January 10, 2024 • 31 mins
On this episode, physician and integrative medicine specialist, Dr. Mary Hardy will tackle the question of whether there is evidence to support the use natural therapies with conventional cancer care. We will dive into the role of scientific studies in integrative oncology and how you can make safe and effective decisions regarding your care.
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Five To Thrive Live Radio Show is broadcast on W4CS Radio – The Cancer Support Network (www.w4cs.com) part of Talk 4 Radio (www.talk4radio.com) on the Talk 4 Media Network (www.talk4media.com).
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(00:00):
Any health related information on the followingshow provides general information only. Content presented
on any show by any host orguest should not be substituted for a doctor's
advice. Always consult your physician beforebeginning any new diet, exercise, or
treatment program. Welcome to five toThrive Live, a podcast about thriving I've
(00:44):
been Affected by cancer and chronic diseaseof doctor Lisa al Schuler and a co
host of my good friend Carolyn Gazella. You can find all past show podcasts
on any major podcast outlet and alsoon our website, which is I think
plan dot com. Well, Iam very excited to have doctor Mary Hardy
with me this evening. She isa Board certified internal medicine physician and a
(01:08):
specialist in metical and integrative medicine.She has actively combined complementary and alternative therapies
with traditional Western medicine for over thirtyyears in both her clinical practice and research
projects. Doctor Hardy is the pastmedical director of the Simsman UCLA Center for
Integrative Boncology, and she is arecognized leader in the field of integrative ononcology.
(01:33):
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And now we go to Mary andMary Welcome to five to Thrive Live.
(03:07):
Thanks Liza, it's great to bewith you. Indeed, I know you
know, I think we've known eachother for over twenty years now. I
think it is. I think itis just when we were babe and babes
in the woods, we met babydoctors, baby doctors. That's right,
that's right, that's right. Andin fact, yeah, you've been you
(03:27):
know, in practice, teaching,writing about integrative medicine for most of your
career, and so that qualifies you, I think as one of our pioneers.
Why did you focus in on integrativemedicine so soon in your career?
I think it's interesting. There arebasically two ways for me to answer that
question. I grew up in avery medical family, so I had sort
(03:47):
of the conventional part of medicine reallyin inculcated early. But I grew up
in New Orleans, which our folkmedicine still and then right after my residency,
I went to China with my collegeroommate and we saw acupuncture surgery.
(04:09):
Surgery be done in accupunctury. Anesthesiawas radically different from the way things were
set up for Western medicine, butthey were able to operate perfectly well and
the patient was awake, alert andtalking. And once my paradigm kind of
cracked, that led a lot moreinformation in and then my patients led me
(04:31):
first to integrative medicine and emphatically secondto integrateive oncology. So break your paradigm,
you get new stuff in the door, and then you look out for
the best way to help people thatyou care about. And that's how that
happened for me. I love it. Yeah, So you had, you
know, your views expanded, andyou realized, given you're tire to help
(04:55):
people, that there was lots oftools available to you. So, you
know, let's guide right in becausewe're going to really talk about, well
is this an evidence based thing todo? So first we have to find
what evidence based medicine is. Sohow do you define evidence based medicine?
You know, what is it andwhat is it not? Okay, so
I think there's been I think there'sbeen some some change in the way evidence
(05:18):
medicine was first introduced and what it'sbecome. I like the way it was
first introduced by Artie Cochrane and hisother colleagues, you know, probably more
than probably closest twenty five years agonow. And what they said then was
that you were supposed to blend togethertake the best available scientif available nation that
(05:43):
was there, and then you're supposedto add in your your clinical experience.
And then it was all supposed tobe based on what the patient's value system
was, So you were supposed toput the patient at the root of this
and then look for your your yourinformation science, and your own clinical experience.
(06:05):
What it's become now is sort ofcookbook medicine, people say, And
that's a distortion. Evidence. Evidenceis not it's not available for frankly,
direct evidence is not available for franklya lot of what we do, and
even conventional medicine. So I thinkyou have to really remember how this all
(06:27):
started, and it's a three leggedchair and all three components need to be
present. In an effort to stepaway from what evidence medicine has become people
are now using the term evidence informed, which I think gets back to the
original sense was first there. Soyou think evidence informed is more in keeping
with the definition that you just gave. I do, I do, And
(06:49):
I think it gets us away fromthis rigid locked step that if you can't
prove it's absolutely true, it's absolutelynot useful and absolutely should not be used,
or worse, it's harmful. Andsometimes I think when the conventional system
assess assesses integrative medicine, the standardsare kind of distorted. In other words,
(07:14):
it's not enough. I mean,first, you know, premium nonnecessary.
