The Aging Healthfully Virtual Library – The Works of Majid Ali, M.D.
Saying No To Chemotherapy
From The Book What Do Lions Know About Stress
Treatment decisions facing patients with cancer were once simple and easy to make.
Surgery, radiation and chemotherapy were considered scientifically proven, effective therapies. The physician’s word was gospel, and there was no room for doubt. Decisions about cancer therapies were easy precisely because there was no choice””and no stress.
However, there was no choice in cancer treatment because patients were uninformed. In the past, patients often went for a second opinion about chemotherapy. That second opinion was, of course, never different from the first one. This confirmation was reassuring to the patient and made his decision easier to accept. The consulting doctor who rendered the second opinion always agreed with the referring physician. (As conventional wisdom goes, you don’t bite the hand that feeds you. Giving a different second opinion would jeopardize chances of receiving future consults.)
Consensus medicine is comfortable for physicians, and it also brings comfort to the patient.
A second opinion in mainstream medicine is one opinion for which the patient pays twice.
The Cortical Monkey and Healing
Now all that is changing rapidly. Many cancer patients are well-informed. They read about alternative therapies that are being used in foreign countries and in the United States. They are aware that there is a mushrooming underground of unapproved therapies. Physicians vigorously caution their patients against the dangers of unapproved therapies, but patients are increasingly rejecting that party line. Almost everyone knows of patients who were told surgery had removed the whole tumor or chemotherapy had burned down all of the cancer, yet the cancer returned and killed the patient. They also know of patient who clearly died of “approved” chemotherapy drugs rather than of their cancer. Many people also know of people who opted for “unapproved” nondrug cancer therapies, and who lived without cancer for decades.
Few things are as stressful as the decision to choose the right operation and whether or not to accept chemotherapy. Cancer drugs are invariably very toxic and seriously damage the immune system. Most people know someone who had chemotherapy and have seen the havoc it wreaks.
Although many oncologists believe the toxic effects of chemotherapy are reversible, I have yet to hear a patient say he was the same person before taking chemotherapy as he became after it. This phenomenon is common knowledge among well-informed people. And yet, oncologists continually tell patients are continually that by not taking chemotherapy they are destined for certain death, as if certain death is something patients taking chemotherapy can escape.
GRANDPA GUIDES FROM HIS GRAVE
Patty, a woman in her early forties, came to my office one day. She looked anxious and distraught to a degree I had never seen before. When I had cared for her two little boys for multiple food and mold allergies, she always looked serene. I knew something extraordinary had happened. When I asked what the problem was, she smiled bravely and said,
“I have a difficult problem this time. It is breast cancer, and I’m facing some difficult decisions. I have two little boys whom you know. I have a loving husband. I have to survive this cancer.”
Patty had her breast cancer diagnosed by a biopsy. She asked me whether she should follow the biopsy with a lumpectomy and node sampling or mastectomy. I told her both were reasonable options, and asked what her personal preference might be. She said she would rather choose a mastectomy. I supported her decision, and advised her to take an intravenous nutrient infusion before and after the surgery to promote healing and minimize the possibility of infection. I further asked her to return for a consultation and management plan after surgery.
Three weeks later, Patty returned for advice. Fortunately, her axillary nodes were found to be free of cancer. Predictably she had been advised to undergo chemotherapy by an oncologist. She told me she was very troubled by the prospect of serious immune injury caused by chemotherapy drugs and asked whether that was the right course of action for her. I told her she was not facing an immediate decision and that she could think about it. Furthermore, I advised her to seek a second opinion from another oncologist. She said she already had done so, and the second oncologist concurred with the first. She now wanted an opinion on non-chemotherapy options.
Patty was uncomfortable with some of the answers she had received from her oncologists. Specifically, she had asked about the possibility of chemotherapy causing a second cancer and had been told that such a risk didn’t exist. She had considerable difficulty accepting that statement. She asked me if I agreed with the statement. I told her that such a risk was very difficult to assess because there are simply too many variables. I thought about a recent report in the New England Journal of Medicine that reported somewhat higher risks of cancer developing in the opposite breast of women taking chemotherapy than in the control group who did not. Then my mind wandered to a conversation Choua and I had about the report some days earlier.
A SACRED DECEPTION
One day I reviewed the slides of biopsies and surgical cases for the monthly breast-cancer conference at the hospital. My administrative assistant told me she would distribute copies of a current article on the value of chemotherapy in treating breast cancer. She also said the article had appeared in the April 6, 1995, issue of the New England Journal of Medicine and had been widely reported in newspapers, radio and TV. She then suggested that I might want to glance at the article before the meeting. I gave the article a cursory look and showed it to Choua.
“Interesting!” Choua spoke as we walked backed to my office after the conference.
“What’s interesting?” I asked.
“The folks at the National Institutes of Health traveled all the way to Italy to prove that chemotherapy effectively treats breast cancer.”
“I suppose because it’s easier for oncologists to sell the program to Italian women than to American women.”
