Mistletoe therapy

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The mistletoe is one of the most frequently used procedures in complementary medicine cancer treatment in the German-speaking countries of the founder of anthroposophy Rudolf Steiner and the doctor Ita Wegman was initiated. To this day, mistletoe therapy is mostly used within anthroposophic medicine as an additional treatment for malignant diseases and within the framework of palliative medicine to improve the quality of life.

The effectiveness of mistletoe therapy in cancer treatment (extension of survival time and improvement of quality of life) is very questionable according to the study situation. In various review articles , methodologically sound studies showed no advantages of mistletoe therapy compared to placebo . Studies with positive results contained methodological deficiencies. A therapeutic effectiveness could not be determined.

Mistletoe therapy should only be used as a supplementary measure and with caution, as mistletoe therapy can be associated with rare, significant side effects. The basics of anthroposophic medicine and thus mistletoe therapy were viewed in 2008 by two professors of medicine and elsewhere as pseudoscientific .

History of origin

A white berry mistletoe ( Viscum album )

The foundations of anthroposophical cancer therapy and the subsequent therapeutic consequences “go back exclusively to Rudolf Steiner , who is the only one who has communicated them so far from direct spiritual research”. In the spring of 1920, Steiner first commented on the possibilities of treating cancer with mistletoe extracts.

The use of mistletoe in tumor therapy has neither a traditional nor an experimental basis, but is derived from Steiner's views, who pointed out, among other things, the analogy between the parasitic growth pattern of mistletoe and the tumor.

According to Steiner, surgical interventions in tumor formation can be replaced by potentising mistletoe. The mistletoe fruit must be turned into a remedy with other "mistletoe powers" with a very complicated machine. In 1920 Steiner dictated how mixtures of summer and winter sap of mistletoe were to be produced according to anthroposophical intentions: The extract should be produced in winter, if possible at Christmas, and in midsummer at the end of June. Then the summer juice should flow down into the winter juice in a rotating vessel. With increasing speed of rotation of the rotating vessel, the effectiveness of the agent increases. Steiner recommended that the mixture be stored in an animal bladder so that the active forces were not lost after centrifugation.

Based on Steiner's descriptions in 1917, the doctor Ita Wegman and the Zurich pharmacist Adolf Hauser developed the first mistletoe preparation Iscar , which in 1926 became the Iscador , which is still in use today . In 1920 Steiner presented the mistletoe therapy tested by Wegman, to which anthroposophical doctors and mistletoe researchers still refer today, at an anthroposophical medical conference in Dornach.

According to Steiner's postulates , the level of action of the mistletoe preparations is located spiritually : in the etheric and astral bodies , whose harmonious interplay can be disturbed by the influence of ahrimanic beings . The longtime director of the Lukas Clinic in Arlesheim, Leroi, explains that the individual etheric body, as an image of the cosmos, was created with the support of spiritual beings who have manipulated it with good and bad influences to this day. At present there is a great danger especially from ahrimanic moon beings living in subterranean fortresses , who manage to partially penetrate the sun-etheric body of man with earth-moon ether during the night . According to Steiner, these internal interventions in the human etheric body give rise to diseases such as carcinomas, diabetes and all kinds of tumor formation.

With the other preparations, the lectin- oriented mistletoe application, reference is made to individual ingredients, especially mistletoe lectin. This variant of mistletoe therapy, in which one refers to lectin as the essential active substance for the purpose of standardization - contrary to the original anthroposophical intention - became marketable due to special regulations under pharmaceutical law for the "special therapy directions". The names of some mistletoe preparations indicate the importance that has recently been given to the lectin they contain, e.g. B. lectinol or cefalectin .

Importance of the host trees

By choosing the host tree on which the white berry mistletoe ( Viscum album ) grew, the effect on a sick person could be more focused on their individual constitution and their diseased organ system. A distinction is made between two or three breeds of mistletoe according to their host trees: hardwood, fir and pine mistletoe or deciduous and coniferous mistletoe. In diseases of the metabolic and urogenital organs z. B. Hardwood mistletoe selected: oak mistletoe for men and apple mistletoe for women. Fir and pine mistletoe have an effect on the nervous and sensory system.

