Robin Daly – A huge welcome to you all and thank you so much for making the time to come together in this way at all hours of the day and night

Welcome Michael Lerner from the farther reaches of the west coast of the US. Michael is a man who spent a lifetime working tirelessly to change the face of oncology.

Welcome to Dr Bernie Siegel, pioneer of mind-body medicine, talking to us from the East Coast.

Also from the east side, a big welcome to the legendary author and researcher Dr Ralph Moss.

From further north, Chicago, we have the doctor who is justifiably referred to as the father of integrated oncology, Dr Keith Block.

From the far side in Australia, I’d like to welcome Ian Gawler, who has done so much since those early years to broaden up ideas on what could help those with cancer.

And last but by no means least, also in Australia, we have the inspirational Petrea King, a beacon of light for people with cancer for more than four decades

As I said in my introduction, you all qualify as heroes of mine, respected names from the dawn of my consciousness around oncology, people who were talking sense long before the rest of us were caught up. I never dreamt I’d even get to meet you, let alone have the privilege of gathering you together in this super-panel.

I have a bunch of questions to you all, that have come from current practitioners, supporters of Yes to Life in fact, all of whom have you to thank for the ground they are standing on now.

Our first question is from Dr Penny Kechagioglou, a senior NHS oncologist and also co-chair of the British Society for Integrative Oncology. She writes:

“I’m a mainstream clinician and chose to train in integrative and functional medicine to understand and offer a personalised approach to cancer care. isn’t it time that integrative medicine became mainstream, and what needs to change?”

Michael Lerner – First of all, thank you, Robin, for assembling us. All of the folks here are old friends, and I’m so honoured to be with you all.

I’ve worked on these questions of integrative oncology for 40 years. I really find, in response to your colleague’s question, that integrative oncology or what Wayne Jonas calls the Whole Person Oncology, is really ready to take the next step. I really believe that. I really believe it is ready to move toward being standard of care. This is in the face of many, many vast financial and political forces that are, for very good reasons, completely committed to the status quo. It’s different in the UK where the financial incentives are different and perhaps in Australia as well. But in the United States, I can say that there are simply immense forces, largely Big Pharma, that almost control the system. I don’t say that as an accusation for Big Pharma. As long as medicine and pharmacology are for-profit institutions, that’s how it’s going to work. Those are where the forces are. Some of us believe that medicine and pharmacology should be outside of the market system, but as long as they’re part of the market system, those forces will be arrayed.

But we know from experience that, for example, when women began to demand a better approach to birth, or when women began to demand a more integrative approach to breast cancer, that because women are market forces with a stronger interest in integrative approaches, the demand side mad a difference. I recently did a conversation that will be up on the cancerchoices.org website with Wayne Jonas MD who was director of the Office of Alternative Medicine at the National Institutes of Health, very distinguished VA physician. What I really grasped in a strange, fresh way for the first time this past month is that for 40 years, I have been understating the limitations of conventional therapies. I have been understating the impact of whole person therapies. I’m a very careful person. I’m a very evidence-based person. Cancerchoices.org, and my original MIT Press book Choices and Healing, both focused on the case for it.

But even spending 40 years on it, I just hadn’t fully recognised that, you know what, from an oncologist point of view, they know the limits of conventional therapies, but it typically doesn’t get conveyed to the patient in terms of what those limitations are. Then if you go to whole person integrative care, it actually can deliver a better quality of life, longer life, and lower chance of recurrence. So after 40 years of work on this, I have a fresh appreciation of the limitations of conventional oncology, which I believe in where it’s useful, and the force of whole person practices should bring us to a new recognition that this should be the standard of care. I won’t say it will be easy, but I will say the evidence is there and it should become the standard of care.

” I asked 100 medical students to draw themselves working as a doctor. Only one drawing had a patient in it. “

Bernie Siegel – I learned this in a shocking way. I asked 100 medical students to draw themselves working as a doctor. Only one drawing had a patient in it. That’s something we need to incorporate. The same is true when you say to a patient; draw yourself receiving chemotherapy. One drew the devil giving him poison. Another drew God as the source of chemo who has no side effects, the person who’s receiving treatment from God. That’s why physicians have to learn to treat people, not just the disease, and then you have a very different response.

In my office, everybody got a box of crayons, who were told draw yourself, your disease, your treatment, your immune system, and then I could guide them and help them to make choices. It could be anything in their life, draw yourself to work, we have more deaths, illnesses on Monday mornings. If you hate your life, and then you get cancer, guess who’s more likely to die; the person who loves what they’re doing, or quits. That’s the other thing I saw so much of, how many people quit what they were doing, I’m going to be dead in a few months, so I’m moving, I’m getting a new job, I’m quitting the law office and playing the violin, I’m going to the mountains to live. When I wasn’t called to funerals, I’d call up to say, why didn’t you invite me; the person who I thought was dead answered the phone, and said, I didn’t die, that’s why you didn’t get invited. Because they were living a different life and the body got the message.

We’re all going to die. But living is the important part. It’s easy to tell what people need help with when you say to somebody: give me a word that describes what it’s like to have cancer. Failure. I said, how does that fit your life? She said, low and mighty fails me. I said that is not my question. How does failure fit your life. My parents committed suicide when I was a child, I must have been a failure as a child.

I don’t make up any of these stories. But when you hear a word like pressure, failure, and you eliminate those things in their life, their body responds also.

Whenever I read medical journals, why do women live longer than men with the same cancers? Why? Because sitting in the office, what does the man say? I can’t work anymore, what’s the point of living? I said turn your head to the left, you got a wife and three kids. And what do the women say, and I don’t make up any of these stories, I have six kids, I can’t die till they’re all married and out of the house. 20 years later, her sixth child, the daughter married, and her cancer came back and she died. We can’t separate people’s lives from their outcomes. We’re all going to die, but help them to live and what a message their body gets that it didn’t get before.

Ralph Moss – I second what Michael Lerner was saying; Michael and I have been friends and colleagues for almost from the start from the 80s. Our thinking is along parallel tracks. But it’s interesting, because we never talked about this issue that he just brought up. My last book, Cancer Incorporated, which is at my website, themossreport.com, goes into considerable detail on the monetary payoff, payments from the drug industry to the oncologists.

This data is hiding in plain sight. Because part of Obamacare was an Act passed in Congress, by partisan Tom Harkin, a Democrat and another Republican at the time, both sponsored its legislation to force require the drug companies to report to the penny, how much money they were giving to American doctors. It’s phenomenal. You have to look at this, everybody has to look at this. As I say hiding in plain sight. Because some American oncologists are getting up to $3 million a year from individual drug companies for basically promoting their products. The immediate response would be that the way the system is set up, they have to take that money, because how else would they do their research? But what we’re talking about here is money that goes into the pockets of the individuals. we’re not talking about research funds, we’re talking about funds that are given for amorphous services that these doctors provide to the various drug and other medical related companies.

This came to a head about three or four years ago, when the physician in chief at my former institution Memorial Sloan Kettering Cancer Centre, Jose de Silva, was exposed on the front page of The New York Times for taking $3 million from a drug company. He was promoting their products so heavily that it raised suspicions at the Times and at ProPublica, which is a public interest research group. Why is this guy pushing drugs that even the company itself isn’t? He didn’t coordinate his statements with the company; the company pulled the drug even from development, and he hadn’t gotten the memo, he was going on, like Marie Antoinette after her head got cut off, he was still going on promoting this drug with outrageous statements. My former department at Memorial Sloan Kettering, Public Affairs, was putting out press releases with his handsome face on it on the press release, about the wonders of this drug that behaved so poorly in clinical trials that they pulled the drug.

The point being though, I’m not going after so to speak the rank and file of the 25,000 or so oncologists in America. I think they have a huge problem. This goes back to what Michael was saying. The problem is, to put it in very forthright terms, is a problem of corruption, that the field, the leadership of the field of oncology, as embodied in ASCO, American Society for Clinical Oncology, has been corrupted by big pharma. The vehicle, the mechanism of that corruption is, first of all, to provide much of the research funds, the researchers who sit on the panel of doctors who are evaluating the results.

