The deepest problem:
of the immortality of the crab,
is that a soul it has,
a little soul in fact …

That if the crab dies
entirely in its totality
with it we all die
for all of eternity

Miguel de Unamuno, ‘The Immortality of the Crab’

 

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Pensar en la inmortalidad del cangrejo (‘Thinking about the immortality of the crab’) is a Spanish phrase used to excuse one’s daydreaming;  a humorous reference that one was not merely vegetating, but rather actively engaged in contemplation. A recent post on my Forum had me thinking about the immortality of a different crab. A visitor posted the following:

Why does Dr. D recommend chemo for cancer? Seems like a primitive approach, and not in line with the Hippocratic Oath.

 

First of all, the Hippocratic notion of ‘first do no harm’ (primum non nocere) is not an accurate interpretation. It is more accurately, ‘if at all possible, do no harm.’ i.e it is a heuristic, not an algorithm. If it were a law then draining a abscess or giving a B12 injection would be a violation.

I suspect this question came up because of a case I had written about in my book The GenoType Diet. It involved a man who was blood group A, FUT2 positive (secretor) and homozygous for blood group M (MM) that had a cancer known to have ‘A-like qualities’. Under these circumstances I have discovered that these individuals have a much more difficult time with things. There are a variety of reasons for this. This constellation of blood group genetics has a higher rate of multiple drug resistance (MDR). (1) There is evidence that the levels of p-glycoprotein (the carrier molecule that is part of the system) molecule that up to seven times more abundant in tissues of individuals who are blood group A, which may go along way towards explaining why it appears that type A’s with cancer who receive chemotherapy often do not have as beneficial an effect as the other blood types. Finally, blood group A appears to have lower circulating levels of anti-Tn (Thomsen-Freidenreich) antibodies. The Thomsen-Freidenreich (Tn) antigen (also known as is usually present on cell surfaces in a cryptic form covered by N-acetyl neuraminic acid moieties and released into circulation in many different cancers. (2) Thus it provides a means of cancer surveillance, and it is this function that is compromised in blood group A, probably because the Tn antigen shares some structural similarity with the group A antigen. The Tn antigen is currently under intense study as a possible site for a cancer vaccine. (3)

In this case, which is not all that uncommon, the patient had ‘shopped around’ until they found an oncologist who had recommended a very mild protocol. Upon consulting with me they were surprised that I had instead recommended that they seek the more aggressive alternative protocol.

Why did I recommend chemotherapy in this situation and why would I recommend chemotherapy at all? Because in many instances, without it, people die unnecessarily. Is that a ringing endorsement of modern oncology? No, there is much evidence that in many instances chemotherapy is not all that effective and merely degrades the patient’s quality of life. But what should we propose instead to tell a kid with a pediatric leukemia that is highly treatable: To juice raw liver and take coffee enemas instead?

I’m currently monitoring two brain cancer cases who are bucking the odds for long-term survival. In both cases they received convention treatment plus a tailored regimen from me. I doubt if they had received only one or the other that they would be alive today, though I am certain that some natural medicine gurus would have told them that this was all a big mistake. Trouble is, where are these guys when the patient comes back with the recurrence? I can tell you that they are no where in sight. That’s when they send in the assistant to tell you that ‘maybe it is time to do the chemotherapy.’

Here are some case histories from the front line of the naturopathic/conventional oncology interface:

Case History #1

Years ago I had a patient who had an early-stage testicular cancer. This cancer is 100% curable with chemotherapy. His wife, a massage therapist, was pushing that he go ‘completely natural.’   I politely explained that there were many, many options he could use to help control and optimize his results, but it would not be wise to forgo a treatment such as this, which was so reliably successful. They opted instead to do juice fasts and go elsewhere. Six months later they were back in my office, he riddled with metastasis, now taking that very same chemo to simply ‘debulk’ the cancer and help him survive a bit longer pain-free.

Case History #2

I treated a patient for a number of years who suffered from a rather uncommon combination of non-Hodgkin Lymphoma and Hodgkin Disease. It was though to be the result of Agent Orange exposure that occurred from the patient’s multiple tours of Vietnam while in the military. He received aggressive allopathic treatment from Sloan-Kettering, but was advised that the best one could hope for would be a rather short-lived reprise. We commenced some nutritional and botanical co-treatment, which none of the Sloan-Kettering physicians objected to. After two years disease-free it was clear that the patient had experienced an exceptional result. Frankly, although many people believe that conventional medicine has no interest in naturopathic type therapies, he was asked back to the hospital, and in his own words, ‘put in a large room filled with guys in white coats who wanted to know exactly what, how much and how long had I been taking these naturopathic things.’

Several years after that the patient, a life-long smoker, was diagnosed with bladder cancer. He was treated, with chemotherapy and with variable degrees of success by physicians at Johns Hopkins. The doctors here advised him that they would not treat him unless he stopped all naturopathic treatment, which he did. Eventually his bladder was removed and some metastatic spread was noted soon after that was thought to be from the non-Hodgkin Lymphoma He was placed on a series of Rituxan (Rituximab) injections and seemed to do well for a while. However, these eventually stopped working, the disease spread and at his final consult before being set up for hospice, when asked if there was anything left they could explore, was told that ‘maybe they should contact their naturopath and see if there was anything he could do.’

My take on things

A primitive approach, IMHO, is to base your decision on broad sweeping conclusions drawn from consumer reading material that limits your ability to decide what is the right thing to do then and there. Hopes, aesthetics and dreams are nice, but we must also deal with realities.

The goal of any good physician is simple: To get their patients from one side of the river over to the other. If it can be done exclusively with naturopathic modalities, so much the better. If in order to do that I need to combine modalities, well, that is part of the equation. If the only way that I would agree to ferry them across would be to require them to do only that which is acceptable to me I would not be much a ferryman, now would I?

A liability we physicians labor under is the delusion that our patients cannot get better without us and our methods. As soon as we let go of that we can participate in their improvement joyfully no matter from which direction it comes from.

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1. Weinstein RS, Kuszak JR, Jakate SM, Lebovitz MD, Kluskens LF, Coon JS.ABO blood type predicts the cytolocalization of anti-P-glycoprotein monoclonal antibody reactivity in human colon and ureter.Hum Pathol. 1990 Sep;21(9):949-58.

2. Uhlenbruck G. The Thomsen-Friedenreich (TF) receptor: an old history with new mystery. Immunol Commun. 1981;10(3):251-64.
3. Heimburg-Molinaro J, Lum M, Vijay G, Jain M, Almogren A, Rittenhouse-Olson K.Cancer vaccines and carbohydrate epitopes.Vaccine. 2011 Oct 1.

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Tags: cancer | dogmatism | epic fails