First, do no harm. That'swhat we took our socratic oath for.
And so I think things should havea really robust evidence or sense of
safety, and beyond that, withno evidence of harm, then evidence of
effectiveness or efficacy is useful. Buteven if you have the indication that it's
(07:38):
helpful, that may be enough,or you have other data that's indirect that
may tell you, inform you asit were, that this could be helpful.
You know, once you know it'ssafe, you have a lot more
leeway to let your clinical experience guideyou. Yeah, and I agree with
what you're saying. I think Iwould add to that too that for me,
(07:59):
when I think about evidence informed medicine, I think about something which to
your point, always takes into considerationsafety versus potential harm. But also maybe
the evidence isn't you know, thebest most well designed randomized clinical trial.
Maybe the evidence is more you know, early clinical trials, or maybe in
(08:20):
some cases there's no clinical trials,just have you know, jud dish trusts.
And in those cases, you know, I think it gets a little
more difficult. That's where you reallyhave to go back to your point,
to that first definition, and usethe judgment of a well trained practitioner to
that body data and say is thereenough data here? Is there potential harm
(08:43):
here? And then of course takeinto account the patient's desires. So I
think, you know it, really, this evidence informed medicine, I think
really becomes important when there's a lessrobust body of evidence. True, it's
astonishing how much we don't have,frankly, really rigorous evidence for you know,
(09:03):
you think if you're having a heartattack, everybody would say, oh,
bypass surgery, that's definitely a thingto do, and you'd be surprised
at how very little direct evidence thereis for that. Evidence that that's the
best thing, that's better, forexample, than very robust medication use.
So that's just one example that wedon't always know what we think we know
(09:24):
when you look right into it.So yeah, that's very true. So
you know, with respect to integrativeoncology, evidence is king. I mean,
you know, these ecologists are usedto looking at vast, huge trials
that have been replicated in many differentplaces before they step foot into the ring
(09:45):
with the therapy. So how doesthat then work with integrative oncology kind of
uniquely? Yeah, I mean whatdoes that sort of position integrade of oncology
if you will. Yeah, thinkit's interesting here to contrast how evidence is
looked at in regular in conventional oncology. I don't want to say regular,
(10:05):
like what we do is not regular. I think what we do is exceptional.
But if you think about it fromconventional oncology, you know, it's
always a risk benefit analysis. Issomething low enough risk or is there a
high enough benefit? Et cetera.And for cancer care, for cancer treatment,
conventional cancer treatment, that's a veryThe therapists have to walk a line
(10:31):
because the therapies they're given are forgranted toxic. You know they're toxic,
you know they're going to cause harm, and you hope that they cause more
harm to the cancer than they causeto the patient. That's the whole rationale
for chemotherapy in a nutshell, thatit attacks the fastest growing cells, and
you hope those are the cancer cellsyou expect that they are, but fast
(10:54):
growing normal cells will also get affectedas well. So they're very focused on
the evidence of benefit. Right.They know they have higher risk, so
they feel like they have to havereal solid evidence for benefit. On the
other hand, our kinds of therapyis in integrative oncology, I think,
(11:16):
are quite different because we have thebenefit of a strong safety a safety data,
you know, in other words,for example, I use honey for
mucositis. That's about as benign asa therapy can get. Right. Therefore,
I don't feel like I need thesame piles and piles and piles of
(11:37):
data proving benefit because my therapy isso non harmful. Therefore, if the
patient feels benefit, if they dowell, that's good enough for us.
You know, it's very madic ina way, and it really is for
me. The way I practice extremelystrongly on quality of life. You know,
I'm really about making the intervention thatthey're taking as non toxic as possible,
(12:03):
so that they get the full benefitof the of the Western medicine,
which is which is modern, thenegative effect of which the harshness of which
is modified by the kind of therapiesI like to employ. And I think
that gives you the best of bothworlds, and why not, you know,
yeah, why not? In fact, I would even take that a
step further. I think your exampleis a good one because natients who are
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getting certain chemotherapy or chemo radiation treatmentscan develop such a significant degree of nucositis,
which for listeners who aren't familiar withthat term, refers to ulcerations and
the mouth, tongue, throat.Those ulterations can get so severe that their
conventional treatment might need to get dosereduced or stopped prematurely, in which case
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they're not getting the benefit of thetreatment. So if we can step in
and provide something that is going tobe helpful for that symptom, it actually
supports the conventional treatment. I thinkis a really important component in creative ecology
specifically, absolutely absolutely, and alsoyou know, in that case, when
the mouth gets so sore. Sometimespeople it's so painful they can't even eat.
