Terry Thompson’s Blog

The most talked about issue in the country now is health care reform.  After President Obama’s news conference this week, the subject is even hotter.  I try to avoid politics in this blog, but I must say that the more the president pushes his plan, the less credible he becomes in the minds of the public.  The reason is that the promise of more options, better coverage, and less cost is unsubstantiated by specifics, and the people aren’t buying it.  Even many in his own party are skeptical.  Meanwhile, the Congressional budget office’s analysis of the plan includes the “T” word (trillion) in its cost reports.  The cold, hard facts are that you can’t get there from where we are in conventional medicine.  The costs of developing, producing, and applying the exotic drugs and high-tech equipment are exorbitant. 

This administration’s assumption is that the health care system is broken.  I don’t believe it’s broken.  America has, without question, the best health care system in the world.  It just costs too much.  Since cancer treatment in general is more expensive than treatment of any other disease, it is certainly a big part of the problem.  It is driving insurance premiums out of reach of many employers and individual policy holders.  Cancer victims who are not insured often end up declaring bankruptcy.  There is an answer to this that you will probably never hear about, because it is hardly ever talked about.  And, it doesn’t require tax increases to implement the reform.  It is a change in strategy to integrative oncology as the mainstream practice in cancer treatment.

 Integrative oncology, as currently practiced in the U.S. by a relatively small number of oncologists, can reduce the level and duration of chemotherapy and radiation.  Although it adds complementary therapies to the conventional protocol, the costs of these therapies are minuscule compared to the cost of portions of conventional therapy it can replace.  As the efficacy of the complementary therapies are proven on a larger scale, the ratio of complementary to conventional therapy will become higher, thus saving even more.  This new strategy should at most drive a paradigm shift in cancer treatment and at least be a significant part of health care reform.

Two things would have to happen for integrative oncology to be a major piece of health care reform.  First, the administration would have to promote it as such.  Secondly, insurance companies would have to be required by law to cover integrative therapies.  Presently, few integrative medicine therapies are covered by insurance.  If these two prerequisites were accomplished, the cost of cancer treatment would be tremendously reduced.  More importantly, cancer victims would live longer and have greater quality of life during treatment. 

Keep this in mind as you listen to the debate.  Don’t miss a chance to speak up for and support integrative cancer treatment.   

A cultural barrier exists between the hands-on medical science community–those who do the research and treat the patients–and institutionalized medicine–universities, pharmaceutical corporations, and grant providers.  This conclusion was supported by a survey project presented at the 2005 convention of the Society for Integrative Oncology.  The “Survey of Cancer Researchers and Practitioners Regarding Complementary and Alternative Medicine” by Dr. Oluwadamilola Olaku and others included 321 respondents from a wide spectrum of oncology labs and clinics.  Ironically, the survey was sponsored by the National Cancer Institute which does relatively little in the complementary and alternative medicine (CAM) arena.  Generally, the researchers and practitioners agreed that there was great promise in the following areas of CAM: pharmacologic and biologic treatment, nutritional therapeutics, mind-body interventions, and alternative medical systems.

Of the researchers surveyed, 83% expressed interest in collaborating with CAM practitioners.  Ninety-six percent of the CAM practitioners were interested in collaborating with cancer researchers.  Evidently, there is a groundswell of interest among hands-on researchers and practitioners to charge forward in exploring the vast potential of integrative oncology.

When asked what they saw as the most significant obstacle to CAM research and practice, the single factor most frequently identified was lack of funds. Lack of time was also given as a significant obstacle.  Time allotted to projects and services is, of course, determined by priorities which are determined by funds.  The funds are going to the large medical institutions in the form of private and government grants.  These institutions are almost entirely focused on research and development of conventional medicine with little regard for CAM or integrative practices.  Until this changes, we will continue in the circular, closed system of medical science.  Keep your Congressional delegation informed of the need to fund integrative medical research and support foundations that fund such research exclusively.

Like millions of other Americans, I watched the non-stop replays of the lunar landing yesterday as we celebrated the 40th anniversary of man’s first step on another celestial body.  As an Air Force pilot trainee at the time it happened, I was especially intrigued at the technological threshold we were crossing.  It seem more than our minds could comprehend as we tried to grasp the reality that the project was accomplished in such a short period of time.  Just a decade earlier, the concept of travel to the moon was relegated to fiction books and comics.  Yet, a nation acted on the challenge of its president, even with the backdrop of an unpopular war and civil rights unrest, to accomplish the unthinkable in a period of about seven years.  The present estimate of the cost of the entire mission from Mercury through Apollo was about $25 billion in then-year dollars.

