A Basis for the Understanding of Anthroposophical Medicine and Cancer Therapy

By: Peter Heusser

Translated by Harold Jurgens with permission from Mitteilungen aus der Behandlung maligner Tumoren mit Viscum album. 19(3), 140, 1987, Verein fur Krebsforschung, Arlesheim. Addendum 1990. ©1991 Mercury Press, JAM 8(2), Fall 1991

Introduction

Anthroposophically oriented medicine is sometimes reproached for being based on a world view and not science. 1,2,3 If one thinks about this view one notices two things.

Firstly, those who utter the reproach about a world view are apparently unaware that this also applies to them, because they also represent a world view, namely the modern scientific one. A science of medicine without a world conception is actually impossible. Every therapeutic method presup­poses specific knowledge, concepts and ideas about man and medicine; in short, it presupposes a definite view of man and nature. One can not really reproach someone for having a world conception. The only justifiable ques­tion is to what extent a world conception can be scientifically established. And this applies to every world conception. Therefore critics would have to say why they think their view is scientific while the anthroposophical view is not. However, one finds no such statements because the critics look neither at their own cognitional foundations nor at the anthroposophical ones. 4,5,6,7

This brings us to the second point; namely, anyone who wants to judge the scientific foundation of the anthroposophical world conception has to know it. However, the critics mentioned do not seem to know it. They ac­cuse anthroposophy of not being scientific, but paradoxically they do this without taking the anthroposophical cognitional foundations and the latter's connection with natural science into account. This is paradoxical be­cause the consideration of this foundation has to be expected precisely from those who believe that they have to defend science against anthroposophy. Under such conditions it is of course impossible for them to understand anthroposophically oriented medicine.

Public discussion about this medical line of thought is usually stirred up by mistletoe therapy for cancer and very often this is in connection with the Iscador therapy developed by the Society for Cancer Research in Arlesheim and Stuttgart. Therefore in this paper we will discuss the foundations of anthroposophically oriented medicine in a general way. We will go into anthroposophical spiritual science and its relation to natural science and then into the relation of the anthroposophical view of man to medicine, and finally into an example of the practical application of these foundations to mistletoe therapy for cancer, as far as this can be done within the framework of this paper. This should make it clear that anthroposophy does not try to oppose natural scientific medicine nor does it try to offer an "alternative" but that it tries to extend natural science in a particular way. Only in this context can mistletoe therapy become comprehensible.

Chapter 1

Anthroposophy as Spiritual Science and its Relation
to Natural Science

A cognitional and scientific foundation of anthroposophy and its fun­damental relationship with natural science is to be found, among others, in six of Rudolf Steiner's books. 8,9,10,11,12,13 Without a knowledge of the foundation of anthroposophy given in these works, it is not possible to form a judgment about the scientific character of its view of man 14,15 and its ap­plication to a special field such as medicine. 16,17

Of course, the scope of this paper does not permit an extensive presen­tation of these basic principles and thus readers are referred to a study of the books mentioned. However, a central question of human cognition will be pointed to and the answer to this will enable one to understand that (and to what extent) anthroposophy is not an alternative to natural scientific medicine or something that is opposed to it but that it brings an extension to it. It is the question: Do the laws gained in the cognition of a real thing or process have a real significance for the object itself, or are they only subjec­tive classification-criteria for our world of percepts? Seen historically this question was extensively treated in the scholastic debate between the nominalists and the realists (about universals).18 As one will see, however, these principles are of decisive importance for the world conception of modern natural science.19,20,21 Therefore we will take this question as our starting point.

For nominalists the general law (general, and therefore universal) which is thought in a conceptual form has no significance for the particular, per­ceptible thing. It is only an abstract summary of the latter's most important characteristics, a purely ideal diagram in the subject's consciousness, a mere name ("nomen") for the perceived phenomenon, and one only looks for ob­jective reality behind this. Kant still considered the categories to be some­thing subjective in this sense, whereas the "thing in itself" behind the perceived phenomenon is thought to be objective. 22 For the realist, the law grasped by the knower works in the phenomenal world in a real way and does so completely independently of the subject (e.g., the structural law of a perceived substance, such as a crystal). What is grasped in man's conscious­ness as the law of a thing is identical with the law working in the thing, as far as its content goes. However, it has a different state of form, depending on whether it really works in the thing (as "universale in re") or whether it is thought of in a merely ideal form (as "universale post rem"). A third state of form must be distinguished from these two, namely that of "universale ante rem" in which the law is neither thought nor does it actually work in the things, but in this state of form the law is potential; that is, there is a real possibility (Lat: potentia, Gr: dynamis) that it will be realized "in re" (Lat: actus, Gr: energeia) or that it will be thought "post rem."

The standpoint of thought realism is the only consequent one. Firstly, cognition would not be possible at all if the cognizing subject could not grasp the law working in the object. And secondly, whoever says that such a cognition is impossible contradicts himself, because he presents his state­ment as an objective certainty with the aid of concepts and ideas to which he does not want to concede objective value otherwise. Seen in this way nominalistic subjectivism cancels itself. 23

Yet supposedly authoritative theoretical scientists are still nominalists today. Like Kant they do not consider cognitional concepts to be objective truths but think of them as subjective or psychological hypotheses. 24,25 It is clear that natural scientists who are under the influence of this view of cog­nition look for access to reality exclusively in or behind the perceptible world of phenomena, and that they only want to use concepts and ideas to copy or explain a perceptual world which is thought to be finished and complete in itself. In their view the contents of concepts and ideas have nothing to do with the finished reality of the percept.

For Steiner on the other hand, and incidentally also for the scientifically active Goethe, 9,10 the content of perception as such is nothing finished or closed off, which need only be copied or explained by the concept. For what is pure perception before it is elaborated by thinking? It is nothing else than an aggregate of disconnected details, none of which have anything to do with any other, and insofar as they are merely perceived they are all indif­ferent to each other. "If it is to become clear to us that this or that fact has greater significance than another we must not only observe the things but put them into thought relationships.”26

What is perceived remains a riddle for us without this thought relation­ship. This riddle is only solved if we add a conceptual content to the mere perceptual content through thinking. Thus thinking is not something abstract and without content but it brings its own quite definite and concrete content from man's world of concepts and ideas to meet the perceptual content.27 This conceptual content is what we can call the explanation of the percept,27 and therefore it is the actual "what" or "being (essence)" of the phenomenon.28

Now there is no reason to suppose that this conceptual content is not just as much an element of reality as the perceptual content which it ex­plains. Of course we are absolutely certain that the concept has to be brought forth by our own thinking activity.29 But this bringing forth is not a "creating" but a "bringing to light." Only because we are so certain that our thought act is our own activity can we be misled into thinking that our thought content is also created. However exact observation shows that only the act is experienced as our own creation whereas the content is one which is independent and self-subsistent.10 This is why we experience this content as "lawfulness" or "necessity" because it "compels" us to think it the way it is.