Areas of application

Oncological treatment today in the narrower sense means the three pillars of surgery , chemotherapy and radiation therapy , in the broader sense soothing and supportive measures, plus psychological and self-help . Mistletoe therapy can be added to the established procedures in all phases of cancer if the practitioner sees an indication . However, the American National Cancer Institute recommends the use of mistletoe therapy only in the context of high-quality studies. Use outside of studies is not recommended due to the lack of proof of effectiveness.

Since 2011, mistletoe preparations can no longer be prescribed for curative, adjuvant cancer therapy in Germany at the expense of statutory health insurance . The reimbursement for the palliative therapy of malignant tumors to improve the quality of life remains.

As a rule, the mistletoe extract is injected by the patient under the skin ( subcutaneously ) or - in the clinical setting by doctors - directly into tumor tissue. Oral , intravenous or injection into certain body cavities are also possible : in the pleura and pericardium , if fluid accumulates due to cancer, a sterile inflammation with subsequent adhesion, the so-called pleurodesis or pericardiodesis , can be stimulated.

Clinical studies

The independent Cochrane Collaboration came to the conclusion in 2008 in the evaluation of high-quality studies that four showed no survival benefit with breast cancer , in one there was evidence that mistletoe extracts can improve the quality of life in this indication. However, the latter has not been confirmed by other studies. In 2008, a meta-analysis financed by the manufacturer of the mistletoe preparation, including all prospective matched-pair studies in patients with breast cancer who received conventional oncological treatment at the same time, showed no significant survival advantage when taking a mistletoe preparation when the randomized studies are considered were. In the non-randomized, non-blinded studies, however, this pharmaceutical-sponsored study showed a significant survival benefit under mistletoe therapy with a hazard ratio of 0.43. In the group of patients who received the mistletoe preparation, the results were significantly better in those who showed good self-regulation . However, this was only evaluated for both study arms together, with a significantly higher proportion of non-randomized patients.

In 2014, Wilfried Tröger and colleagues published a randomized controlled study that examined the quality of life of patients with advanced pancreatic cancer with the help of mistletoe therapy. The patients in the mistletoe extract group received subcutaneous mistletoe extract injections three times a week throughout the maximum study period of one year, in addition to symptom control of pain, nausea, vomiting and dyspepsia - called "best supportive care" . The authors came to the conclusion that this mistletoe therapy significantly improved the quality of life of patients with locally advanced or metastatic pancreatic cancer compared to best supportive care alone. The work was sponsored indirectly by the manufacturing pharmaceutical company. The work was criticized by several specialist recipients. In particular, the study methodology was rated as poor. On the occasion of the publication of the study, Martin Pollmeier referred, among other things, to the potential risks of mistletoe therapy: Because there is a risk that the stimulation of the immune defense will also stimulate tumor growth, and because of possible undesirable effects up to life-threatening shock, both the American Cancer Society and the Swiss Society for Oncology reject mistletoe injections.

In 2019 , the effect on survival of mistletoe therapy in addition to conventional cancer therapy was evaluated in a comprehensive meta-analysis by the research group of Professor of Integrative Oncology, Jutta Hübner . This effect was almost always marginal among the participants and, moreover, could not be shown in the high-quality studies. There was no influence on quality of life in the studies of higher methodological quality. The authors come to the conclusion that there were no advantages in terms of survival, quality of life or therapy-related side effects from mistletoe preparations for cancer patients.

Lack of effectiveness

So far, no evidence of therapeutic efficacy has been provided for any mistletoe preparations on the market. The evidence of the clinical benefit is rated as “weak and not convincing”, the quality of the observation reports with regard to the methodology as “disappointingly poor”. The published data on mistletoe therapy and the clinical experience gained with mistletoe extracts "do not justify the uncontrolled general use and claims made in advertising". In the absence of conclusive clinical efficacy studies, the use of mistletoe in cancer therapy is "currently not justifiable in the care of tumor patients from a scientific, ethical and socio-economic point of view".

