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Alternative medicine has a long tradition in German-speaking central Europe. Sixty-five percent of Europeans turn to natural remedies when they are ill.1 One important domain of alternative b,medicine is the (supportive) treatment of chronic diseases, particularly cancer. Up to two thirds of cancer patients in Germany and Austria receive alternative therapies, primarily mistletoe treatments.2-4 Mistletoe treatment against cancer was introduced in 1920 by Rudolf Steiner, founder of anthroposophy, and Ita Wegman, MD. Today, mistletoe remedies are among the most frequently prescribed biological drugs. In Germany they have the status of a biological standard therapy and are used for adjuvant or palliative purposes, either alone or in combination with radiation or chemotherapy. Recently they also have been used in the treatment of AIDS patients. Like other prominent alternative therapies, mistletoe treatment has received enthusiastic sympathy as well as harsh rejection.
For several years the biological properties of mistletoe extracts (Viscum album L) have attracted scientists. In animal experiments, mistletoe extracts displayed antitumor and antimetastatic activities. In in vivo and in vitro studies they stimulate immunocompetent cells (eg, natural killer cells, macrophages, T lymphocytes, granulocytes), exert strong cytostatic/cytotoxic effects against human and murine tumor cells, and induce apoptosis. Different components with cytotoxic, immunoactive, and tumor-inhibiting properties have been identified, including mistletoe lectins I-III, VisalbCBA, "Vester proteins," "Kuttan peptides," viscotoxins, polysaccharides, oligosaccharides, alkaloids, and vesicles. In addition to their cell-- killing activities, Viscum album L extracts also possess DNA-stabilizing properties, exert tumor-preventing effects, and protect against toxic myelosuppression due to radiation and chemotherapy.5,6 Nevertheless, many details are still in need of clarification.
Some 50 studies and clinical series on cancer patients report survival advantage and/or improvement of quality of life associated with mistletoe treatment. Several of these studies, however, are of poor quality and their validity is questioned because so few are randomized (due primarily to ethical concerns about randomization among anthroposophical physicians as well as strong patient preference). Still, significant therapeutic results have been found.6
Spectacular tumor remissions are rare and are...