Just as the content of perception is given so the conceptual content is given, but in a different form. If our sense organization is intact the content of perception is given to us without any help from us. By contrast, the con­ceptual content only appears to us through the mediation of our own ac­tivity. However with respect to their being given in principle and therewith with respect to their objectivity, both are of equal value.10

It can also be established that percept and concept are not only two equally justified, given elements of cognition—even though they are given in a separate and different way—but with regard to their factuality and con­tent they also belong together as elements of one and the same reality. This establishment is given if one can experience both these elements and their connection as "given." This is the case in real cognition, which one can describe as follows:

Thinking's first act is to bring up a particular concept for a particular percept. This has to coincide with the percept with regard to content if it is to represent the lawful relation of the latter's elements. Thinking tests whether it does this in the second, actual act of cognition by bringing per­cept and concept together. 30 In cognition, as Steiner understands it, thinking does not arbitrarily bring about a connection between percept and concept but it continues to look for the right concept until a factual coincidence of the same with the percept results. Only this result can be called cognition.31

Thus the contents of percept and concept belong together and they rep­resent two complementary sides of one and the same reality. "The percept is therefore nothing finished or complete but is only one side of the total reality. The other side is the concept. The act of cognition is the synthesis of percept and concept. Only the percept and concept of a thing constitute the whole thing.”30

It is not due to the things themselves but to our cognitional organization that the laws working in nature do not appear to us directly from outside as the perceptual side of this nature does, but from within, and then only through the mediation of our own thinking activity.32

"The thoughts [naturally what is meant is the objective thought content and not the subjective thought form, P.H.] belong to the reality of the sense world except that thoughts in the sense world do not appear outside on this, but inside man. However thought and sense percept constitute one exist­ence. When man looks at the world with his senses he separates the thought from reality; however, the former just appears in a different place, namely within the soul. The separation of percept and thought has no significance for the objective world; it only occurs because man is placed in the midst of existence. Therefore the illusion arises for him that thought and sense per­cept are a duality."33 Thus the real crystal is not only the substance accessible to the senses but it is the unity of the same with its lawful form which is only accessible to thinking.

Rudolf Steiner's science of knowing (epistemology) leads to the verifica­tion that the idea is a constituent element of reality and it also provides a presuppositionless foundation for the reality of universals.34

The answer to the basic question as to whether ideas are objective realities or merely subjective ideals or nomina is of great importance not only for philosophy or epistemology but also for modern natural science, because it has consequences which are of fundamental importance for the natural scientific picture of the world. According to the foregoing, what is this law which is grasped by the natural scientist in idea form and which is some­thing actually working in nature? It is an "ideal" but at the same time a "real" and therefore a real spiritual something. There are two important consequences for the world picture of anyone who realizes this. Firstly, mat­ter down to its smallest parts is only material to the extent that it is a phenomenon, but as a lawful "what" or essence it is ideal, i.e., something spiritual. The grasping of this fact signifies the overcoming of the materialis­tic view of matter. Materialism arises because the essence of the phenomenon is sought in or behind the latter instead of in the ideal (through thinking).

And secondly this spiritual something, as a real constitutive law of a thing or process, cannot be considered to be something "merely" ideal. It is true that the law in human conceptual form (as universale post rem) is ex­perienced as something which is merely abstract, intellectual, shadowy and lifeless; but as an element which really works in things (universale in re) the form has to be endowed with a concrete, active force, otherwise it could not regulate substances. Therefore the aristotelian Vincent Knauer says that this law "cannot and must not be a mere thought thing, even though it is only accessible to thinking and not to the senses, but it has to be something active and therefore very real."35

We have now reached the point where the fundamental relationship of natural science and Rudolf Steiner's anthroposophically orientated spiritual science can be discussed. The natural scientist who sees that his grasped, lawful, essence determinations have to be realities in the above-mentioned sense will also be able to admit that this spiritual science is not only justified but that it should be demanded by natural science as a scientific form which complements it and extends it. Then not only the lawful effect of the work­ing laws in the sense perceptible phenomenal world is to be concretely in­vestigated (this is the task of natural science), but also the direct working of the law as such is to be concretely investigated, be it in its actual or potential state of form (cf. p. 7). For the forces with which the laws work within the framework of nature are not perceptible to the senses. Thus not a single sense organ can be named by which electromagnetic, radioactive, chemical or other known forces of nature could be directly perceived. All forces which work in the chemical and physical realm can only be made visible in­directly through their effects in the sense perceptible realm (e.g., color, movement of small parts, etc.) and then on the basis of these effects they must necessarily be thought of as elements which have a real effect.36  This applies already to the realm of the inorganic or mineral world, but even more to all other more complex, active processes in the organisms of living, ensouled and spiritually-endowed entities (plants, animals and man), whether these processes are of a normal physiological or pathological kind. All processes which can be the object of biology and medicine have to be recognized as concrete realities even though they are withdrawn from direct sense perception. From this point of view natural science is at the boundary of its cognition with respect to the realms of active processes (forces, ener­gies) as such. Thus for a direct investigation of these realms it has to demand a higher form of cognition which relies on supra-sensible percep­tion and which proceeds just as scientifically within its field of perception as natural science does with its realm.

The idea of such a cognition of the supra-sensible realms of reality and a science based on it was already consequently thought out and demanded by several middle-European thinkers in the first half of the 19th century, for ex­ample by the physician and philosopher I.P.V. Troxler (1780 - 1866) who wrote of an "anthroposophy" which would provide a new foundation for medicine; then also by I.H. Fichte (1796 - 1879), and F.W.J. Schelling (1775 - 1854).37

In his anthroposophy Rudolf Steiner (1861 - 1925) founded such a science of the supra-sensible epistemologically, described its method exactly, gave it a detailed content and also realized it in concrete areas of life such as the practice of medicine.

The epistemological foundation is given in the books mentioned above (p. 5). The anthroposophy of Rudolf Steiner is to be understood as a spiritual science which investigates the supra-sensible realm while using the same principles of cognition which natural science uses for the physical sense world.9 The realm of perception is different for each, but the general scientific character remains the same. Spiritual science "desires to free the natural-scientific method and its principle of research from the special ap­plication that limits them, in their own sphere, to the relationship and process of sensory facts, but, at the same time, it wants to retain their way of thinking and other characteristics. It desires to speak about the supra-sen­sory in the same way natural science speaks about the sensory. . . . Its method does not speak about the sense phenomenon as such, but speaks about the supra-sensory world content in the way the scientist talks about the content of the sensory world. It retains the mental attitude of the natural-scientific method; that is to say, it holds fast to just the thing that makes natural research a science. For that reason it may call itself a science."38

The method by which the supra-sensory capacity for cognition can be attained has been described by Steiner at great length in many books.14,15,39 It is firstly based on a stepwise development of the capacity of perception for supra-sensible reality through systematic exercises and secondly on the capacity to rationally penetrate everything one experiences in the sensible and supra-sensible according to the described principle of scientific cogni­tion.9 This latter capacity can already be developed in natural science.

The principle of the exercises which lead to the capacity for perceiving the supra-sensibly real can become clear if one considers the following: al­ready in ordinary natural scientific cognition there is a point where one can experience not only an ideal, abstract element but a concrete, real spiritual element every day, except that one usually does not become aware of this fact and its consequences. Thought content and pure laws are experienced as things which are feeble, shadowy and ideal. However, thought activity is experienced as an ideal, but very real force, and the thinker is absolutely sure that he is generating it. The experience of our thought power is the first and only point where we can have the certain experience of a real supra-sensory force within our ordinary consciousness. The principle of the exer­cises mentioned consists in systematically strengthening ordinary thought power through intense concentration on simple, easily surveyable thought contents to the point where this, at first, still indefinite force-experience can be extended to the differentiated perception of very different force-activities within and without man. 16,39 Here one should expressly emphasize that all exercising and cognizing in the Steiner sense presupposes that level of con­sciousness which ordinarily can only be experienced in purely logical or mathematical thinking. By contrast with teachings which go back to earlier civilizations, anthroposophy has nothing to do with a lowering of ordinary consciousness.40 It is a modern western science.

The content of what has been thus perceived and grasped logically and conceptually by the spiritual investigator is then presented by him in the usual conceptual form. What he presents can only be discovered by some­one who has developed the supra-sensory cognitional capacity for himself. However, it is rationally comprehensible to anyone who applies a sound sense of truth and open-minded logic to it.15 Therefore the testing of the results of spiritual scientific investigation is also possible for those who have not developed the faculty of supra-sensory cognition themselves.