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And a conventional oncologist will often bevery aware of how bad that it
is for the patient, but theysay they're taking the long view, and
they say, look, if yousurvive this cancer, whatever pain you have
now is worth it for survivorship,for cure. And I don't take that.
I don't lose that perspective. ButI also maintain the perspective that how
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you get through something is as importantfor how how much of a shock it
is your system, how much ofa stress it is for you, how
hard it is for the rest ofyour family, you know, And so
I want you to get through thisand feel like you were in the name
of your show, thriving every day. I think you should strive to be
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as well as you can poss willbe regardless, you know, no matter
what the circumstances are. And that'sthe key thing of integrative oncology, for
sure, I think for sure.And we also do have evidence that there
are times when a therapy may anon conventional therapy may make the chemotherapy work
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better. You know, There's beenevidence of that with certain herbs and even
antioxidants there's a sense that there aresome things that we call radio sensitizers.
For example, if you take certainherbs, I think her cumin might fit
in this perspective where it makes thecells that are the abnormal cells more sensitive
to the radiation, so it makesthe radiation even more therapeutic. Milk thistle
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has been used like this for abladder cancer radiation during bladder cancer treatment.
So I do think that you canactually hunt and peck. And we're beginning
to find more evidence about ways inwhich the interaction in between chemotherapy and natural
products is actually beneficial to conventional therapy, and that's one of the most exciting
(15:07):
areas of this research that's being done. I'd like to see much more of
that so we could really understand howto interdigitate things better. That would be
brilliant, It would be absolutely Andyou know, I want to go back
the example of using natural therapy toaddress potentially a side effect, because there
are situations like, for example,nausea from chemotherapy. Frankly, conditional anti
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emetics or anti nausia work really thebest. So yeah, you know that's
I would recommend my patients take.But there can still be breakthrough nausea,
in which case we have therapies likeginger, for example, that actually has
a pretty strong clinical research base.So I think the other yes, I
think there's also this sort of ideathat you know, it's not necessarily always
(15:58):
natural is better. But it's likeyou're suggesting, let's how do we better
and I love that word interdigitate thesetherapies, how do we really determine,
given what we know, given whatthe patient's experience, given the options available,
how do we make the best decision? Yeah, and a good example
taking your nausea and vomiting example ondonstrone is the conventional medication. And you
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know, for people who whose familymembers had chemotherapy, let's say a generation
ago, fifteen years ago, whennausea was just debilitating, these really are
like a life saver. But thereare times when people either are somewhat sensitive
to them, or they can makeyou constipated, or the patient just doesn't
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like the way they feel on them, and so they want to limit the
amount of time they use those.That's a great time for ginger because ginger
can help with a little bit ofthat full, that relentless, little under
the surface feeling which is that's ascientific term bloup, which you'll recognize,
(17:07):
and and so that's terrific. Youcan use acupuncture too. You can change
the pattern and the way you eat. For example, eating protein more in
the morning will make you more lesslikely to have more nausea and vomiting and
maintain nutrition in a better state.There's lots of lots of little techniques like
this, and that's that just quickoverwall tells you. That's a good example
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of how integrative therapy looks like.I've also used aroma therapy in this but
in this position, smelling things likepeppermint or citrus smells can often help relieve
an acute nausea episode. So youmight have a multiple different things. You
load up the patient's tool belt withall these different routine things that they can
try, and they will come backand tell you this one worked the best
(17:56):
for me, or you're right aboutthat that I really like the best,
and that I think is another thingthat's important about integrated moncology, which is
that we empower the patient to bea participant in their care rather than a
passive recipient of care who's on,as I like to say, the worst
roller coaster ride of their life,no control. Every surprise is a bad
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surprise. It's just going to getmore and more horrible. And so they
just really want they want a sensethat they can contribute to getting better,
that they have some choices they canmake, and that they that they are
not helpless, that they are activeparticipants. So yeah, I think a
really good way to a good agood goal. Yeah, yeah, yeah,
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it's a great, great scenario thatyou laid out. So you've been
in this for a while, severaldecades. What have you seen. Would
you characterize how the evidence based forspecifically integrated moncology, how's that changed over
the past three decades? You know, it's it's actually a really hopeful story
because I started doing this probably inthe early nineties, nineteen nineties maybe,
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and so, oh my god,that is a while ago. So I
and I actually when I first started, I was dragged into it by my
patients because I'd been I had anintegrated medicine clinic and I was happily treating
menopause and back pain and knee painand high cholesterol. And then my patients
started inevitably having cancer, and theysaid, look, you were my doctor
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when I had all these other things. Why can't you participate now? And
I really thought, yeah, youknow, why can't I participate now?
