The role of your cancer health professional is to create an environment of openness and trust, and to help in making informed decisions about alternative/ complementary therapies. Collaboration will improve the safe integration of all therapies during your experience with cancer. The "Summary" and "Professional Evaluation/ Critique" sections of this Unconventional Therpaies manual are cited directly from the medical literature, and are intended to help in the objective evaluation of alternative/complementary therapies.
Summary
"Researchers at the NCI and Memorial Sloan-Kettering Cancer Center have found that it [Essiac] has no anticancer effect." (Spencer)
Description/ Source/ Components
Essiac is a tea made from four dried herbs - Indian rhubarb (Rheum palmatum), sheephead sorrel (Rumex acetosella), slippery elm (Ulmus fulva or Ulmus rubra) and burdock (Arctium lappa). it is manufactured by the Resperin Corporation in Toronto, and has no connection with the Federal Government.
"The herbs contain potentially active compounds rhein, emodin, high molecular weight polysaccharides, and possibly arctigenin." (Boik)
Essiac can be taken orally in a liquid form or can be injected into the tumour site. (LeMoine)
"Essiac is sold in health-food stores and catalogs as a nutritional supplement. In Canada, it is also available through a program for patients for whom no effective conventional cancer treatment exists." (Cassileth)
History
Essiac is an herbal remedy given by native North American Indians to Nurse Rene Caisse whose name spelled backwards is the name of the preparation. (Fraser)
"The original recipe is said to have been formulated in northern Ontario by an Ojibwa healer "to purify the body and place in balance the great spirit". (Kaegi)
"Caisse refined the original formula and developed oral and injectable components." (Boik)
Before Caisse died in 1978, she gave the recipe to Resperin Corporation of Ontario. (Health)
In 1991, Resperin, who had held the rights for 15 years, assigned their rights to Mankind Research Foundation, with David Dobbie of New Brunswick as their distributor. The Canadian Trademark "Essiac" is held by Mankind of Maryland, USA. (Flor*Essence)
Proponent/ Advocate Claims
"Proponents of Essiac claim that it strengthens the immune system, improves appetite, relieves pain and improves overall 'quality of life'. They also claim that it may reduce tumour size and may prolong the lives of people with many types of cancer." (Kaegi)
"Caisse believed that Essiac worked by attacking the tumor directly, first hardening it, then causing it ot soften and break up, and finally discharging it from the body." (Cassileth)
Rene Caisse is an 88-year-old nurse from Bracebridge, Ontario who "has been convinced for 50 years that she has an herbal remedy that's effective against cancer. In the '20s and '30s, she defied the medical establishment to treat hundreds of cancer patients (most of them terminal) with her secret remedy, and produced remarkable results." (Fraser)
"In 1938, Essiac came within three votes of being legalized by the Ontario government as a remedy for terminal cancer patients." (Robinson)
"There is some evidence from laboratory research that each of the main herbs found in the Essiac formula have some biological activity (an effect on the structure or function of cells, tissues or organs). However, herbalists believe that the synergistic interaction of herbal ingredients (i.e. the combined effect of the constituent herbs) is critical to their beneficial treatment effects and to the control of side effects. The proponents of Essiac also claim that the effect is dependent on the herbs being present in the correct proportions, in accordance with approved recipes." (Canadian)
"A purified extract of burdock injected into mice with transplanted solid tumours has been reported to result in tumour inhibition (slowing the growth or spread of tumours). In another study burdock was shown to contain a desmutagen (a factor that reduces the ability of an agent to cause changes in the DNA of chromosomes in cell systems)." (Canadian)
"Extracts of rheum palmatum have been shown to cause significant tumour necrosis (cell death) in a mouse study using an implanted sarcoma 37 test system (a special test often used to evaluate the potential anti-tumour effects of new agents). (Canadian)
"Another constituent of plants in the rhubarb family - aloe emodin - has been tested in mice and... shown to have tumour inhibition properties. It should be noted that the activity of aloe emodin in this study varied with the extraction method used to remove and concentrate aloe emodin for testing purposes. This emphasizes the need to consider the extraction methods used, as well as the strength and the potency of herbal extracts when evaluation and interpreting experiments on these agents." (Canadian)
Professional Evaluation/ Critique
"A 1982 study by the Canadian government of cancer patients taking Essiac found that patients did not benefit from it, and laboratory research conducted in 1983 by the U.S. National Cancer Institute found no merit to the product." (Cassileth)
"...360 patients with breast, prostate or GI cancer attending outpatient clinics at Princess Margaret were surveyed regarding their experiences with Essiac... Of patients on Essiac, 30% felt it had helped them. The benefit was described as psychological in 54%, physical in 29% and unspecified in the remainder." (Karn)
"Long term anthranoid laxative [eg. rhein and emodin found in essiac] use is correlated with increased risk of colon cancer." (Van Gorkom)
"The review of all the information about Essiac for the task force reveals some weak evidence of its effectiveness and suggests that Essiac is unlikely to cause serious side effects when used as directed. However, the nature and quality of studies reporting benefit are such that the findings can only be regarded as preliminary. High-quality and open-minded research into the effects of this popular unconventional therapy is needed. The principal danger of this and other unconventional therapies is that they may delay the diagnosis and conventional treatment of serious diseases." (Kaegi)
"Keith I. Block, M.D., director of Cancer Care at the Edgewater Medical Center in Chicago, is among those physicians who do not regard Essiac as particularly powerful against cancer. It is possible that Essiac is less effective today than it was decades ago. Certainly our diet and environment have become increasingly polluted since the early 1900's, and that places a growing burden on the body's immune and detoxification systems." (Diamond)
Dr. K.J.R. Wightman, medical director of the Ontario Cancer Treatment and Research Foundation and a former president of the Royal College of Physicians and Surgeons commented on the studies: "In the past three months there has been considerable emotion and concern regarding a herbal remedy for cancer (Essiac). During this period the preparation as supplied by Nurse Caisse from Bracebridge has been tested by a reputable investigator on patients with a variety of malignancies... there is no evidence of any alteration in the disease process of any of the patients. However subjective improvements in the sense of well being were noted in a number of the patients, although this could or could not be a placebo effect."