This testing can be done in two ways: Firstly, the spiritual scientific statements must be logical and they must be self-supporting. (It is under­standable however that one can not judge single statements of the spiritual investigator if they are torn out of their overall context). Secondly, spiritual scientific contents must not only be logical but they must be applicable to concrete situations in life. What works supra-sensibly must also find an expression in the world which is accessible to ordinary consciousness. This kind of testing is especially important in medicine. Steiner said that his spiritual scientific statements about medicine were only guidelines or work­ing hypotheses, which should only be accepted as scientific certainty if they fit in with and are applicable to the empirical truths of natural science. 41 "You will see that these working hypotheses can be verified in the same way in which hypotheses are customarily verified in medical science. In no way do we want these things accepted as assertions without prior verifica­tion.” 42

Therefore one should not see a contradiction in principle in the fact that representatives of anthroposophically oriented cancer therapy and medicine base their medical thinking on findings about health and illness which have come from spiritual investigation, and that they also want to bring natural scientific facts into a relation with these. On the contrary, this relation is a necessary one. It is to be expected because the regions of reality dealt with by natural science and spiritual science are two sides of one overall reality. Therefore a natural science which understands itself demands a spiritual science such as Rudolf Steiner understood it, as extension and complement.

Chapter 2

The Anthroposophical View of The Human Being as
a Foundation for an Extension of Medicine.

In the preceding chapter we pointed out that in principle anthroposophy or spiritual science represents an extension of natural science. We will now go into certain aspects of the content of this extension insofar as it is of impor­tance for the picture of the world and man which underlies medicine.

A so-called holistic knowledge must not look upon man as a physical body only but must see him as a differentiated unity consisting of body, soul and spirit. For only in this overall context can health, disease and therapy be fully understood.

According to Steiner, knowledge of the physical human being can only be gained through present-day natural scientific methods.16 For the reasons mentioned earlier a knowledge of the higher parts of the human being through direct vision is only possible by means of suitable spiritual inves­tigation. This leads to three important results with regard to the principle behind the picture of man, which round off natural scientific findings about the physical side of man into an overall view. These results regard man's body, soul and spirit.

Let us begin with the "body" or organism. In principle no distinction is made between the inorganic and organic in modern biology and medicine. An organism is supposedly just a complicated mechanism. In all biological, veterinarian and human medical disciplines one considers life processes to be mechanisms. 44 One imagines that a substance works on the next one in a kind of chain reaction or in the way that one part of a machine works on the adjacent part. One thinks of these reaction chains purely mechanically and talks about feedback in the sense of so-called cybernetic feedback control systems, and one considers the organism to be a complex network of such feedback control systems. People, like the proponents of the latest life theory called synergetics who think more in chemical categories, imagine life processes to be circular chemical reactions such as the Belousor-Zhabotinsky reaction which seems to run by itself.45

However such purely chemical or mechanical explanations of life are really the result of an inexact way of thinking. To be consequent in one's thinking about these reaction chains one would also have to include their constructors. For the lawful arrangement of the individual links of the chain in the proper order, and the forces through which this order is realized, and the impulse which is given for a properly regulated function have to be brought to the links from outside and are therefore not explainable through the latter. Many scientists realize this and therefore use "chance" as an explanation (i.e., Monod 46). Yet chance explains nothing. As an explanatory principle it is just as unscientific and obscure as any unknowable metaphysical principle. One has to see that the consequent comparison of mechanism and organism necessitates one to think in terms of a superordinated creative instance for the latter. For the parts and their forces and laws in a mechanism such as a clock, are coordinated with each other. Whereas the laws (plan) and the forces by which the organism's designer brings about the lawful arrangement of these parts are superordinate to them.

However there is a fundamental difference between an organism and a mechanism. The law of the mechanism is outside it. The mechanism does not realize this law itself, either structurally or functionally. But the or­ganism realizes its plan itself. What is outside the machine is inside the or­ganism. The law and the power to realize it have moved into it.47 It contains its superordinate constructor in itself.

This means that one has to speak of two classes of regularly working forces in the organic realm—as opposed to the inorganic realm. Firstly there are the forces in the underlying material parts which are coordinated with each other. (This class includes all the chemical, physical and electromag­netic forces etc. which are known to present-day natural science). And secondly there is a class of forces with whose help the organic form or plan (superordinated to the substance) realizes itself structurally and functional­ly. Since these forces constitute the difference between the organic and inor­ganic one can call them "organic formative forces”8 without anticipating their real nature with this expression.

Since formative action occurs during the organism's life span and not only in the beginning, as in the mechanism, the formative forces have to be thought of as being continually active. And since this activity is one which is highly organized and is always related to the entire organism, it has to be ascribed to a concrete force organization. One should not think of the latter as being like a rigid electromagnetic field because the developing organism is continually active. One therefore has to do with an organism of living for­ces which one can also call a body of formative forces,14 if by "body" one does not think anything physical or material but understands it as the just-mentioned continually active organic, formative force system. According to this, every organic physical body must have such a body of formative forces underlying it and forming it.

On the basis of its regular effects in the physical body the real existence of such a body of formative forces must be accepted with the same necessity as for example in the inorganic realm one has to infer the concrete working of the force of magnetism on the basis of its effects, even though it is inacces­sible to direct sense perception. However the general acceptance of the existence of such a body of formative forces is still not the same thing as a dif­ferentiated knowledge of its concrete workings as such.

As shown above (p. 8) direct knowledge of concrete organic action is not possible for natural scientific investigation but only for the aforemen­tioned, complementary, spiritual investigation. At the level of imaginative cognition 15,16 (which is the first of three stages of supra-sensory cognition) spiritual investigation leads to insight into the reality, the regular nature and the differentiated organization of this organism of formative forces, which can only be postulated by natural science. In harmony with histori­cally older, more instinctive views, Steiner calls this the etheric body. 14 (This organization of life forces was known by all the writers of ancient medical works and later on also by van Helmont and Paracelsus, but more recent proponents of vitalism only had an unscientific inkling of it). Only the name goes back to the older views. These views are of course quite inferior to the modern form of scientific knowledge. 16

Such an etheric body is active in every organism until the latter dies and it is responsible for the latter's vital functions of growth and reproduction and also for all defensive processes and self-healing processes. The "organic self" which uses immunological processes to defend itself against foreign objects or against some of its own substances which have become foreign (e.g., tumors) is based on this etheric body. (In this connection what is said below about DNA in general, also applies to the so-called histo-com­patibility genes). It is clear that knowledge of this etheric body and its laws must also bring corresponding viewpoints from therapeutic practice.

The reality of this etheric body presented by the spiritual research of Steiner can be verified (cf. p. 10) by means of natural scientific research it­self. For example we have Spemann's experiments with fertilized sea urchin eggs; after the developing germ is artificially divided at an early stage one does not get two halved sea urchins but two whole, albeit smaller, sea ur­chins, even though up until they were divided the overall plan to be real­ized was distributed over both undivided halves. 48 These and other more recent genetic experiments 49 prove (also to natural science!) the existence in principle of two levels of reality: a law-receiving, material one (to which DNA belongs) and a law-giving one which in this case is capable of arrang­ing the totality of organic matter (including DNA) in a new way, both struc­turally and functionally. The law-giving instance, or the organic plan and the system of forces which realizes it must therefore lie in a plane which is superordinated to all organic matter, although it of course maintains exact connections with this matter.

On the other hand modern biology does not think that the uppermost instance of life is above matter but thinks that it is in matter or in the hereditary substance DNA, and according to its central dogma 50 it ascribes vital phenomena to this in the same way that all motions in a machine can be ascribed to an initial pushing of a button. However it can be shown that DNA as such can not be the highest instance of the organism but must itself be subject to such an instance.

