Sometime in early August 2007, Swee (not real name, 71 years old female from Indonesia) had coughs with blood stained phlegm. She consulted a general medical practitioner who ordered an X-ray to be done, suspecting that she might have tuberculosis. The X-ray showed a tumour in her lung. She was subsequently referred to a specialist who did a CT scan and found "a 4.8 x 3.9 cm soft tissue mass with lymphadenopathy of the right lung." It was a 3A cancer. A biopsy was recommended but Swee declined and decided to come to Penang for a second opinion.

In Penang, a bronchial biopsy was done and the result confirmed the earlier diagnosis. It was a "infiltrating, poorly differentiated carcinoma." Swee was referred to an oncologist for chemotherapy.

A day before Swee was scheduled for chemotherapy she received a phone call from a relative telling her to go for treatment in China instead. This she did without hesitation.

Swee was treated in a private hospital in China for twenty-eight days. She underwent the following treatments:

1. Chemotherapy with Navelbine.

2. Cyroablation using Argon-helium. Three cryoprobes were inserted into the lesion and the whole freezing process was monitored with the CT scan until "iceball" completely covered the target mass. After two freezing-thaw cycles the cryoprobes were pulled out.

3. Radioacative iodine seeds implantation. Under guided CT scan, 15 radioactive iodine-125 seeds were implanted into the tumour mass.

The doctors concluded that these treatments were successful. Swee was allowed to return home to Indonesia.

In November 2007, Swee returned to China for her second round of treatment. This visit lasted fifteen days. She underwent the same treatments: chemotherapy with Navelbine, cryoablation and iodine seed implantation. According to the doctors, the second procedure was successfully carried out and the patient's condition was better.

According to her son who accompanied her to China, the Chinese doctors suggested that Swee undergo a total of six treatments. Her son said: "The doctors assured us that the tumour will go away but at the same time warned that the cancer can spread to other parts of the body. There is no guarantee that it will not spread. He did say which part of the body it will spread to."

After Swee returned to her home, the members of her family were in a dilemma. They did not have the funds to proceed with further treatments in China. The cost of her first treatment was 87, 000 Yuan. The second treatment cost 57, 000 Yuan. Swee wanted to sell the house the family is staying in to finance her treatment. Her five children (two sons and three daughters) were unsure if this was the correct thing to do. This is because there is no certainty that Swee will be completely cured.

Swee's son came to see us in December 2007 and wanted to know the following:

1. What should they do?

2. Whether it is possible to take our herbs and at the same time undergo the Chinese treatment, should they decide to go to China again. This is with the hope that herbs can help Swee in some ways where medical treatment cannot.

I told the son that the main point to take in serious consideration is the possibility of the cancer spreading to the brain. Nobody can stop that and the possibility of this metastasis is very high. To this the son said: "Yes. While I was in the hospital in China I have seen some patients who suffered like my mother and who underwent similar treatments. About six months after the treatment the cancer spread to the brain. The doctor also told me that the type of cancer my mother has is very aggressive and there is a 90% chance that it will spread to other parts of the body. There is no guarantee that it will not spread."

Comments

It is very hard for me to advise in this case, except to say that from my reading of medical literature, lung cancer is fatal and the chance of a cure is nil. But how can I put forward this message in a manner that is not traumatic to patients and/or their family members?

Alexander Spira and David Ettinger (Multidisciplinary management of lung cancer. New England J. of Med. 350:379-392) wrote: "Despite years of research, the prognosis for patients with lung cancer remains dismal."

According to Stephen Spiro and Joanna Porter (Lung cancer - where are we today? Amer. J. Respiratory and Critical Care Med. 166:1166-1196): "Although chemotherapy may be a logical approach, there is virtually no evidence that it can cure NSCLC. The monetary cost ... is high. The other cost of chemotherapy is its toxicity and its potential detriment to quality of life. Disappointing as it may sound, this sums up the reality of the situation."

Even if what I say (lung cancer has no cure) may be true, generally patients would not take it kindly or would not believe me. They want a cure and they expect a cure with the treatment offered to them. If we offer herbs and teach them to change their lifestyle in the hope of prolonging their lives or promoting the quality of their lives, they still insist that we tell them of the chances of cure.

This e-mail to me is one good example to illustrate my point. "The patients put total confidence in doctors to prescribe the best treatment methods i.e., put their lives in the hands of the medical doctors. Those big pharmaceutical companies ... prove to be quite convincing in their scientific explanation until today. That is why a lot of patients still prefer their drugs. On the contrary, herbal treatment offers no explanation as to how the herbs work and to what extent it can help the patients. In other words, there is no guarantee that taking herbs will make you feel better either. Similarly, if I am to ask you personally, how and to what extent your herbs can help the patient, I do not think I can expect a concrete answer. Again, you might say it is up to the person to decide and put his/her faith in whatever decision being made. It is like telling the patient to choose whatever he/she thinks is the right medicine. I don't think this is very right. If I know outright that something works - whether they be herbs or drugs, I would not be scared to commit myself and advocate the fact that it will work.