But you have a situation where if you’re accused of a crime in the United States, in many jurisdictions, you’re going to sit on a jury or judge, you’re going to be examined very closely to make sure you don’t have a conflict of interest. As I was writing my book, I went through this process when I was living in Maine. It was always comical, because we spent an entire day going into the minutiae of the law by the lives of all the jurors to make sure there was no possible conflict. One woman was rejected from the panel, because she had babysat for one of the defendants 25 years before, so they bumped her off the panel. But in America, and maybe in other countries as well, you can be the evaluator, a lead author on a clinical trial of a drug, not legal trial, but something even as much, if not greater, consequence for society, you can be the judge and a jury of a new drug, and be taking money into your pocket from the same company that’s proposing the drug. That’s corruption.

Nobody seems to care or know or do anything. Yes, it made a splash in the New York Times three or four years ago, but the person who wrote those articles moved on to some other things. They’ve never touched it again. I never hear reference to it anywhere. Nobody seems to find this to be abnormal. But this is a mechanism, not the only one.

Dr Bernie Siegel – Part of it is that you become doctors for the wrong reasons. You want to impress people, you want the money and everything else. One of the things I mentioned to medical schools, which nobody has done, I said, when people apply, tell them, draw yourself worthy as a doctor and send it with the application. These are people treating the diagnosis and a disease, not a human being. They want to impress everybody. I always say Donald Trump is an example of what kind of life he lived to make his parents happy so that when you become that doctor, my son the doctor; you’re a doctor for the wrong reasons. You have to know the people, both the doctors and the patients. And the placebo effect, what you tell people, this is a fatal illness, you’re going to die. Yes, there are people who have gone home and died.

” I taught people, not how to not die, but how to enjoy living and lots of lovely and wonderful things happen. Then there are the others whose hope is taken away and it affects your immune function, and boom, you lie down and die.  “

I don’t mind what I call lying to people, to give them hope. Because they’re not a statistic. There was a landscape gardener who had developed cancer, I operated, he had cancer in the stomach, he received the chemo. I said, you need more treatment. He said, no, It’s springtime, I’m going go, I’ll make the world beautiful, so when I die, I leave a beautiful world. Those were his exact words. Six years later, the nurse handed me his chart. I said, he’s dead, we have two people with the same name. She said, open the door. I opened the door to the examining room and there’s sat John, saying, I have a hernia from lifting boulders in my landscape business. He became my teacher and my therapist. He lived to 90. I went to his 70th wedding anniversary. But you see, we should be learning from those patients. Why didn’t you die when you were supposed to? They always have a story to tell you. I taught people, not how to not die, but how to enjoy living and lots of lovely and wonderful things happen. Then there are the others whose hope is taken away and it affects your immune function and everything else, and boom, you lie down and die.

Robin Daly – Thanks, that’s what Dr Penny Kechagioglou is interested in, the lady who asked the question. She’s definitely heading in that direction as a pioneer oncologist in this country. Thanks for the very concise answers about what needs to change there, I think there’s no doubt about what’s being said.

I’ve got a question here from a nutritional therapist, who’s got a strong background in cancer biology. She works here in the UK, her name is Sylvia Grisendi. She sent in her question as a recording:

Silvia Grisendi – Hi, Robin, very briefly about me. I started a long time ago as a cancer research scientist. I have subsequently become a nutritional therapist and functional medicine practitioner here in the UK. For the last 10 years or so, I have been working with people with cancer, using nutritional and lifestyle medicine.

My question for the panel is; we all dream about a near future in which integrative oncology will be the standard of care. Right now, at least in the UK, but in many other countries too I think, this is not so, or even a consideration sometimes for a lot of people. In an ideal world, assuming there were no limits to what kind of treatments or therapies, tests, etc, are accessible to any person who is newly diagnosed with cancer; what will be, in your opinion, the first few fundamental therapeutic strategies that every person who is newly diagnosed should be offered as a standard of care, as they start their recovery process from an integrative oncology standpoint? Obviously, assuming that any strategy will be implemented on a personalised basis. Thank you all for your time and thank you also for the wonderful work that you do.

Petrea King – In many ways, it’s related to that first question. The fact is we got a sick system. What epigenetics has told us is that we need to be aware of what’s in the epigenetic environment, which is about sleep and exercise and nutrition, the chemistry of our emotions, the chemicals that are in the environment. Epigenetics tells us that we have to start treating people, not treating diseases. The whole system became so corrupted, we all fell in love with the idea of a silver bullet because of antibiotics, and we’ve been expecting a silver bullet, that we can live whatever lifestyle we like, there’ll always be a silver bullet that will get rid of any problems. Of course we know that that’s completely incorrect. Perhaps in oncology, more than in any other field, there’s this sense of the ownership of the patient by the system. Indeed, if you disagree with treatment for a child of 12, the child is made a ward of the state, rather than having the parent have care and control of the child. So obviously the oncologist is only focused on the treatment.

What the oncologist needs to say is that there’s a great deal more to healing from cancer than just chemotherapy, radiotherapy and surgery. We really need you to focus on exercise and nutrition and dealing with stress and what’s going on in your life. We have to listen to their stories because everyone’s got a story. You can’t treat a disease, you have to treat a person. Give the patient lots of things to do that empowers them, that gives them hope that they can make a difference in this situation, so that they can actively engage with the healing that they’re involved in. Rather than just expecting a silver bullet, you don’t need to do anything, we’re going to fix you, we know that that simply just doesn’t work. People are dying in droves after the war on cancer. Particularly since the recent times, we have many, many people being diagnosed with stage four cancer. This is just in the last year or so. It’s a very, very serious problem that’s growing dramatically as we speak.

Michael Lerner – I’d love to hear Ian speak on this subject, an old friend and colleague done beautiful work on this end. What are your thoughts Ian?

” … for many people, cancer is a socially acceptable form of suicide… “

Ian Gawler – Sylvia asked about therapeutic opportunities at first diagnosis. From the patient’s perspective, there are a couple of key questions. I always start with one that often surprises people, I ask them do they actually want to live or not? Because for a lot of people, cancer comes in at a time in their life when their lives are actually really quite difficult. An old colleague and mentor of mine, who was a psychiatrist, felt that for many people, cancer was a socially acceptable form of suicide. That’s a pretty strong statement to make. It can confront people. I’ve never met anybody who consciously set out to give themselves cancer and die of it. But there’s this element of “how much do you want to live” is an important starting point.

Given that people do want to live, then the next question is, who’s going to be responsible for my healing, and the decisions around it? Do I look to other people, which might be from the family, from friends, from doctors, from natural therapists, and ask them for their best advice and do when I’m told? Or do I seek that advice, but actually retain responsibility for my own choices? The majority of people I’ve worked with over the decades have been people that lacked choice. Particularly these days, anybody who gets on the net and looks at what can I do if I’m diagnosed with cancer, takes about what 5-10 minutes to feel overwhelmed.

I started running groups in 1981. Our organisation was a source of information. People came to us thinking there was nothing they could do, and looking to us for possibilities. Just the fact that there were possibilities was transformative, because it took them from feeling hopeless with no possibilities, to realising there were a lot they could do for themselves. That shift in hope was dramatic in the impact it had on both their physical health and their mental state, even their spiritual wellbeing.

When people take the initiative, and they are clear that they want to be the one who decides, then clearly the most important thing is the mind. Because we can talk about things like diet and exercise and medical treatment and natural therapies and so on. But it’s actually the mind that decides whether you do stuff or not. it’s the mind that decides how committed you are and how much you follow through, how much you persevere.

That’s why in an ideal world, I always recommend to people to start a meditation practice as soon as they possibly can. Because through meditation, there’s a very reliable and direct means of finding some inner peace and calm. When people are first diagnosed with treatment and trying to work out the options, their minds often do quite the opposite; freaked out, to put it bluntly, that can feel confused, can be emotionally distraught. It’s very hard to think clearly and calmly. To provide somebody with a direct means to actually settle their mind and to give them the potential to use their most powerful asset to its best and to be able to make good choices and follow them through. That’s why meditation is the actual practical starting point, because that leads to everything else.

