By Steven Johnson, DO, anthroposophical physician & Editor in Chief, Dr.
Robert Zieve, MD
Published in Cancer Strategies Journal, Volume II, Issue 2, Spring 2014
Iscador (Mistletoe extract) is a standardized and registered plant extract from European mistletoe (Viscum album).
It is the most widely used and most researched mistletoe preparation for complementary cancer treatment.
One of the most successful aspects of Iscador therapy is as adjuvant support for conventional cancer therapy. In almost all cases it is given as subcutaneous injections although in Europe it is frequently used intravenously as well. Tumor cell effects include cytotoxicity (membranes, ribosomes), apoptosis, and inhibition of angiogenesis. Effects on the organism include immune regulation of lymphocytes and gene protection of immune competent cells. Other preparations of mistletoe exist including Helixor and Abnoba, which have higher lectin content (the portion that is immune stimulating). Presently it is not FDA approved for cancer in the U.S. However, under the compassionate care act it is available to individual patients from Europe.
Weleda owns the brand Iscador and actively sells and supports it in Europe and some other parts of the world. In the US however, the medicine is not readily available to patients and doctors, because it is not on the market. We hear from doctors and their patients that they buy the product in Europe or in Canada, where it is available in the pharmacy.
There is a form of mistletoe available in the US, listed with FDA, which can be purchased from Uriel Pharmacy (www.urielpharmacy.com, (262) 642 2858. It is called by the generic name Viscum, and comes in 8 different host tree types (Mali, Quercus, Pini, Crataegi, Abietis, Tilia, Salicis and Populi) in the strengths associated with Iscucin (A-G) and Potency Series 1 and 2. While it is labeled for oral use and for the homeopathic indication of headache, it is a sterile isotonic solution that can be used at the physician’s discretion for off-label uses.
Most research on Iscador is conducted in Germany, Switzerland and France where advanced integrated Anthroposophic clinics exist; in fact there are nearly 100 studies in existence at this time. Johns Hopkins University has recently begun a Phase 1 Mistletoe study to evaluate safety of the preparation and has plans to move onto a phase two trial as an adjuvant treatment for renal cell carcinoma. Many of the European studies conducted in anthroposophic clinics show significant quality of life improvements such as pain reduction, improved appetite and immune function. These were further improved when anthroposphic therapies such as eurythmy, art therapy, psychological counseling and other therapies were added. It would be of great interest to study the therapeutic environment and the impact this has on quality of life and survival with cancer patients. Unfortunately, we do not have similar integrative cancer care delivery involving mistletoe therapy in the US.
Mistletoe therapy has its roots in Anthroposophic medicine, which began in the 1920s with Rudolph Steiner and Ita Wegeman, the lead doctor at the time working with Rudolph Steiner who put together the initial principles of Anthroposophic Medicine. One of the unique aspects about Anthroposophic medicine is that we try to understand every therapy we use in relation to the whole human being, physically, psychologically and spiritually. Anthroposophic medicine is a rational science even though it talks about spiritual matters. It is important to be able to verify that the substance actually works physiologically in some way towards the healing of the illness. That side of it is unique.
All research studies have both qualitative and quantitative aspects to them. When we study Iscador therapy we do not just study the effects on tumor cells -- there are also studies on the psychological effects of the remedy. Many studies suggest positive quality of life changes during the course of mistletoe therapy.
Iscador is intended to be given in an integrative framework, in conjunction with other medicines and other holistic practices. Anthroposophic medicine has its own whole framework of treatment, therapies, remedies, but Iscador can be adjuvant to almost any therapy. There are very few documented side effects or drug interactions with mistletoe, and there’s been no demonstrated drug interactions with chemotherapy and radiation, which is nice to know.
One of the things often misunderstood about Anthroposophic medicine – it is not just a totality of the remedies and medicines and therapies; it’s a whole path of understanding the human being and our relationship to nature around us. Iscador can be used with any therapy whether you are an Anthroposophic physician or not, and many physicians integrate several other therapies besides Anthroposophic medicine together quite successfully. Often Anthroposphic medicine is described as “salutogenic”. That means it is a study of medicine, which strives to understand the origins of health in contrast to the “pathogenic” model that focuses on the origins of the disease processes. One of the many unique aspects of Iscador is how much it has been studied. There are over 100 studies on Iscador treatment, which is amazing for a natural substance, and is a credit to the work that Weleda and the physicians in Europe have put into studying it. Some mistletoe trials have come close to completing the FDA requirements for approval. However, the final steps to legitimize any natural cancer treatment within the framework of conventional research standards is cost prohibitive and the progress remains challenging.