“That’s ludicrous,” I rebuked him.
“Then why pay Italian doctors American dollars to test chemotherapy drugs?” he pouted.
“I’m sure they didn’t give Italian doctors American money to do that research study. Doctors don’t get money when they conduct research studies.”
“They don’t?” he frowned.
“You’ve a warped mind,” I scolded him. “What difference does it make whether the study was conducted in Italy or in Kenya?”
“I guess you’re right,” Choua smiled impishly. “It makes no difference what country the study was done in as long as the folks at the National Institutes of Health have the ability to draw wrong conclusions.”
“Oh shush, Choua. You are annoying,” I said, irritated. Then I asked, “What did the study say anyway?”
“The report declared emphatically that chemotherapy works in treating breast cancer,” he replied.
“That’s not unexpected. So?”
“After pronouncing chemotherapy effective on the front page, the report later gives detailed statistics.”
“Which support the front page conclusions, right?” I asked.
“Wrong,” Choua chirped.
“Wrong? How can that be? Didn’t you just say the front page concluded that chemotherapy works?”
“Yes, it did,” he winked.
“So, what’s the catch?” I asked, perplexed.
“That’s the fascinating part. The report showed that 20 years after giving chemotherapy for node-positive breast cancer, eleven percent of women given chemotherapy were alive without disease, while ten percent of those in the control group who were spared toxic drugs did as well.”
“Are you saying chemotherapy improved the disease-free survival only by one percent?” I challenged him. “I don’t believe those numbers. Are you sure you are citing the data correctly?”
“Take a look yourself,” Choua thrust the article at my face.
“I can’t right now. I have to sign out some biopsies,” I replied, pushing the article away from my face. “Why don’t you tell me more about it?”
“That one percent advantage in the chemotherapy group was outnumbered by new cancers that appeared in the opposite breast of those in the chemotherapy group,” he smirked.
“That’s understandable. What are the data?”
“2.2% women in the control group developed a second cancer while 3.4% did so in the chemotherapy group. That’s a difference of 1.2%””a trifle more than the 1% difference between the disease-free survival rates in the two groups. Now, if they would publish their data again in ten years, they will surely find…”
“That overall disease-free survival would be actually higher in the control group,” I completed his sentence.
“Yeah,” he jeered.
“What else does the article say?” l asked.
“Actually, it isn’t what they say, but what they omit, that’s interesting,” he winked again.
“What’s that?” I asked, puzzled.
“They diligently hid the data pertaining to cancers found in other body organs in the women of the two groups. Surely, chemotherapy would have caused cancers in other body organs as well.”
“Oncologists insist that doesn’t happen,” I provoked him.
“Of course!” he thumped the table contemptuously, causing vibrations in the video screen attached to my microscope.
“Calm down, Choua,” I admonished him. “I am trying to look at slides, and you are shaking my microscope.”
“I’m sorry,” he relented. “How can those oncologists say, with straight faces, that chemotherapy does not cause more cancers in other body organs when they know it does so in the breast?”
“That’s a surprise. Why wouldn’t they report additional cancers in other body organs?”
“Is that really a surprise?” he pouted. “Either they didn’t bother to keep a tally of other cancers, or they deliberately withheld the data. Now that shouldn’t surprise you, should it?”
“You see things with your cyclopean eyes,” I teased. “What else?”
“They deftly avoided the subject of the toxic effects of chemotherapy on various body organs as well. Clever rascals, those researchers.”
“That’s not being true to research.”
“Truth in research, eh!” Choua mocked.
“Don’t you think researchers are obligated to include adverse data when they report favorable data?”
“Are you really that naive?” he scowled. “Since when have men of money in medicine worried about truth in reporting? You should know better. You wrote the Rats book.”
“Okay! Okay!” I yielded. “But didn’t you tell me that the efficacy of chemotherapy in that report was widely reported in the media? How did that happen?”
“Miracles of medical statistics, my friend,” he scoffed.
“How did they do that?”
“Simple,” he laughed. “They reported data for the earlier years of the study that favored the chemotherapy group.”
“So, chemotherapy was beneficial. The Journal was right after all.”
“Right, but with an incomplete story.”
“What is the complete story?”
“They prudently kept quiet about the higher risk of additional cancers, and didn’t raise ugly questions about why chemotherapy was not a poison for the group of Italian women when it’s a poison for everyone else. That’s a sacred deception, isn’t it?”
Choua walked over to the window before I could respond. He looked out and was soon lost in deep thought. I knew nothing volatile would be forthcoming for a while and returned to my slides.
When my wandering mind returned, Patty, my patient with breast cancer was staring at me.
“You were thinking about something, weren’t you?” she asked.
“No. Yes.” I was flustered that she caught me in my reverie.
“About the benefits of chemotherapy.”
“About the difference between the touted and actual benefits of chemotherapy. Wasn’t that it?” she smiled disarmingly.
“Yes,” I admitted.