Ralph Moss – I would like to weigh in on this about what doctors can do. One of the very important components of the convergence of conventional with complementary medicine is immunotherapy. The idea that the immune system has the power to overcome the cancer and that there’s a struggle going on between the cancer and the immune system, is a very old idea. It goes back to the ancient times. In modern scientific development, it was noticed in the mid-19th century that people who got particular kind of infection sometimes had a spontaneous regression or resolution of their cancer. This associated with the name of William B. Coley who was a bone surgeon at Memorial Stone Kettering. In the 1890s he started to give a streptococcal microorganism derived from a skin disease and inject cancer patients with that and got remissions of the cancer.

He had a conventional practice as a bone surgeon, a head of the department bone surgery at Memorial, also had a private practice giving people a mixed bacterial vaccine. We know a tremendous amount about the outcomes of these patients. It wasn’t a clinical trial because the modern clinical trial wasn’t invented until the 1930s and 1940s. But in the early phase of his career, from about 1893 to about 1911 or so, he had a very effective vaccine and many people at different stages of cancer were put in remission. I used to do a lot of radio shows, I was on Bob Atkins Show and many other shows around the country. Twice I had the experience of having people calling in and saying that they had been treated for cancer and had been cured of cancer back in the day before World War I. They were kids with bone cancer, they grew up and they were now old people. One time this person said, I went to New York and I was cured of my cancer. I said, you must have been treated by William B. Coley. He said how do you know that? Well, of course, because he’s the only one who could have cured you at that time.

Fast forward to a couple of years ago and jim allison of MD Anderson cancer center in houston won the shared the nobel prize for discovery of the immune checkpoint inhibitor drug uruvoy and that class of drugs. Jim Allison is the Scientific Director of the foundation founded by William B. Coley’s daughter, Helen Coley Nauts and is one of the leading immunotherapists in the world. There is a direct link between Coley’s work and the work what’s now conventional medicine for several different kinds of cancer like melanoma and some forms of lung cancer, an increasing list of cancers.

The key thing though, and this is something that everybody should be aware of, but very few people are, is that small doses of these drugs work as well as big doses. The reason, in my opinion that they don’t promote this work and there have been at least four studies showing that there is no dose response curve in the use of these drugs, it’s more like an on off switch; the reason they don’t is because the drug company gets paid by the milligram or the millilitre of the drug that they sell. It’s entirely profit-based on the amount that they can push onto people. These drugs make billions of dollars. I think Keytruda made over $20 billion last year. That’s one of these drugs. So there’s no profit in it for them to cut the dose three or four fold. It’s quite the opposite. It’s like saying, hey, you made 20 billion, how does 5 billion sound? Or maybe 1 billion?

Ian Gawler – Ralph, can I ask you a question? Because you’re really into this stuff. What you’re saying is probably reasonably general knowledge but why aren’t the administrators intervening here? if the drug companies are pushing so hard, you can understand that, and they’ve obviously got a financial imperative. But why are our administrators falling on their side and allowing big pharma to take over cancer medicine in the way that they have?

Ralph Moss – Because bribery and corruption of leading oncologists is not illegal.

Ian Gawler – I meet a lot of oncologists and I lead a lot of administrators, and there’s some very good people there, and there are lots of people who are interested in exposing corruption. Do you think it’s just overwhelming? What do you think about the potential for the future in this?

Ralph Moss – It’s a whole system. It isn’t one thing. First of all, if you or I were an oncologist, it’s very hard to change the system. If you go up against it, you are basically going to spend your life doing that and probably not be successful. It is going to take either some governmental shake up or it’s going to take some brave individual. We have somebody in the US, Vinay Prasad, who has similar views to my own, and he’s an oncologist, at University of California, San Francisco. He’s written a book, he’s written articles, so there is some motion around this. But how far do you get if you are functioning within the system? How far do you get if you attack the people up above you and accuse them of being corrupt?

Ian Gawler – It seems to me that this is a key issue for integrative oncology. In the past, more than ten years ago, it was the patient groups who were leading the way on this. It was the patients giving voice to what they really needed. And yet, from what I can tell, it seems to me that the patient groups themselves have become big businesses.

Ralph Moss – They were penetrated by pharma, and some of them were bought off. I had personal experience with this, that sometimes they were set up. It’s what’s called astroturf. In other words, instead of grassroots, it’s a synthetic grassroots movement created by the drug company to promote the rights of the patient, which means that if the FDA occasionally does the right thing and doesn’t want to approve or continue approving a drug that doesn’t work, next thing they know, there are picket lines around FDA headquarters of patients who either are bought and paid by the drug company or else are duped by the people who are bought and paid by the drug company. So it’s complicated.

What’s going to bring this down is the greed of the drug companies. Meaning that if it cost a million dollars to treat patients with immunotherapy, which is now what it costs for receiving two drugs, by the time you’re done, it comes to a million dollars a patient. Which means, as the New York Times had an article the other day, that a lot of people just can’t afford these modern medications that are supposedly miraculous. But there’s actually a way out of this, and that is that with immunotherapy you can lower the dose and simultaneously increase the immune potential of the patient.

Because we know with very good research that the biggest predictor of survival with immunotherapy is the innate strength of the immune system, which is measurable in terms of the number of lymphocytes the person has. If you have something in hand that can boost the immune system, meaning primarily or at least measured by the number of lymphocytes, you can then greatly increase the survival time and the likelihood of long term remission of the patient.

You work on it on both ends, lower the dose so that these horrible side effects that are associated with modern day conventional immunotherapy become much less drastic and you boost the immune system so that you can take advantage of the immune modulating drugs. But of course, the conflict here is what’s the biggest thing that brings down the immune system? It’s chemotherapy. I certainly agree about the role of the mind in this because there’s a correlation too, between your mental mood, your emotional state, your mental state and the state of your immune system. They’re one and the same, really.

Robin – Thank you. I’ve got another recording of a question here, so I’m going to play that:

“I’m Dr Wafaa Abdel-Hadi, I am a clinical oncologist and a functional medicine doctor. My question for the wonderful panel is very simple. I’m not going to ask about nutrigenomics or optimising vitamin D or special diet or microbiome diversity. I just need to ask, based on your vast experience, what is the most single affordable modification or change that you do for your patients in order to make them feel that they are on the right track, that they have hope to continue on this path? Because healing doesn’t happen overnight and cancer didn’t happen overnight. What is your best advice when a cancer patient comes to you? Thank you very much.”

Petrea King – One of the most important things, in fact, the most important thing is peace of mind to say to a person, drink your juice and meditate and forgive everyone and eat a fabulous diet so you won’t die. By all means, drink your juice, eat a fabulous diet, meditate, forgive everyone so you live today well, so that the emphasis is on living. We have these two systems in the brain, the Default Mode Network, which is all our past experience, the I’ll be happy when story. Then we have the Task Positive Network, which is our neocortex. That’s the bridge to our spirit. When we connect people with their Task Positive Network, their executive functioning brain, then we have access to the qualities of our first nature rather than what’s become second nature to us. People say all the time, it’s second nature for me to feel like this, think like this, react like this. No one ever questions, well, what’s your first nature? But when we teach people to meditate, to harness their attention and operate through the Task Positive Network, then you have access to insight, intuition, wisdom, humour, spontaneity, creativity, compassion.

These are the qualities that lead you in the direction of healing. In the beginning, most people are in shock for the first six to eight weeks, a little discombobulated by the whole thing. Our presence is the most important therapeutic tool in that first interview. If you turn up 100% and are deeply present to another human being, and you have your Task Positive Network engaged, you know which questions to ask, you know that listening is far more important than talking, that you can help this person to know themselves and to make choices that resonate with who they are. Because if it doesn’t mean something to them, then they’re just doing it for somebody else. It has to engage the person. They have to feel that they have the opportunity to make choices around what they eat, when they go to bed, how they go to bed, how they switch their mind off, all of these very, very practical things that only are the surface of integrative oncology. Helping people to sleep, to eat, to be. If you have your stomach removed, then you’re not going to be able to eat the diet that you ate before. We have to tailor everything to the individual. That’s why our presence is incredibly important, because if our mind is not still, we won’t know those skilful questions to ask a patient to help them to understand and know themselves in their own depths.