As mentioned earlier, Anthroposophic medicine strives towards a model of “salutogenesis,” which can integrate into the modern model of pathogenesis. We are striving to understand the origin of health, not just the origin of disease, and that’s what “salutogenesis” means. Pathogenesis takes us more and more into a reductionist model of thinking where we’re always looking at smaller and smaller pieces. Anthroposophic medicine is not about just of treating the pathology, that’s only part of it. We also want remedies, therapies and medicines that strengthen that innate capacity of the human being to be well. It’s really quite a miracle that despite all that goes on around us every day, all the stress and toxic environments we are exposed to, that we are actually still essentially as healthy as we are. Trying to understand this miracle is an important part of what integrative /holistic medicine is all about.
Several recent studies on meditation and telomere length have demonstrated how attitude and belief can influence us right down to our DNA. It is a shame more attention wasn’t paid to the spiritual scientific model of anthroposophic medicine earlier on but I still think there is a lot of inspiration and intuitive guidance to be found in this medicine.
Anthroposophic medicine does look at the physical human being. We look to the physical properties of life, the chemical reactions and all that is measurable in the body, in nature and physical science to lay the basis for a rational therapy. However, this is not enough. If you are cremated you have all your minerals and you have all the substances but it’s nothing without the architecture that brings life. We ask, what is it that binds the life process to our mineral/
chemical body? In Anthroposophic medicine we speak about this as the etheric body or sheath. Everything that has to do with growth and regeneration, metabolism, nutrition, self-
regulation, self-healing, this is the salutogenic principle that sustains life and that innate ability to stay well and promote health. Health is not just not having cancer or other disease, health is also healthy thinking, healthy feeling, the ability to be active and creative, and a measure of quality of life, not just how long we live. We also create movement and change in the human being. Sometimes in my experience as a clinician, it seems that if you can get someone to change his habits it almost does not matter sometimes what therapy you utilize. When people change something about themselves, a healing process is initiated. Therefore rational healing treats the disease and the individual “I” of the patient. As modern research is finally showing, as an individual changes the way they think out of their own initiative and freedom, health can change at the cellular level as well.
In a healthy human being there is a balance between feeling/soul-life and the etheric body. Anthroposophic medicine will often say that almost every illness has an imbalance in the soul-life part of the human being. If the emotions, the sympathies and antipathies, and the feelings are pushing too strongly we get imbalanced and we begin the seed for illness. Our capacity for self-awareness allows us to gain power and regulation over our soul/feeling life.
The path of Anthroposophic medicine, simply stated, is that we are trying to attain consciousness of what we are doing within the physical, etheric and soul-life through our treatment. We are looking for both physical and spiritual changes within the healing of the patient, especially with more chronic and serious ailments. When we say Anthroposophic Spiritual Science, we are trying to understand the phenomenology or “being” of the illness with the scientific realities of what we can see, taste, measure, and feel.
In Anthroposophic medicine, when we are treating cancer patients we look at different therapies that we believe also connect to different parts of the human being. For instance when we need to support the physical body, we’re working with surgery, radiation and chemotherapy. Anthroposophic medicine is an extension of medicine, not a replacement. We do physiotherapy, massage, manual therapies and nutrition and then if we want to support the etheric body, we add phytotherapy like homeopathic medicines, herbal medicines, Iscador, homeopathy, and therapeutic Eurythmy, which all work directly into this etheric life realm. We try to activate this process of salutogenesis, working with the etheric body and the individual “I” of the patients to improve self-regulation to support health.
In the soul realm we work with art therapy, music therapy, poetry, psychotherapy, helping patients to overcome their sympathies and antipathies and learn to find empathy so that they’re not swinging back and forth in an intense way, which is very stressful on the organism. Very important in cancer therapy is the integration of the organism, trying to engage the patient into finding that creative, coping, cognitive capacity, that thread of their life that gives them meaning, that thread of feeling connected to one’s individual potential in
life. We work on this with meditation and biography, working through a patient’s relationship to their self, trying to activate higher consciousness where we can encourage a clear awakening to what we are doing in life, how we stand above it, seeing what we are doing.