Caisse's story, which was published in Homemaker's Magazine (Toronto) in 1977 precipitated a great deal of public interest and resulted in scientific investigation.
In one trial, out of 40 patients, 18 have died and 15 have been withdrawn because of definite deterioration. Four who had initially very slowly progressive disease continue on the preparation but have shown no response. The remaining three patients with chronic lymphatic leukemia had no change in any parameter of their disease status. Data on a further 25 patients are being compiled by a separate investigator with similar results. "These unequivocal negative statistics refute any claims made as to the efficacy of this cancer cure with the material provided in the suggested dosage schedules." (Wightman)
The Health Protection Branch (Canada) contacted 150 physicians who were known to have received supplies of Essiac from Resperin Corporation in Toronto for individual patients. Replies from 74 of the physicians concerning 86 patients revealed that "47 patients reported no benefits; 8 of the reports were not evaluable; 17 patients had died; 1 patient was reported to have had a subjective improvement; 5 patients were reported as requiring less analgesia; 4 patients were said to have an objective response; and 4 patients were in a stable condition." In 1982, the 8 patients who had an objective response or who had remained stable were re-examined by their physicians and the following results were obtained:
"In 3 of the 8 the disease had progressed; 2 had died; and 3 were remaining stable. The 3 stable patients' histories were further documented and it is the impression of the Health Protection Branch that in these cases the stability was due to other forms of treatment. The conclusion from these 86 patients must therefore be that Essiac had not altered the progression of cancer in these patients, and did not show any specific benefit with the exception of a possible placebo effect in some cases." (Sproul)
In a later issue, Homemaker's Magazine printed the following retraction: "The two doctors who tested Essiac - Caisse's herbal tea which appeared to have merit in the treatment of cancer - have concluded that there is no evidence that the preparation cures cancer... they revealed that Essiac had been given to 60 cancer patients, and that the results were 'without evidence of any alteration in the disease process...'" (Hughes)
Prior to signing over the formula for Essiac to the Resperin Corporation, Caisse refused to share her secret remedy. At least eight offers to help her achieve recognition and distribution for Essiac were made. Some were from scientific groups, some from laymen. She rejected them all. (Fraser)
In 1936 Dr. Banting of the Banting Institute offered to provide Mrs. Caisse with mice inoculated with mouse sarcoma, provide her with chickens inoculated with Rouse sarcoma and "the animals will be placed at her disposal in the laboratory within the hours of 9-5." She was not asked to divulge any secrets concerning her treatment. This offer by the Banting Institute was turned down by Mrs. Caisse.