I’m sure it won’t surprise you that the secondary impression that I got from reliving the feat 40 years later was how it compares to the war on cancer that was born on the heels of the space race.  Two years from now, we will acknowledge the 40th anniversary of the war on cancer.  Regrettably, I use the word acknowledge rather than celebrate.  With the moon landing, we celebrated a huge victory of a presidential declaration seven years prior.  Today, we are still searching for victory in the cancer war that was declared by the president almost 40 years ago.  We spent $25 billion to put a man on the moon.  We have spent over $200 billion to put an end to cancer.  Compare the returns on investment.  If we can come together as a nation to accomplish the unimaginable in seven years at a cost of $25 billion, why can’t we accomplish the seemingly less complex in 40 years at a cost of over $200 billion?

I believe that we don’t care enough, collectively as a nation, about winning the war on cancer.  It is not of the priority, in government, in the medical community, in our educational institutions, and among the general public, to cause the national focus that the space race enjoyed.  We as a society have become hardened and accepting of the idea that the same old traditional concept of trying to kill the cancer cells with chemotherapy and radiation is the only option.  We have abrogated our responsibility for creative thinking to the scientists who keep testing the same categories of therapies hoping to find a new chemical compound that works. 

The cancer war can be won if we at the grass roots will generate the same fervor that we did in the ’60s and support a new strategy for the war.  We must demand the research and development of promising new medicines and theories that enhance the effectiveness of conventional treatment, lower its side effects, and reduce its duration.  We must turn to integrative oncologists who practice evidenced-based complementary therapies and reject the exclusively conventional treatment doctors who offer no choices.  It’s time for an expedited, aggressive, no-holds-barred paradigm shift to a new strategy for the war on cancer.  

My last post described a typical initial appointment with an integrative oncologist.  Today, I will contrast that with what you would generally expect of the first appointment with a mainstream conventional oncologist.  An important caveat here is that obviously all doctors are not the same.  This is only a generalization, but nevertheless characteristic of most initial visits in the majority of cancer clinics. 

First, you notice that the doctor appears somewhat rushed.  Then you remember being surprised at the large number of patients in the waiting room.  He or she can’t keep them waiting too long.  Conversation begins, void of preliminary small talk, with a mini-lecture about your type of cancer and what the standard therapy is.  You hear names of some chemicals that you think you have heard of before and others you have never heard of.  If radiation is necessary, you are told that you will be transferred to another doctor at that point.  Your oncologist warns about how important it is that you maintain disciplined in keeping the treatment regimen.  Little is said about side effects other than to inform him or her if and when you have them, so they can be treated.  Nothing is said about the success rate of the therapy or your chances of survival.  You are told that the appointment desk will give you your schedule of treatments, and that you can report to that desk for each treatment.  You will also receive your next appointment with the doctor in about a month.

When asked if you have any questions, you inquire about your diet, any supplements you might need, and about physical exercise.  You are told to eat what you like, since your appetite will be suppressed with chemo and to try to keep up your daily routine as long as possible.  If you ask about availability of other potential complementary therapies to enhance the effectiveness of the conventional therapy, the doctor will say he or she is aware of such therapies, but is skeptical of them.  He or she cautions you that such complements could interfere with the success of the conventional treatment and could even be dangerous.  glancing at a clock on the wall, the doctor says that you shouldn’t worry, and that he or she looks forward to seeing you in a month or so. 

Please review my last post and compare these two visits.  Of course, these descriptions are overly concise and simplistic, but I believe they do accurately illustrate the basic differences between conventional and integrative medicine, particularly in the field of oncology.  I have personal experience with both.  I accompanied my late wife to initial visits with a conventional oncologist first, then with an integrative oncologist.  The two descriptions I have written are true of my experiences.  I think you can see one more reason I am passionate about the future growth of integrative oncology.  It is the new strategy that is absolutely essential for victory over this awful disease.   

After this week’s posts about doctors spending more time with patients, I thought it would be fitting to describe a typical initial appointment with an integrative oncologist.  Crossing the threshold from cancer diagnosis to treatment is, of course, filled with fear, anxiety, and depression.  The experience of the first appointment with an oncologist makes a tremendous difference in the success of the entire treatment.  Most patients of conventional oncologists leave this visit with too few options, insufficient information, and not enough individual attention.  Let’s look at how the initial visit with an integrative oncologist might be conducted.