And so I had to go backand read a million papers and it was
very hard to find good data.You had to sometimes look at traditional medicine.
What did a Chinese practitioner do?What did you know? An artlist
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do? What did and I Evadisdo? And there was the data was
scanty, there wasn't a lot ofit. And then I'm happy to say
over the ensuing time, we there'sjust been so much more information. In
two thousand and eight, I wrotea big review about dietary supplements help or
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harm to look at all the dataI could find, and I was able
to fit it into one article orthe overwhelming majority of it. I don't
I think it'd be hard to fitit in a book. Now. That's
how much more information we have,and that's terrific. That is terrific because
the more we know, the betterwe quip we are to help one hundred
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and you know, yeah, it'svery exciting actually to see all the new
data that's coming out and infect thequality of the research. I mean,
it still varies. There's some badstudies but there's some really good studies too,
and even analyzes and systematic reviews thathave taken the body of data and
analyzed it. Yeah, you comea long way, baby, as they
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say. And I love your storybecause it was your patients who said,
hey, yeah, I wanted tobe my I'm going through the s cancer
experience. So how would you characterizethe role of the patient in creating an
evidence based approach to their answer?Do they have any responsibility in this?
Well, that's that's a very interestingquestion. And I think in a really
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a very robust and caring relationship betweena provider and a patient, that is
the first little atom of research.That's the first little bit of data.
You know. They call it theend of one, one person's experience,
and really all the clinical trials isa very rigorous way to eliminate bias and
(21:52):
sum up everybody's little ends of one, you know. But I think a
clinician is often very much educated bytheir experience a patient at a time.
They have all this information they've learnedand all the studying they've done. And
a physician of any type, orhealthcare provider, any type, an alternative
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provider, however you want to putthe label on that. We all have
an expectation of what will be beneficial, and then we tell the patient that,
we tell them why we recommend wetell them how to use something,
and then we watch and then theycome back and say yes or no,
or it worked like this or thisdidn't work. And so that's the beginning
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of research. Really is a practicea provider listening to a patient with an
open mind and an open heart andreally ready to hear what that was like
for that particular person. And yeah, I think they have everything to do
with this. Actually, you know, of the way I answer that question,
I think that's so true. Ican't tell you how much I've learned
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from my patients, because like saying, we make recommendations based on what we've
worndarned, but it's really only thevicarious observation of how people experience or recommendations
that we really learned, you know. Then we get to explain the nuances.
Okay, I'm giving you this becauseit's going to help with your feed
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and given what my patients have experienced, this is going to take about two
weeks to work, you know,or whatever the case might exactly. Yeah,
so that patient reporting is really critical, really respects, really critical,
really critical, And I think Ithink the patient also has a responsibility to
tell us what they value. Iwas working with a patient just the other
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day and we were sorting through acomplex decision about how to approach this particular
They've just been diagnosed, and theyhave some choices to make. Yeah,
if surgery, what kind of surgery? And if you do more radical,
what's the benefit here and there?And I was thought, I was really
struck by how this patient was goingthrough and organizing their thinking. And they
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said the question the two questions Iasked themselves, I thought were brilliant.
What am I most afraid of?And what do I value most? And
then ranking the things that they learnedabout, and out of that kind of
matrix, I think the decision emergedfor them. And that's a great example
of how to how to how toapply evidence informed medicine because the exact decision
(24:30):
he had to make surgery alone.But a radical surgery versus, you know,
a less radical surgery with chemon radiationhad not been compared head to head
in a clinical trial, so therewas no one study that was going to
tell the answer. But this patientfound their way to the answer through a
(24:52):
very I just was knobsmacked by watchingthem do that. That was just brilliant.