At some time in the 1950s, Dr. Shields Warren of the U.S. National Cancer Institute suggested they would do animal tests but this was rejected by Mrs. Caisse when it was found that the Cancer Institute would require the formula. (Boyes)
"Dr. D. Walde of Sault Ste. Marie, obtained some Essiac and tested it on 40 patients with proven cancer. In none of these patients was there any measurable improvement." (Boyes) (Walde)
"However, despite its long use as a folkloric remedy, no solid evidence exists that burdock exhibits any useful therapeutic activity." (Tyler)
"There are a number of herbal distributors who claim to sell the original Essiac. However, there are also disputes about whether certain brands are the real thing." (Ontario)
Toxicity/ Risks
Health and Welfare Canada acknowledges that "Essiac is not harmful to a person's health as long as it is not taken instead of proven forms of cancer therapy." (Ontario) (Health)
"Since Essiac may cause nausea, vomiting and diarrhea if taken with food or soon after meals, proponents recommend that it be taken two or three hours after meals or at least one hour before meals." (Canadian)
"The Canadian Journal of Herbalism ("Old Ontario Remedies," July 1991) warns that two of the herbs in Essiac contain large concentrations of oxalic acid, which could upset nutritional metabolism and make the remedy unsafe for people with kidney ailments and arthritic conditions." (Kriegel)
"There have been some unconfirmed reports of possible burdock toxicity. The most common side effects are those characteristic of the drug, atropine - disorientation, flushing of the skin and the enlargement of the pupils. However, it is not clear whether these symptoms were due to burdock root toxicity or to contaminants in the preparation of the herbal mixtures that were administered to the patients." (Canadian)
"...the constituent herbs may cause allergic dermatitis in addition to their laxative effect." (Kaegi)
"Spasmodic gastrointestinal complaints can occur as a side effect to the drug's [rhubarb's] purgative effect. Long-term use leads to losses of electrolytes, in particular K(+) ions, and as a result of this to hyperaldosteronism [an abnormality of electrolyte metabolism], inhibition of intestinal motility and enhancement of the effect of cardioactive steroids; in rare cases also to heart arrhythmias, nephropathies [diseases of the kidney], edemas [the presence of abnormally large amounts of fluid in the intercellular tissue spaces of the body] and accelerated bone deterioration." (Physician's Desk Reference)
Costs
When bought from the Resperin Corporation, Essiac costs $40 at regular price for an 18-day supply. Discounts are offered if Essiac is bought in larger quantities (eg. 8 units costs 27.95 each). (Essiac website, 1999)
Flor*Essence is a popular commercial brand claiming to be the original Essiac. It costs approximately $20 Cdn for a bottle or $25 for three 21g packets. (Ontario, 1994)
Caisse signed over the formula to Resperin Corporation. "This means that Essiac is tied up with a commercial venture that could stand to gain considerable financial advantage from marketing this herbal remedy should they deem it effective in the treatment of cancer." (Hughes)
"...the average amount spent per month on Essiac was $50."(Karn, 1997)
In December 1985, the Resperin Corporation decided to charge $10 per bottle for Essiac. Patients usually require about 3 bottles a month; the recommended length time for the treatment is generally one to two years, sometimes longer. Patients must also pay for the air courier service, usually about $35 for a month's supply. (Essiac Information, 1985)
References
Boik J. Cancer and natural medicine: a textbook of basic science and clinical research. Oregon: Medical Press 1995:160.
Boyes DA. Memorandum on Essiac. Vancouver: BC Cancer Agency Cancer Information Centre, 1978. (BCCA Cancer Information Centre search file 1961E)
Canadian Breast Cancer Research Initiative. An information package - Essiac. Toronto: Canadian breast cancer research initiative, 1996:3-7.
Cassileth BR. Alternative medicine handbook: a complete reference guide to alternative and complementary therapies. New York: W.W. Norton & Co., 1998:162.
Diamond WJ, et al. An alternative medicine definitive guide to cancer. Tiburon: Future Medicine Publishing, Inc., 1997:817.
Essiac Information. Vancouver: CJOR 600 Radio Station, 1985.
Flor*Essence update. Health Action 1992/1993 Winter:7.
Fraser SS, Allen C. Could Essiac halt Cancer? Homemaker's Magazine 1977 Aug:3,6,9-42.
Health and Welfare Canada. Essiac_an ineffective cancer treatment. Issues 1989 Feb 7.
Hughes J. Update Essiac. Homemaker's Magazine 1978 Jan:5.
Kaegi E, on behalf of the Task Force on Alternative Therapies of the Canadian Breast Cancer Research Initiative. Unconventional therapies to cancer: 1. Essiac. Canadian Medical Association 1998; 158:897-902.
Karn H, et al. The use of the herbal remedy Essiac in an outpatient cancer population. Proc Annu Meet Am Soc Clin Oncol 1997;16:A245.
Kriegel C. Alternative cancer therapies: can your patients benefit? Alternative & Complementary Therapies 1994 October:1-7.
LeMoine L. Essiac: An historical perspective. Canadian Oncology Nursing Journal 1997;7:216-221.
Ontario Breast Cancer Information Exchange Project. Guide to unconventional cancer therapies. 1st ed. Toronto: Ontario Breast Cancer Information Exchange Project, 1994:62-64.
Physician's Desk Reference. PDR for herbal medicines. Montvale, New Jersey: Medical Economics Company 1998:1092.
Resperin Canada (1999). Essiac The "Real Thing" from Resperin Canada, [Online]. Available: http://comboweb.com/essiac/ [1999, May 17].
Robinson E. Essiac: nature's cure for cancer: an interview with Dr. Gary L. Glum. Wildfire 6(1):48-55.
Spencer J W, Jacobs JJ. Complementary/alternative medicine: an evidence based approach. Toronto: Mosby, 1999:142.
Sproul JD. Communication on Essiac. Ottawa: Health and Welfare Canada, Health Protection Branch, 1987. (BCCA Cancer Information Centre search file 1961E)
Tyler VE, Foster F. Tyler's hones herbal: a sensible guide to the use of herbs and related remedies 4th Ed. New York: Haworth herbal press, 1999:71-72.
Van Gorkam BA, et al. Multidrug resistance-associated protein efflux pump reduces cellular toxicity. Proc Annu Meet Am Assoc Cancer Res 1997;38:A3933.
Walde D. Essiac. Ann R Coll Physicians Surg Can 1978;11(1):69.
Wightman KJR. Can Med Assoc J 1977;117:1069.
Revised February 2000