I like to give patients verses. For purposes of this article I will give verses by Rudolf Steiner but it could be from anything that the patient connects to themselves and to their life path. One simple example could even be Grace. This brings reverence to what we eat. People eat fast or they start to think of food as a way to cure their cancer, thinking that they have to eat this or that because it’s going to make them healthier. Just the process of eating, standing back and experiencing eating, can be a very reverent experience if one takes the time to think where their food comes from, that they chew their food, that they eat slowly, as a social time, not just watching TV or getting into the car, or getting that smoothie quickly or that juice quickly, going on to the next thing to get it done.
This is a common verse by Rudolf Steiner that I often give patients for meditation or grace:
“The plant seeds are quickened in the night of the Earth, The green herbs are sprouting through the might of the air, And all fruits are ripened by the power of the sun, So quickens the soul and the shrine of the heart, So blossoms the spirit power in the light of the world, So ripens man’s strength in the glory of God.”
This whole connection that food is not just a substance, that there’s something much more to the quality of the food matters-- is what we try to impart to our patients in anthroposophic medicine. We are learning so much about how grass fed, free range meats for instance act differently in the human body than other meats (for instance cholesterol doesn’t rise as fast) and soon we are likely to see the same concerning other foods. Part of the anthroposophic approach to nutrition in cancer therapy is the quality of the food, not just the specific foods we eat. Quantitative nutritional analysis can be misleading us about what health really is and we are learning this more and more as of late. Quality matters.
One of the unique things about Iscador therapy are the studies on quality of life scores. There are definitive studies in the literature about Iscador as it relates to quality-of-life measurement.
In a study done by Peter Hoyser in 2006, 144 patients with advanced cancer -- GI, breast and pancreas, uterine, ovarian, and lung cancer -- were studied for quality of life improvements in several domains: physical, emotional, cognitive, spiritual, and social. Four months out the patients reported much higher sense of quality-of-life and appreciation for life, less side effects from their medications, and a more positive outlook.
Iscador is very likely at the top of comparable literature for this quality of life score if we compare it to other treatments. There has always been the thought in the anthroposophic care model that if these benefits were extended with positive “spiritual” or psychological transformations in the cancer patient, salutogenic healing capacities could be more activated and extend possibilities for healing and remission.
In Germany Iscador has been approved by the Federal Institute for Drugs and Medical Devices, which is a very strict rigorous organization similar to our FDA.
The Mistletoe Plant
“This can become a remedy for cancer,” said Rudolf Steiner when he introduced the plant to the doctors studying with him. The gesture of the plant speaks to this. It’s unique. It’s an ancient plant, going back to prehistoric times. It is semi-parasitic; it lives off the sap of the tree in which it exists. The little balls in the tree that look like little tumors are mistletoe. It has no geo-tropism, it never touches the earth, it never ever grows on the ground, it is always spherical, unlike other plants that tend to grow outwards mistletoe will grow only two leaves a year which will always start to grow back towards the center. This inward gesture of looking back towards the center is very unusual. Mistletoe is unique because it fruits and blossoms in the winter so it doesn’t necessarily obey the normal life rhythms of nature -- it has its own individuality. Mistletoe is propagated by the mistletoe thrush that eats the berries and then deposits the seeds on the trees, which then grow into the tree limbs. This type of phenomenological observation is part of the training of an anthroposphic physician.
Rudolf Steiner strongly felt that rational spiritual training of the mind could lead to powers of observation in the natural world that could add a rational perspective to scientific investigation.
Viscum Album is the specific plant used in Iscador therapy. The Viscum Album grows primarily in France and now is being cultivated in Switzerland and Germany. It grows particularly well on pines but there is also a variety that will grow on deciduous trees, especially Apple and Oak. It has a preference for certain trees and that is also unique.
Viscum Album is harvested in the summer and winter and those juices are mixed together. Only plants that are extremely healthy are used. The extract is fermented, mixed together in a centifuge by special pharmaceutical processes.
The most common mistletoe preparations are Iscador, Abnoba, Helixor, Iscasen, and Isorell. These preparations are sterile filtrations, put in ampules, and the quality controls are extensive. The labs meet any criteria in the world for best pharmaceutical practices.
