James "Rhio" O'Connor Memorial Scholarship Essay Contest Entry:

The Future of Complementary Cancer Treatment

by Alex Reiley

James Rhio O'Connor's battle against mesothelioma is a microcosm of the systemic problem of incomplete cancer treatment resulting from the monopolization of medicine by the allopathic paradigm. Rhio's prognosis gave him only one year to live after being diagnosed with pleural mesothelioma caused by asbestos exposure. Pleural mesothelioma is cancer of the membrane enveloping the lungs and chest cavity. Surgery was not an advantageous possibility because the primary tumor was too close to the spine. Chemotherapy was not an option given the progression state of Rhio's cancer. Allopathy told Rhio that all he could do was try to maintain quality of life and settle his final business affairs. Rhio took health into his own hands and sought professional advice on mind-body techniques, nutrition and supplements (www.survivingmesothelioma.com/rhiooconnor.cfm). Integrating complementary medical advice enabled Rhio to live for 7 years beyond his prognosis. Rhio's experience illuminates the fact that the necessary tools of the mesothelioma survivor are not yet all allopathy approved. If Rhio was fighting his mesothelioma in 2020, he may have been administered an entirely different treatment plan. New technologies are in the latter stages of FDA clinical investigation that offer completely novel mechanisms of interfering with the molecular pathway of cancerous cell proliferation. In order to create the most complete cancer regime, allopathy needs to embrace a holistic vision of integrating mind-body therapy as well as innovations that selectively target the underlying mechanisms of cancer, such as angiogenesis, into the standard protocol. Allopathy has traditionally been slow to incorporate alternative modalities into medical practice because allopathy is rooted in a history of an antagonistic attitude toward alternative paradigms.

In 1904 the American Medical Association hired Abraham Flexner, who was not a medical professional, to do an evaluation of all the medical schools. Flexner publicly admitted that he did not have the medical knowledge to make informed decisions regarding closure of medical institutions.1 Nonetheless, the Flexner Report led to the closure of 35 schools by 1910.1 Allopaths wanted to make more money, so they organized the American Medical Association as a coalition to oppose the other leading healing systems, which are generally more holistic (treating the whole person) rather than focused exclusively on treating symptoms. By selectively closing down the medical schools that did not strictly adhere to allopathic values, and labeling them "alternative", the AMA was able to establish a monopoly on American medicine. From its inception, the AMA has been biased in favor of allopathic medicine and determined to exclude competing schools of medical thought. By using the AMA to reduce the competition of non-allopathic medicine, the pharmaceutical industry was able to monopolize the American system of health care. The idea that allopathic medicine has inherently superior scientific standards is a mythology that started with the Flexner Report. The irony is that it is the criticizers, the pharmaceutical oligopoly, that keep alternative medicine "unscientific" by not yet adequately funding research into mind-body modalities, biologics and other complementary medicine. The allopathic system of cancer treatment has not adequately combated cancer in part because it is biased against integrating alternative modalities that would synergistically improve the conventional regime.

The current war on cancer is fought primarily with surgery, chemotherapy, and radiation, all of which have significant downsides. Surgery removes the primary tumor, but the primary tumor uses anti-angiogenesis chemicals to suppress surrounding tumors in order to monopolize the blood supply, so removal of the primary tumor allows residual cancer cells to grow into another tumor or metastasize to new tissues in the body.2 Chemotherapy works by indiscriminately killing fast dividing cells, but has hundreds of traumatic side effects because there is no mechanism for differentiating between healthy and cancerous cells. Radiation therapy uses gamma rays and x-rays to damage cell DNA, but also has no mechanism for distinguishing cells. Many types of cancer, for example pleural mesothelioma, are refractory to chemo and radiation because the decreased quality of life outweighs the potential benefits. According to a Harvard M.D., of the approximately half a million people who die each year of cancer, only about 2% to 3% actually gain any benefit from chemotherapy.3

Western medicine is excellent at designing scientific research to gain insight into the limiting factor mechanisms of cancer proliferation. If a million cancer cells are able to divide then a 1mm diameter tumor develops, but is still too small to cause serious damage to the body.4 Without nutrients the cancer cell cannot grow any larger and won't become a full grown tumor or metastasize. Only .1-.3% of cancer growths will ever access more blood by creating new capillary sprouts, angiogenesis, and grow any larger than 1mm in diameter. However, it is this .1-.3% that causes 95% of malignant tumors and death.2 Angiogenesis inhibitors used in combination with chemotherapy illuminates the synergistic efficacy of combining conventional treatment with new methodologies. Angiogenesis therapy improves the targeting of chemotherapy drugs by normalizing the vasculature thereby making it a more efficient delivery pathway for therapeutic drugs.5 Vascular endothelial growth factor (VEGF) is one signal protein known to be used by cancer cells to recruit new blood vessels. A 2011 clinical study showed that angiogenesis inhibitor E7080 suppressed the proliferation of VEGF-producing malignant pleural mesothelioma and prolonged patient survival.6 Angiogenesis inhibitors’ targeted mechanism of action is particularly promising for cases where surgery and chemotherapy are often not viable options, such as mesothelioma. Several anti-angiogenesis drugs are currently in Phase II Clinical Trials for FDA approval for use against mesothelioma. Tetrathiomolybdate is a copper depleting agent shown in a clinical study of patients with malignant pleural mesothelioma to inhibit angiogenesis post-surgery and thereby delay the time of cancer progression.7 Avastin is a VEGF inhibitor already FDA approved for cancer treatment that is currently being investigated for combinational efficacy in mesothelioma patients who have already been treated with chemotherapy. Angiogenesis inhibitors are certainly not the only new technology contending cancer that is on the precipice of mainstream incorporation. Angiogenesis is one crucial mechanism to attack and well represents the importance of targeting the mechanisms necessary for cancer proliferation. Angiogenesis is a perfect example of how allopathic medicine can combine emerging scientific technologies with complementary medicine to holistically contest cancer throughout its etiology. Enhancing the immune system with mind-body techniques and nutrition fights cancer indirectly by mobilizing antibodies to target angiogenic markers expressed on tumor vasculature.8

