August 30, 2005

Michael Tierra

While I tend to agree that local surgery and cauterization of basal cell carcinomas (BCC) is often preferable to the use of escharotic salves, this is especially true because of obvious liability issues to anyone involved with the process.

I have interviewed a number of people including a primary source individual, Clark Bigham, who was financially involved with funding Vipont Pharmaceutical Company, located in Fort Collins, CO, some time in the 1960s. The company was specifically formed to research and bring to market a "Black Salve" consisting of sanguinarea, galangal and zinc chloride mixed with distilled water. The salve was and still is widely used in veterinary medicine throughout the Wyoming and Colorado areas. It was, and probably still is, used by individuals on local external cancers.

It so happens that Clark lives in Santa Cruz and was a former student of mine. He said he was introduced to the salve by Howard McCreary, a 'cowboy' in the region. Together with Howard's investment, they formed Vipont Pharmaceuticals. Their research went as far as their money. They also have a letter from Sloan Kettering, who after their research, stated that their salve was the most effective substance against cancer they had ever seen. They found that a diluted version (5%) of the salve is 100% effective as diluted eye drops for macular degeneration and one type of glaucoma. Because when mixed at a 5% ratio with Tom's toothpaste it cures gingivitis, it was bought out by Colgate-Palmolive and is presently sold as Viadent toothpaste.

Clark's personal formula uses up to 50% zinc chloride, so the remainder would obviously be bloodroot and galangal. He will dilute it (5 to 10%) for various uses, especially cosmetic uses and uses it straight on moles, warts and such. In over 28 years, he has never seen an adverse reaction.

The term anecdote (suggesting that something is unproven) is thrown around so that I think its meaning is often stretched. By definition, one can offer both 'anecdotal' positive as well as 'anecdotal' negative evidence because neither is proven. There's a question and to what degree evidence becomes non-anecdotal. To my way of thinking, to say that something is effective based on personal observation, meaning not confirmed by others, is anecdotal, but isn't saying that something is ineffective based on personal observation also anecdotal (unconfirmed)? Then who, how, under what circumstances and how many people need to witness evidence before it becomes non-anecdotal?

I say that the escharotics deserve and are in need of more debate and scientific research. I suspect that there are problems on all sides of the issue.

I question the escharotic power of dried bloodroot. I think the fresh exudate, like the exudates of fresh celandine and the fresh oils of garlic, are mildly escharotic, but the dried root of sanguinarea? I've never just added water and topically applied it to see if it is escharotic, but I've used the tincture topically for the treatment of skin funguses and think that the fresh herb tincture would be best.

So few people who are proponents of escharotics talk about the properties and importance of a 'major' active ingredient in the formulation, zinc chloride.

Thanks to the generosity of Ingrid Naiman, I have a copy of the medical text, Chemosurgery by Frederic Mohs M.D., edition 1978. This book, first published in 1958, gives absolutely no credence or acknowledgement to over a century of use of what is essentially the same paste used by Felter and the Eclectics nearly 60 years previous. He also gives no acknowledgement of Harry Hoxsey's use of essentially the same paste for decades previous up into the 1950's. It is a glaring fact and in my opinion an obvious prejudice among the medical community that Mohs misrepresented on page 3 how he 'happened' to come upon his 'chemosurgery' formula.

He does acknowledge that zinc chloride was found as early as the 19th century to be the most "satisfactory" chemical for the paste because it produced the least toxicity and "did not impair the reactivity or healing quality of the tissues beyond the deepest level of fixation."

So right off the bat, we have the proponents of the folk application who tacitly seem to deny that the basis of their 'natural' therapy is herbal (based on the use of bloodroot) when a pure chemical zinc chloride is at least responsible for 50% of the activity of the formulation. On the other side, we have Mohs, developing what to this day is regarded as an effective external anti-cancer therapy (we're not talking about minor excrescences and spots on the skin, but large major areas of the eroded cancerous flesh, eye, breast, genitals, back, etc.) and thousands of cases that Mohs personally treated with his method, while giving absolutely no acknowledgement to the popular use of essentially the same paste, which I can only conclude is because of political reasons. 

I also read in detail a citation offered by Paul Bergner as criticism of the use of escharotic agents. Now this reference paper was written by dermatologists at the Vermont College of Medicine in Burlington. There are some problems with this paper which to my mind make it even more suspect and biased against the popular use of the paste and its value.

1. They claim to review the history of escharotics for skin disease and based on Mohs' use alone, they claim that the use of "escharotics without surgery has been discredited by allopathic medicine" --- this is at the top of the article and there is no reference. Their conclusion is for the FDA to be given authority to regulate the production and distribution of escharotics and by implication other herbal preparations, so it is my opinion that there is an agenda here.

Later, despite Mohs' use of essentially the same paste, these same individuals claim that "Hoxsey's work has never been accepted as valid." (Not mentioned is that despite a will to prove otherwise, it has also never been proven to be 'invalid'.) They claim that Mohs' method is different only in the fact that it included surgery.

This last point is something to consider. I find that scientific manuals such as Mohs' are generally poorly written (i.e. failing to impart the highest level of clarity) either deliberately, or, even worse, to disguise certain elements that they specifically do not want the reader to know.