Mistletoe is always harvested in natural settings, and is always standardized, especially the “Iscador Special”. If you use Iscador long enough with patients you eventually use Iscador Special. That’s the highest milligram content of Iscador availble. Iscador Special is highly regulated as to the lectin content and the viscotoxin content.
Fermentation assures a well-balanced extraction. It is manufactured according to GMP-rules and official quality requirements for pharmaceutical drugs. Quality is ascertained by harvest control, content analysis, bacteriology and chromatography. There are regular inspections and registration approval by Swiss and German Drug Administrations.
It is not reimbursable at this time in the United States, although it does have an insurance ID number. A patient can request it via the “compassionate care act” and order it from Europe but clinicians cannot make any FDA claims for using it for cancer treatment.
The active components are lectins and viscotoxins. These are the primary substances that have been studied extensively. The lectins and viscotoxins have properties of immune stimulation and immune regulation and cytotoxicity. The viscotoxins are chemically similar to snake venom. There are also other substances in the mistletoe which have anti-angiogenic properties, although it’s not clear at this time which of the substances are doing that. There are some very new cohort studies showing improvement in gene protection and also gene repair.
Invitro studies show the inactivation of ribosomes in cancer cells by lectins which affect the ability of the cell to replicate. Mistletoe also causes perforation of cancer cell membranes, disrupting the cytoskeleton of the cancer cell causing tumor cell necrosis.
Iscador was effective in about 70 out of 100 cancer lines tested. There are some new studies showing how Iscador inhibits microtubule formation, and using Iscador Special show the disruption of the cytoskeleton of the tumor cell.
Overview of Clinical Mistletoe Studies
There have been over 100 clinical studies in Anthroposophic medicine involving Iscador and other mistletoe preparations. 23 are prospective controlled studies. Of those, 16 are reported positive, 6 trend positively and one trends negative. There are 37 retrospective studies; 34 out of 37 showed significant benefit. In 35 cohort studies and case series, the majority is positive for beneficial results. Most of the studies showed increased survival times of late stage cancers studies ranging from 6 months to two years.
A very well known study done in 2001 showed survival rates in particular cancers in patients that were followed over several years. 496 age matched pairs were followed for similar cancers. They were matched for epidemiological data and we see that in general people who took Iscador with their treatment increased their survival time ranging from half a year to a year. Most of these patients were already stage 4 - late stage cancer patients. This study was very promising.
The following graph shows survival time for cancer patients treated with and without Iscador.
One of the things we see with subcutaneous injections is changes in the micro-circulation at the injection site and short and long term effects on white blood cells, cytokines and antibody production. There is a beautiful video that shows the insertion of a fiber-optic camera into the blood vessels then infused with Iscador. Following this, the white blood cells start rolling off the endothelium into the circulation at high rates. Iscador actually changes the adhesion and migration of the white blood cells, releasing them into the circulation.
Often there will be slight increases in white blood cell counts as well as eosinophil counts and lymphocyte counts, especially CD4 and CD8 on standard blood tests.
At a therapeutic dose we start to see actual red blotches at the site of the injection, which is subcutaneous. These are perivascular infiltrates, 60% lymphocytes, 40% macrophages; there is also an increase in T-cell lymphocytes. We do not see in the skin reaction an increase in the neutrophils, eosinophils or mast cells, but we do see that in the blood.
In Europe they have tested to see if a good way to monitor Iscador therapy is to test the increase in eosinophils or test the actual increase in natural killer cells or white blood cells. Those results have been inconsistent, and that is still being studied. When we monitor the CBC (Complete Blood Count) of Iscador patients, we sometimes see a change in the eosinophil count. In some small European studies this has been correlated with positive results. However, further studies are needed. In the short-term, we also see increased leukocytes, neutrophils, lymphocytes, interleukins, increased phagocytic activity, and an increase in natural killer cell activity within the first 6 to 24 hours of Iscador injection.
When someone has been doing Iscador therapy for several weeks, these effects will last longer, and in some cases even up to a week. Iscador effects are not just short term. They are persistent even when taking mistletoe long term, even up to a year.
Adjuvant Support for Conventional Cancer Therapy
One of the most successful aspects of Iscador therapy is adjuvant support for conventional cancer therapy. Subcutaneous Iscador has been shown to reduce the immune suppression associated with radiation therapy as well. There are studies showing that after radiation and or chemotherapy that we see a much quicker rebound of natural killer cells and immune regulation in the body after administering Iscador. All these studies are available on anthomedlibrary.com under mistletoe research.