Robin: Dr Block, what’s your best advice when a cancer patient comes to you?

” …if we get a diagnosis of any life-threatening disease but certainly particularly malignancy, this isn’t necessarily going away just because the scan is clear “

Dr Keith Block – Robin, I would actually say simply that emotional support, encouragement in providing an environment that is life affirming, a communication that deeply acknowledges and provides hope. But you have to really truly believe it. People can see right through it when it’s not authentic. I would say that it means one has to provide real tools, real therapies, substance behind the communication in order to really make a difference. Keeping that in mind, I would say cancer itself is a marathon and it’s far from a wind sprint even though that’s what all of us, if we get a diagnosis of any life-threatening disease but certainly particularly malignancy, this isn’t necessarily going away just because the scan is clear. I often say that cancers, the invisible aspects of the disease are probably worse than the visible aspects of the disease and I mean that in multiple layers. The most obvious one is that these are microcellular diseases. They’re molecular diseases. They’re diseases of energy and pathways and metabolism, as much as they are of tissue and replication and abnormal cellular biology. Certainly they’re considerably beyond mutation even though most would agree that mutagenic biology is as fundamental to a cancer. But also the idea of damage to DNA on its own is not the whole story. We know that this is modifiable. It’s something that can be adjusted, modulated, changed by how we take care of ourselves.

The way that I would frame this, because the issue of affordable comes to mind, is that one thing that has been relatively ignored throughout medicine for the last at least several hundred years, with some exceptions in pockets here and there, is that it’s not only about DNA and the cell. It’s also about the environment that the disease exists within. In that environment, which you might call the microenvironment, back in the 70s as a medical student, I called that environment the terrain. The terrain is made up of a variety of biochemical immune metabolic factors and pathways that if disrupted, drives disease, interferes with treatment, drives adverse effects, interferes with quality of life. It has a profound impact and yet we can measure it relatively easily with a whole wide footprint of various laboratory testing and we can modulate it by fixing that environment so it’s cancer inhibiting and not cancer promoting.

Keeping in mind that the cells will hijack your biology to support themselves. So we have to get a hold of the soup, the soil that these seeds, these abnormal seeds are growing in and we’ve got to transform that environment. That is not costly to do. It’s time consuming. It requires a commitment because it is impacted by every aspect of how we take care of ourselves, how we live, how we eat, how we sleep or not, what our relationships are and the impact on us in terms of sympathetic nervous system and adrenergic biology, how we attend to our own parasympathetic needs in terms of whether it’s meditation, prayer, music and even optimism or the lack thereof, and what its consequential impact is on us.

”  optimising one’s terrain, it can be fixed so that it is cancer fighting, so that you can reduce treatment toxicities, you can boost treatment efficacy, you can reduce resistance from developing and yes, you can boost outcome “

I would say that extracellular environment is a biggie to answer your question for me, that terrain needs to be fixed. Without sounding self-serving, in my book Life Over Cancer, I spent seven chapters discussing the importance of the terrain and substantiating all the science behind it. Keeping in mind that I spent a good part the 70s 80s 90s doing research to demonstrate that that microenvironment is real, is critical to what happens to a patient, just as important as the cell is the extracellular environment with. Optimising one’s terrain, it can be fixed so that it is cancer fighting. It can be fixed so that you can reduce treatment toxicities, you can boost treatment efficacy, you can reduce resistance from developing and yes, you can boost outcome. So virtually all of the challenges that we face are interwoven with getting that environment optimised.

Robin Daly – Thanks very much. Maybe we’ll go into something a little bit controversial at this point. I’ve got a question here. This is going to be right up Ralph’s street. It comes from Dawn Waldron, who’s a nutritional therapist specialising in supporting people with breast cancer. Indeed, she’s an ex-breast cancer patient herself. She asked:

“As our knowledge of epigenetics and nutrigenomics expands, it becomes increasingly clear that the DNA damage inflicted by some conventional treatments has the potential to significantly accelerate growth and repair pathways in ways that may be undesirable in people with active cancer. While my practice currently focuses on helping clients make the most of integrative care, I find myself wondering if our evolving understanding of cancer behaviour has arrived at a point where chemotherapy in particular may be considered to harm more people than it helps. Can we honestly justify its continued use?”

Ralph Moss – I wrote a book called Questioning Chemotherapy 25, 30 years ago. Facts don’t lie. Because there is so much resentment and hatred of chemotherapy understandably, it’s important to emphasise that there are situations where it is necessary, where it does work. We don’t have a substitute for it right now. Of course I’m thinking of the acute lymphocytic leukaemia cases, there’re paediatric cancers. Statistically chemotherapy in the higher risk breast cancer and colon cancer cases does seem to extend survival. So I don’t think we’re just ready to get rid of it right now, quite yet, let’s put it that way. I do think that eventually it’s going to be looked upon as the way we look on the use of mercury and opium and bloodletting in the future. But we’re not at that point yet.

I can’t say, even conceptually, that it has no uses. But for the advanced stages of cancer, stages three, and especially stage four, of the solid tumours of adults, Yuri Abel, a biostatistician at University of Heidelberg, did a book about 30 years ago, Chemotherapy for Advanced Epithelial Cancers, which was the inspiration for my book Questioning Chemotherapy, and basically showed that chemotherapy had very little impact. There have been many studies since then, since my book came out, confirming that the percentages are small. Even Jim Allison, at University of Texas and the Anderson Cancer Center, in his Nobel Prize acceptance speech said, for most advanced cancers, if we can move the needle over by a couple of months, we’re doing really well. It’s more or less a proven thing; chemotherapy has really moved into the rear guard in terms of the drug industry. I saw statistics of the drugs in the pipeline, only about a quarter of them are even chemotherapy, the rest of them are targeted therapies and immunotherapies. So it’s had its day, but we have to be able to show that we have methods that are as good, if not better. But the battle really now is more over the question of the targeted drugs and the immunotherapy drugs.

Michael Lerner – Ralph’s work on this has been really important and very substantive. Ralph mentioned VK Prasad’s book Malignant, which is one of the important books questioning conventional therapies. I’d like to add that, as Ralph well knows, there’s a whole history of these. For example, when I was writing Choices in Healing over 25 years ago, there was a man named John Cairns who did a piece for Scientific American on the limits of conventional therapies. He had been really well respected up until he wrote this piece. Then he got just an immense amount of abuse about it. He wrote one more piece, got more abuse, and after that, he just went back to other subjects. There’s a guy named Clifton Leaf who wrote a very important book called The Truth in Small Doses, which tells the story of what happens to John Carrance and others. That was given to me by a leading person in cancer oncology who thought very highly of Clifton Leaf. Then there is VK Prasad’s recent book called Malignant, which is excellent, but also Azra Raza has written a book called The First Cell, and she’s a Professor of Oncology at Columbia, and her husband died of the cancer that she was treating.

The point is that if you begin to look, she references hundreds of articles in the oncology literature on this subject, there is an immense body of literature on the limitations of conventional therapy, and then there’s another literature on whole person approaches which we’ve been hearing about today. A place where I have a different emphasis from Ralph, though I don’t disagree with him, is that he calls it corruption, which you can call it that; I am inclined to use softer language. It’s not that I differ from his characterisation, but I simply say that the incentives for oncologists and so forth are such. Similarly to the question that you were asked before, actually that Ian Gawler was asking about why the government doesn’t step in. The polite answer to that isn’t corruption. It’s called agency capture.

What agency capture means, you could call it corruption, is that there is a revolving door between the agencies that are supposed to decide these things and the drug companies. People go back and forth among them as a career decision. It depends on who you’re addressing. As to the corruption, language is more useful, It’s straightforward and accurate, or whether you’re talking into the mainstream, in which case there is milder language that makes the same point.

