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Natalie Lane is production editor for
journals at the Pharmaceutical Press, London
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An article in the June issue of Focus on Alternative and Complementary
Therapies looks at the factual information available on diets (as forms
of complementary and alternative medicine) and cancer. Data show that
cancer patients attempt to treat their condition with dietary approaches,
while others use a dietary regimen in order to prevent cancer.
The authors first searched the internet using keyword combinations such
as “‘diet’ and ‘cancer’ and ‘prevention’ or ‘cure’”,
which alone generated some 20 million hits in Google. The majority of
such websites did not provide much information and there was little objective
information. Three websites were discussed for their wide range of information
about diets and inclusion of a variety of attitudes.
Additionally, the authors hand-searched department files at the Peninsula
Medical School, Plymouth, and identified several CAM diets. These provided
terms for searches in Pubmed, Embase, Amed and Cinahl
databases.
Searches conducted by the authors identified 26 different diets, some
claiming to be curative, others as preventive or supportive regimens.
The regimens varied and occasionally it was found that they contradicted
each other. The authors’ findings confirmed earlier findings that
a variety of CAM cancer diets exist “without any scientific evidence
in support”. And it was concluded that the “risk-benefit
balance” was not positive for any CAM cancer diet. Ernst and Boddy
found that this area of CAM was more akin to religion than nutrition
(or science).
Cancer patients require appropriate nutritional care during both cancer
therapy and recovery. It was thought that most of the diets jeopardised
the important nutritional goal of caloric balance and might lead to overt
malnutrition.
Ernst and Boddy are aware that their review has limitations — not
all diets were listed in the article and relevant primary studies may
have been missed out.
However, in conclusion, none of the diets has been proved effective in
clinical trials but the risks are substantial. Cancer patients should
be informed of this and be provided with “responsible nutritional
guidance by conventional health care professionals” with expertise
in nutrition.
Cannabinoids for symptoms of MS
A summary and commentary in FACT looks at the long-term effects of
cannabinoids on spasticity and other symptoms in patients with multiple
sclerosis
(MS) by looking at a follow-up study, where 502 patients were followed
for a total of 52 weeks. Patients received capsules containing one of
three ingredients: synthetic delta-9-tetrahydrocannabinol (synthetic
delta-9-THC), a standardised cannabis extract or a placebo. Muscle spasticity
was measured using the Ashworth scale as the primary outcome. Secondary
outcome measures included mobility and general health. The study found
a small, but significant, effect of synthetic delta-9-THC on muscle spasticity
over 12 months but the effect of Cannabis sativa (cannabis) was similar
to the placebo. The authors concluded that there was limited evidence
for long-term treatment with delta-9-THC for muscle spasticity, although
cannabinoids may have benefits for the management of MS symptoms.
The commentator notes that there was no benefit for muscle spasticity
on the Ashworth scale in the original 15-week study but that there was
a small statistical benefit for the synthetic delta-9-THC group in the
follow-up study. Also, as noted by the study’s authors, the biases
of the study include the voluntary nature of the long-term participation
and the evidence of unmasking in the original study. Yet the study is
noted for providing additional evidence about oral cannabinoids helping
to ameliorate common MS symptoms.
The authors of the study responded that their study was the first randomised
controlled trial of cannabinoids in MS and that they view the results
as interesting. They say that some of the issues raised are not problems
but questions, requiring further work to answer. The authors responded
that the small change in the Ashworth score as a clinically relevant
treatment effect is a difficult to answer. However, they have recently
published a new scale, the “MS spasticity scale 89”, to be
used in further studies looking at the symptomatic effects of cannabinoids.
Furthermore, the authors are involved in a new study which they hope
will address the issues discussed in this summary and commentary. Rose-hip and arthritic pain
A study examined the effect of a subspecies of Rosa canina (rose hip)
on the symptoms of osteoarthritis. Patients were given either Rosa
canina powder or a placebo for three months. After three months the alternative
treatment was given. The Western Ontario and McMaster Universities osteoarthritis
index (WOMAC) and the consumption of analgesics was the primary outcome
measure, with WOMAC scores of stiffness and limitation of physical function
among the secondary outcome measures. The authors report that during
active treatment there was reduction in WOMAC pain scores and consumption
of analgesics in 21 patients. The study concludes that a standardised
rose-hip powder from a subtype of Rosa canina has beneficial symptomatic
effect in patients with knee and hip osteoarthritis.
The commentator remarks on a well-designed study but thinks the results
are confusing and inconsistent, such that the authors do not explain
what the delta value is, despite
the important part it appears to play in analysis.
The commentator also remarks that there should be more attention paid
to the magnitude of the effects. Comparisons of scores from outcome measures
only serve to give the impression of confusion. The commentator agrees
with the authors that this remedy should be studied further.
The authors’ respond to the commentary agreeing that the table
legends in their study could have been more explanatory and that the
impact of Rosa canina powder on different symptom scores could have been
demonstrated more clearly. They note that allowing a reduction in the
consumption of rescue medicine during the period of study meant it became
more difficult to “calculate the magnitude of the impact of treatment
on symptoms”. Yet they note that it is a “strong point” if
patients reduce consumption of rescue medicines and herbal medicines
show only a poor impact if the consumption of additional painkillers
are changed. Thus, the authors found it relevant to include “symptom
scores as well as a possible change in the consumption of rescue medicines
in the present study.” They also go on to discuss the inconsistencies
as raised by the commentator.
The authors’ response concludes with their explanation that enhancement
of a symptom score in placebo treatment may be a progression of the disease
and this might explain why active treatment did not reduce symptom scores,
but meant they remained unchanged. |
The
Pharmaceutical Journal