Firstly, DNA is not the information itself but it is its carrier. It only has that lawful connection with it which is well-known to us. 53

Secondly, DNA does not contain all of the organism's information, either qualitatively or quantitatively. Qualitatively, as far as its content goes, the DNA's coded information is nothing but the law of the primary protein structure and therefore it is the ordering principle for the beginning, se­quence and end amino acid chains in proteins. Not included in this informa­tion are the laws for the secondary and tertiary structures, forms, arrangements and functions of the microorgans of cells, cells, organs, and organ systems, or for their complex relationships within the overall organism. Thus, qualitatively only a part of the overall organic plan is coded by the DNA. Even quantitatively the maximum amount of information which can be coded by the DNA is completely inadequate. For example it would not suffice to explain the existing regular cross linking of neuronal networks, or immunological interactions. 51

Thirdly, one should realize that the DNA is just as dependent on the protein as the protein is on the DNA. For just as the buildup of a protein's primary structure is dependent on the presence of a quite particular DNA-nucleotide sequence, so conversely the buildup of the primary DNA struc­ture is dependent on a quite definite sequence of specifically acting enzymes (DNA-polymerases). The latter play an active role in nucleotide incorpora­tion, and a wrong or faulty enzyme leads to the incorporation of the wrong nucleotide. 52

These enzyme cascades are therefore no less information carriers for the DNA structure than the DNA is for an enzyme structure; 53 on the contrary, enzymes (proteins) also contain information for the higher DNA struc­tures, 54 and they are so mobile that in certain cases they can become carriers for different pieces of DNA information, as for example in the recombina­tion of a gene (see below). Insofar as DNA and protein presuppose each other, neither is superordinate to the other. Each is a code for the other's in­formation. Both are only parts which are related to each other in a whole. And since the law of the referend is always superordinated to the law of the reference, so too the force with which this referend is realized is hierarchi­cally superordinated to the force of the reference elements by one level. As was shown, the law of the relation and its force are to be sought in the or­ganism itself rather than outside, as in the machine (see p. 10).

Fourthly, the subordination of DNA to a law-giving instance superor­dinate to it becomes quite obvious in the recombination of genes, which was recently investigated and which plays an important role not only in bac­teria 55 but also for example in the highly specific immunological processes of higher organisms. 56,57 Through its B-lymphocytes or plasma cells the or­ganism continually produces specific antibodies or protein immuno­globulins against all kinds of foreign substances (antigens). The structure of these antibodies presupposes corresponding genetic information. Until a few years ago it was a riddle how the organism arrives at its information for such antibodies which, for example, are directed against entirely new kinds of foreign industrial substances which did not even exist before. Is all the defensive information about the macrocosm and about substances yet to be discovered already present in the microcosmic, hereditary substance from the beginning? This interesting but absurd view was actually advocated for some time. 58 Today it is known that the code for such information is not present in the organism from the beginning but is produced by the latter whenever it needs it. It does this by making a new combination of definite gene sequences in the appropriate lymphocytes which were differently ar­ranged before, 59 so that the desired immunoglobulin gene is produced. The recombination itself is always the result of a strict, regular, enzyme action. 60 This means that after a new kind of antigen contact a particular enzyme cas­cade becomes a carrier of information for a primary DNA structure which did not exist before and which therefore is not inherited or predetermined but arises for the first time. And since in this process the existent DNA rep­resents the law-receiving material which is subject to the giving of a new law, these genetic immunoprocesses prove in principle that DNA can not be the highest law-giving instance but must itself be subject to such an in­stance. According to what was said previously this instance can only be the organization of formative forces which constructs the physical body, i.e., the etheric body working in the physical body. It is the element which protects our organism against foreign objects. On closer examination therefore genetic and immunological-molecular biology does not lead to the estab­lishment of the materialistic and mechanistic explanation of life but on the contrary to its overcoming, though without losing any of its exactness in the process.

These viewpoints are of fundamental importance for the understanding of all organic processes in physiology and pathology and also for under­standing the effects of active substances. In the living organism one always has to reckon with two levels of active causalities of which the lower is sub­ject to the higher in a real way. A biocatalyst does not simply set a linear, causal, mechanical chain reaction in motion for which it is the effective cause (causa efficiens), but it activates a reaction which no doubt involves material interaction, but not just according to the inorganic realm's own ten­dency (otherwise one would face a corpse) but in accordance with organic laws of the action and coordination. These become realized through their forces and are therefore an organic causa efficiens which is hierarchically su­perordinated to the inorganic by one level. Seen in this way the bio-catalyst is not the effective cause in the sense of a mechanically conceived causal nexus, but is the conditional cause (causa occasionalis) of the organic reaction. The law (causa formalis) and force (causa efficiens) of the reaction have a lawful connection with this substance but their content is not explainable from it, i.e., from its law and its force-impulse. This applies to all active substan­ces, whether one is dealing with natural or synthetic drugs, enzymes, hor­mones, neuro-endocrine mediator substances or immuno-modulatory mediator substances, etc. Messenger substances which are information car­riers for an organic reaction are not the information themselves but only have a lawful relationship to it. The organic information is an organic law which is to be realized and therefore it is a supra-sensory reality (cf. p. 7) which is to be brought to manifestation in the sense-perceptible substance. Strictly speaking there are no pure operational mechanisms in the organism.

The overall plan of the organism is the unity of all its structural and functional information. Development, maintenance or restoration of the or­ganism is of equal importance with the stepwise realization of its differen­tiated partial laws. The realization of these laws is complexly organized. Here one has to differentiate between laws which act spatially and those which act temporally. The spatial whole, or physical organism is not real­ized all at once but its parts are brought to manifestation according to a definite, but at the same time mobile schedule.53

Thus a complex temporal law is superordinated to the spatial laws of structure and function, and a "time form" whose content does not result from the spatial law is superordinated to the physical spatial form. (One will therefore look in vain for a physical, inner clock which is an effective cause of the organic time program; at most one will find physical, conditional causes for the realization of this superphysical time program). What works there in time is the etheric body shaping the physical body; this is a "time body" with typical organic rhythms.61

The differentiated action of the etheric or time body in health and illness in connection with the content of the medical picture of man comprises a first large area in which anthroposophical, spiritual investigation constitutes a real extension of natural scientific research. For the former, the living body or organism proves to be the unity of physical body and etheric body. In this paper we will only be able to point to this extension in principle and we will give an example of it in mistletoe therapy. For concrete contents we refer you to a study of the original anthroposophical literature (see p. 5 ff.). But one can describe the exact point where natural science and spiritual science (in the sense meant here) meet.

In its investigation of the organic, natural science moves up from sen­sible empiricism to the grasping of the pure laws of the spatial and temporal organization (as for instance in histology, anatomy, physiology, chronobiol­ogy, etc.) But it only grasps these laws in a weak, abstract form (as univer­salia post rem, cf. p. 7). However in these laws it comes to meet anthroposophically oriented spiritual science. The latter also arrives at the organic laws, but from the other side.

It moves down from supra-sensory empiricism 62 or from the concrete perception of the action of these laws (as universalia ante rem or in re) to their abstract, inactive or paralyzed form. 12 What natural science says about the organization of the physical body is complemented and extended by what spiritual science says about the etheric body, and this knowledge can be ap­plied therapeutically.

A second and third realm for such an extension of natural science and psychology concern man as a psychical and spiritual being. Man is related to the mineral kingdom through his incorporated inorganic substances and forces. Through his organic (etheric) forces and soul forces he is related to the plant and animal kingdoms respectively. And through his I or the spiritual core of his being he is differentiated from the other three kingdoms of nature.

The action of soul forces in the shaping of the organic in animal and man has to be accepted as just as much of a reality as the action of organic and inorganic forces. This is proved, for example, by psychosomatic interac­tions and Pavlovian reflexes, etc. To be sure, recent psychology and biology have imitated the mechanical chain thinking which is only justified in physics, and therefore consider psychological processes and their interactions with other systems to be nothing but mechanisms.

