Use of herbal supplements on cancer

1. Cancer Patient Use and the Marketing of
Herbal Supplements
K. Simon Yeung, MBA, PharmD, LAc
Jyothirmai Gubili, MS
Barrie Cassileth, MS, PhD
Society for Integrative Oncology Conference
Boston, MA
November 11, 2006
Integrative Medicine Service

2. Purpose
To uncover popular dietary supplements
currently sought by cancer patients
To determine the scientific basis for
promoter claims
To determine if there is an association
between popularity and marketing
intensity

3. Background
Cancer patients tend to use multiple dietary
supplements in hopes of cure and for symptom
relief
Many of these products have adverse effects
and can interact with conventional drugs
These products are not regulated by the FDA
and are promoted heavily, primarily to cancer
patients

4. Prevalence
Centers for Disease Control survey in 2002:
38 million Americans use botanicals
A survey by Gupta et al,* on 227 cancer patients:
– 71% used dietary supplements
– 53% did not consult a healthcare professional
– 25% of supplements identified might have adverse
interactions with chemotherapy
*Gupta, D., et al., Support Care Cancer. 2005.

5. The AboutHerbs Web site
An MSKCC Integrative Medicine Service
Information Program
www.mskcc.org/aboutherbs
217 monographs
4,700,000 hits from health professionals
and public internationally since 2002
This website is in FOCUS
• Free access
• Objective information
• Cancer related
• Updated frequently
• Searchable database

7. Advisory Board
Barrie Cassileth, PhD James Dougherty, MD
Chief, Integrative Medicine Service, MSKCC President, Arcus Group
Charlie Lucarelli, MS, RPh Donald Garrity, RD
Director, Department of Pharmacy, MSKCC Nutrition Specialist, Integrative Medicine,
MSKCC
Nai-Kong Cheung, MD, PhD
Head, Neuroblastoma Program, Department Robert Kurtz, MD
Of Pediatric Oncology, MSKCC Chief, Gastroenterology and Nutrition Service,
MSKCC
Gary Deng, MD, PhD
Assistant Attending, Integrative Medicine
Michael Krychman, MD
Co-Director, Sexual Medicine Program,
Service, MSKCC
MSKCC

8. Methods
 Page view data compiled by Web site statistics
tracking programs were analyzed
 The five most visited monographs in the first
six months of 2006 were identified
 Medline data on the safety and efficacy of these
five supplements were extracted
 The distributor Web sites for these five
products were searched for marketing and
promotion practices

9. Top 5 Monographs
Jan – June 2006
Total Hits % of Top 5
1. “JuicePlus+” 26584 32%
2. Lycium 15681 19%
3. Reishi 14232 17%
4. Aloe 13379 16%
5. Mangosteen 13195 16%

10. Top 5 Monographs
Jan – June 2006
Total Hits % of Top 5
1. “JuicePlus+” 26584 32%
2. Lycium 15681 19%
3. Reishi 14232 17%
4. Aloe 13379 16%
5. Mangosteen 13195 16%
•In contrast, the top 5 dietary supplements used by the general
public: echinacea, ginseng, ginkgo, garlic, and glucosamine*
*CDC Advance Data No. 343. May 27 2004

11. Results: Top 5 Products
Top 5 Products
by Popularity
Rank
1. “JuicePlus+”
2. Lycium
3. Reishi
4. Aloe
5. Mangosteen

12. Results: Top 5 Products
Top 5 Products Medline
by Popularity Articles by
Rank Product
Name
1. “JuicePlus+” 1
2. Lycium 145
3. Reishi 162
4. Aloe 796
5. Mangosteen 43

13. Results: Top 5 Products
Top 5 Products Medline
by Popularity Articles by Clinical
Rank Product Trials on
Name Medline
1. “JuicePlus+” 1 1
2. Lycium 145 4
3. Reishi 162 9
4. Aloe 796 24
5. Mangosteen 43 0

14. Results: Top 5 Products
Top 5 Products Medline Cancer
by Popularity Articles by Clinical Related
Rank Product Trials on Clinical
Name Medline Trials
1. “JuicePlus+” 1 1 0
2. Lycium 145 4 1
3. Reishi 162 9 6
4. Aloe 796 24 10
5. Mangosteen 43 0 0

15. Results: Top 5 Products
Top 5 Products Adverse
Medline Cancer
by Popularity Effects:
Articles by Clinical Related low +
Rank Product Trials on Clinical moderate ++
Name Medline Trials high +++
1. “JuicePlus+” 1 1 0 +
2. Lycium 145 4 1 +
3. Reishi 162 9 6 ++
4. Aloe 796 24 10 +++
5. Mangosteen 43 0 0 ++

16. Results: Research in Cancer
Reishi studied in cancer patients
Aloe vera:
– Aloe for radiotherapy-induced skin damage:
conflicting data
– Injections of Acemannan, extracted from aloe,
resulted in several cancer patient deaths
Lycium used in one observational study
Mangosteen and “Juice Plus+” no research
in humans

17. Results: Marketing
Cancer related Info
Top 5 Products
by Popularity
“Product name” AND “Cancer”
Rank
(# of web pages per Google)
1. “JuicePlus+” 29,000
2. Lycium 47,000
3. Reishi 196,000
4. Aloe 1,280,000
5. Mangosteen 388,000

18. Results: Marketing
Cancer related Info Marketing Intensity
Top 5 Products
by Popularity “Product name” AND “Independent
“Product name” AND “Cancer” Distributors”
Rank
(# of web pages per Google) (# of web pages per Google)
1. “JuicePlus+” 29,000 19,000
2. Lycium 47,000 50,000
3. Reishi 196,000 1,000
4. Aloe 1,280,000 183,000
5. Mangosteen 388,000 95,000

19. Results: Marketing, concluded
Reishi and aloe have been in common use for
decades and are available through conventional
channels, including pharmacies and health-food
stores
“Juice Plus+”, lycium, and mangosteen became
popular in the US only in the last few years and
are promoted mainly via network marketing
schemes

20. Limitations
Number of visits may be due to increase in referral
sites and hyperlinks
Do not have breakdown by visitors and by referral
sites
Only reflect the demand on information, not usage
Sales figures of these products are not available for
comparison
Data have not been subjected to statistical analysis

21. Conclusions
Cancer patients tend to seek information on
specific herbal supplements
In vitro and animal studies suggest beneficial
effects for some supplements
Clinical trials to support their uses for cancer
are limited
Many products have adverse effects and may
interfere with cancer treatments
These supplements are sold through network
marketing and are promoted as alternative
treatments for cancer