Conclusions

Plants have catered to the medical needs of human civilization since prehistoric times, but it is only during the last 100 years that mankind has begun to scientifically characterize their active principles and put them to use in modern medicine. According to the World Health Organization, up to 80% of the world's population relies mainly on herbal medicine for primary health care. In countries like India, the practitioners of "traditional" medicine outnumber registered doctors.

The World Wildlife Fund estimates that plants have contributed more than 7000 compounds produced by the pharmaceutical industry in industrialized nations.186 The folk medicine and indigenous medicine developed by different native cultures across the world is based mainly on herbs. Indeed, more than 200 of the herbal drugs listed in the U.S. Pharmacopoeia were used by Indians in Mexico, the West Indies, and Central and South America.187 The popular traditional medical systems—Chinese medicine, Ayurveda, and Unani—have suggested cancer cures involving herbal medicine. Dr. J.Hartwell and other researchers compiled a long list of plants that have historically been used around the planet for treating cancer.188 During the last two decades, cancer patients, driven by the well-founded desire for improved quality of life coupled with the freedom to choose, have moved toward natural herbal therapies. Studies indicate that up to 60% of cancer patients use unconventional medical therapies, and nearly half of them do so without informing their physicians.189 Some of the herbs have also been used for purposes other than cancer cure, especially for alleviating symptoms arising from mainstream cancer therapies.

Despite the popularity of some of the herbal cancer therapies known around the world, there is no absolute evidence that any herbal supplement will actually cure cancer. Unlike modern cancer medicines, which are thoroughly studied and developed toward a chosen goal, herbal medicines have been adapted from empirical evidence based on their long record of use through primitive trial-and-error methods. Because of the absence of controlled studies and lack of technical monitoring of extraction and preparation processes, the general scientific acceptance of herbal medications among the established medical community remains very low. The meager number of human studies that did exist were mostly undertaken retrospectively, leaving scope for potential errors. Unconventional cancer therapies like essiac and laetrile caused a war of attrition between people on both sides of the issue of unconventional medical treatments. Many of these battles were rather political, and some grew to the status of a national movement. The important step to bring an upward swing in the popularity for herbal supplements would be initiating double-blind, placebo-controlled clinical studies on human subjects. Unfortunately, no pharmaceutical giants will ever be inclined to invest millions of dollars to conduct such studies on well-known substances that are already being used for the same purpose. The onus is now in the hands of the government agencies, like the U.S. NCI and its counterparts in other countries, to take up the clinical trials on important natural herbal therapies for the benefit of the general public.

Even though herbal supplements have yet to muster strong support for their positive role in cancer cure, they have already established a niche as cancer chemoprevention agents. Cancer chemoprevention is a relatively new but important medical science. Oxidation within biological systems plays a crucial role in carcinogenesis. Chemoprevention by naturally occurring antioxidant herbal supplements appears to be a practical approach to fight cancer. There is overwhelming scientific evidence from epidemiological studies, in vitro studies, and in vivo studies on animals that a large number of herbal supplements have a profound influence on cancer prevention before cancer onset and following cancer treatment. Preliminary studies demonstrated that antioxidant supplements could work as complementary treatments to reduce the side effects of chemotherapy and radiotherapy and also to enhance the efficacy of some cancer drugs.190191 However, the combination of antioxidants and chemotherapeutic drugs may not be completely immune to potential problems for patients due to possible interference with the biological functioning of the primary drug. Antioxidants like soy isoflavones exhibit paradoxical effects with respect to breast cancer. Such ambiguities can be kept in check by considering the dosage and timing of administration. The medical community should therefore consider the research generated during the last few decades on the benefits of natural antioxidants and work with the patients to judiciously choose an effective agent at the proper dosage.

The current pace of technological advancement has given us a great deal of room to maneuver in identifying anticancer herbs and active ingredients. Scientists all over the world are focusing on locating biological response modifiers that inhibit cancer growth by immune system stimulation and by modulating the activity of hormones, enzymes, and biological factors. Manufacturers of herbal products, for their part, are concentrating more on standardization of the herbs with respect to active principle or biological activity for greater consistency in activity profile. The standardized herbals are now seen as a compromise between crude plant medicine and phytopharmaceutical drugs. Governmental and nonprofit organizations are making an effort to improve the standards and legal setup to ensure the quality and safety of the products. Overall, scientists see a greater advantage by integrating the knowledge of traditional herbal medicine with mainstream medical research for the advancement of effective cancer therapies.

Estimates suggest that a mere 1% of plant species have been screened for their potential medicinal value. Unfortunately, more than 50 million acres of tropical forest are lost every year due to human activity. Unless we expedite the bioprospecting efforts, thousands of untapped species and potential molecules will be lost forever. Finding a new cancer cure from nature is like finding a needle in a haystack. Consequently, scientists are embarking upon a new strategy involving the knowledge of indigenous people, which should have a better potential than randomly collected samples. For example, mayapple is an example where two cancer drugs, etoposide and teniposide, were developed based on the traditional knowledge of indigenous people. Mayapple was used by the Penobscot Indians of Maine to treat certain tumors like venereal warts. Vincristine (Oncovine®) and vinblastine (Velban®) are cancer drugs based on folk knowledge available on Madagascar periwinkle, although for conditions other than cancer. Similarly, Pacific yew (Taxus brevifolia), widely used by native tribes in western North America, became the most popular anticancer drug of the last century, namely Paclitaxel®. Ethanobotany is a rapidly expanding discipline in both academia and industrial arenas, particularly for exploring indigenous knowledge on the medicinal value of plants.

Cancer is an emerging health concern in many countries, and its incidence in some Western countries has reached epidemic proportions. With many cancers showing resistance to existing chemotherapeutic drugs, there is a clear need to develop new cancer medications. Many researchers believe that nature is still the best source to look for new therapies for cancer cure and prevention. After all, nature is the ultimate chemist.

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