“Tell me, would you take chemotherapy if you were in my position?”
“I don’t know,” I smiled back. “I don’t know how I would face such a decision. It isn’t easy.”
“So, you would?” she asked, her eyes intensely fixed on mine.
“I didn’t say that,” I hastened to add. “In fact, I probably wouldn’t. But such decisions are never easy. I don’t know what I would do if I had to advise my wife about it. The long-term results of chemotherapy are dismally poor. Some studies do show some short-term benefits, but what makes the decision more difficult is that chemotherapy results are compared to control subjects who do not receive nondrug therapies.”
“But you would put yourself on a comprehensive non- chemotherapy protocol, wouldn’t you?”
“I definitely would.”
“For obvious reasons””herbs for their known anticancer effects, nutrients for their immune enhancement, slow and sustained exercise for fitness, and meditation and spiritual work for escaping the cruelty of cancer statistics.”
“And, knowing what you know about the ways chemotherapy destroys the immune system, would you still take chemotherapy?” she pressed.
“I probably wouldn’t.”
“I really don’t think you would take chemotherapy for my kind of breast cancer,” Patty smiled knowingly.
“Probably not,” I repeated.
“So, what next?”
“Has anyone died in recent years that you loved deeply?” I asked.
“Yes, my grandfather,” she beamed. “I was very close to Grandpa. I guess I still am.”
“Good!” I replied. “Here is what I suggest. Visit his grave three times during the next several days. Maybe there you will find an answer you are comfortable with.”
“How do you know that?” she asked, bewildered.
“I don’t know that. I just think it might work,” I replied.
“Well, I’ve already done that once.”
“Do that some more,” I advised.
“I think I know what Grandpa will tell me,” she smiled and left.
I took up the chart of the next patient, looked at the progress sheet to read the notes I made during the preceding visit. Within moments, the staff ushered in my next patient. The office hours ran late that evening, as they usually do. It was past eleven p.m. when I prepared to leave the office.
“Why didn’t you tell her about the full risk of chemotherapy?” Choua asked curtly, standing at the office door.
“Because it is not clear to me how to balance that risk against the risk of saying no to chemotherapy. That’s why,” I replied.
“Not clear to you or not known?” he scowled.
“Okay, not known to me,” I replied with irritation.
“Have you never seen a case of a cancer caused by chemotherapy?” he persisted.
“How does anyone know whether a second cancer was caused by chemotherapy or just developed coincidentally?” I asked, feeling a bit angry.
“There are statistics on that,” Choua was unrelenting.
“Statistics!” I mocked. “Since when are you impressed by medical statistics? Aren’t you always knocking medical data?”
“What about that Kaposi sarcoma that you diagnosed in a patient receiving chemotherapy for malignant lymphoma?”
“What about that?”
“Multiple nodules of Kaposi sarcoma developed within months of starting chemotherapy for lymphoma, but then the tumor nodules spontaneously regressed months after chemotherapy was discontinued.”
“I remember that.” I recalled the case clearly. “But you can’t cite such anecdotal case reports when someone asks your opinion about the treatment of his cancer, can you?”
“Do you what know an oncologist said at the tumor board meeting?”
“What was that?”
“He said I know chemotherapy doesn’t work for anaplastic cancer of the lung, but I still believe in it for its possible anecdotal value.”
“Anecdotal value?” I looked askance. “Hard to believe an oncologist would say something like that.”
“Especially because that’s exactly the argument they use to dismiss the holistic physicians’ reports of positive results with nondrug therapies,” Choua chimed.
“Still, that sort of information is not adequate in discouraging anyone from taking chemotherapy,” I explained my position.
“You will change your position,” Choua stated emphatically.
“I wish I had a better handle on the benefits of anticancer herbal therapies, organic coffee enemas, bio-oxidative therapies, charge neutralization techniques, light therapies and other therapies. I wish some group of knowledgeable, diligent physicians would undertake a careful study of integrated nonchemotherapy therapies to come up with a clear sense of what can be achieved in this area. Wouldn’t that be wonderful?”
“Yes, it would be wonderful,” Choua agreed, gazed at me intently for a long while, then asked, “Why don’t you?”
Before I could say anything, he stomped out of my office.
It has been over a year since Patty saw me for advice about chemotherapy. She seems remarkably at peace with her decision to say no to chemotherapy. She has traveled and attended some workshops about nonchemotherapy options for cancer. She is taking the anticancer herbs, nutrients and coffee enemas that we prescribed. The last time I performed a microscopic oxidative stress test (MOST Test), her blood cells and plasma proteins showed minimal evidence of oxidative injury (as is shown by other people in good health without cancer). All her other blood tests are also negative.
The day she came to tell me of her decision to turn down chemotherapy, I was impressed by the serenity on her face. It wasn’t that she didn’t understand the gravity of her decision. Rather, her serenity existed because she arrived at her decision from a higher visceral-intuitive level””in the presence of her grandfather. The old man helped his granddaughter from his grave.