Though scientific research on alternative medicine has begun, allopathic understanding of ancient eastern wisdom like Chinese Medicine and yoga has not yet been incorporated into the allopathic status quo conception of cancer. Acupuncture and herbal medicine are proven to reduce side effects of chemotherapy and radiation. Chinese herbal medicine, dietary adjustments, and acupuncture can help increase production of red and white blood cells, as well as platelet counts.3 Stress and depression cause suppression of natural killer immune cell response and increased angiogenesis.9 Mind-body techniques decrease the stress chemicals that inhibit the immune cells that fight cancer. Tibetan yoga integrated into cancer care has been shown to cause increased appetite and increased tolerance to side effects of radiotherapy.10 Medical Qigong practice has been proven to significantly reduce side effects of cancer drugs, lower cortisol levels, and increase production of immune system response cells such as lymphocytes and interferon.10 At the Kuangan Men’s Hospital, in Beijing, China, 93 cases of advanced malignant cancer were treated with a combination of drugs and Qigong exercises, while a control group of 30 patients were treated by drugs alone. Eighty-one percent of the Qigong group gained strength, 63% had increased appetite, and 33% were free from diarrhea, compared to control group improvements of 10%, 10%, and 6%, respectively.3 Despite its proven efficacy, the concept of Qi is still ignored by Western medical practice, labeled as "unscientific" because it is has not yet been thoroughly researched. Qigong is a cost effective healing technique that individuals can learn to use daily as both preventive and curative medicine. Incorporating breathing awareness as complementary treatment is particularly logical for treating pleural mesothelioma because one of the major symptoms is shortness of breath. More clinical trials are necessary to elucidate the mechanisms of mind-body practice throughout all phases of cancers etiology, further discover synergistic combinations of cancer treatment, and subsequently increase use of mind-body modalities in oncology care.

The time has come to confront the mythological image of allopathic medicine existing on a pedestal of scientific validity because this toxic belief is exacerbating the illusory separation of conventional and alternative medicine. America needs a holistic medical system that embraces all efficacious medical treatments in order to actualize a cancer treatment process that is more preventive and participatory. We are currently witnessing the beginning of a new era of comprehensive cancer medicine that aims to maximize synergy by expediently incorporating innovative unconventional technology, such as angiogenesis therapy, as well as complementary methods proven to safely improve cancer prognosis.

Alex Reiley, Cabrillo College Medical Assisting Student.

Works Cited

1) Rothstein, W.G. “American Medical Schools and the Practice of Medicine: A History” Oxford University Press (1987): 143-44.

2) “Angiogenesis-Dependent Disease.” Video clip. With lecturer Judah Folkman. Lectures in Frontiers of Cancer Research. 6 December 2004. UC Santa Barbara. 3 April 2009 http://www.youtube.com/watch?v=_0ay0dtR92U.

3) Alternative Medicine: The Definitive Guide. Goldberg, Burton. Berkeley, CA: Celestial Arts, 2002: 63, 436, 580-592. 

4) Naumov, George N., Judah Folkman, and Oddbjorn Straume. “Tumor Dormancy Due to Failure of Angiogenesis: the Role of the Microenvironment.” Clin Exp Metastasis 26 (2009): 51-55.

5) Jain, Rakesh K. “Normalizing Tumor Vasculature with Anti-Angiogenic Therapy: A New Paradigm for Combination Therapy.” Nature Medicine 7.9 (2001): 987-88.

6) Yano, S, et al. "Antioangiogenic therapies for malignant pleural mesothelioma". Frontiers in Bioscience.(2011 Jan. 1);16:740-8. Division of Medical Oncology, Cancer Research Institute, Kanazawa University.

7) Pass, H, et al. "A Phase II Tril of Tetrahiomolybdate After Surgery For Malignant Mesothelioma: Final Results". The Annals of Thoracic Surgery. (2008 Aug.); 86(2): 383-9. Department of Cardiothoracic Surgery, New York University School of Medicine.

8) Jianmei, Hour, Tian Ling and Wei Yuquan. “Immunotherapy of Tumor by Targeting Angiogenesis.”Science in China 47.6 (2004): 545-52.

9) Thaker, Premal H, et al. “Chronic Stress Promotes Tumor Growth and Angiogenesis in a Mouse Model of Ovarian Carcinoma.” Nature Medicine 12.8 (2006): 939-42.

10) Chandwani, Kavita D., et al. “Mind-Body Research in Cancer.” Integrative Oncology: Incorporating Complementary Medicine into Conventional Cancer Care (2008): 139-53.