Unlike plant life, animal life is not exhausted by mere vegetating or by the organic shaping of substance, but this shaping is subordinate to the higher psychological life. 63 Just as in the plant the working of inorganic for­ces is the "substance" for the superordinated organic forms, so in the animal pure organic action is the substance for a still higher soul form. This is a spe­cial, independent organization in each being and it is a kind of organism of a higher psychological kind, and on the basis of its manifestations its exist­ence would have to be demanded by psychology with the same necessity of thought as the existence of a body of formative forces working in the physi­cal body would have to be accepted by natural science. Direct, perceptible knowledge of this third member of man and animal is only attainable at the second stage of supra-sensible cognition known as inspiration. 15,16 Steiner usually chooses the expression "astral body" to name this member, in con­nection with those older, primitive spiritual views, which otherwise are not very useful for modern cognitional purposes. 16

Man is not only an ensouled being but in addition he is endowed with an individual spirit. Through his thinking, self-conscious, and self-determin­ing "I" man is clearly different from the animal which is not able to control its soul life and its drives, instincts and emotions but is driven or trained by these and by its natural and human environment. The physical and organic shaping of man is not only subordinate to psychical functions but also to spiritual ones. Therefore the astral organization has a still higher law-giving instance or I-organization superordinated to it whose reality or active form is only directly accessible at the third stage of supra-sensible cognition known as intuition. 15,16

Thus, according to anthroposophical cognition, man is a four-mem­bered being consisting of physical body, etheric body, astral body and an I. And in anthroposophical medicine the attempt is made to do concrete jus­tice to man as a totality, right down into individual therapeutic measures.

By contrast, school medicine or the critics of anthroposophical medicine still advocate the world conceptual materialism of the 17th, 18th and 19th centuries, whether it be in its monistic or dualistic form. For monists like de la Mettrie man is a machine, 64 and life, soul and spirit are reduced to mechanically acting forces and matter. Dualists also look upon man as a machine but as one with a nervous system (which today is considered to be a kind of computer) into which a ghost-like soul works in some way, 65 a la Descartes. These dualists do not distinguish between the inorganic and the organic nor between the soul and the spirit. With their mechanistically con­ceived psychosomatics they believe they can grasp man as a totality. But materialists do not arrive at man at all, and their picture of man is that of a highly organized, mechanistic animal.

Man is neither a machine nor an animal, but a human being, or a hierar­chically organized totality consisting of (enlivened) body, soul and spirit. Health and illness are not a matter of somato-psychic mechanisms and their defects in need of repair but they involve complex interactions of the four members of a being in an organ, organ system, or in the entire organism. The soul and spirit does not just live in the system of nerves and senses and produce its physiologically ascertainable traces there. 66 The real task of the nervous system is to make the soul and spirit conscious, but the soul and spirit also live unconsciously and in a differentiated way in all organs and organ systems. In fact, the differences between these systems come about because the physical body, etheric body, astral body and I interact in dif­ferent ways in each one. One also has to think of disease as a differentiated disturbance of these complex relations. Therefore the cause of a disease can exist at different levels, i.e., it can be physically, etherically, psychically or spiritually caused, and in man's case, it may be karmically determined. What the natural scientist establishes on the physical plane about a healthy or pathological process is not the whole process but the result of an interac­tion between the physical and superphysical (etheric, soul and spirit) ele­ments.

Medicinal therapy is not a matter of an activity mechanism which is in­duced by an active substance but it is a complex process which involves all four members of the human being, even though a specific effect on the physical body, the etheric body, the astral body or the I-organization is at­tained depending on the kind, origin and manufacturing process of the sub­stances used. This applies to all drugs including those from a materialistical­ly oriented pharmacy. Their main effects and side effects on vital psychical and spiritual functions indicates this clearly. Anthroposophical pharmacies manufacture their medicaments on the basis of presently available (spiritually - scientifically - deepened) findings about the relation of the various kingdoms of nature to the human organization. Thus different mineral, plant and (certain) animal substances are used in a rational manner. The medications are made and used in such a way that the organism is not overpowered, but self-healing processes are stimulated when possible. These processes can be supported by curative eurythmy, which is a move­ment therapy by means of which specific effects on organic and functional processes can be attained through regular forms of movement. Artistic therapy like painting, modeling and music, etc. can promote healing from the soul and spiritual side.

Anthroposophically oriented medicine and (natural) scientifically oriented medicine both take natural scientific findings about man's physical body into account. However, the former arrives at an extension of the latter by complementing the latter's findings with its own scientific findings about vital, psychical and spiritual elements in man and nature. Concrete therapeutic possibilities arise from this, such as mistletoe therapy in the treatment of cancer.

Chapter 3
Mistletoe Therapy and Tumor Resistance From an
Anthroposophical Viewpoint

The foundation of mistletoe therapy is only fully comprehensible if one takes its epistemological and anthropological foundations into account (chaps. 1 and 2). These foundations have to be assumed here.

From the foregoing one sees that anthroposophically oriented medicine is trying to develop a medical method which is based on the rational knowledge of the entire human being and his physical body, life organiza­tion, soul and spirit and also of his relations to nature. It is not simply a question of dealing with particular medications here, but what is involved is the elaboration of a comprehensive medical method in the above-mentioned sense.

The focus of this method is the concrete, individual patient and there­fore the therapy is individually tailored. Depending on need, it includes various measures, as for example, in cancer therapy. Mistletoe treatment is the most important but not the only element of anthroposophically oriented cancer therapy. Other elements include various plants such as hellebores, lichen preparations and colchicum, different mineral and metal prepara­tions, external and internal applications, curative eurythmy, and many others. As was said previously, their use aims at the differentiated stimula­tion of self-healing forces in the sick human being. Conventional measures are also used if necessary. These include operations where possible, hor­mone therapy, chemotherapy and radiation, when absolutely necessary. For the anthroposophical physician is always a "conventional doctor" who was educated in a conventional medical school. He does not aim at an alterna­tive medicine but at an extension of medicine in the sense indicated. And he practices this extension to the extent that this is possible under present con­ditions. Medicine is an art, and natural science and spiritual science furnish its elements.

If the following discussion seems to be exclusively about mistletoe therapy it is because this therapy is the most important element in anthroposophical cancer treatment and because it is currently the focus of public discussion. Therefore it will be used to show the relation of natural science to anthroposophical spiritual science in principle.

How is the natural scientific view about the warding off of cancer re­lated to the anthroposophical view and what role does mistletoe have in this?

Cancer development is a complex, stepwise process which often takes years, and it is scientifically traceable right down to its molecular and genetic elements. 67 A carcinoma is living tissue which has made itself inde­pendent from its organic connections. The organism's own tissue has be­come foreign tissue. The organism defends itself against this, but often in an inadequate or mistaken way 68,69 which is hard to influence therapeutically, and immunotherapy for cancer is relatively new. 70 Up to several years ago leading oncologists questioned whether the immune system's role in warding off cancer should be taken seriously. But there has been considerable progress in immunology since then and important things have come to light which may also become important for therapy.