” …whole person cancer care with more emphasis on health promoting activities and reduction of the use of conventional therapies that only extend life by two or three months, and it’s often miserable months, and they bankrupt families “

That’s why I just want to come back to the fact that we are at a point where whole person cancer care with more emphasis on health promoting activities and reduction of the use of conventional therapies that only extend life by two or three months, and it’s often miserable months, they bankrupt families and they bankrupt the entire system. We’re really at a point where it’s rational, profoundly rational, to make this the standard of care.

Dr Keith Block – It’s actually a fabulous question. It’s a very complex question because as chemotherapy is more often than not utilised, I would embrace the question as a legitimate question because of the level of toxicity, the limited use as a single tool in context of the multi-layered system that we understand today. It would be hard for me to believe that any one or two or even three bullets would be enough to hit the 50 or 500 bullseyes that make up the biology that’s driving malignancy. Our medical model has been fixated for way too long, specifically in this idea that we’re going to find a magic bullet, a silver bullet that’s going to knock down just the right bullseye and everything else is going to follow.

The only exception to what I’m talking about is immunotherapy and some of the newer drugs and newer approaches with regards to immune treatments can have a multi-targeted impact, even though it might be one drug that’s given, it’s working with multiple arms of the immune system that can have a rather profound effect. But the problem here is that so far it works in amazing ways, but only in a very small number of patients.

I would argue that this speaks even more aggressively to integrative care because we know from a number of randomised controlled trials, gold standard research that if we get the microbiome diverse, if we get those bacteria having dozens and dozens and dozens of cousins, that diversity will drive up the effectiveness of immunotherapy markedly. If we get rid of agents and strategies that actually narrow our diversity of our microbiome, it does just the opposite. If we get rid of them, we enhance. Examples of that are tricky because sometimes it’s life threatening, sepsis or pneumonia or some infection that has to be treated with an antibiotic. But we know that antibiotics as well as probiotics, not prebiotics; as well as probiotics narrow diversity. Fermented foods, high fibre diets, healthy diets, cashews, Jerusalem artichokes, for reasons that we don’t fully grasp and understand, drive up favourably diversity. There’re things that we can do to really influence this from the perspective that you asked the question.

Additionally, and maybe from my perspective much more importantly, the real question about chemotherapy may be solely the way it’s currently given. That said, science first shows, most importantly, that incomplete chemotherapy reduces survival. If you get significant side effects, the classic thing we doctors do is drop dosing or delay treatment or widen the interval between treatments, all of which diminishes outcome, shrinks survival. Well documented in multiple studies. There’s a breast cancer study that was done several years ago, almost 500 patients with early-stage breast cancer. Of those patients where they received 25% to 30% fewer treatments because of quality of life and toxicity from adverse effects, those patients were unable to complete their treatments or they delayed it, they had shorter survival. It was rather pronounced, and I would argue that it’s a no brainer.

Integrative treatment approaches improve quality of life. They reduce toxicity. They allow patients to complete full courses of treatment. The data speaks for itself that it improves outcome and survival. What we know and what the research shows is that anything that leads to the need to reduce treatment dosing, anything that leads to a delay in the interval between treatments, interrupted treatment schedules, or anything that leads to a patient abandoning mainstream treatment, leads to shorter survival and worse outcomes.

I’m going to go in a little bit different direction just for a minute. Since opening our doors in 1980, we’ve been looking for research-based strategies that can help reduce toxicity, reduce treatment resistance, improve quality of life, improve survival. A patient with greater health integrity, whether that’s nutrition, fitness, circadian health, sleep, bio-behavioural care, all of the different factors that make us up; the patient who has better integrity does better. There’s no surgeon on the planet that would have an argument with having a healthier patient on the table. Why should that be any different for anybody practicing medical oncology, radiation oncology, surgical oncology, it doesn’t make any difference at all for integrative oncology.

” every drug has a window on a 24-hour clock that I would call the happy hour. It’s when the drug is the most effective and the least toxic “

In the 90s, I came across a pioneer in the field, Dr. William Rashevsky, who actually had the original idea of what today we would call chronotherapy or chrono-modulated chemotherapy, time sensitive drugs. Chrono means time sensitive. Every drug has a window on a 24-hour clock that I would call the happy hour. It’s when the drug is the most effective and the least toxic. It’s significant enough that in some cancers you can get as much as a 400% improvement in five-year survivals based on existing randomised controlled research. That is a huge statement because so many of our drugs get licensed for sometimes as little as weeks, most often months. So many of our drugs really have a very small percentage impact in a large set of research that has been looking at trying to make better drugs and get better outcomes. So the importance of timing is essential because it speaks to reducing toxicity. If you implement drugs when the healthy cells are at rest and they’re the least vulnerable to chemotherapy, and you implement those drugs also when the cancer cells are the most active and most vulnerable, which turns out to be the same timing in terms of research, you get much, much better outcomes.

On a 24-hour clock, there’s a window that I refer to as a half happy hour, if I give you the drugs in that window, you get the best results, best response, best outcome, least toxicity. But if I give you exactly those drugs 12 hours earlier or later, you get the most toxicity and the least benefit from the drugs.

But it’s not just the time of day. It’s also what we call the style of the infusion. Think of this as if you drop frogs in boiling water, they jump to save their skin. But if you start with room temperature water and you sneak up on them with heat, by the time they recognise they’re being cooked, it’s too late, they already are. Now take cancer cells, we know this because of the existing research, you drop them into a pool of chemotherapy, high concentration. They’re not stupid like the frogs jumping out of water, they shut their pores, they congregate, and they go to sleep. What we do instead is we start with a tiny trickle of drug and that actually agitates cells. When they become agitated, they start gobbling up chemotherapy at two, three, four times the rate of a normal cell. When I say that, we’re talking 100% times the rate. We slowly, slowly, slowly increase the concentration in what’s called a sinusoidal wave. You need special technology to be able to give drugs this way. by doing that, by the time those cells recognise that they’re being poisoned, it’s too late, they already are. We can capture far more cells by giving drugs this way.

It’s a different model of care from that perspective. The timing, along with nutritional and nutraceutical support can actually have a profound effect on countering resistance. Drugs work better, work longer, and we get diminished adverse effects, which is one of the main reasons patients abandon treatment or their doctors reduce dosing or delay treatment all of which leads to significantly poorer outcomes.

So I would argue that there is a way to give chemotherapy. I would argue it shouldn’t be done alone. It should be done as part of an entire comprehensive system of care. I would argue that nutritional support, whether it’s oral, whether it’s dietary, whether it’s infusional, in my case, I would say all of the above, whether certain off-label drugs can be used and can be enormously helpful, not only for tolerance, but for synergistic value for boosting the effectiveness. Maybe more importantly, we know that infusional nutrition, I refer to a lot of IV nutrition, not just vitamin C, but a tremendous number of compounds that we use are pleotropic, these compounds have the ability to multitarget. They grow in nature in a pleiotropic model or manner that allows them to hit not 1, or 2, or 15, but sometimes hundreds and hundreds of bullets with the same agent, same formulation. That adds to the therapeutic potential both because it can enhance the effectiveness, the drugs diminish the toxicity of a disease and multitarget the disease. The drugs can enhance the efficacy. The natural products can enhance the efficacy and diminish the toxicity at the same time. But they also have the capacity to multitarget the disease, the underlying disease itself.

One example is that we know because of multiple randomised controls that were done with lung cancer patients, that these patients will get a platinum-based chemotherapy regimen and in 32 randomised controlled trials over 2,800 patients, when a platinum is given, a Chinese herbal formula, also European called the astragalus, or a Chinese formula that contains the astragalus with it, the research shows a marked decrease in the risk of death, of mortality, and an increase in response and outcome. it’s one of these kinds of examples that are really very relevant.

