrhizaCQ, citing research suggesting that it can boost the remission rate of standard chemotherapy.
Because choosing the combination and timing of herbs is complicated – and because herbs can be toxic – herbalists stress that you should not fool around with self-medication. Chances are you won’t know what you’re doing.
The trouble is, you can’t be sure your herbalist knows, either.
“There is no quality control for herbalists,” says Blumenthal of the botanical council, though many herbalists are also acupuncturists, who often take training in herbal medicine.
Last year, the National Commission for the Certification of Acupuncture, which administers the national exam for acupuncturists, developed a separate exam in Chinese herbal medicine. Increasingly, many states, including Massachusetts, are beginning to demand that acupuncturusts show proof of training in herbs if they use herbs in their practice.
But the issue of training raises a deeper question: How solid is the research on herbal medicine to start with?
“I do believe that empirical observation by astute Chinese healers has identified active compounds over the past 3,000 years,” says Dr. Jerome Groopman, chief of hematology and oncology at Deaconess hospital.
But Groopman worries that sometimes “neither the herbalists nor the physicians really know what’s in these compounds.”
Beyond the question of what’s really in those funny little packages of twigs, dried flowers and curly, brown things is the question of research standards.
“Clinical trials in China are frequently not randomized controlled clinical trials,” warns Michael Lerner in his cautious book, “Choices in Healing.”
“And even when they are,” he writes, “the methodology is often suspect by Western scientific standards.”
There is quality control for herbs themselves, says Blumenthal, but it’s “variable from one company to another.”
So far, the US Food and Drug Administration has stayed on the sidelines. Legally, the FDA says, herbs are classed as dietary supplements and do not need its approval before they hit the market. Once a product is marketed, however, the FDA can have it removed if evidence accumulates that it is is dangerous.
All this, of course, leaves patients like Ingrid Schorr fending for themselves and eager for physicians like Dr. Keith Block.
“I get more than 50 calls a day from people looking for doctors who do what we do,” says Block, vice president the American Cancer Society chapter in Chicago and medical director of the cancer program at Edgewater Medical Center, a hospital affiliated with the University of Illinois School of Medicine. “As far as we know, we’re the only place in the country trying to put it all together, to combine the best of both worlds.”
Based on his early data – presented at a conference in 1994 and published in the proceedings of that meeting – Block thinks his individualized program “buys patients better odds.”
Ingrid Schorr hopes so, too, and so far things look good. Despite all the chemo, she has not lost her hair or her monthly periods. She also has a good appetite and has had little nausea.
Of even greater importance, she says, is her peace of mind.
“The main benefit I’ve had from finding a doctor who could put it all together for me is that I don’t feel so scrambled,” she says. “I was trying to do it all myself before and that was making me crazy.”
1 If you are considering herbs
- If you want to take herbs while in the care of a mainstream doctor, there are several things you can do to bridge the gap between East and West.
- The first is to get a list – in your own language – of all the herbs you are taking or that have been recommended. Give this list to your doctor and ask if he or she recognizes any of the herbs and knows of any ill effects.
- You might also ask your doctor to keep your list on file and compare your experience on herbs with that of other patients. This may not help you directly, but it can lead to the slow accumulation of anecdotal evidence that, with further research, can become genuine science.
- This approach has already helped boost knowledge of alternative remedies for AIDS, says Dr. Calvin Cohen, research director for the Brookline-based Community Research Initiative. Through CRI, 700 Boston-area patients with AIDS or HIV have joined a Canadian-American study of 15,000 patients aimed at keeping track of how patients fare on alternative treatments.
- “This is not a prospective study, but it is a first step,” he says. “Unless we start to acknowledge these anecdotes, people get cynical. They think doctors don’t care.”
2 Licensing herbalists
- At the moment, there is no licensing of herbalists in Massachusetts, which means that anyone can hang up a shingle and hand out herbs.
- But there are ways to protect yourself, and the best is probably to find a licensed acupunturist who has been trained in using herbs, as many have. Acupuncuturists are licensed – by the committee on acupuncture of the state Board of Registration in Medicine.
- Beginning in January 1998, acupuncturists who use herbs will have to submit evidence that they have been trained in herb use in a nationally accredited program in acupuncture and Oriental medicine, or an equivalent state-approved program.
- To learn if your acupuncturist is licensed and is trained in herbs, call 727-3086 ext. 363 on Wednesdays, 2-4 p.m., and Thursdays and Fridays, 9 a.m.-4 p.m..
3 For more information
For more information, you might read:
- “Choices in Healing,” by Michael Lerner; MIT Press, Cambridge.
- “Double Vision,” by Alexandra Todd; University Press of New England, Hanover, N.H.
- “Herbs of Choice: The therapeutic use of phytomedicinals,” by Varro E. Tyler; The Haworth Press, Inc., Binghamton, N.Y.
- “HerbalGram,” a quarterly journal of the American Botanical Council. For a ($ 25) year’s subscription, send name, address and check or credit card number to P.O. Box 201660, Austin, Tex. 78720.
For general information on alternative therapies, call:
- Commonweal, a research and environmental research institute in Bolinas, California, 415-868-0970.
For information on finding herbalists, call:
- National Holistic Health Directory & Resource Guide, 1995-1996. No referrals by phone, but guide lists practitioners by specialty and region. Call 800-782-7006 for the $ 5.95 guide. The guide is also available at newstands and online at: http://www.spdcc.com/home/newage
- Herbal treatments are available through the teaching clinic of New England School of Acupuncture, 617-926-4271.