Bridging the Gap. James Eugene Munson
in part personality, but also strengthened by her career as a social worker, trained to manage and navigate resources. She was determined to do everything possible to beat her diagnosis, and if that meant trying acupuncture, she would. I would learn not to expect anything less of her over the four years that she bravely journeyed through her cancer experience.
Samantha’s story is not unique to modern day oncology. A patient seeks medical care and often presents with a myriad of physical symptoms that can create a bit of a guessing game for allopathic physicians. Stomach pain may be acid reflux, not a sign of gastrointestinal tumors; easy bruising and fatigue may only be anemia, not acute leukemia. Western physicians are questioned ad nauseam by patients wanting an immediate, accurate diagnosis from the minor to the complicated. One does not begin with an oncologist when there is abdominal bloating, nor should they. The phases of diagnosis have been predetermined by a framework and structure of care that physicians mandate and patients follow: first primary care, then specialty care. This was true of Samantha, digestive problems led her to her general physician, who referred her to gastroenterology, which led her to gynecology (by her own doing) and finally to oncology. It is from this point in her journey that Samantha’s experience broadens from the singular, reductionist method of Western oncology, and into the expanse of integrative oncology, including multiple holistic therapies, like traditional Chinese medicine (TCM), which she powerfully harnessed to extend and improve her quality of life.
“So, you had a piece of cake for your daughter’s birthday?” I remember responding to Samantha’s panic-stricken statement. Her eyes were welling up, and she was visibly shaken. We both knew it was not merely one piece of cake that triggered the recurrence. She nodded, took a breath, but still began a discourse on how she knows sugar “feeds cancer” and negatively impacts the immune system. She expressed guilt for enjoying this one piece of cake, attributing it in part to her current circumstance. While we both recognized the link between sugar and cancer, it was apparent these concerns were merely superficial facts secondary to her fear and disappointment. Throughout the four years she was a patient, Samantha endured numerous cycles of chemotherapy, periods of remission and relapses. Through the depth of our established rapport between patient and provider, we knew, once again, we were about to embark on the next phase and progression of her disease. This would require more refinement and deeper integration of body, mind and spirit: the truest essence of Chinese medical oncology.
After listening patiently to her confession, I smiled and asked, “Was it at least chocolate cake?” Her eyes glistened with tears, but she grinned and said, “Well, of course.” This early clinical experience with Samantha is imprinted in my mind, particularly as my career evolved from general practice with few oncology patients, to almost entirely TCM oncology. A vast majority of these patients had forged beyond the realm of Western medicine and were actively consulting with a myriad of complementary and alternative medicine providers to integrate with their conventional protocols. Samantha’s cancer journey illustrates this dynamic as she developed her own integrative treatment plan that included Chinese herbal medicine, acupuncture, Naturopathy, Reiki, Energy Healing, oncology-specific nutrition and dietary programs alongside chemotherapy. Despite this amalgamation of healing therapies, there was no communication among the providers, and I was not an exception. Each healthcare professional diagnosed and treated according to their own scope, but this occurred separately and without a unified, collaborative plan. This seemed a significant disservice to our shared patient, contrary to the main principles of integrative medicine that emphasize a sharing of information based on therapeutic, patient-centered care.
Thus, as the number of individuals with cancer sought Chinese medicine, my curiosity to learn more about the disease itself from both a Western and Eastern perspective piqued. In order to dialogue with a range of medical professionals, it was necessary to become more informed and prepared to communicate effectively. The exploration led me directly to the practice of integrative oncology (IO), which afforded an opportunity to examine its structural foundation, concepts and with equal importance, the role of TCM within it. Here I discovered an immense discrepancy between the philosophical framework and ideology of IO with its practical application. Ultimately, this illustrated a need for true integration of TCM in modern oncology.
This is where the journey began.
Dr. Di Giulio
Foreword
We generally live in oblivion to what is actually happening to us. We rarely remember that we breathe, and we must do so, or have a heart-beat, which is obligatory for our life. We are happy with that silence. We notice it only when the silence is broken, by exertion or unfortunately through illness. Mostly, only then do we turn our attention to how the silence was broken. Medicine is the study that attempts to view and understand the silence, how it is broken and what can we do about restoring the silence or fixing what is broken.
Cancer is probably the best example of a disease that manifests many years following the initiation of the cancerous process, carcinogenesis, a process we still mostly don’t understand. Nowadays, we diagnose many cancers because we screen for them through their silence with visual (mammograms or colonoscopies), molecular technologies (PSA for prostate cancer, or CA125 for ovarian cancer), or genetic analysis (BRCA gene mutation). When patients come to us with symptoms, and when finally we may diagnose the patient with cancer, for the most part these symptoms are not exclusive or specific to cancer, and frustrate patients, families and medical personnel alike. Cancer remains silent even when it rears its head.
The cancerous process from initiation, development and potential progression and spread (metastasis) involves invisible processes and interactions. Cancer is defined by cellular transformation (mutations), changes in shape (morphology), uncontrolled growth (neoplasia) and lack of obedience to structural and architectural determinism (invasion and metastasis). This description is fully modern, since we really didn’t look at cells and defined their structural and molecular differences until recent decades. The technologies allowing us to interrogate cells, their parts and the substances that control their fate are all but modern. These processes take years to become visible even with the best of technical abilities.
As practitioners involved in cancer treatment and the care for patients with a cancer diagnosis, we learn another important lesson about medicine; the appreciation of time and the importance of vigilance. It takes many years to realize that immediate responses to treatment, like the complete elimination of a tumor, are only a suggestion to what might happen, and the fact that we cannot see or foresee what will happen next. With experience in cancer care comes a strange confidence in the need to attempt to translate the anxiety of the unknown and the anxiety of what we know might happen with practical vigilance. We generally view time as the progression from the past that happened, to the present that is, toward the future that will. In cancer vigilance we wish to transform the cause in the future, to change the past. This is a strange view of determinism. But, if we believe the only way to reverse the irreversible process of mutation in carcinogenesis is by elimination, we need to ask, elimination of what?
We now know how to harness and manipulate physiological processes such as the immune system and the endocrine system, or target cellular processes, such as growth and division signaling in the treatment of cancer. I remember just two decades ago when we were highly doubtful the immune system had anything to do with cancer control, while nowadays it is one of the only areas funded in cancer research. It is only three decades ago that we referred to cancer care as slash, burn and poison. Going back to my point above, we are still shy, arrogant and ignorant of what does it mean to eliminate cancer.
Chinese medicine developed a unique view of physiology, pathology and treatment modalities. Their system involved physiological concepts of invisible properties such as vitality, energy and spirit, viewed as both physical and non-physical. Or, organs that do not exist anatomically, such as the triple burner, or physiological functions ascribed to organs that do not correlate with our current view of organ functions, like ascribing metabolism to be mostly controlled by the spleen. Lack of instrumentation was not unique to Chinese medicine, and European medicine was modelled mostly after Greek tenets, although multiple empirical, non-theoretical practices co-existed. Plurality of practices with no theoretical coherence existed in China as well. When introduced to European anatomical and pathophysiological work