The first moments would be devoted to just getting to know the patient–family life, support network, work situation, values, beliefs, spiritual connection, goals, etc.  This is important in understanding what motivates and inspires the patient.  Then the doctor discusses his or her own background and principles of practice.  This is to comfort the patient and build a positive relationship.  Next, the doctor explains the details of the type of cancer the patient has and is frank about its threat.  He or she shares that the treatment will be for the patient as a whole person and not just the disease.  The therapy will certainly involve conventional means, but will also be immune system building, emotionally stabilizing, mentally challenging , spiritually enhancing, and physically stimulating.  Then the doctor will lead a lengthy dialog to determine what specific therapies would most prepare and sustain the patient for their particular battle ahead.  The ultimate decision on the types and levels of therapy will be the patient’s.  The culmination of this visit will be an all-inclusive prescription including a vitamin supplement regimen, a custom designed nutritional diet, an exercise program, and several other lifestyle adherence requirements.  If you have been a patient or care partner who has experienced an initial visit to a conventional oncologist, you will likely agree that what I have just described is far removed from what you received.  Integrative oncology is the future of cancer treatment.  Patients must insist on it and go out of their comfort zone to get it.  It is far better treatment with less pain and higher survivability rates.  

Let’s continue yesterday’s perspectives on the American Society of Clinical Oncologists (ASCO) new statement on discussing costs with patients.  As I indicated, a doctor/patient dialogue on treatment cost should lead to consideration of lower cost complementary therapies, but instead, it will probably be used to caution against such ”unnecessary” therapies. 

However, anything that gets doctors to take time to talk more with their patients is a good thing.  At a recent Institute of Medicine conference I attended in Washington, D.C., doctors repeatedly confessed that they needed to spend more time with patients.  Increased patient load and added emphasis on revenue has turned most clinics into assembly lines.  While this is becoming a growing issue among the medical community, health care reform proposals appear to portend even less personal connection between patients and their providers. 

A key principle in the strategy of integrative oncology is more time and conversation between the oncologist and patient.  The concept involves the oncologist understanding the patient–his or her values, beliefs, personality, and desires.  When conventional therapy is accompanied by specific complementary therapies that reduce physical and emotional stress, build confidence and self esteem, and support a desired lifestyle, healing is faster and less debilitating.  Such treatment requires extensive one-on-one discussion.  This concept is far removed from the typical conventional treatment where the oncologist dictates the patient’s treatment, orders it up, and tells him or her when to be there to receive it. 

A huge paradigm shift from exclusive conventional treatment to integrative treatment is desired by many, but extremely slow in coming.  I urge you to become active in the fight.  Learn more about it and demand it.

A surprising statement was just released from the American Society of Clinical Oncology (ASCO) after their annual meeting in Orlando.  The guidance statement urges oncologists to discuss the potential financial costs of care with their patients.  These clinician/patient discussions about cost, the guidance statement declares are “a key component of high-quality care.”

This unprecedented and sudden concern for transparency in cost of treatment comes as reports on health care spending show cancer treatment rising at 15% annually.  The new guidance statement, published in the Journal of Clinical Oncology, is said to also be for consideration by insurers and other stakeholders in the cancer treatment industry.  The life-or-death nature of cancer has previously kept the conversation of cost out of the doctor/patient relationship.  One doctor participant in the ASCO meeting added that providers need to minimize costs by ensuring that they focus only on evidence-based practice and avoid treatments of questionable value.  I read that as attempting to justify exclusive reliance on conventional therapies with little or no consideration of complementary therapies.

As costs increase, most traditional oncologists will likely circle the wagons around chemotherapy, radiation, and surgery and further reject natural enhancements as adding to the cost unnecessarily.  They will tell their patients that avoiding complementary therapies will reduce their cost.  The minority of integrative oncologists will argue that such a position actually increases costs.  Complementary therapies that boost the immune system, selectively target the cancer, provide psychological support, etc., enhance the conventional therapies and reduce their duration.  That results in cost reduction and has been proven effective.  Less expensive complementary therapies that reduce the need for more expensive conventional therapies would obviously shrink overall costs.  Concerns about the high cost of cancer treatment should translate to greater interest in integrative oncology.  Unfortunately, we are already witnessing moves toward generating the opposite effect.   

Continuing my analogy of cancer treatment and America’s war strategies, I want to contrast two periods of our war history.

Generally, two types of political approaches have characterized the wars of the past century.  In WWI and WWII, political influences were directed almost entirely to uncompromising victory.  How we won was less important than the determination to win.  The victory over the European Axis was through the overwhelming employment of conventional forces.  The victory over Japan was through the ultimate in unconventional force–the atomic bomb.  Total victory in WWII was through the combination of conventional and unconventional weaponry.  It took something fierce and previously unknown to bring Japan to a declaration of surrender.  On the other hand, the Korea, Vietnam, and Iraq wars were replete with political complexity.  Winning was not as important as how we would win.  The troops and their commanders were under countless constraints while Washington debated political ramifications.  The nation’s industries were not on a wartime footing, but essentially doing business as usual.  The American citizens were much less committed to victory than they were in the World Wars.  Compare the results. 

