Mistletoe, a semiparasitic plant once held sacred by Germanic tribes, the Celts, and Druid priests, has been used medicinally over the centuries.

In 1920, Iscador, an extract of the European mistletoe, was proposed as a cancer remedy by Austrian thinker and biologic researcher Rudolf Steiner (1861-1925), the founder of Anthroposophy, a spiritual philosophy and movement.

Since 1963, Iscador has been a key component in the cancer therapy offered by the Lukas Klinik in Arlesheim, Switzerland. It can also be administered totally outside the context of Anthroposophical care.

Steiner suggested, without any proof, that mistletoe was a possible treatment for cancer, basing his hunch on an analysis of the plant's unusual characteristics. Subsequent studies have demonstrated that mistletoe extract enhances immune-system activities that ward off or inhibit tumors. For example, it stimulates the thymus, the chief regulator of cellular immune reactions. It also increases the number of granulocytes, which are the scavenger white blood cells that consume invading antigens, and enhances phagocytosis, the white blood cells' ability to ingest and destroy other cells or foreign material.

Iscador elevates the number of immunocompetent white cells and activates natural killer cells capable of spontaneously destroying tumor cells.1 Mistletoe extract also contains biologically active proteins (lectins) and other substances that have exhibited powerful antitumor action in animal and cell-culture experiments. In cancer patients, Iscador therapy -- usually as an adjunct to conventional treatment, but sometimes on its own -- has produced a slowing of tumor growth, occasional regression of tumors, and, in some cases, remission, even in "hopeless" or "terminal" cases.

Proponents of Iscador claim that it is the only well-known cancer drug with a double-barreled effect -- the destruction of cancer cells combined with a stimulation of the body's natural defenses. One theory holds that mistletoe proteins have a direct effect on DNA's genetic code, preventing the "translation" of the gene segments responsible for accelerated, uncontrolled cell division. Despite a growing international medical literature in support of Iscador's anticancer properties, the mistletoe extract is blacklisted by the American Cancer Society.

The ACS condemnation is based on an evaluation of the literature undertaken by Dr. Daniel Martin, a surgeon who has been an outspoken opponent of unorthodox therapies, and Dr. Emil Freireich, a pioneer of chemotherapy who was on record as an opponent of nonconventional cancer treatments. The two doctors found that the seventeen positive clinical and scientific papers sent to them on Iscador constitute "no evidence" of efficacy.2 While Iscador is not widely used in the United States, some American physicians incorporate it in their practice.

American doctors can legally order Iscador directly from European manufacturers, even though the extract is not approved for sale in the United States.

A handful of physicians in the United States who practice an Anthroposophically extended medicine include mistletoe as part of their therapeutic protocol. American patients can elect to travel to Europe for Iscador treatment. Mistletoe therapy is available at clinics, at hospitals, and in private practices in Switzerland, Germany, the Netherlands, the United Kingdom, Austria, and Sweden. Iscador has been used mainly as an adjunct to surgery, radiation, and chemotherapy. The best results have been obtained in the treatment of solid tumors both before and after surgery and radiotherapy. Clinical trials at the University Hospital in Munich and in Basel, the Wien-Lainz Hospital in Vienna, and the Lukas Klinik have shown that Iscador therapy improves the survival rates for cancers of the cervix, ovaries, vagina, breast, stomach, colon, and lung as well as other locations. Preoperative mistletoe therapy is given for ten to fourteen days prior to surgery. Its aim is to help prevent metastatic spread of the cancer due to the surgical intervention.

Postoperative treatment is ideally begun immediately after surgery or radiotherapy. It is continued for a number of years, with a gradual reduction in dosage and an increase in the intervals between courses of injections. This follow-up treatment reportedly reduces the risk of recurrence after surgery or radiation. Iscador is usually administered by subcutaneous injection at or near the tumor site. In some instances, it is given orally, such as with primary tumors of the brain and spinal cord. A typical course of treatment consists of fourteen injections given in increasing concentrations. In postoperative care, injections can be administered by a nurse or a relative, or by the patients themselves, with a progressive reduction of doses. Thus patients can look after themselves, as diabetics do, and need only see a doctor for occasional checkups.