Especially with adjuvant intravenous mistletoe studies (performed in Europe only) we see large increases in colony stimulating factors, and significant rebounds of white cell blood counts after high-dose chemotherapy. This has been studied extensively and can be one of the great benefits of using Iscador. Patients can take Iscador right up until the day before surgery or radiation safely, but typically we tell patients to discontinue mistletoe injections three days before a procedure. Be careful with the location of sub-Q injections so that it’s not near where a port is or where a surgery is going to be performed. The practitioner will be alarmed when they see a big red blotch and the patient has an inflammation.
Intravenous infusion is used a great deal in Europe. Many patients in Europe with advanced cancer therapy will receive intravenous infusions. In the US, the FDA does not approve intravenous infusions at this time.
Intravenous infusions are used with patients who won’t respond with the expected parameters to sub-Q injections. In the old days doctors reported that patients with even low doses of Iscador therapy got small fevers. Most practitioners today find it’s much more difficult to get patients to have a febrile response. That used to be one of the main indications for how you knew if the therapy was effective. The patient’s temperature would rise, which demonstrated a positive immune reaction. Sometimes fevers are easier to achieve with IV Iscador according to studies in European hospitals.
Higher doses are being experimented with lately and hopefully these studies will be published soon. Now most of our patients have a baseline temperatures of 96 or 97 degrees Fahrenheit, so if we do a temperature curve and see at least a 0.5 increase temp Fahrenheit, we consider that a good response. With some patients we are looking for a stronger response, a true fever response in the range of 100 to 102 degrees Fahrenheit.
Several studies now show faster rebound from surgery with correction of the immune suppression usually seen after both anesthesia and chemotherapy, and much faster rebounds in white blood cell counts after chemotherapy. In a study done in the Filderklinik in Stuttgart, 21 patients with colon cancer demonstrated this phenomenon.
There are some larger studies as well that show rebounding natural killer cell activity after anesthesia and surgery. Side effects of IV infusions of mistletoe preparations include shivering, high fevers, and nausea; muscle aches have been observed as well, particularly in sarcoma patients. In some instances, extreme pain may persist for several hours after an IV Iscador infusion, which is often witnessed in European clinics. Be prepared to treat the pain, but be aware that such dramatic responses are simply manifestations of a strong immune response. Clinical experience is necessary before attempting such advanced usage of these preparations.
There are allergies to mistletoe but they are very rare. There are just a handful of case reports of true anaphylactic reactions to mistletoe, which would be managed emergently as with any other anaphylactic reaction, using some combination of epinephrine, IV antihistamine, and steroids, depending on which symptoms are most prominent.
With Mistletoe therapy, sometimes we see reactions at very low doses, which can be equally as effective as high doses. It’s not about the dose, but rather the process and the reaction imparted into the body with the dose. If we escalate the dose too quickly we might start forming antibodies to the medicine and it will become ineffective much more quickly.
People can be on Iscador therapy for several years and sometimes after 3 to 5 years we may start seeing antibody reactions that can inactivate the mistletoe. Rotating the preparations, changing the plant or the host tree or even the manufacturer just to make sure the patient is not always seeing the same antigens may prolong the effectiveness.
Reduction of Side Effects of Conventional Cancer Treatment
There are over 30 studies demonstrating that Iscador reduces the side effects of conventional cancer therapy. We see DNA stabilization, and a reduction in DNA strand breaks. One of the ways Iscador improves side effects from other treatments is by protecting DNA against hyper-methylation. We see improved white blood cell counts, DNA repair, and we see a lot less cachexia and weight loss as well.
The following figure illustrates a study done in 2004 that appeared in the journal Drug Research. A controlled study with 732 patients who received conventional chemotherapy and/or radiation for breast cancer, were compared with 710 similarly treated patients who also received Iscador. Only 16% of patients who received Iscador reported significant side effects compared to 54% of patients not taking Iscador who had significant side effects. This has to do with things like appetite, weight loss, pain, nausea, sleep, and fatigue. The improved tolerance to conventional therapy is often the primary reason to use Iscador in patients receiving conventional cancer therapies.