Interactions

When assessing whether lectin-related mistletoe therapy is clinically harmless, the documented ambivalence of cytokine effects has recently become the focus of interest in the case of immunomodulators , which play a key role in the effect : “After activation, cells of the immune system can not only antitumor potency unfold, but by cytokines and growth factors, angiogenesis and stimulate tumor growth. "the basic research of recent years have shown that the cytokines that by mistletoe lectin I in vitro and in vivo are released increases, the proliferation of cells of different tumors , leukemias and Can stimulate lymphoma . The experimental findings showed the realistic possibility of endangering at least individual patients with certain types of tumors or in certain tumor stages for lectin-related mistletoe use. Mistletoe therapy should therefore not be used for cancers that originate from the immune system (e.g. leukemia or lymphoma) or in the presence of immunomodulating drugs.

Side effects

The information on side effects differs from mistletoe preparation to mistletoe preparation. The background to this is the special approval conditions for mistletoe preparations. Most of them were approved within the framework of the provisions for “special therapies and traditional drugs”, which means that approval as a drug is not linked to the implementation of modern studies.

Horneber et al. found in their 2001 systematic review that there were generally reports of adverse events associated with the use of mistletoe extract that were mild and non-life threatening. Local inflammatory reactions at the injection site (such as redness, swelling, pain) were among the common side effects. Occasional side effects included generalized pruritus, generalized urticaria , and rhinitis . Other rare to very rare side effects related to the cardiovascular system, gastrointestinal tract (nausea, vomiting, diarrhea, dehydration ) and the immune system (fever, increase in white blood cells in the blood), as well as dyspnoea and bronchospasm . Serious complications were rare. These include rare allergic reactions. So far, anaphylactic shock has been reported in rare isolated cases .

Mistletoe therapy is not indicated during pregnancy or breastfeeding. In addition to the possible influence on tumor growth (see section: Interactions ), reported diseases with possible immunopathogenesis must also be taken into account in connection with mistletoe applications . When used for primary brain tumors or brain metastases, mistletoe therapy can cause edema.

literature

Writings of anthroposophical authors

  • GS Kienle and H. Kiene: The mistletoe in oncology. Facts and conceptual bases . Schattauer, 2003, ISBN 3-7945-2282-6 .
  • GS Kienle, H. Kiene, H. Albonico: Anthroposophic medicine in clinical research. Effectiveness, benefit, economy, safety . Schattauer, Stuttgart 2006, ISBN 3-7945-2471-3 .