Over the decades, Iscador has proven to be generally free of side effects, though many patients experience a moderate fever on the day of the injection and, in some cases, inflammation around the injection site, temporary headache, and chills. Very rarely, a local or general allergy develops, with skin reaction, shivering, bronchospasm, or shock, which may require discontinuation of the treatment. Many cancer patients given Iscador therapy experience reduced pain, relief of tiredness and depression, better sleep, improved appetite with weight gain, and elevation of hemoglobin and red-blood-cell levels. Where Iscador therapy does not bring remission, it improves quality of life and may extend life. The best responders to Iscador are carcinomas of the bladder, genitals, and digestive tract, and melanomas, according to Dr. Rita Leroi, who for many years was the supervisor of the Lukas Klinik. She says, "Breast cancer in women is a somewhat difficult field; for these, our best results are in the postoperative phase, whereas the present tumor is often refractory.

A similar situation arises for inoperable lung carcinoma where we cannot boast of more than a somewhat longer life expectancy, whereas results with operable lung carcinoma are especially good."3 In treating inoperable tumors, prolonged Iscador therapy sometimes results in a better demarcation between the tumor and its neighboring tissues. This makes surgery possible and sometimes leads to the arrest of the tumor growth or even an occasional regression. When Iscador is used concurrently with chemotherapy, hormone therapy, or radiation, it often alleviates the undesirable side effects of these conventional treatments. But the best results with inoperable cancers have been obtained with tumors of the bladder, stomach, intestine, and genital organs, as well as skin cancers.

The growth of bone metastases is often retarded. However, the results are not as good in treating inoperable cancers of the breast, lungs, or esophagus. Iscador is also used to treat cancers of the bone marrow, connective tissue, and blood-forming organs, specifically lymphomas, sarcomas, and leukemias, although it is less effective with these cancers than with the solid carcinomas. Leukemia does not usually respond well to mistletoe therapy. Anthroposophical physicians also recommend mistletoe extract for what they consider precancerous states, such as ulcerative colitis, cervical erosion (such as dysplasia), a chronic gastric ulcer, abnormal growth of breast tissue (proliferative mastopathy), and Crohn's disease (chronic inflammatory bowel disease). Rudolf Steiner believed that mistletoe preparations could correct the imbalance between the body's "form-giving forces," which create structure and find expression in the immune system, and its "cellular forces," which regulate cell division and growth. In Anthroposophical medicine, the form-giving tendencies hinder the development of tumors, but when these individualizing, formative forces are critically weakened, cellular growth gains the upper hand and, if unchecked, can lead to cancer. Factors believed to disrupt the formative forces include environmental carcinogens, impurities in the daily diet, poisons such as alcohol and tobacco, and chemical or genetic damage to the embryo.

Beyond the physical, cancer is viewed by Anthroposophical medicine as a disorder that generally has its roots at the level of soul and spirit. "Severe strokes of fate, failure of life-plans, unsatisfactory conditions of life etc. weaken the immune system... depressing the form-giving principle," according to Rita Leroi, M.D.4 Dr. Leroi also says, "The essence of cancer lies... in a certain paralysis and disintegration of the higher principles, a process beginning on the level of spirit, trickling down gradually into the soul and the physical body."5 As the formative forces weaken and lose their ability to keep cells performing their specialized functions, the cells become autonomous and selfish. "The cancer cell falls back into its own individual life -- it no longer puts itself into the services of a higher organ or organism -- it becomes egotistic," explains Anthroposophical physician Friedrich Lorenz.6 Just as the cancerous growth acts autonomously, rebelling against the ordering principles of the organism, so, in the realm of soul and spirit, a parallel process takes place in thinking, feeling, and willing, according to Anthroposophical medicine. "When thinking separates itself from feeling and willing and carries on its own, separate activity, then it also separates itself out of the reality of its proper purpose," writes Lorenz. "Thoughts become icy-cold and without love."7 Feeling, if no longer guided by thinking and will, leads to selfish desire, greed, and addiction, emotional or physical. Willing, if not imbued with life-filled thoughts or true feelings, becomes a destructive force. "In our day and age, we are surrounded by these phenomena world-wide -- the same tendencies which manifest themselves in cancer as a tumor," states Lorenz. Steiner predicted the anticancer properties of mistletoe extract, which he named Iscador, through an intuitive understanding of the plant's striking botanical characteristics.

Unlike other plants, which align themselves with either the Sun (through heliotropism) or the Earth (through geotropism), "mistletoe is a self-willed plant in that it behaves as if the Earth were not there," says Leroi. A bushy plant that grows on trees, drawing off the water and mineral salts it needs, the European mistletoe "grows in any direction which happens to suit it, sideways, downward, any direction where it finds room to build up its own inner space."8 Mistletoe also goes its own way with respect to time: it produces berries all year long, and it flowers in the winter. Mistletoe has no real roots but penetrates the tree's wood with sinkers, wedge-shaped rudimentary organs. Steiner described mistletoe as a survivor of an ancient epoch in the Earth's evolution, a time before the surface of firm mineral ground had formed. In his scenario, there was a soft primeval mass with islands that supported the growth of plants at a developmental stage somewhere between our present-day plants and animals.