Other Uses of Iscador
Clinics in Europe are using Iscador intrapleurally for pleural effusions, as well as intra-tumoral injections into breast tumors, and melanomas with some very good results. There are some wonderful studies on HIV and hepatitis C, even in conditions such as severe osteoarthritis.
Iscador can be used with prolotherapy, injecting ligaments and joints for regeneration. There are a lot of applications for Iscador as you get to know it.
Iscador was used extensively in a study after Chernobyl and especially on the children who were exposed to radiation at the Chernobyl meltdown. There were significant improvements in infections, fatigue, pain, sweating, and normalization of leukocyte counts, T cells, T helper cells, balance and ratios of cytotoxic and suppression cells. It was a wonderful study and many patients ended up taking Iscador after that Chernobyl accident.
The frequency of infections, subjective symptoms, and clinical examination findings before and directly after treatment, and after 3-4 months and 15 months were documented. Determination of lymphocyte subpopulations’ phagocytosis, and immunoglobulins and serum complement factors before and after the treatment and after 3-4 months were assessed. 19 out of 25 children completed the study. A considerable reduction in incidence of respiratory infections was noted in 14 out of 19 children. Before the treatment, in the 25 children, frequency of infections was above 6 per year in 24 children. During the months of observation, in the group of 19 children only 4 children had new infections and improvement of general wellbeing and appetite, reduction of fatigue and pains were noted. A significant increase of levels of T lymphocytes (CD3 +), phagocytosis, IgM, IgA, sigA in the saliva and complement factor C4 was observed after the therapy and in 3-4 months.
The Iscador therapy proved to be clinically and immunologically effective and well tolerated in immuno-compromised children with recurrent upper respiratory infections due to the Chernobyl accident.
Studies expanding the use of mistletoe are as follows:
• Studies with pleural effusions
• Intra-peritoneal studies for ascites
• New promising studies for breast cancer
• HIV and Hepatitis C Studies, Arthritis
• Equine and Animal Uses
Two case reports by Maurice Orange who runs one of the clinics in England that came out in 2010. A 75-year-old lady with a Merkel cell tumor, which is a very rare and deadly neuroendocrine cancer of the skin, declined radiotherapy. She received just less than 10 months of Iscador therapy, receiving 592 Viscum Album extract injections over that period. The tumor actually became impalpable at four months and was still in remission at three years. She also received some IV Iscador therapy as well and this patient was followed out for 3 to 4 years using only high dose Iscador injections sub Q.
The second patient is a woman with a synchronous breast cancer; she actually had a grade 1 estrogen negative tumor in one breast as well as an estrogen positive grade 3 tumor, and an additional Her 2 positive ductal carcinoma in the other breast. They were all isolated lesions, no metastasis. The patient refused surgical and other conventional treatments and instead received ultrasound guided intra-tumoral injections of Abnoba. She is still in remission four years later. There is increasing interest in intra-tumoral injections of mistletoe preparations, based on anecdotes such as this one. This is difficult to do in your own office, except with very superficial and palpable tumors.
If there was one message I want you to take away, it is to consider Iscador as an adjuvant treatment to what you’re doing because of few side effects to speak of.
Principles of Iscador Sub-Q Treatment
Iscador is typically given sub-Q. It’s also fairly cost-effective. Mistletoe injections can be given for about $100 a month. It’s given very much like an insulin shot into the subcutaneous tissue. Most females receive Iscador Mali (Apple) and most males receive Iscador Quercus (Oak), meaning the mistletoe was grown on a specific host tree but in some case these are interchangeable. Certain cancers are treated with Pini (Pine), which is Iscador grown on pine trees. Quercus always has a higher lectin content than Mali and Pini. In recent studies on pancreatic and breast cancer, we are seeing that Iscador Pini may be more effective for use in these specific cancer types. Usually we start with an induction phase, starting with Series 0. This is a homeopathic potency series. We watch to see if the patient has a reaction at any particular potency. Sometimes we then use that potency for a while. Many patients go through two boxes of Series 0. A good reaction would be at least a small mark that’s about 1 inch (2.5 cm), and bigger than a silver dollar would be too big. If it’s too big we usually stay on Series 0. If the patient is reacting to even one of these too strongly, we go down and give a lower dose.