So and your patients always tell you, And this was the most explicit
telling of this I had seen ina long while. And I think it
allowed this person to come to thedecision with a great degree of comfort that
(25:14):
everything had made everything had been thoughtabout, you know, and we like,
for example, the chemo portion ofthis might be taught difficult to tolerate,
but I could step in and say, I can lighten that part for
you, and and that way itallowed this person to balance out all the
choices for themselves. So what aboutthe oncologists, the conventional ecologists, but
(25:41):
also the integrative either you know practitioneror integrative oncologists. How what's their responsibility
and how do you like what's yourI guess prescription for how we can not
triangulate patients because it's still quite commonfor patients to receive well thought out recommendations
(26:03):
from an integrative practitioner, present thoseto their and essentially be dismissed. So
what do we do? How dowe resolve this? That is that is
difficult? And I I'll give youthe experience I had in my time at
UCLA. When I first got there, integrative oncology really wasn't a thing yet.
They didn't have its own name.And now it's a much more it's
(26:25):
becoming, you know, like itit's it's it's so much like a thing.
You can look it up and Ihave a Google alert for it on
my on my email. So butI I The first thing was that the
patients the doctors were yeah, wedon't know exactly what you do, just
like, yeah, you know whatever. And then my patients started doing really
well. They didn't have to havetreatment reductions. They were generally quite cheerful.
(26:51):
They got through all their therapy,and and in that in the the
most the most hot crucible of therapy, the chemotherapy, everybody was talking to
each other because my patients weren't thrownup and those patients were or my patients
still look good after three treatments,and the other patients look really like they'd
been had been through a hard time, and so they started talking to each
(27:12):
other about what they were doing.This got back to the physicians, and
I'll never forget one of the breastcancer therapists called me up one day and
said, you know, I reallydon't know what you do, and frankly,
I don't really want to know toomuch because I really it's the whole
new thing. But your patients alwaysdo better. So I would like to
just send my patients to you.You do your thing. I understand that
(27:34):
you understand what I do. You'llstay out of my way, and that's
all I have, and then youmake them better and we'll be fine.
So I think it's a matter ofthem getting used to you, understanding that
you really do know what the workof the oncologists is and you really do
appreciate that risk benefit calculation I talkedabout before, and that you're not going
(27:56):
to you won't do anything to makethe therapy less effected because then patients get
all the toxicity and less benefit oftherapy. So you know, so I
think once they get I would encourageyou to introduce yourself. To know who
your therapists, who your oncologists are, and for them to know who you
are, for them to see youas a serious minded person. You can
(28:18):
volunteer to give presentations. They shouldall be you know, evidence referral,
evidence base. You talk about theevidence, you show them where the studies
are there's citations on the slides,et cetera. And that way they get
to trust you. And once theytrust you, honestly, it's much less
of a problem. And I hadthe benefit of working at UCLA. We
(28:40):
were all kind of organized together,so we sort of had to get along.
But it still does happen. Andwhen that happens, I say to
the patient, you know, letme try talking to your doctor if that
soul isn't very effective. And thenwe sit down and we say, look,
we have to make up our mind. And you know, the doctor's
not going to be the one athome feeling terrible, so let's go through
(29:03):
this and maybe we'll pick out thethings they like the least, but we
can certainly do all these other things. And that's I don't like to be
dishonest, but I think sometimes youhave to be asked for forgiveness. But
if you didn't get permission, youknow, right, well, unfortunately we're
almost out of time, and soI will actually ask you one final question
(29:26):
in a minute or less. Ifsomebody interests a patient is interested in the
therapy and they don't have an integratedoncologist to guide them, yes, where
should they research this well. Ithink that's difficult question, because if they
have access to a medical library,they can do that. There's integrative oncology,
a good book by Donald Abrams,your book and Carolyn's book by five
(29:51):
to Thrive, and everything on yourwebsite is a terrific resource that I strongly
recommend people go to. And evenif they don't have in an oncologist who's
also integrative, they can find someonelike me who has been doing this,
an internist or a natural path There'sTheology A A n P, the A
(30:14):
and P, the Oncologue Association ofNatural Pathic Physicians. That's another place to
look for references. S I O. I think I think has a recommendation
for therapists, and so I thinkthat there are places where you can find
someone to help you. This isa complicated thing to work through on your
own, right, I mean,I think that's a really important point.