Steiner believed mistletoe to be such an "animal-plant," left behind from the "Old Moon period" of the Earth. He spoke of mistletoe's "insane aristocracy," its tendency to do everything by its own rhythms, in its own time. "Just so is the tumor a manifestation of forces that work in an insane way in the human organism," observes Leroi. "But mistletoe conquers the tumorous tendency with its own rhythmically built-up formation, and with its exaggerated flowering impulse in which differentiation, subduing mere growth, is evident. This dynamic power to overcome tumor growth, conveyed to patients by injection of a suitable preparation, has a healing effect."9 Iscador, a fermented extract of the whole mistletoe plant, is manufactured by a "method designed to enhance the plant's formative forces. Part of the processing takes place in a centrifuge, which blends saps extracted from plants in summer and in winter "to create a unity." The mistletoe used to produce Iscador grows on various host trees: oak, apple, elm, pine, and fir. "Iscador M" refers to preparations made from mistletoe grown on apple trees and is used to treat women with cancer. "Iscador P," from pine trees, is for both men and women. Different preparations are chosen according to the patient's gender and the location of the primary tumor. Some types of mistletoe extract are combined with minute quantities of various metals, such as silver, mercury, and copper, thought to enhance the activity of Iscador on specific organs and systems. For example, an Iscador preparation with copper is used for primary tumors of the liver, gallbladder, stomach, and kidneys.

Metals are added in exceedingly diluted concentrations, for instance, one-hundredth of a milligram of copper per one hundred milligrams of mistletoe. (In contrast, the dietary Recommended Daily Allowance for copper is two milligrams.) The European mistletoe (Viscum album) is a different plant from the American mistletoe (Phoradendron flavescens). The herb should be taken only under proper supervision. The berries are poisonous and should not be eaten. Persons with heart trouble should be careful when using mistletoe, since it raises the blood pressure and speeds up the pulse. Mistletoe extract should never be taken at the same time as any prescription medicine containing a monoamine oxidase (MA01) inhibitor; the mixture will cause serious side effects. In Anthroposophical medicine, cancer is not so much a tragedy as an opportunity to undergo inner spiritual change and find new direction. For Steiner, the patient is a being of body, soul, and spirit who has the capacity for wrestling with the illness and even growing through it.

The Anthroposophical physician enters into dialogue with patients to help them solve personal problems and gain insight into their destiny and their illness. Patients are encouraged to see the cancer not as a punishment but as a springboard for a change of mind and heart, allowing new impulses and new possibilities to be nourished. In Dr. Leroi's words, "We endeavor to help patients realize that their soul and spirit are an indestructible, God-given integral whole, and that they can grow inwardly because of their illness, even if it were to lead to disintegration of the physical body."10 At the Lukas Klinik, Iscador is part of a program encompassing diet, herbs, and therapies that use art, music, and movement. Artistic activities like painting, clay modeling, creative speech, and color therapy lift the patients out of their fixed habits and help them unblock their creative faculties. Eurythmy, involving rhythmic exercises, allows the soul to "breathe freely" again; group eurythmy is intended to help "introverted and self-centered cancer patients... learn hereby to take notice of other people and to move along with them in a common rhythm," according to Dr. Leroi.11 Physical therapy includes oil massage as well as heat in various forms, such as hot baths with oils or herbs "prescribed in order to activate the warmth organism."

Heat therapy not only boosts the immune response but is also valued by Anthroposophical healers for creating warmth believed to permeate the entire disease process at all levels. The vegetarian diet recommended by the Lukas Klinik consists of organic, fresh fruits and vegetables, whole grains, juices, salads, olive and sunflower oils, some butter, sour milk, yogurt, and light cheeses. Foods to be avoided include tomatoes (held to be carcinogenic), mushrooms, hardened fats like margarine, and refined sugars. Alcohol and cigarettes are taboo. Patients should follow a light diet, with small meals taken at regular intervals and fairly frequently. Fifty years of research on Iscador's antitumor and immune-enhancing properties support Rudolf Steiner's original insight, even though his goal -- a complete disintegration of the tumor -- has only been achieved to a limited extent. A 1990 study found that in cultures of human cells, a mistletoe lectin (protein) increased the production of tumor necrosis factor-alpha, a hormone secreted by immune cells that destroys cancer tissue. This lectin also boosted the production of interleukin-1 and interleukin-6, important mediators of immune response.12>

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