1. Cellular sloughing reactions like those against foreign tissue seem to play a certain role. The specific action of T-lymphocytes against the tumor is of particular importance in this sloughing-off process, whereas T-cells depend on an intact thymus function. 72 Fifteen years ago the specific T-cell function was considered to be the most important factor in tumor defense.  This has not been fully confirmed, since tumor antigens are usually weak, i.e., they usually trigger immune responses which are not very specific. 70

2. Because this is so, the humoral defense reaction or the formation of specific antibodies by B-lymphocytes or plasma cells, is usually unimportant, and therefore therapeutic experiments along these lines have had few practical results. 70

3. Non-specific, natural immune defense seems to be more important than specific immune defense. It is almost certain now that natural killer (NK) cells and antibody-dependent killer cells (Antibody Dependent Cell-Medicated Cytotoxicity) play an important role in hindering tumors and in preventing metastasis.  Natural killer cells are lymphocytes which so far can not be assigned to B-cells or T-cells, and are therefore sometimes called "null cells." They can destroy tumor cells without previous antigen contact. Morphologically, killer cells belong to the group of so-called large granular lymphocytes (LGL), which are lymphocytes with coarse azurophilic granules in a weakly basophilic cytoplasm.74 Similar to killer cells, neutro­philic granulocytes and macrophages/monocytes play a role in tumor resistance, e.g., through their phagocytotic activity. 75

4. Tumor resistance is a complex process, i.e., it is not merely the occurrence of individual factors but the action of a system of humoral and cellular elements with which the organic "self” defends the entire organism against the parts which have become rebellious. But in patients with tumors, several aspects of this defensive system have been weakened or disturbed, either absolutely or in relation to tumor activity 70 and this worsens the prognosis. On the other hand, if these factors are more active the prognosis is improved. Thus it is known that the survival time of patients with operations can be correlated with the lympho-histiocytic infiltration of regional lymphnodes,76 that bacterially induced inflammations can destroy tumors, 77,78 that allergic people are less likely to get cancer,79 and that, con­versely, relatively few children's diseases and fevers can be found in the anamneses of cancer patients.80,81 In hyperthermic treatment various varia­tions of general inflammatory reactions are used against cancer therapeuti­cally.

These findings clearly show that the "inflammatory potency" of the or­ganic "self" contains a system of factors which is directed against the cancer process and that therefore this "self" can acquire prophylactic and therapeutic significance.

What is the organic "self" which should protect itself (with the aid of the inflammatory system) against foreign elements or elements which have become foreign? As can also be shown from a natural scientific and psychological standpoint (chap. 2) it is not a mechanism but an organism which is enlivened, ensouled (in man and animal), and in man's case also spiritualized. From an anthroposophical point of view the organic self is a physical organism whose life functions (including the defense against a non-self) are all regulated and activated by the etheric body. The etheric body for its part is regulated by the astral body in animal and man, and also by the I-organization in man. What natural science can discover on the physical plane in the field of human tumor immunology is always the result of life processes which in turn are influenced by the soul and spirit.82

What is a carcinoma? From the modern natural scientific viewpoint it is an enlivened part of an organic totality which has emancipated itself from the latter in a way which is known right down to its molecular details. This emancipation is only possible if the whole or a part of the whole loses its control-functions over the part for some reason. The information in the whole is no longer realized in the part.83 With respect to structure and func­tions the part withdraws from the differentiated directives of the partial whole. Progressive dedifferentiation is synonymous with the progressive development of malignant growths. Looked at in this way a carcinoma is really a form (or an in-form-ation) catastrophe. In this respect there is a reciprocal relation between the activity of the part and the activity of the whole. A carcinoma is not just a problem in the cell but it is a relation of the cell and the organism 84, and this is not just when the cell is to be eliminated but also when it is first formed. It is important to realize that the whole from which the part initially withdraws is the same one which should then defend itself against this part. One will then see that a weakened or insuffi­ciently active immune system does not eliminate the tumor sufficiently, but it does not cause it.70 In the further course of the disease there is a reciprocal relation between immune activity and tumor activity.85

The spiritual scientific research of Rudolf Steiner does not arrive at its results through hypothetical inferences, but through a direct, perceiving cognition of the supersensible parts of the organizations of man, animal, and plant, and therefore they are at first entirely independent of the percep­tible empirical findings of natural science. The next step is to relate the spiritual scientific findings to the natural scientific ones and here the spiritual scientific results have to be verified by natural science (cf. chap. 1).

According to spiritual scientific research, carcinomas arise in man be­cause the etheric body which is regulated by the astral body and I-organiza­tion, can not (generally speaking) extend the differentiated action of its for­mative forces over the entire physical organism as in a healthy person, but it is held up at a particular place in the physical body. 86 The cause of this can lie on the physical plane, e.g., through an outer attack, 87 or it can be caused by the abnormal activity of the etheric body itself, or by the faulty regulation of the etheric body by the astral body or I-organization. 89 An abnormal etheric activity then develops at the physical site in question and the former then emancipates itself from the overall etheric body and thus also from the astral organization and I-organization. The result is a carcinomatous degeneration. 86

Spiritual scientific findings about pathology lead directly over to therapy, with which one has to try to reduce the pathological condition and restore the relations of the members of being. Here one has to find measures to induce this regression and this restoration. 16 Rudolf Steiner's spiritual re­search furnishes knowledge about the deeper relation of man and nature which again is obtained directly by the spiritual investigator, that is, independently of the findings of natural science about this relation, and this then leads to therapeutic measures. Specific substances or processes in outer na­ture correspond to specific pathological processes in the sick organism. This knowledge of the relation of man and nature has nothing to do with analogism or with an external classification system. It is based on the aforementioned exact, perceiving knowledge which corresponds exactly to natural scientific procedure in its own province (chap. 1).

On the basis of his spiritual scientific investigations R. Steiner recom­mended mistletoe for cancer therapy and this was first put into practice by Ita Wegman. 90 This occurred without double blind experiments on man and animal but only with the spiritual scientist's intensified and direct capacity of insight into the relation of this special plant to the pathology of the human organism. What this insight reveals is that mistletoe develops a spe­cial form of etheric activity which expresses itself in a regular rhythm which is opposed to the growing rhythms of the rest of the plant world. 86 The spe­cial material and botanical characteristics of this plant 92,93 and its annual rhythms 91 which have been investigated by natural science are the physical results of special life processes which again are only directly accessible to the spiritual scientist. Thus mistletoe substances are connected with this plant's special life processes in a regular way. According to anthroposophi­cal cognition they should stimulate particular activities in the etheric body of the sick human being which are not functioning during the illness. The injected mistletoe substance is meant to stimulate the etheric body so that it becomes active again in the places where it is no longer active during the cancer process.

According to the above, in the early stages of cancer the malignancy would have to be reduced or stopped with mistletoe therapy in the ideal case and mistletoe would then be of importance in the prophylactic treat­ment of pre-cancerous patients. In fact, several clinically and histologically or experimentally verified cases in which malignancies regressed or were ar­rested are known. 94-97

Then again, according to the above, mistletoe treatment would have to activate defensive processes against the tumor which are dependent on the etheric body. On the basis of spiritual scientific connections the spiritual in­vestigator also demands this. According to Rudolf Steiner the injected mistletoe preparation should stimulate the life processes regulated by the astral body and I in such a way that an inflammatory warmth mantle is created around the tumor which aims at dissolving and eventually eliminat­ing the tumor. 98,99 To achieve an adequate effect, the inflammatory tenden­cy directed at the tumor should be increased by the appropriate dose, until fever reactions set in.99,100 As Steiner discovered through anthroposophical cognition, inflammatory tendencies and carcinomatous tendencies con­stitute a fundamental polarity therapeutically.

This is a general outline of the existing connections between mistletoe therapy and cancer which were discovered by Rudolf Steiner's spiritual science. Those who are unwilling to acquaint themselves with the principles of this spiritual science will never understand its relation to natural science. But one who knows spiritual science does not have to merely believe its contents if he is unable to test them directly through his own developed capacity for spiritual cognition. On the contrary, these contents should be investigated with regard to their overall logical connection and consistency and their practical applicability (chap. 1).

The anthroposophically oriented physician's attitude towards natural science and spiritual science can be shown in principle by the mistletoe-therapy example, namely:

He accepts the spiritual investigator's thought contents about mistletoe and cancer as a hypothesis, in exactly the same way that he accepts the find­ings of natural science, which he also did not investigate himself. He knows the scientific procedure of both lines of investigation and his relation to their contents is the same in principle. If these contents make sense to him he can use them as working hypotheses. He gains two things thereby, firstly, they make a deepened understanding of the pathological process possible and secondly, they make it possible for him to act concretely in specific cases. In either case these contents must prove to be scientifically verifiable through practical use. In the case of mistletoe therapy and the warding off of cancer this means that:

1. The basic polarity—first pointed out by Steiner—between inflamma­tion and tumor must be demonstrable.

2. One must be able to show that appropriate mistletoe preparations are able to activate immunological parameters which are relevant to the ward­ing off of tumors.