Today, our arch enemy is not a nation.   It is terrorism carried out by radical fundamentalists.  Like cancer, this enemy doesn’t identify itself until it is too late.  Then it goes into hiding among the normal, noncombatant population.  Conventional warfare is virtually useless against.  Yet that is in large measure what we are fighting it with.  Terrorism can only be defeated by unconventional means, much of which may not have even been discovered or invented yet. 

The war on cancer will only be won with the political and cultural resolve of the World Wars including their use of the unconventional.  We cannot continue to fight it the way we fought North Korea, North Vietnam, and Iraq.  Conventional therapy is still needed, but we must have the resolve to also bring in the unconventional, natural, and non-toxic complements necessary for ultimate victory.  Such is the goal of this blog and web site. 

For the next two days, I want to draw an analogy between the military war experiences of our country and the war on cancer.  Interestingly, they have the same issues.  We need to learn from our military wars and apply that strategic knowledge to our arch health enemy–cancer.

The best scenario for victory in wartime is an “apolitical” war with everyone focused on winning.  The strategy would be clear with unified support.  The government branches and agencies would give equable support to all weapons and tactics necessary for victory.  Professional support agencies in coordination with industrial suppliers would ensure the development and production of the best weapons without political bias or profiteering.  Free market competition would assure the employment of the most efficient and effective weapons and operators.  Field generals and battle field commanders would be free to choose the weapons and tactics they deemed best.  Troops on the front line could use a wide array of weapons and tactics depending on the enemy capability and movement.   Unconventional forces and non-traditional methods of battle would catch the enemy off guard and keep them on the defensive.  Ultimately, the lean, mean fighting machine would be victorious.  It would have never tasted victory under its previous constraints and status quo.

This is the political, social, and governmental environment necessary to win the war on cancer.  Unfortunately, it is more of a dream than a reality.  However, we must dream.  Then we must fulfill that dream with action.  As a nation, our focus on cancer prevention and treatment must be unified.  We must be determined to provide the “best” and not get sidetracked with the adequate.  Free market competition for treatment options must abound.  Doctors must be freed up to prescribe what is needed, not what is convenient and profitable.  Everything must be on the table for scientific analysis.  Integrative oncology must become the rule rather than the exception. 

Since this blog is relatively new on the cyber scene, and many have just recently begun reading it, it’s probably time to review some basics.  The purpose of the blog is to generate awareness and support for a new strategy for the war on cancer.  This new strategy has integrative oncology as its core.  So, let me go back and explain briefly just what integrative oncology is.

To understand integrative oncology, we have to realize that traditional cancer treatment in America for the last half-century has been limited to surgery, chemotherapy, and radiation.  This conventional strategy of treatment continues to be very intrusive and harmful to the body, but it does have some degree of success against the disease.  However, the overall mortality rate of cancer has changed very little in the last 50 years.  Conventional treatment weakens the immune system at at time it is most needed to fight the cancer.  Hence, although many cancer victims have survived because of conventional treatment, its overall effectiveness is certainly questionable.

Over the past decade, the evidenced-based, legitimate options that have grown out of alternative therapies have been developed by a few researchers and oncologists.  These options include such therapies as nutrition, dietary supplements, acupuncture, stress management, spiritual and psychological counseling, physical exercise programs, massage, music therapy, anti-angiogenesis (constraining blood supply to tumors), hyperthermia, nanopartical implantation, chelation, and mind-body interface.  These example and other integrative practices are natural, non-toxic, and proven effective.  They are meant to be prescribed as a complement to, not a substitute for, conventional treatment.  Integrative oncology combines certain of these practices with conventional therapies to increase conventional treatment effectiveness, reduce its negative side effects, and shorten its duration.  Integrative therapies have the potential of significantly reducing our dependence on conventional treatment as they becomes more commonplace.  They show promise of lowering cancer mortality rates and certainly extending the live of cancer victims.

Presently, there are relatively few trained and experienced integrative oncologists.  Most of them have full patient loads and waiting lists.  Yet, few people know about the options, and few oncologists are familiar enough with integrative therapies to even discuss them with their patients.  Again, awareness and support of integrative oncology is the purpose of this blog, the http://cancerchoices.org website, the book I am writing, and the Connie Thompson Foundation.