The dermatologists' paper states that Mohs only used the salve as part of a "fixed tissue technique" as if everyone reading would understand what this means. Mohs, in his first chapter, does not help to define what he means by "fixation in situ" so I'll venture to surmise that the application of the salve seems to destroy or "fixate" primarily cancerous lesions, and "did not readily penetrate the keratin layer of the skin" -- this being the thicker, more impenetrable areas of the skin (similar to the soles of the feet). So healthier skin tissue seems to be more resistant to the topical application of zinc chloride --- this seems to substantiate to some degree the claims of those who popularly use the salve. In fact, Mohs would have to specifically apply a keratolytic chemical, namely dichloracetic acid first in some cases, to allow the zinc chloride paste to penetrate.

Then, on page 4, Mohs says the most pertinent thing: "Zinc chloride (with sanguinarea added) did not impair the reactivity or healing qualities of the tissues just beyond the deepest level of fixation. To this property was credited not only the rapid separation of the final layer of fixed tissue, but also the healthy infection-resistant granulation tissues, the rapid epithelization and the minimal scarring that resulted from its use. This lack of damage to surrounding tissues by zinc chloride (my own inclusion is -- including sanguinarea) contrasted with the effect of cauterization of tissues by heat which could cause thermal damage to tissues just beyond the deepest level of actual cauterization."

So it seems that Mohs is opting for a chemical burn as opposed to an actual thermal or radiation burn because the chemical burn is more selective specifically to unhealthy cancer cells and causes far less damage to healthy tissue. Again, this is what is being claimed as a benefit by popular or folk protagonists who use the salve.

Another distinction is that Mohs used surgery. Except for the obvious benefit in first debriding a large tumor before applying the paste, it's not clear why else he needed to use surgery, except that perhaps he simply did not want to wait out the couple of weeks before a complete and distinct eschar would form and by itself, slough off. Consider that he already admits that the paste fixates the cancerous area of a lesion, that it does not penetrate non-cancerous tissue (which is why he uses zinc chloride over other possible chemicals) and this is based on Mohs' personal treatment and observation of thousands of patients, but after the cancerous lesion is affected and begins to isolate, Mohs cuts it away. He then microscopically examines the area and continues to apply the paste followed by surgery until there are no signs of cancer.

So the difference between the popular recommendation of the salve is they claim that once the eschar is formed, it should be allowed to run to completion and slough off on its own and this optimizes the complete excision of cancer from the site. Here criticism may well be in order, because experience seems to demonstrate that not always is the cancer completely removed after the initial eschar is sloughed off and so amid the success stories with the use of escharotics, there are the negatives of cancer recurrence that are also reported (how many times is this true after conventional chemo or radiation therapy?). It seems that this would be a good place for cooperation between the two camps. Selective microscopic analysis and biopsy of the area after the eschar sloughs off seems a most appropriate use of that technology and would make the entire procedure exponentially more effective.

In the past I have assisted a few patients with escharotics without witnessing particularly dazzling results, although I confess that this may well be because of my tendency to err on the side of being conservative. Nor will I sell the paste to anyone who requests it. Healing is a potentially risky business and different ones of us must choose their own personal level of risk and my own would not allow me to go the distance. However, regarding pain, I have much knowledge because after applying the paste, pain is to a greater or lesser extent a reality sometime over the course of the first three days. It is very idiosyncratic; for some it is a minor thing somewhat more than an irritation, for others it is excruciating to the point that no herbal pain killers, unless we could be permitted to use our opiates, would be effective. Aspirin and Tylenol are a welcome part of therapy. After the initial few days, presumably when the nerve endings have desensitized, pain killers are no longer necessary.

Scarring and mutilation: Before damning escharotics as being scarring and mutilating, please consider the effect of other heroic measures such as surgery, chemotherapy and radiation. Cancer is a serious disease and its treatment, whether conventional or so-called 'natural' is serious and not without consequences. Let's assume, again without the research that I would really like to see, that there are cases where the cancer cells extend beyond expected areas and the salves cause massive disfigurement and scarring. Or even that on some individuals the keratinized areas of the skin or deeper tissues are susceptible to damage by the salve (although most claim it is not and I have never seen it to be), there will be a need for reconstructive surgery for some. Again, one only chooses this technique not because it is risk free, but because it offers the best possible outcome over any other method considered. That is the price that one pays. Some who undergo it, either ill advised or with misleading expectations, understandably may be seriously upset with the outcome; this happens all the time in conventional treatment of cancer, so why should it not be a reality in so-called alternative medicine?

The real question is: Should the potential benefits of escharotic treatment for a wide variety of cancers be not one of the choices a patient can opt for in deciding their best course? If conventional medicine does not make this available and continues to ignore and deny research to an area that even one of their most respected members gave credence to, I believe that escharotic pastes will continue to be available on a 'buyer beware' basis. Our right and freedom to choose, hopefully based on informed understanding, is what is at stake, and I don't believe that freedom should legislatively denied. Doesn't this sound a bit familiar regarding other issues of the day?

Michael Tierra

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