3. One must be able to prove that tumors are being suppressed and that these defensive reactions play a part in this.

Are such proofs available?

1. The general opposition of carcinoma and inflammatory tendencies has been confirmed by existing natural scientific facts. (cf. p. 23-24).

2. Mistletoe demonstrably enhances factors in the immune system which are known to be relevant for the warding off of tumors; it does so in the form of the therapeutically administered overall extract (proven espe­cially for Iscador) or in the form of individual components of this extract, or in the form of the unelaborated raw extract. For details, we refer to the ap­propriate literature. 103-109 Here we will summarize the past results of the widely used and much investigated Iscador preparation.

Regularly occurring activations of the following factors in vivo in patients could be shown: the number of peripheral, neutrophilic granulocytes and their phagocytic function, leukocytic mobilization, mitogenic activation of T-lymphocytes by phytohemagglutinin (PHA) and concanavalin A (Con A), the ratio of T-helper cells and T-suppressor cells, the cytotoxic action of natural killer (NK) cells and antibody dependent cell-medicated cytoxicity (ADCC), the concentration of large granular lym­phocytes (LGL), and temperature reactions. In addition the following was found in animal experiments in vivo: morphological thymus activation, mitogenic activation of T-cells, adjuvant intensification of cellular immune reactions of the delayed type, and also of humoral reactions, a-interferon in­duction (also partially demonstrated in man), enhancement of the phagocytic function of macrophages/monocytes, peritumoral inflammatory infiltrations and encapsulation of the tumors with connective tissue. The lat­ter was distinctly correlated with tumor inhibitions. Also, reduction of malignity and metastasis, and prevention of tumor-induced pathological changes in copper metabolism (so-called nutritional immunity). According to this, Iscador's immuno-modulatory effect on factors which are relevant to the warding off of tumors is established. Investigations are underway for the further clarification of this modulation and its connection with tumor in­hibition.

3. Mistletoe therapy is effective on tumors in animals and man. Between 1938 and 1986 a total of 64 individual animal experiments were done at dif­ferent centers with different mistletoe preparations, 35 of them with Iscador® . In 26 of these 35 animal studies with Iscador, clear-cut tumor sup­pression and the partial arresting of metastasis was achieved.106,110 Mistletoe preparations (mostly Iscador® and also Helixor®) have also proven effective against tumors in man as can be seen from the results of 32 clinical studies, and also from a large number of individual cases. The studies concern tumors of the following primary organs: cervix and uterus, ovaries, rectum, colon, stomach, liver (metastases), lungs, breasts, and skin melanoma.111 Further studies are underway.

To be sure, orthodox oncologists dispute the significance of these studies for methodological reasons.7 They think that the effectiveness of a medication can only be properly verified through controlled, randomized, clinical experiments and very few of these have been done with mistletoe.112 The demand of these oncologists would be justified if the controlled, clinical study were a sufficiently sure and ethically unobjectionable method for the proof of effectiveness of a medicament. But fundamental doubts exist about this even among medical statisticians.

Almost all current medication tests have serious methodical defects.113 At the Herdecke Institute for Clinical Pharmacology, a comprehensive analysis of about 2000 studies showed that there are practically no studies in the medical literature which "can be considered as perfectly objective and generally valid proofs of effectiveness for medications." This Herdecke analysis is of considerable importance because the studies it analyzed were the very ones which had been cited as authoritative by the German authorities, the medication commission of the German medical profession, and by numerous pharmaceutical companies.114

Then too, different studies about the same theme often come to con­tradictory results so that contrary to theoretical dogma, the results of ran­domized studies have little importance in the practice of medicine. For ex­ample, with respect to chemotherapy for metastasized breast cancer a leading Swiss oncologist resignedly concludes that "despite a great number of good, carefully planned, randomized studies (and a still greater number of bad studies) we are still today hardly in the position, in the single case which we need to treat, to come to an optimal treatment decision. However, every experienced oncologist believes to know when or for which pathological manifestation he must subject the patient to an aggressive and debilitating chemotherapy and when he can be less aggressive or even withhold treatment for the time being. He is hardly ever able to base his decisions upon secure data obtained in large randomized studies. If he nevertheless does so he can support almost any therapeutic decision with published data, because they are often contradictory and one can almost al­ways select from the literature what suits best. It might be a bit provocative to represent the thesis that, despite at least fifteen years of intensive and im­mense investigations, oncology is not in the position to formulate for medi­cal practice in the individual case a valid treatment recommendation. Even the well-informed oncologist has difficulties in deriving help for decision-making out of the plethora of available data. As a rule he is unable to do this without significant personal practice experience." 115 And this can not be otherwise. Because the theoretical reproducibility which is often demanded could only be attained if man actually were that randomized mechanism which the materialistic theory says he is. But since man really is an in­dividual being consisting of body, soul and spirit (cf. chap. 2), comparative, statistical investigations can never lead to absolute statements but only to relative ones.

Prospective randomized studies are sometimes not applicable to certain medical fields at all, like surgery and psychiatry. Nevertheless surgical methods and psychopharmacological drugs are used in practice with at least as much certainty as cytostatic drugs. This shows that there are other reliable instruments for the proof of effectiveness of a therapeutic method besides prospective randomized studies. In practice, open and retrospective methods and personal experience prove to be just as reliable.

Besides, randomization is burdened with insoluble ethical problems. The honestly obtained agreement of the informed patient is, strictly speak­ing irreconcilable with consequent random selection, because each free co-decision of the patient invalidates the selection system or leads to a one-sided selection of patients. Through the use of random selection the physician gets away from his real medical assignment which is to treat the individual case with a "clear conscience and to the best of his knowledge." This "clear conscience and best knowledge" may coincide with random selection theoretically but in concrete practice and especially in cancer therapy, it does not.

Anyone with extensive, personal, oncological experience who thinks about this complex problem and surveys all the experimental and clinical studies on mistletoe therapy would have to be convinced that mistletoe therapy has been shown to be effective against tumors just as surely as this can be shown for any cancer therapy which is used by conventional medicine. It could be that not too many oncologists share this view yet, but there are medical statisticians who do, and that might be more to the point. 116

Thus in principle the third of our requirements resulting from spiritual science can be considered verified by natural scientific methods, even though our work in this field can not be considered finished by any means.

Summary

In this paper an attempt was made to show what one means by an anthroposophical extension of medicine on hand of the example of mistletoe therapy. What is meant was formulated by R. Steiner and I. Wegman as fol­lows:

"It is not a question of opposition to modern medicine which is working with scientific methods. We take full cognizance of the value of its prin­ciples. It is also our opinion that what we are offering should only be used in medical work by those individuals who can be fully active as qualified doctors in the sense of those principles.

On the other hand, to all that can be known about the human being with the scientific methods that are recognized today, we add a further knowledge, whose discoveries are made by different methods. And out of this deeper knowledge of the world and man, we find ourselves compelled to work for an extension of the art of medicine."117

This extended knowledge concerns elements of life, soul and spirit in man and nature (chap. 2). But the methods for gaining this knowledge are just as scientific as the methods of natural science (chap. 1). And the ap­plicability of this knowledge to special fields of medical practice can be tested by natural scientific methods (chap. 3).