Web links

supporting documents

  1. ↑ "Mistletoe is a complementary cancer treatment that is widely used, usually in addition to and alongside recommended conventional cancer therapy." Maurice Orange et al .: Durable Regression of Primary Cutaneous B-Cell Lymphoma Following Fever-inducing Mistletoe Treatment: Two Case Reports . In: Global Advances in Health and Medicine. Volume 1, Number 1, March 2012, p. 18.
  2. ↑ Consensus statement under the auspices of ÖGAM: Complementary cancer therapy in general medicine: Importance of mistletoe therapy (PDF; 178 kB). In: International Journal for Medical Training. No. 8 / April 2005, ISSN  1726-0027
  3. ↑ Lutz Edler: Mistletoe in cancer therapy: questionable results of recent clinical studies . In: Dtsch Arztebl. 101 (1-2), 2004, pp. A-44 / B-39 / C-39.
  4. ^ E. Ernst, K. Schmidt, MK Steuer-Vogt: Mistletoe for cancer? A systematic review of randomized clinical trials. In: Int J Cancer . 107, 2003, pp. 262-267. PMID 12949804
  5. ↑ a b M. A. Horneber et al .: Mistletoe therapy in oncology. In: Cochrane Database Syst Rev. (2), Apr. 16, 2008, p. CD003297. Review. PMID 18425885
  6. ↑ a b c d Edzard Ernst , M. Pittler, B. Wilder (eds.): The Desktop Guide to Complementary and Alternative Medicine. 2nd Edition. Elsevier 2006, p. 442.
  7. ↑ Klaus-Dietrich Bock and Manfred Anlauf: At the end of the road: Magic as a cash benefit? ( Memento from April 15, 2008 in the Internet Archive )
  8. ↑ Does mistletoe help against cancer? June 14, 2017, accessed July 4, 2019 .
  9. ↑ Dirk Böttcher: Hope in low concentration - brand eins online. brand eins , accessed on July 4, 2019 .
  10. ↑ Barbara Burkhard: Anthroposophic Medicines. A critical consideration. GOVI, Eschborn 2000, p. 109.
  11. ^ Paul G. Bellmann and Willem Frans Daems . Is mistletoe an old cancer cure? In: Sudhoffs Archiv 49 (1965), no. 4, pp. 355-363. Conclusion: “… Our investigation asked whether mistletoe (Viscum album L.) is an old cancer cure. A review of the relevant literature available to us did not reveal any evidence of this. A reference to the introduction of mistletoe in cancer therapy was only found in Rudolf Steiner (1920). Rudolf Steiner, Humanities and Medicine. Twenty lectures, Dornach March 21 to April 9, 1920, ed. 1961, p. 246 ff. Steiner commented on the cancer-curing effects of mistletoe after studying the plant for more than a decade: he mentions it as early as 1904 in his Berlin lecture series "The planetary development" (VI. lecture of October 31, 1904). "
  12. ↑ Barbara Burkhard: Anthroposophic Medicines. A critical consideration. GOVI, Eschborn 2000, p. 116f.
  13. ^ Theodor Much: Viva Miraculix: Mistletoe therapy . In: “The” kidding patient? , Edition Va Bene , Vienna, 2003. p. 117.
  14. ↑ Christine Murphy: Iscador: Mistletoe and Cancer Therapy . Lantern Books, New York, 2001. pp. 52 f.
  15. ↑ Ita Wegman . Portrait on kulturimpuls.org , biographies, documentation of the Kulturimpuls research center, Dornach; accessed on February 27, 2020.
  16. ^ H. Ramm: Influence of soil chemical location factors on growth and pharmaceutical quality of oak mistletoe (Viscum album on Quercus robur and petraea). Landbauforschung Völkenrode - FAL Agricultural Research, Federal Research Center for Agriculture (FAL), Braunschweig, 2006. P. 1 f.
  17. ↑ Once upon a time, 100 years ago . Iscador AG, on the occasion of the 100th anniversary of mistletoe therapy; accessed on February 27, 2020.
  18. ↑ a b H. Rüdiger et al : News from Lectinology. Deutsche Apothekerzeitung -online, 17/2000.
  19. ^ A b Barbara Burkhard: Anthroposophic Medicines. A critical consideration. GOVI, Eschborn 2000, pp. 133-135.
