Newsletter - Complementary Therapies: Nature(al) versus Nurture
- kati810
- Nov 2, 2021
- 4 min read
Updated: Jun 9
Complementary Therapies:
Nature(al) versus Nurture
A Message from Dr. Tony Blau
Many myeloma patients are understandably drawn to traditional or complementary treatments to ameliorate or even substitute for “Western” medicines and their side effects. Emblematic of natural remedies, Curcumin is of perennial interest to patients with myeloma and other cancers. As a number of patients have inquired about the topic recently, here I provide an updated view to that described in All4Cure’s newsletter from 4 years ago.
After re-reviewing the literature (links provided below), I don’t find convincing evidence of a beneficial effect of curcumin in patients with monoclonal gammopathy (MGUS), smoldering myeloma (SMM), or multiple myeloma (MM). Studies describing the beneficial effect of curcumin in patients with MGUS, SMM, and MM share a number of important limitations. While not all of the limitations cited below pertain to all reports, all of the literature that I have reviewed is encumbered by two or more of these factors.
These studies are short-term - lasting weeks to months. In patients with MGUS and SMM, years of observation are often required to discern trends.
These studies describe results obtained from very few patients. This limitation makes it difficult to discern a significant effect, even if one existed.
These studies often exclude results from patients who fail to respond. The colloquial term that refers to this phenomenon is “cherry-picking.”
These studies lack key controls. This is especially important because disease markers (M protein and free light chain levels) typically fluctuate in patients with SMM and MGUS, without intervention.
Reports from these studies provide very little data. This is hard to understand because the data that is likely available from these patients vastly outstrips the data presented.
More fundamentally, the blood levels of curcumin following oral administration are not well defined. Curcumin is poorly absorbed and is rapidly metabolized, and thus even if curcumin were hypothetically effective in treating myeloma, how would one know that curcumin is being given at a sufficient dose and frequency to elicit the desired effect?
Other limitations include different sources and formulations of curcumin and the fact that curcumin is often combined with many other natural therapies or dietary interventions that can confound results.
In considering the available evidence it seems to me that advocates for curcumin may have fallen into a trap that I’ve tried hard to avoid, albeit not always successfully, over my 30-year career as a scientist.
Biomedical scientists are charged with advancing knowledge about how molecules, cells, or whole organisms work. Experiments put their ideas to the test, and when initial findings are supportive, it's hard not to dream big about the potential impact of one’s idea. But these initial hopes are frequently dashed against the rocks of more extensive and rigorous experimentation. Science is hard. It takes an iron will to not impose one’s own wishes on the interpretation of an experiment result, even (and especially) if the results don't pan out exactly as had been hoped. The best scientists commit to proving themselves wrong, and only after repeatedly failing to trash their hypotheses do they share their findings with others.
The hope for a particular outcome often transpires below the threshold of conscious awareness. Patients may be least well-positioned to insulate themselves from this most human of tendencies. Perhaps the most direct way out of the curcumin forest would be a carefully planned clinical trial to compare the outcomes of patients with MGUS or SMM who agree to be randomized to one of two groups: 1) a group that receives curcumin (at a dose and schedule that is established to produce desired levels of curcumin in the bloodstream) versus 2) a group that receives a placebo. This would probably be best implemented in patients with MGUS and SMM. While I don’t know for sure, I imagine that this is the type of intervention that investigators associated with the P-CROWD initiative are planning. Patients with MGUS and SMM who want to help move the ball forward should consider enrolling in P-CROWD at https://www.enroll.pcrowd.org/.
Vermorken AJ, Zhu J, Van de Ven WJ, Andrès E. Curcumin for monoclonal gammopathies. What can we hope for, what should we fear? Crit Rev Oncol Hematol. 2012 Dec;84(3):350-60.