In addition to that, there’re many natural products that we use to protect the heart from HER2 type drugs, these HER2 new inhibitors like Herceptin and Pergetta and Lapatinib and others. These drugs could cause cardiac damage. We know that the drug Adriamycin can have damaging consequences to the heart muscle. But we can give agents like Hawthorne, Coenzyme Q10, a number of antioxidant compounds that can protect and even sometimes reverse some of the damage that has occurred with patients from taking those drugs. I like to use those drugs prophylactically, preventatively so that we’re not chasing the problem after the fact, but preventing it upfront.

” walking 3 to 5 hours per week in breast cancer patients was enough to cut mortality by half; in colon cancer patients, getting upwards of 6 hours a week of walking was enough to cut mortality by 61% “

But just as I say, we can deal with adverse effects, there’re compounds we can give to reduce resistance so your drugs work better and longer and there’re agents we can use that are synergists that like the astragalus example, enhance the effectiveness of drugs. These are not petri dish examples that I’m giving. These are clinical trials that have been done to really assess the potential value. Even something like fitness, we have fairly good data to show that keeping patients going through chemotherapy really active can make a big difference in reducing toxicity as well. Even walking 3 to 5 hours per week in breast cancer patients was enough to cut mortality by half. In colon cancer patients, getting upwards of 6 hours a week of walking was enough to cut mortality by 61% and cut recurrence by more than half. So we know that these compounds can have an effect and these lifestyle alterations, making better dietary choices can really make a big difference for people as well. It’s from my perspective a comprehensive model of care that is essential and a system that is directed at multitargeting but selectively and specifically. I do not believe you can throw the kitchen sink at a patient. I don’t think that works. I’ve seen enough examples of patients that have come through the door trying to follow alternative, complementary integrative programs that got themselves into deep trouble by overdoing it in what I would call a non-systematic, non-systemic manner in in ways that actually can be unfortunately detrimental rather than therapeutic. But done right, you can get enormous benefits. I would argue that chemotherapy has a place still, and I don’t think that that’s going to disappear anytime soon.

” according to the analysis based on the outcome of chemotherapy for 22 most common cancers, chemotherapy improved the five-year survival by 2.8% … “

Ian Gawler – Back in 2004, three senior cancer specialists in Australia did quite a detailed analysis based on investigating the outcome of chemotherapy for 22 most common cancers. They came up with the percentage that chemotherapy improved the five-year survival by. I was really stunned by the figure myself because I thought in those days it might have been something 10-20%. I went round and I asked friends and family and the highest figure I got was 90%, which was from a merchant banker, and most people put it around 30, 40, even up to 50%. Everybody was stunned by the real figure which was 2.8%…

The marketing of these drugs and the way they’ve gone into popular perception is that and this is well researched and well validated in the research, they’re clearly oversold and overused. As part of what’s happened in our culture, is that to discuss this is really quite difficult and people don’t really want to have the conversation. The media doesn’t want to have the conversation. Even the patient groups don’t want to have the conversation. If the patient wants to have it, often their family doesn’t want to have it.

There’s a lot of pressure that comes from families or the individuals to have these treatments because they want them to live and they’ve got the perception that this thing is going to offer a lot more than they actually do. One of the challenges in integrative oncology is to be able to have a rational conversation based on evidence about what the likely outcomes are of particular treatments, but also about what the outcomes are of actually lifestyle changes. For example, exercise, we know actually has got more chance of increasing five-year survival for a woman with breast cancer than chemotherapy does. But most women, when they go to an oncologist, get encouraged to have particular treatments and hopefully more are getting encouraged to do the exercise and look at their nutrition and all those other things.

Robin Daly – Not in Britain. I think you’re better off in Australia from that point of view. There’s more happening in the lifestyle.

Ralph Moss – I remember the reaction to Keith Block when he put exercise machines in his clinic and had people exercising while they were getting chemotherapy or had them out jogging along Lake Michigan. Even I was shocked. Because it’s one thing to talk about this, another thing, can you really do that? Well, yes, you can actually. You can actually exercise while you’re getting the chemo. But it’s very complex. I speak here also as a cancer patient myself, because I was diagnosed with a very aggressive prostate cancer seven or eight years ago. You are so susceptible. You are at the most vulnerable point maybe in your adult life. In my case, I’ve written about this and was horrendous what happened to me at an Ivy League affiliated medical school, medical university, so much so that I wonder whether there was maliciousness involved in the way that I was treated or whether the doctor in question was reading from the wrong patient records. I don’t know, because I was given a completely false diagnosis and told that my cancer had escaped the capsule and had disseminated through my body, which, as it turned out, was not true. I was told there was no treatment, no effective treatment. Here I am seven, eight years later because I refused to go any further with that department. I went to New York University Langone, which was my Alma Mater, and was well treated there with cryoablation. So here I am still. There can be good outcomes, but I’ve been through that mill, and I know what patients go through. From my case, my perspective, it was far worse than I suspected that it would be. You’re dealing with potentially a fatal disease, so you have all these Camus, these existential thoughts about life and the meaning of it or the lack of meaning of it, and you’re dealing with that, and you’re getting the pressure from your family to take the chemo. It’s complicated because there’s always going to be something the public is going to latch on to that gives that hope that maybe there’s a way out of this situation. The medical laetrile, which was a non-effective, treatment that was promoted and highly believed in in the 70s, that taught the medical establishment how far they could go if they if they could convince the public that there were effective treatments for their end stage or advanced cancers.

This is social dynamite. It’s something very powerful in the human psyche that goes back thousands of years to the witch doctors and the priests and the healers and the shamans and so forth. It’s just human nature. You’re going to look around and once find something. It’s just normal. I found myself even in this whole process, three in the morning, buying stuff on the Internet, then in the clear light of day I said, why did I do that? It’s there in the background of your mind. Then that becomes like the whole thing about quackery, which is baked in the cake in terms of medical, conventional medical education, is that if you promote something outside the realm of so called scientific medicine, well, you’re the lowest of the low. You’re a quack. Nothing could be worse than that, right? Somebody who exploits this fear and this angst of this tremendous need, instead of going with what’s scientifically proven. We’ve seen that the way in which these conventional treatments are promoted, even though the doctors are cautious in their statements usually.

There’s a wink-wink situation going on because the way it finally reaches the supermarket tabloid is, a miraculous cure has been discovered for cancer. One case, it could be a great case, but one case then becomes the proof of the effectiveness of this. You don’t see the broad picture, like with the immunotherapy. You don’t see the enormous number of people being harmed by the side effects of these treatments. When you combine, at the maximum dose, these two of these drugs, more than 50% of the people are winding up with grades three and four and even five, side effects from the drugs. That part doesn’t make it into the headlines. It doesn’t make it into the supermarket tabloid or the internet sensation. It’s complicated. But I wouldn’t throw chemo out entirely. That’s why I believe in integrative oncology, because I don’t think anybody has the answer. I don’t know whether we ever will have. We have bits and pieces of answers. There are very important components; nobody has mentioned cancer stem cells, for instance. A very important discovery of the past 10-15 years, the immunotherapy part. What about the metabolism? What would I do if I knew what I know now and I was entering this field? I would try to understand better and draw people’s attention to the link between type two diabetes, sedentary lifestyle, the way we eat today compared to the way most of us ate when we were kids, or the way our parents and grandparents and ancestors fed themselves. In the United States 48% of the population is now diabetic or pre-diabetic. It’s probably worse than that. It’s more like two thirds of the older population is diabetic or pre-diabetic, which is basically sliding a slippery slope down towards actual diabetes. This relates to cancer. I’m not saying one causes the other, but there’s something going on in the metabolism of the average person, especially the sedentary, middle class, older person who is combining bad diet, eating out a lot, eating prepared foods, eating a lot of carbohydrates, drinking a lot of beer and wine and then sitting around basically watching TV or not really being involved in consistent and vigorous exercise.