  20. ↑ Barbara Burkhard: Anthroposophic Medicines. A critical consideration. GOVI, Eschborn 2000, p. 112ff.
  21. ↑ a b Mistletoe in cancer therapy: standard or alternative method? , Cancer Information Service of the German Cancer Research Center (DKFZ), Heidelberg. October 23, 2012. Retrieved September 4, 2014.
  22. ↑ http://web.archive.org/web/20140111132926/http://www.bkk-arzneimittelberatung.de/content/themen/druckversionen/phyto_druck.pdf. (PDF) Archived from the original on January 11, 2014 ; Retrieved June 5, 2015 .
  23. ↑ Mistletoe in the GKV. In: www.gaed.de. Retrieved June 5, 2015 .
  24. ↑ BSG, judgment of May 11, 2011 - B 6 KA 25/10 R. In: lexetius.com. Retrieved June 8, 2015 .
  25. ^ MA Horneber et al .: Mistletoe therapy in oncology . In: The Cochrane Database of Systematic Reviews . No. 2 , April 16, 2008, p. CD003297 , doi : 10.1002 / 14651858.CD003297.pub2 , PMID 18425885 .
  26. ^ Renatus Ziegler, Ronald Grossarth-Maticek : Individual Patient Data Meta-analysis of Survival and Psychosomatic Self-regulation from Published Prospective Controlled Cohort Studies for Long-term Therapy of Breast Cancer Patients with a Mistletoe Preparation (Iscador). In: Evidence-based complementary and alternative medicine: eCAM. Volume 7, number 2, June 2010, pp. 157-166, doi : 10.1093 / ecam / nen025 , PMID 18955332 , PMC 2862937 (free full text).
  27. ↑ W. Tröger, D. Galun, M. Reif, A. Schumann, N. Stanković, M. Milićević: Quality of life of patients with advanced pancreatic cancer during treatment with mistletoe-a randomized controlled trial. In: Dtsch Arztebl Int. 111, 2014, pp. 493-502. doi: 10.3238 / arztebl.2014.0493 . PMID 25142075 . German full text .
  28. ↑ Andreas Neubauer: Many open questions In: Dtsch Arztebl Int. 112 (1-2), 2015, p. 8; doi: 10.3238 / arztebl.2015.0008a .
  29. ↑ Jutta Hübner : Some shortcomings In: Dtsch Arztebl Int. 112 (1-2), 2015, pp. 9-10; doi: 10.3238 / arztebl.2015.0009b .
  30. ↑ Bernhard Wörmann: New drug in the treatment of inoperable pancreatic carcinoma? In: Dtsch Arztebl Int. 112 (1-2), 2015, p. 10; doi: 10.3238 / arztebl.2015.0010a .
  31. ↑ M. Lelgemann et al .: untenable claims In: Dtsch Arztebl Int. 112 (1-2), 2015, pp. 10-1; doi: 10.3238 / arztebl.2015.0010b .
  32. ↑ Frank P. Meyer: More questions unanswered than answered In: Dtsch Arztebl Int. 112 (1-2), 2015, p. 11; doi: 10.3238 / arztebl.2015.0011a .
  33. ↑ Martin Pollmeier: Mistletoe therapy as homeopathic magic In: Dtsch Arztebl Int. 112 (1-2), 2015, p. 9; doi: 10.3238 / arztebl.2015.0009a .
  34. ↑ M. Freuding et al .: Mistletoe in oncological treatment: a systematic review: Part 1: survival and safety . In: Journal of Cancer Research and Clinical Oncology . tape 145 , no. 3 , March 2019, p. 695-707 , doi : 10.1007 / s00432-018-02837-4 , PMID 30673873 .
  35. ↑ M. Freuding et al .: Mistletoe in oncological treatment: a systematic review: Part 2: quality of life and toxicity of cancer treatment . In: Journal of Cancer Research and Clinical Oncology . tape 145 , no. 4 , April 2019, p. 927-939 , doi : 10.1007 / s00432-018-02838-3 , PMID 30673872 .
  36. ↑ a b Annette Mende: Mistletoe therapy for cancer: no effect on healing or quality of life. Pharmaceutical newspaper , March 29, 2019, accessed December 4, 2019 .
  37. ↑ Barbara Burkhard: Anthroposophic Medicines. A critical consideration. GOVI, Eschborn 2000, p. 134.
  38. ↑ a b The mistletoe therapy - effectiveness. Retrieved April 2, 2018 .
  39. ↑ C. Bauer et al .: Anaphylaxis to viscotoxins of mistletoe (Viscum album) extracts. In: Ann Allergy Asthma Immunol (94) 2005, pp. 86-89. PMID 15702822
  40. ↑ Barbara Burkhard: Anthroposophic Medicines. A critical consideration. GOVI, Eschborn 2000, pp. 133f.