If we get through the two boxes of this type of Iscador with a seven-day break in between, then we move up to Series 1, which is higher in potency. We work our way up to Series 2 and higher. If we get a serious reaction to the injection we can treat the red, blotchy area with cool compresses, diphenhydramine (Benadryl) if it is a terrible reaction, or if they do get a large reaction we can stop for a week and then restart at the next lower potency.
Most positive reactions to Iscador correlate with increased eosinophil counts, improved CD8/CD4 ratios, and increases in natural killer cells. These are often measurable but not always consistent. Iscador Special is the strongest Iscador available without going into other mistletoe preparations like Abnoba, which comes in stronger potencies. Iscador Special has the highest lectin content. Most patients with advanced cancer metastases, female cancers, breast, ovarian, will work their way up to Iscador Special which will probably be the preparation they will be on for the longest period of time. Iscador Special is typically the type used for IV administration; usually in ranges of 5 to 40mg. However, Abnoba and Helixor are often commonly used.
With sub-Q injections you can keep a patient on one single dose like 1 to 10 mg for a long time if continue to get an appropriate sized skin reaction lasting several weeks. It’s also important to ask patients how they are doing. Do they have a sense of wellbeing? Many patients taking Mistletoe therapy will say they feel better. Their appetite is better, they’re sleeping better, feel more uplifted. This information can be used to adjust dosing for an experienced practitioner.
With any increased intracranial brain pressure we would only use a very homeopathic dose like a D30, and we would stay with homeopathic dosing. Many clinicians are extremely cautious when there are brain metastases involved.
-Steven Johnson, DO
Dr. Steven Johnson DO has practiced integrative anthroposophic medicine for the past 17 years. He has helped develop non-profit, for profit and state funded integrative care models. He has trained in several integrative hospitals and clinics in Europe and has taught extensively in the area of integrative medicine and therapy in the U.S., Europe and India.
Dr. Johnson helped develop the archive anthromedlibrary.com, which has many articles on Iscador cancer therapy and Anthroposophic medicine.
A note from Robert Zieve, MD, Editor in Chief, on Principles of Viscum Sub-Q Treatment and the Availability of Mistletoe In the United States...
Because Iscador is not currently available in the United States due to FDA instructions to the company that makes Iscador, injectable mistletoe is available through Uriel Pharmacy, an anthroposophical pharmacy in East Troy, Wisconsin. In this way, the practitioner can make use of FDA-cleared subcutaneous mistletoe in the United States. The directions in its usage are as follows:
Start with Viscum Mali Series I, and administer it subcutaneously three times per week till there is a red spot at site of injection 4-12 hours after the injection. The box labeled Series 1 is the lowest strength. If at the end of this box the patient has not developed any red spots at the site of the injections, go on to the Series 2 box. In the Uriel boxes of mistletoe extracts, the vial on the left in the box is the weakest strength, and the patient progresses in self-administering the vials from left to right in the box.
If the patient is suspected of having a depleted immune system, you can start with Series 2. If no red spots all through Series 2, go to Viscum Mali 12.5mg -- the strongest available in US.
You can call Uriel Pharmacy and ask for more information on the use of these extracts at:
These extracts are administered subcutanously. The injections are often given in the morning, with a period of 30 minutes rest after the injection, to give the injection time to take hold in the body. If the patient feels a bit fluey for a while after the injection, this is good. In these situations it is probably better to administer the injection later in the day.
Most practitioners who use mistletoe have the patient or a family member administer it at home. The fact that the FDA has currently limited the availability of Iscador in the United States flies against recently published articles by the National Cancer Institute. See the following link for more information: http://www.cancer.gov/cancertopics/pdq/cam/mistletoe/patient/page2.
This article explains the background of mistletoe extracts and why they are used in cancer.
It is important to see this in its wider context: the suppression of many so called “alternative” cancer therapies that have good research and outcomes that have shown their effectiveness and lack of harm. Unfortunately, this is becoming a common theme today in the United States. As we have seen with Donald Yance, CN, RH(AHG), MH and his ETMS program, many oncologists today are resistant to even learning about or applying these well-researched principles and practices in their practices. How much this has to do with the finances and control of modern oncology is up to the reader to decide.
Many patients are waking up to these realities and are ordering FDA-banned treatments from overseas and are using them in the US. Practitioners have to be careful to make sure to remain within the legal guidelines of use of such therapies. These guidelines may vary from state to state in addition to FDA regulations.
-Dr. Robert Zieve, MD