There are questions patients might ask when considering your herbs as an alternative treatment such as: can you confidently say that your herbs work much effectively than modern treatments?"

I fully understand that patients want a guarantee or a promise of cure. But our experience tells us that there is no cure for cancer, be it be an early stage or a terminal stage. To tell patients otherwise, amounts to cheating by misleading or misinforming them. To us, healing (note the use of the word healing not cure) of cancer is not about taking herbs alone. Most patients missed the point that they must first learn how to help themselves by changing their lifestyle, diet and mindset if they want to find healing. Unfortunately, this change is something very hard for patients to do. In this case, her son told us that Swee is not a person who is willing to change. She is not prepared to change her diet and believes in eating anything she likes. The argument is: "why must I not be able to eat anything I like - I am going to die anyway." It did not occur to Swee that it could be the unhealthy lifestyle and diet that led to the death of her husband (complications of hypertension, diabetes, etc.) In addition her sister died of colon cancer, brother of stomach cancer and auntie of nasopharyngeal cancer (NPC).

Secondly, the herbs are not going to taste good and the son is not hopeful that Swee would even want to drink it. In short, most patients like Swee is only interested to find healing on their own terms. They seek that elusive magic bullet to make them well.

Drs. Richard Deyo and Donald Patrick, professors at the University of Washington, Seattle, USA, in their book, Hope or Hype: the obsession with medial advances and the high cost of false promises, wrote:

1. We are born "with our own blind trust in a medical establishment that preys on our deepest fears, all the while purporting to ride to our rescue with "miracles cures."

2. "The combination of industry greed, media hype, political expediency and our own "techno-consumption" mindset is leading more and more often to a reliance on costly treatments that are marginally effective at best - and sometimes downright dangerous."

3. "When choices involve new treatments, the assumption is almost always that more and newer can only be better. Conveniently, this stance almost always coincides with financial self-interest."

4. "It is said that doctors are ever too willing to prescribe the latest drug without even looking into the evidence whatsoever it makes them happy, it makes the patients happy and it makes the drug rep happy."

We do not believe that there is such a thing as a magic bullet for cancer. We are not true to our cause and betray our mission if we say or act as if we have one. It is hard for many to understand that we are here trying to help. We have not desire to push our herbs. We set no sales target and do not aim to conquer new markets. Our work is driven by love and compassion, not profit. If ever there is any assurance or guarantee patients get from us, it is this: "Try the herbs for one or two weeks. If the patient doesn't getter any better, stop taking our herbs and find someone else for help."

Let me conclude with this story. Lung cancer was previously treated with Iressa. When Iressa was first launched it was hailed in the media as: The Drug of Tomorrow; The Miracle Drug; The Smart Drug; Miracle Cure - the drug that Rises from the Ashes and various other superlatives.

The message to the world was clear: "A breakthrough is at hand - there is great hope and great anticipation. Lung cancer patients need not die any more. A miracle drug is at long last here." The US-Food and Drug Administration approved its use. This makes it even more convincing. This is the kind of guarantee cancer patients the world over want before they swallow their first pill - the writer of the above e-mail included.

In an article: Iressa should have never been approved (http://npojip.org/iressa/iressa ISDB-Feb-2.html) Rokuro Hama wrote: "An estimated 23, 500 people has so far been administered with Iressa in Japan, 644 of them suffered adverse reactions. Of these 183 have died. The drug was approved in July 2002 in Japan and by end of January 2003 - barely six months later, the death related to the adverse reaction to Iressa had reached 183."

In the Western countries, Iressa was withdrawn and was shown to be not effective anymore in spite of the earlier great media hype. But in the countries of the East, Iressa is still being prescribed to many cancer patients, even today. Patient needs to spend about RM 7, 000 to RM 8, 000 for a month's supply of Iressa. With Iressa being phased out, some oncologists turn to another drug called Tarceva, a sister drug to Iressa. One Tarceva pill cost RM 270 which calculates to RM 8, 100 for a month's supply. Is Tarceva effective? The company's website said it is proven to have increased overall survival by 37% and had shown a demonstrated significant symptom benefits by prolonging the time to progression of symptoms. Doctors and patients love such assurance. The scientifically generated statistic quoted is very impressive indeed. But what does 37% mean? The truth is: if you take Tarceva, you can live 9.5 months and if you don't take Tarceva you only live 6.7 months. In real terms Tarceva only increased survival by 2.8 months.

How does this assurance sound to patients? Do patients know or informed about this? Remember, this promise of being able to live 2.8 months longer comes with a price tag of RM 8, 000 per month.