Unique Courage

My stepfather, Russ, spent his 60th birthday in a hospital bed in Texas dying of complications from an aggressively growing brain tumor. All of his closest family members were there, some of whom had flown from across the country to surprise him. But it was a bittersweet surprise, as we all knew they’d made such an effort to visit because Russ wouldn’t be with us much longer.

It’s easy to feel helpless in the face of cancer, a disease that turns our body’s very own cells into a reckless and mutinous army, destroying normal cell architecture and function. Learning about cancer as a medical student has been even more vexing because I have a sense now of what we still don’t know about it and its overwhelming diversity of presentations.

But thinking about my stepfather and hearing the stories of other patients who have lived with or survived cancer provides a necessary personal context for this scientific mystery and reminds me of why I was inspired to become a physician. One such story is that of James Rhio O’Connor, who was diagnosed with mesothelioma in 2001. Decades before, he was exposed to asbestos, which over time caused the cells lining his lungs to become cancerous. Mr. O’Connor rejected the dire prognosis given by his doctors, took his health into his own hands by working with clinicians to incorporate alternative therapies into his diet and lifestyle, and lived for years longer than conventional medicine had predicted.

This is an increasingly common scenario. A patient is faced with a frightening diagnosis, and after months or years of treatments, her doctor tells her that there’s nothing more medicine can offer. Instead of abandoning all hope, many patients are turning to alternative therapies. As far back as 1997, Americans spent the same amount of money out of pocket on alternative treatments as they did on conventional medicine.

So what is alternative medicine, and why are people using it in greater numbers? It’s commonly and rather tautologically defined as anything outside of conventional medicine. This is a dynamic definition, as some treatments previously considered alternative, such as chiropractic care for back pain, are now supported by enough evidence that they’re largely accepted in mainstream medicine.

Conventional medicine particularly excels at treating and preventing acute, life-threatening illness. Antibiotics and vaccines, in particular, have saved millions of lives over the last hundred years and dramatically increased our lifespan. But just like every modality of medicine, this new scientific brand is limited. What we, especially in the developed world, are left with in our new longer lives is, inconveniently, exactly what conventional medicine hasn’t really figured out yet: chronic disease. Instead of dying within weeks of a smallpox infection, we succumb to years-long battles with coronary artery disease, diabetes, hypertention, cancer, and their many complications. Most conventional drugs are merely band-aids that treat symptoms and don’t resolve the underlying cause of someone’s chronic illness.

Patients like Rhio O’Connor turn to alternative medicine because when faced with your own mortality, you’ll exhaust every option before giving up. Unlike conventional medicine’s often one-size-fits-all approach, alternative medicine examines each patient holistically, looking at every aspect of someone’s life and character to determine how best to manage their unique illness. It encompasses a broad range of treatments, including mind-body therapies, massage, acupuncture, nutrition, yoga, and natural herbal therapies. And unlike the more hierarchical physician-patient model of conventional medicine, alternative practitioners see their patients as partners who hold equal responsibility in managing their care. This active engagement and the breadth of options in alternative medicine are the very things that patients like Rhio O’Connor crave when conventional medicine tells them there’s nothing more that can be done.

While pharmaceutical companies are unlikely to invest in research on naturally occurring and therefore un-patentable substances to determine their medicinal value, the National Institutes of Health saw the growing demand for alternative treatments and founded the National Center for Complementary and Alternative Medicine to fund scientific research in this historically underfunded and understudied area. In addition to this new research focus, we ought to look to healers in ancient systems such as Traditional Chinese Medicine and Ayurveda who have honed treatments over thousands of years of empiric observation and have strong suspicions of anti-inflammatory effects in turmeric or anti-cancer properties in the bark of a local tree. Likewise, the Neanderthals didn’t need molecular biology or double-blind randomized clinical trials to tell them that the poppy seeds found in their graves contained opiates that would alleviate their pain.

A particularly fascinating area of alternative medicine is its embrace of the placebo effect. In scientific research, it’s the noise in your data that you try to quiet to see the “real” effects of whatever treatment you’re testing. The marker of success for a new drug is if it is more effective than a placebo. This means that for some conditions, the placebo is one of the most effective treatments that exists. So while researchers view the placebo effect as a nuisance, patients love it because it works. Our mind’s effects are incredibly powerful. Plus, they’re side effect-free, unlike every pharmaceutical drug. As an alternative-friendly physician, I’ll vehemently support my patient’s use of an herb, as long as it’s not harmful, to help treat her cancer whether there’s scientific data supporting its efficacy or not. Simply put, if she feels like it will help her, then it necessarily will. Science usually dismisses these individual cases as anecdotal; instead, we ought to study the placebo effect itself and figure out how we can harness this tremendous intrinsic power to heal ourselves.

The real shame for cancer patients is when conventional and alternative practitioners refuse to work together due to ideological differences. No modality of medicine has every answer, but we can use our clinical knowledge and each patient’s preferences to determine an optimal plan utilizing the most effective treatments from all modalities to give her the best fighting chance. For example, a patient with estrogen receptor positive breast cancer could adjust her diet and lifestyle, practice mindfulness meditation to lessen her anxiety and bolster her immune system, and take her tamoxifen treatments with ginger to minimize nausea and omega-3’s to reduce the risk of blood clots associated with the drug. Another patient with inoperable tumors might forgo chemotherapy and radiation entirely and opt instead for gentle alternative treatments to prolong her life and ameliorate her symptoms.

But when we can’t work together, patients have to choose one system or the other and miss out on many options that might work synergistically to save their lives. Or they face dangerous drug-drug interactions between their conventional and alternative treatments because they’re afraid their oncologist will be angry if they admit that they’re taking Chinese herbs. For the sake of patients, we must abandon the false dichotomy of conventional versus alternative and communicate with each other to find what works best, when, and for whom—whether it comes from a pharmaceutical lab or a tribe in Africa.

Cancer is one of the leading causes of death in the United States, and we’re more prone to it as we age because it’s a disease of our DNA, which accumulates small mutations over time that can lead to unregulated cell proliferation. Unfortunately, cancer will never go away, and there is no single cure from either conventional or alternative medicine. Each cancer is different. This is not simply to say that lung cancer is different from prostate cancer. People with the same type of cancer often have very different outcomes because one has more virulent cells or the other has a genetic type that responds better to a certain drug, alternative treatment, or lifestyle change. And we’re not very good yet at predicting who has the kind that will progress. Even within a single tumor, cancer cells are heterogeneous. A treatment that kills half of a tumor’s cells might leave the other half to metastasize to other organs. Adding complexity, from birth, we all have distinctive genetic predispositions to certain cancers.

Genetic breakthroughs are only just beginning to sort this out, but indications are that they will usher in a new era of personalized cancer medicine; people will be diagnosed and treated based on the genetic make-up of their particular tumor. I see this as the perfect opportunity for conventional medicine to align and integrate with alternative medicine and its broadest goal: to treat each patient as an individual with her own unique disease process and experience in order to provide the best possible care. I’ll need the tools of both of these systems to be a competent and compassionate healer to my future patients, and I’ll remember my stepfather Russ and James Rhio O’Connor and their unique courage and experiences battling cancer and embracing life to guide my practice of a more integrative and holistic cancer medicine.

By: Angelotti, Amanda

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