Complementary and Integrative Medicine in Cancer Care and Prevention: Foundations & Evidence-based Interventions. Marc Micozzi (ed). New York, NY: Springer Publishing Company; 2007. Hardcover; 478 pages. ISBN 0-8261-0305-7. $80.00.
Marc Micozzi, MD, PhD, a physician and anthropologist, is the author of several textbooks in the area of complementary, alternative, and integrative medicine. He is well-qualified to address the area of integrative approaches to cancer, having done research at the National Cancer Institute in the 1980s on diet and cancer, emphasizing the roles of micronutrients and macronutrients. He served from 2003–2005 as the director of the Center for Integrative Medicine at Thomas Jefferson University Hospital. He also has a background in forensic medicine. His background naturally informs the content and approaches of this volume. He has also selected well-qualified contributors for several of the chapters.
The book comprises 5 major parts: biology and ecology of cancer; mind-body approaches; diet, nutrition, and natural products; alternative systems of medicine; and alternative therapies and practices. The initial chapters on cancer’s biology and ecology are written by Dr. Micozzi and include a good review of basic biology, as well as a fascinating chapter on the alleged antiquity of cancer. In this chapter, Dr. Micozzi’s anthropological and forensic background allows him to conclude that much of the historical or archeological “evidence” for cancer does not, in fact, refer to cancer but to other conditions. This makes it more likely that cancer is, indeed, most often a disease of modern societies.
The chapters in the mind-body section are written by experts in this field, including Marty Rossman, a prominent teacher of guided imagery. In addition to guided imagery, these chapters cover mind-body approaches such as hypnosis and meditation, expressive therapies, and the roles of religion and spirituality in cancer.
The section on diet, nutrition, and cancer is written by Dr. Micozzi. Most of the material on diet is oriented towards questions of prevention. It includes an introductory section on the history and basic biology of how diet might affect cancer, followed by a chapter on the question of diet and breast cancer. Based on his review of the literature, Dr. Micozzi seems to believe that this effect is largely mediated by patterns of breast-feeding. However, this is not really consistent with the current thinking on breast cancer and diet. While admitting continuing problems in solving the problem of diet and breast cancer, recent reviews stress links to obesity and adult weight gain, vitamin D levels, alcohol intake, and other factors separate from the effects of breast-feeding. One problem in Dr. Micozzi’s review, which continues throughout the volume, is that the chapter relies almost exclusively on older literature: only 3 of the citations were dated after 2000. It is not clear why this should be the case in a volume dated 2007. Dr. Micozzi also includes in this section a chapter on micronutrients and whole foods, which concludes that promise for cancer prevention lays largely in the area of whole dietary patterns, despite the interesting data on individual micronutrients. This is certainly a conclusion that recent trials of individual micronutrients and cancer prevention bears out.
The diet section also includes smaller chapters on treatment of cancer with alternative diets (e.g., Livingston-Wheeler, Gerson) and micronutrients. It concludes with a chapter on natural products, primarily herbal medicines such as green tea (Camellia sinensis, Theaceae), garlic (Allium sativum, Liliaceae), camphor (from Cinnamomum camphora, Lauraceae), red clover (Trifolium pratense, Fabaceae), and others. The reviews of these herbs are generally well-done, but again, the chapter suffers greatly from the lack of post-2000 references. For instance, the discussion of PC-SPES would have greatly benefited from more up-to-date references. (PC-SPES is a formula of concentrated fractions from Chinese herbs that was found to be adulterated with prescription drugs after having already been started in NIH-funded clinical trials. It was withdrawn from the market in 2002, a fact that could certainly have been included in a 2007 book. New, apparently non-contaminated formulations are now being studied).
The natural products chapter also includes a section on herb-drug interactions (HDIs). While much of the general medical concern about HDIs in cancer seems (to this reviewer) to be quite overblown, this chapter goes somewhat too far in the opposite direction. Working mostly from his familiarity with Chinese medicine, Dr. Micozzi downplays the significance of HDIs in general and implies that simply taking herbs and drugs about an hour apart is enough to avoid interactions. No scientific evidence is adduced to support this—curious in a book with “evidence-based” in the title. Overlooked entirely are early, specific reviews and studies about possibly clinically significant interactions, such as a 2002 study indicating a lowering of blood levels of the chemotherapy drug irinotecan (a natural product-derived chemotherapy drug) by St. John’s wort (Hypericum perforatum, Clusiaceae).
The following section on alternative systems of medicine is much more authoritative. Dr. Micozzi has authored well-done chapters on naturopathy and Ayurvedic medicine, and, with Harriet Beinfield and Efrem Korngold, a very good chapter on Traditional Chinese Medicine. A chapter on homeopathy is also included. All of these are systems with which practitioners should be acquainted, and these chapters serve as good introductions.
The last section, on alternative therapies and practices, includes a chapter covering controversial therapies such as antineoplastons, hydrazine sulfate, and other alternative treatments such as shark cartilage and laetrile. Alan Dumoff’s chapter on the legal and regulatory issues surrounding alternative cancer treatments is excellent and very informative. Dr. Micozzi closes with an anonymous account of a doctor’s choice to treat his or her case of non-Hodgkin’s lymphoma with only alternative therapies—a very interesting and thought-provoking case indeed.
This volume is billed as an integrative oncology text for health professionals. It is certainly the case that health professionals need integrative oncology training, and this book has much to recommend it, especially the mind-body section, the alternative medical systems section, the legal chapter, and the well-done reviews of several individual therapies. However, it is also missing several elements. The lack of recent literature citations is definitely a problem—and hard to understand. Dr. Micozzi’s publisher did not do him any favors if this is a result of delays in the publication process. Additionally, the book seems like a good source for background information, but it does not feel all that grounded in the clinical practice of integrative oncology. There is, for instance, very little concrete discussion of a very common question among breast cancer patients—whether the phytoestrogens contained in soy (Glycine max, Fabaceae) and many herbs protect against or stimulate breast cancer. Thus, institutions using this as a text would need to supplement it with a substantial amount of updated and clinically relevant material. It is, though, a book that would be worth including in the library of integrative oncologists as a source of much interesting background information that underlies the current, widespread use of alternative and complementary therapies by cancer patients.
—Charlotte Gyllenhaal, PhDUniversity of Illinois at Chicago College of PharmacyBlock Center for Integrative Cancer TreatmentEvanston, IL