Granting the preliminary character of the present stage of anthropo­sophically oriented medicine, we have pointed to what will be considered valid in medicine in the future:

"Natural science will be valid on the one side, spiritual science on the other. But as in digging a tunnel from two ends, if one surveyed correctly, one will meet in the middle, so also will spiritual science and natural science meet and first give a wholeness to the knowledge striven for by man."43

Addendum 1990

What was said in this paper about four years ago about the clinical and im­munological effectiveness of mistletoe therapy for cancer has been con­firmed in several directions:

Immunological studies:
The already verified action of Iscador on natural killer cells as well as on macrophage/monocytes have been confirmed. 1,2,3 Two constituents of Is­cador have been identified as responsible for these actions: a polysaccharide 3 and a lectin. 1,2 It was also shown that the effect of mistletoe lectins is based on the liberation of cytokines. Mistletoe lectin is bound by mononuclear cells and monocytes of the peripheral blood whereupon these cells liberate the cytokines tumor necrosis factor-alpha (TNF-alpha), interleukin-1 (IL-1) and inter­leukin-6 (IL-6). These cytokines in turn are activators of anti-tumor directed cellular activity. 4,10 The study of mistletoe lectin-I was awarded the Paul Martini Price 1990 at the 96th conference of the German Society for Internal Medicine, i.e. one of the most prestigious awards for medical research in Europe.5

Clinical Studies:
To date the most complete overview of clinical studies with mistletoe is the 1989 dissertation of H. Kiene at the University of Witten/ Herdecke. 6 The results of this work are summarized by Kiene: "At present 46 studies of mistletoe therapy of carcinomas are available; of these, 6 collective studies and 35 controlled studies can be evaluated: The six collective case reports cover noteworthy treatment histories including tumor remissions during mistletoe therapy. The 35 reports of controlled studies (11 historic studies, 12 retrospective studies, 10 prospective studies, 2 randomized studies) show an increase of median or average survival time when mistletoe therapy is used. The quality of the studies is often not satisfactory. Nevertheless 9 of 35 controlled studies show solidity as well as statistically significant results. In general, an increase of study quality correlated with an increased sig­nificance of results."7

Concerning the quality of the studies mentioned here it must be said that this is a persistent problem not only in mistletoe therapy but in all of medicine, especially oncology. This was emphasized in the above paper. Even more pointedly was this problem accentuated in the study published 1989 (in English as Chemotherapy of Advanced Epitheleal Cancer, A Critical Sur­vey, Hippokrates Verlag, Stuttgart, 1990) by the bio-statistician U. Abel from the Heidelberg/Mannheim Tumor Center about the effectiveness of cytos­tatic chemotherapy of solid tumors (solid tumors are responsible for 80% of all cancer deaths in industrialized countries). Abel comes to the following conclusions about the official chemotherapy studies: "During nearly ten years of activity as a statistician in clinical oncology, my initial uneasiness with chemotherapy trials, which I at first attributed to a lack of under­standing on my side, has increasingly intensified and taken shape. This un­easiness arose from my experience in numerous conferences that, while on­cologists often refer to positive results of clinical trials for various chemotherapy regimens and use these results as a basis for new studies, a sober and unprejudiced analysis of the literature has rarely revealed any therapeutic success by the regimens in question. Such misjudgment is by no means harmless; it not only raises ethical questions for it may result in un­necessarily burdening patients with toxic effects, but it is also questionable from a scientific point of view. From my own experience and as docu­mented in the literature it leads to an almost dogmatic belief in the efficacy of chemotherapy. This unchallenged trust in the benefits of chemotherapy, leading to the belief that all patients should receive the benefits of such seem­ingly effective therapy, then effectively blocks the investigation and im­plementation of numerous innovative alternative cancer therapies.

During the years of my involvement with this topic, what initially had been a mere suspicion turned to certainty. Even today, after decades of in­tensive clinical research and development of cytostatic drugs, there is no evidence that treatment of the vast majority of cancers with these drugs ex­erts any positive influence on the survival or quality of life in patients with advanced disease. To say the least, the reports of therapeutic progress commonly made public are misleading as far as advanced epithelial carcinomas are concerned. They are usually based on false conclusions from inap­propriate data....

However devastating the result of this study may appear, it is the un­avoidable conclusion of an attempt to evaluate the complete relevant litera­ture by biometric standards and without professional bias. Surprisingly, the conclusions regarding the effects of chemotherapy on the survival of cancer patients have met with almost unanimous agreement in the numerous per­sonal communications I have received. Although critical publications on the value of chemotherapy in epithelial cancers do exist, the personal views of many oncologists seem to be in striking contrast to communications intended for the public. It was frequently emphasized in the correspondence that the primary goal of chemotherapy is purely palliative, justifying its use even if no prolongation of survival can be achieved. While, by its very nature, a general refutation of this argument is impossible, a close analysis of the con­trolled clinical trials addressing the question of quality of life of cancer patients shows that, again, reality does not quite agree with the ideas and wishes of many therapists.

Of course, one can not exclude the possibility that cytostatic drugs will be developed in the future which greatly improve the survival of patients with advanced carcinomas. In the meantime however, given the lack of suc­cess, the present concentration of clinical capacities on chemotherapy trials is hardly justified. And the reproach that clinical oncologists correctly raise against therapists favoring unconventional methods, that they are unable to give scientific support to their claims, reflects on themselves. A reorientation of cancer therapy and research appears necessary not only for scientific reasons, but also in the patient's interest."8

This situation of contemporary oncology described by Abel was recent­ly discussed at the 15th International Cancer Congress in Hamburg, Septem­ber 1990. The consequence was that the chairman of the Congress had to say: " . . . we must now admit that the conception of our clinical studies was wrong for many years."9

Looking from this vantage point of modern oncology upon mistletoe therapy it becomes clear that it is senseless that oncologists still today place demands upon mistletoe therapy which they themselves have been unable to fulfill!

It is simply a necessity that in all of medicine really new paths must be forged. It is most probable that these paths can only be found if one decides to look at the human being not only as a quantifiable aggregate of matter, but rather as an internally differentiated unity of physical body, life or­ganization, soul and spirit.

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Literature for Addendum:

1. Hajto, T. et al.: Effect of Beta-Galactoside-Specific Mistletoe Lectin on Host Defense Mechanisms. Experimental Cell Biology 57(2) :97-98, 1989.

2. Hajto, T. et al.: Modulatory Potency of the Beta -Galactoside-Specific Lectin from Mistletoe Extract (Iscador) on the Host Defense System in vivo in rabbits and patients. Cancer Research 49:4803-4808, 1989.

3. Mueller, E.A. et al.: Biochemical characterization of a component in extracts of Viscum album enhancing human NK cytotoxicity. Immunopharmacology 17:11-18, 1989.

4. Hajto, T. et al.: Zytokine als Lektin-induzierte Mediatoren in der Misteltherapie. Therapeuticum 4(3):136-145, 1990.

5. Pharmazeutische Zeitung (Editorial), 135(19):51, 1990.

6. Kiene, H.: Klinische Studien zur Misteltherapie der Krebserkrankung. Eine kritische Wurdigung. Dissertation. Universitit Witten/Herdecke 1989.

7. Kiene, H.: Klinische Studien zur Misteltherapie karzinomatoser Erkrankungen. Therapeuticum 3(6) :347-353), 1989.

8. Abel, U.: Chemotherapy of Advanced Epitheleal Cancer, A Critical Survey. Foreword, Hippokrates Verlag, Stuttgart 1990.

9. Hossfeld, D. (Interview) : Der Spiegel 35:203-205, 1990.

10. Hajto, T. et al.: Increased Secretion of Tumor Necrosis Factor-a, Interleukin-I     To and Interleukin-6 by Human Mononuclear Cells exposed to P-Galactoside­Specific Lectin from clinically applied Mistletoe Extract. Cancer Research 50:3322­3326,1990.

Citation: Heusser, P. (1991). A Basis for the Understanding of Anthroposophical Medicine and Cancer Therapy (H. Jurgens, Trans.). Journal of Anthroposophic Medicine, 8(2), 5–38.