If I had changed one thing in my life, in terms of physical life, that would be, I would have paid far more attention to the fact that my own blood glucose numbers were clearly slipping over the year, getting higher and higher. Only one doctor who was an integrative doctor bothered to bring this to my attention and she didn’t push the point as strong as I wish she had. This is a key component of our ill health. It’s why these wealthy societies that we live in are so prone to illnesses, because this is metabolic syndrome, this is cardiovascular disease, it’s diabetes, it’s many different kinds of cancer. That’s the root cause. If we could change one thing, it would be to change the diet, to emphasise certain foods. I do believe certain foods are ,I don’t want to say magical, but there are some foods that are exceptionally healthful and important and essential. Combine that with these mind-body things, which I think are very, very important, but hard to get a handle on. I’m still trying, even though I do call that I do talk about corruption, but I still feel that part of my audience is still oncologists and I’m just trying to shock them, Michael, into recognising what’s going on.

If I were an oncologist, I probably wouldn’t use the word corruption, because I’m not. I’m basically a critical outsider. I feel like, well, who else is going to point out, there’s a simple English word for this? If you have good connections with the oncology community, sure, use a different term, talk about agency capture and so forth. But there is something rotten going on, which is the bribery. I’m just going to use very simple words here. The bribery of the leadership of the oncology field of ASCO by these drug companies to bring them on board to identify their own interests with the interests of the drug company. How this ends, I don’t know, but it’s the money issue with Bernie Sanders, now head of the Health and Welfare Committee in the Senate, maybe we’re going to see some real shakeups in this regard. But this money issue is probably what’s going to with the pharmaceutical industry meets the needs of the public for affordable medicine, both affordable to the individual and affordable to the society, to the government, medicare and to the insurance companies. These are coming into conflict more and more. So I think it’ll play itself out in that realm.

Michael Lerner – What Ralph was just saying, which I also believe Ralph, as I said, your plain speaking is a gift to us all. It all depends on who we’re speaking to. I want to pose a quandary to you all, which is very real for me. If we start with the Hippocratic Oath, above all do no harm. You meet cancer patients who as well, we all know they’re frightened, they’re vulnerable, and they believe in conventional medicine, they do not have a sense of personal agency, we know that only one person in ten has an internal locus of control, that they really believe they can change things, they go to these hallowed cathedral halls of science, believing that this is in their best interest and that the oncologist knows best, and so on and so forth. they just simply want to go in, get the treatment that’s been recommended, believe in it, come out the other side, and hopefully do better. That’s their hope, their prayer, and their whole belief system. we know about the power of placebo, Ted Kaptchuk’s work at Harvard. It’s very, very clear that placebo is active on behalf of conventional therapies when people believe in them.

So the quandary that I face is how delicate it is when you are with a cancer patient as to whether raising doubts about conventional therapies is actually going to help them when they don’t have a sense of agency, they believe in what they’re going to do, It’s hard enough to do it that way. Are we really doing no harm when we suggest to them, meditate, change your diet, exercise, all this stuff, which, number one, they may not believe in, number two, they may not have a sense of agency about, and number three, it’s not their dharma, it’s not the way they’re going to go. it seems to me, and I don’t have a simple answer to this, that the highest art of all is, as Petrea was saying, to listen carefully to the patient as to what they believe in and then adjust your responses to the best path for them, which may be to trust their oncologist, Just go through with it. in other cases, ask them, did you know or would you be interested in? I really think that integrative oncology faces a conundrum of how to follow the Hippocratic oath to do no harm in the face of where actual patients are. I don’t know the answer to that, but it’s what I’m thinking about today.

Ian Gawler – No, you make a very good point, Michael. I got a suggestion there, and I think it’s in the direct interest of the patients and really important for integrative medicine as a specialty. Given that integrative medicine more and more is going to become mainstream and best standard of care; it seems to me there’s a really big need and opportunity to intervene before people start treatment. Between diagnosis and treatment, there’s a real value in having a program where patients are guided to go through all these questions and possibilities that we’ve been talking about before they start treatment. At the very least, we know that most treatments are tough and demanding, both physically and psychologically. for people to be prepared and be given some tools to help deal with that in a way that’s consistent with their own backgrounds and belief systems is really important as a tool.

If we have a program that can actually guide people through that and give them a chance to adjust to the diagnosis, and to actually realise that there is real hope and the hopes can be based on the evidence of people who’ve gone through these experiences well, but is also backed up by empowering people with what they can actually do, then they’re much more likely to make better informed choices about the treatment. when they do come to take them on, to embrace them because they’ve made a conscious choice rather than a fear based panicked choice, which is often where people start their treatments.

The evidence is that delaying the start of treatment for almost all situations, an emergency where you need some sort of intervention, the evidence seems to be delaying treatment for a couple of weeks makes no difference to long term outcomes. there’s a real opportunity there as a paradigm shift in how treatment’s approached, which could be taken on by the patients as their choice and saying to their doctors, I’m really interested in what you’re offering, but I need to get my head together, I need to get my act together, I need to take time to sort out how I’m going to approach this. from integrative medicine saying this is really important if you want the best outcome, it’s like anything, the better prepared for you are for what you’re going to do, the better it’ll work. different groups, different oncology groups could come up with their own idea of how that program could be run. It just seems to me like that could actually solve a lot of this.

I spend a lot of time with people coming to our groups after diagnosis, after treatment and doing this in retrospect and that’s much more complicated. You’re thinking about how you could change things significantly for the better would be to give people time, rest and aside before they start getting help from the outside.

Ralph Moss – Let me just add quickly that if you have a heart attack, you have cardiac rehab. I agree with you completely Ian and that prehab before treatment is an ideal place to do exactly what you’re suggesting. But I also think there’s a psychological space after treatment based on cardiac rehab where it makes all the sense in the world to have oncology cancer rehab. if we sandwiched treatment, whatever it is, between prehab and rehab, we could work it at both hands. there is a real challenge in doing no harm for the average patient who just wants to go in and do what the doctor says. how we approach that gently so as not to do harm, I think is a challenge for integrative oncology.

Robin Daly – we’ve got a question from an energy therapist and spiritual coach with many years experience working in oncology nutrition. She’s called Liz Butler and she asks:

“I’m very interested in the power of the spiritual heart to support healing from illness, including cancer, and have found that a practice of accessing spiritual wisdom through the heart is invaluable for my clients as they navigate their way along their healing path. It seems, however, that the contribution that spiritual connection can make to physical healing is still underappreciated, even though there is now much attention on the power of the mind to support recovery. would you agree? do you see this situation changing?”

Dr Bernie Siegel – Act like a loving parent. Harvard students were asked if your parents love you. If they said no, 95% had suffered a major illness by middle age. If they said yes, 24% had. we need to re-parent people. That’s why I saw the power of the group therapy, where you were loved, you were cared about, and there were other people in the room, all of whom had shared your illness, they were not coming from some other place. There is survivor behaviour, and we don’t teach that. Always ask your basins, how would you describe what you’re experiencing. when they come up with the word, tell them to eliminate whatever in their life fits that word; failure, roadblock, pressure; eliminate it and watch what happens to their health.

Ian Gawler – It seems to me the essence of it. If we think about why we’re alive and the purpose of our life, meaning of our life, which is what people who are diagnosed with cancer tend to do once they get over the shock of the diagnosis, often people do become introspective. If you think about things on a physical level, many people start a healing journey, wanting physical healing. If they accomplish that, that’s wonderful. But it wouldn’t feel like enough. Many people then address what’s going on emotionally, and to feel like you’re emotionally healed would be wonderful. But you see people who have got good emotions in their minds all over the place. To approach it from a mental point of view, get your mind into good shape comes next. But even with all that, if you’ve got a spiritual void, then I don’t think physical health, emotional else, mental health is enough. What’s really at the heart of my life and what’s really important.

