Hickox, Benjamin – Surviving Mesothelioma

Hickox, Benjamin

James “Rhio” O’Connor died exactly one week after I got married; he was told that he was going to die two months into my senior year of college…a difference of nearly eight years.  His journey and survival is very personal when I imagine the brief time that his life and my life were unfolding simultaneously.  His experience is nothing short of miraculous.  But his miracle is not something that has to be all that uncommon.         
 
Today I am a nurse in an intensive care unit in one of the largest hospitals in the United States.  I am also somewhat skeptical of alternative medicine.  This essay was a good exercise in stepping outside of my comfort zone.  This essay was also a good exercise in schadenfreude for my wife.  She feels a very strong connection to alternative medicine and was excited for me to roll up my sleeves and dig into the topic.  I’m glad I did.  
 
Pleural malignant mesothelioma is a horrible disease.  It is an aggressive and lethal cancer of the lining of the lungs that usually occurs many years, often decades, after exposure to asbestos.  There are other agents that can cause pleural malignant mesothelioma, but asbestos is the most common. Most of the professional literature says that if it’s not caught early, the afflicted person should simply focus on staying as comfortable as possible while allowing the disease take its course.  The primary reason that this disease is so deadly has to do with its latency: it takes many years before the signs and symptoms of the disease become evident.  So when the person presents to his or her practitioner, it is most likely in the late stages of the disease.  It seems that this was the case with Rhio.  He had prolonged exposure to asbestos and many years later he began to develop the signs and symptoms that would be diagnosed as those of Mr. Meso.  
 
Conventional treatments are many and varied, but the improvement in quality of life and length of life is on the order of months, not years.  If surgery to remove the cancerous tissue is not feasible or safe, the scientific evidence for medical treatment is in favor of combination chemotherapy involving the medications cisplatin and pemetrexed (Tsao & Vogelzang, 2011).  These medications affect the growth of cancer cells, but also affect the growth of normal cells, which leads to multiple side effects.  Hearing loss, ringing in the ears, joint pain, bleeding, sores in the mouth, pain in the chest, groin, and legs, loss of coordination, slurred speech, etc. are all common (Mayo Foundation for Medical Education and Research [MFMER], 2010; MFMER, 2011).  The list goes on and on.  This is why chemotherapy treatments are very often administered while the patient is in the hospital.  The rare, serious side effects from chemotherapy can be life-threatening.  It is no wonder that Rhio chose alternative therapies.  
 
But why are the therapies that Rhio chose considered “alternative”?  There are two reasons.  The first has to do with capitalism, “free” market economy, and greed.  The second has to do with distrust, ignorance, and medical hubris.  Both of these barriers can be broken.    
 
Bringing a new medication to market, to treat cancer or otherwise, is undoubtedly expensive.  There are good reasons for this and bad reasons.  The appropriate reasons are to establish the safety and the effectiveness of the medication.  To do this does take time and money.  It takes time and resources to develop, implement, and evaluate a well-structured scientific study to determine if a medication is more effective than a “fake” counterpart (placebo).  This is a randomized, controlled trial.  The world has certainly benefitted from these, and things that have their root in nature have found their place in conventional medicine through randomized, controlled trials.  Examples include aspirin (from the bark of the White Willow, Salix alba), digoxin (from the Foxglove plant, digitalis purpurea), atropine (from the Deadly Nightshade plant, Atropa belladonna), and many more.  But unfortunately capitalism, “free” market economy, and greed have stepped in.  These concepts (aside from greed) on their own are not necessarily bad things, but there is substantial evidence that pharmaceutical companies spend inordinate amounts of money advertising their medications and padding their investment and expense accounts, with little or no benefit to the consumer of the medication.  To change this, the power must be put in the hands of healthcare practitioners.  If physicians and nurses placed increasing focus on alternative treatments and educated patients on these treatments, there would gradually be a change in the way Americans consumed their pharmaceuticals.  The pharmaceutical companies, in turn, would listen to their customers and begin researching alternative and complementary therapies…supply would follow demand.  Right now, the power is in the hands of the pharmaceutical companies and unfortunately the educational medium is the television in the living room instead of the practitioner in his or her office.  Healthcare professionals need to take back the power…healthcare is a dialogue, not a monologue.   
 
There is a substantial distrust of and divergence from conventional medicine by those beholden to alternative medicine.  And likewise, those engrossed in the practice of conventional medicine are suspicious and mocking of alternative medicine.  This must be reconciled and ignorance on both sides must not be tolerated.  Again, this reconciliation is best accomplished by education and communication.  Healthcare practitioners themselves must seek the best information regarding both conventional and alternative therapies.  Practitioners of alternative and conventional medicine must be in dialogue and observe mutual respect.  Valuable lessons can be learned by crossing the divide.  Medical Doctors can learn the value of anecdote and individuality, and Homeopaths can learn the importance and strength of a well designed clinical trial.  Networking would also be an incredible benefit, allowing alternative practitioners access to those who have experience and funding for clinical trials so that alternative therapies may be evaluated.  Conventional practitioners would then also be able to network with alternative practitioners who have unsurpassed passion, dedication, and inquiry.  
 
Rhio’s story is a strong case in point for pursuing alternative treatment.  It’s unfortunate that the therapies that Rhio pursued were considered “alternative”, but the word seems to be getting out.  There are centers for complementary, alternative, and integrative medicine in many of the nation’s major medical centers already.  As healthcare practitioners and patients continue to fight to recognize the value of alternative therapies, maybe the pharmaceutical industry will open its eyes and help the patient instead of performing a wallet biopsy.  With some of the changes in healthcare legislation, too, the focus may be drawn toward more cost-effective, higher-value therapies.  Many of these will be “alternative”.  Through education, communication, and cooperation, the most appropriate treatment for any disease may soon be easily found, no matter what the method or school of thought.

References
Mayo Foundation for Medical Education and Research. (2010). Pemetrexed. Retrieved February 25, 2011
Mayo Foundation for Medical Education and Research. (2011). Cisplatin. Retrieved February 25, 2011
Tsao, A. S. & Vogelzang, N. (2011). Systemic treatment approaches for unresectable malignant mesothelioma. In UpToDate.

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