” cancer provoked patients into thinking about what is important in their life, what they really wanted to connect with, what they really wanted to do with their life “

If I look back over the groups that we ran, one of the strengths was that there was a strong spirituality running through the program, but it wasn’t associated with a particular denomination or religious tradition. But it was one of the criteria by which we selected all our therapists. They had to have a strong commitment to their own spiritual path, and they had to have a willingness to be able to open to the diversity of people’s views, whether that be a religious or very committed to a particular tradition. In the way particularly our residential programs unfolded was that it just naturally led to people going into this sort of introspective examination of what was really important in their lives and whether they could actually reconnect if they weren’t already with their spiritual essence. For many people through the trauma of a cancer diagnosis, it leads to a reconnecting with a spiritual life. It just amazes me how many people, when I meet them later on, after the worst of this is passed through, they’ll say that actually the cancer diagnosis was the best thing that ever happened to me. It’s amazing how many people say that. The reason they say that is not because they got well physically, but because the cancer provoked them into thinking about what is important in their life, what they really wanted to connect with, what they really wanted to do with their life. For the majority of those people, how they could actually reconnect with their spiritual essence and live more in tune with their spiritual life than their material life.

Robin Daly – last question for you all. This is from Kirsten Chick. Kirsten is a very experienced nutritional therapist. She sent in this question:

“Do you have a message for integrative medicine practitioners out there that would start: if there’s one thing I wish I learned right from the start, it is…”

Michael – First of all, Robin, I want to thank you for bringing all of us together Petrea, Keith Block, Bernie Siegel, who was one of the first people I visited in New Haven when I was starting my research, Ralph Moss, who I’ve worked with for years, Ian Gawler, who I visited in Australia and just benefited so much. You’ve done something very important, and I’m infinitely grateful to be part of it.

The first thing I would say to an integrative oncology healer is a very ancient adage which is, Physician heal thyself. That goes to Ian Gawler’s point that we really can’t take people any further than we’ve gone ourselves. Whether we frame that in terms of spiritual work, which is a lovely frame, which I love, or my colleague Rachel Naomi Roman has a different way of framing it, which I think is very ecumenical, which is to ask people, what matters now in your life? What matters now? What matters now is a question that doesn’t presume that the answer will be framed in spiritual terms or psychological terms. For many people it will be I want to watch my grandchildren grow up, or whatever it is.

If people can come to terms with what matters now in their own authentic voices I really know the number of people I’ve met. Azra Raza, in her book The First Cell, talks about her husband who was absolutely a scientific materialist. We could have talked to him until the cows came home about spiritual life. It would have meant nothing to him. He had a deeply existential willingness to face a bleak and tragic reality which was his path and talking to him about spirituality would not have helped. Ecumenical questions like what matters now enables people to express their direction, whatever it is in our healing circles global work, our whole thing is about listening to each other, trusting that each person has within themselves what they need for healings, do not advise or fix and so on and so forth. That dimension of engaging with healing work, healing ourselves and from that place of whatever self-healing means to us, being extraordinarily open to the infinite variety of ways that people heal, knowing that some people who only want to do conventional therapies don’t believe in them, knowing when they are on a dharmic path, that that is their way and supporting them in that, having the gift to know when we can open them to self-care, to complementary therapies, to spiritual life, to all of the other things that we have to offer, to the kind of work that Ralph Moss has done such extraordinary work on on different therapies. My message would be, Physician heal thyself and then pay deep attention to how infinitely nuanced it is and how skilful we must be to do no harm and to support people in what they want to do and what they might be open to.

Ralph Moss – I think I answered it already. I couldn’t say thank God I had cancer. But I sometimes do say to myself, thank God I got diabetes because it opened up the entire world of metabolism to me and made me really interested in biochemistry and trying to understand this amazing body that we all have. I want to say about the spirituality, that I’m not a religious person but I get a religious-like insight from art and music and literature, especially literature. There are depths, we all have to confront our own mortality and our demise and so forth and we draw on the legacy, this incredible legacy that was left to us by these truly great people who came before us. I feel that scientifically, having known some great scientific geniuses in my life and learned from their examples and as well as what they taught me, but also it’s such a gift to be able to go back and read the works of the Tolstoys and listen to the Beethovens. You as an individual are never going to be able to write great symphony probably, or compose a great play or an epic. But this has been done for us, and we have access to this. this is what I’d love to impart to my own grandchildren. I’ve tried to do that. I taught Latin to three of my grandchildren so that they could read Virgil. If I were advising a person who was dying let’s say, or in that dire situation, and I’ve spoken to literally thousands of cancer patients over the years; my deepest thought, unless you have a religious belief that will carry you through this process, for a secular person like myself, art and art in the broad sense, is a kind of quasi religion, in the sense that it can bring you to a place where you can be at peace with your own demise. I never try to impose this on other people. If they’ve got a religious belief that will carry them through, well, more power to them. But my own training, background, my scientific orientation, all of that does not allow me to think in terms of a psyche that’s separate from the body. But on the other hand, I have access to amazing riches that we share. They’re at the library, they’re in the bookstore, they’re on the radio. We have amazing heritage of civilisation, and that’s how I would advise people to enrich themselves and be able to deal with these blows that life delivers to us.

Ian Gawler – I’m one of those people who used their life experience to help others. I got a very difficult cancer back in the 70s. When I recovered, I went back to my veterinary profession, but people were asking me how come I was still alive. That developed into running a fairly large organisation to help people with the self help lifestyle based program that we developed. It’s important for people to understand if they’re working in cancer medicine, particularly in sort of support group settings or in integrative medicine, that it is not essential to have had cancer yourself. It’s a help, but it’s not a prerequisite. I certainly work with lots of good therapists and other people who hadn’t had cancer. I would say to therapists who are setting out in this field, the best bit of advice I would give, apart from all the obvious things, but something you may not think of particularly, is to surround yourself with the best people possible and ask lots of questions. that’s the way to success in any field, is to network, go to conferences, do what you can to get in touch with the best people possible and ask lots of questions.

From a point of view of a founder who set out from scratch and with no background in this to running a reasonably middle-sized charity, the two things I would do in retrospect is one I would have done some more deliberate management training and the other one I would have solved the research problem. We tried very hard to get formal research done on the outcomes of our programs and we just never were able to really get that happening. I’m talking about back in the 80s 90s when this field wasn’t attracting much interest at all. We tried very hard and we had some very good people helping us, but we just couldn’t get the funding and solve that problem so I would get respect. I regret that we couldn’t do that and I would have done more management training.

Petrea King – If there’s one thing I’d known right at the start is that it’s not my job to fix people. It’s my job to turn up, be deeply present, have my task positive network engaged, so that I can access insight and all those wonderful qualities that are there to be of assistance to the patient, and that listening is far, far more powerful than talking.

Keith Block – It’s a difficult one because what I would say to them is that heal yourself first before attempting to work with others who are really suffering from illness and certainly if it’s a serious disease like cancer, a life threatening one. I would find it profoundly important to be in touch with what that experience is so that you can carry it over in the communication and the connection with somebody. I guess it’s simple to say something that we all know but we don’t always completely own, and that’s listening might be the most profound thing that we do as human beings. But when it comes to healing and healthcare and people who are suffering with serious illnesses, listening on a more profound level is even more important. And yet you find in my profession, far too often, medical doctors who have learned to shut down and shut off, who are sometimes so lost in their own communications, that they forget why they’re sitting there and that people need to be not only heard but embraced in whatever experience that they’re going through. So having entered integrative care because of my own ill health number one, and because of a loss of three relatives between my 8th and 16th birthday, I was profoundly already affected in that way. It’s a little bit difficult for me to answer that question without sounding like, been there, done that. The truth of the matter is that we can never learn that lesson enough, and particularly those of us who have devoted our lives to others’ survival, others’ health, others’ healing, that’s an ongoing necessity to own that lesson.

Dr Bernie Siegel – a quote, when you want to learn things, talk to the natives, not the tourists.

Robin Daly – Thank you very much. I want to thank you all, really, most sincerely, not just for making room for today’s panel, but also on behalf of myself, everybody at Yes To Life, as well as all those practitioners, activists that are out there striving to push this agenda for integration forward. And lastly, of course, the vast numbers around the world who are now directly benefiting from the unstinting initiatives you’ve all independently generated through your own dedication, continuous effort throughout your lives. I’d say we all know your great debt for your deeply caring missions on behalf of us all. A big thank you.