(30:34):
It's complicated. Get advice from qualifiedpractitioners. Mary, it's been a great
show. Really appreciate your time.Do you have a quick website like to
share with the listeners? You know, I don't, but I've been doing
some of these conversations and I'm goingto start a website. I hope to
talk about this in a way thatpatients can have a better so we can
(30:55):
be able to say go here toget that information. I don't have it
yet, but all right, wellwe'll look forward to it. And that
wraps up the episode. I haveto Thrive live again. We thank our
sponsors n FH, the professional supplementline bridging the gap between nugceuticals and evidence
based medicine, Consistance Toticoline to helpenhance memory and attention, Immuse a post
(31:17):
biotic for immune support, and Doctoror Heroes Probiotics award winning pre and probiotic
formulas. Thank you all for joiningus. May you experience join, laughter
and love. It's time to thrive. Everyone, have a great night.
Any health related information on the followingshow provides general information only. Content presented
on any show by any host orguest should not be substituted for a doctor's
advice. Always consult your physician beforebeginning any new diet, exercise, or
treatment program. Welcome to five toThrive Live, a podcast about thriving I've
(00:44):
been Affected by cancer and chronic diseaseof doctor Lisa al Schuler and a co
host of my good friend Carolyn Gazella. You can find all past show podcasts
on any major podcast outlet and alsoon our website, which is I think
plan dot com. Well, Iam very excited to have doctor Mary Hardy
with me this evening. She isa Board certified internal medicine physician and a
(01:08):
specialist in metical and integrative medicine.She has actively combined complementary and alternative therapies
with traditional Western medicine for over thirtyyears in both her clinical practice and research
projects. Doctor Hardy is the pastmedical director of the Simsman UCLA Center for
Integrative Boncology, and she is arecognized leader in the field of integrative ononcology.
(01:33):
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And now we go to Mary andMary Welcome to five to Thrive Live.
(03:07):
Thanks Liza, it's great to bewith you. Indeed, I know you
know, I think we've known eachother for over twenty years now. I
think it is. I think itis just when we were babe and babes
in the woods, we met babydoctors, baby doctors. That's right,
that's right, that's right. Andin fact, yeah, you've been you
(03:27):
know, in practice, teaching,writing about integrative medicine for most of your
career, and so that qualifies you, I think as one of our pioneers.
Why did you focus in on integrativemedicine so soon in your career?
I think it's interesting. There arebasically two ways for me to answer that
question. I grew up in avery medical family, so I had sort
(03:47):
of the conventional part of medicine reallyin inculcated early. But I grew up
in New Orleans, which our folkmedicine still and then right after my residency,
I went to China with my collegeroommate and we saw acupuncture surgery.
(04:09):
Surgery be done in accupunctury. Anesthesiawas radically different from the way things were
set up for Western medicine, butthey were able to operate perfectly well and
the patient was awake, alert andtalking. And once my paradigm kind of
cracked, that led a lot moreinformation in and then my patients led me
(04:31):
first to integrative medicine and emphatically secondto integrateive oncology. So break your paradigm,
you get new stuff in the door, and then you look out for
the best way to help people thatyou care about. And that's how that
happened for me. I love it. Yeah, So you had, you
know, your views expanded, andyou realized, given you're tire to help
(04:55):
people, that there was lots oftools available to you. So, you
know, let's guide right in becausewe're going to really talk about, well
is this an evidence based thing todo? So first we have to find
what evidence based medicine is. Sohow do you define evidence based medicine?
You know, what is it andwhat is it not? Okay, so
I think there's been I think there'sbeen some some change in the way evidence
(05:18):
medicine was first introduced and what it'sbecome. I like the way it was
first introduced by Artie Cochrane and hisother colleagues, you know, probably more
than probably closest twenty five years agonow. And what they said then was
that you were supposed to blend togethertake the best available scientif available nation that
(05:43):
was there, and then you're supposedto add in your your clinical experience.
And then it was all supposed tobe based on what the patient's value system
was, So you were supposed toput the patient at the root of this
and then look for your your yourinformation science, and your own clinical experience.
(06:05):
What it's become now is sort ofcookbook medicine, people say, And
that's a distortion. Evidence. Evidenceis not it's not available for frankly,
direct evidence is not available for franklya lot of what we do, and
even conventional medicine. So I thinkyou have to really remember how this all
(06:27):
started, and it's a three leggedchair and all three components need to be
present. In an effort to stepaway from what evidence medicine has become people
are now using the term evidence informed, which I think gets back to the
original sense was first there. Soyou think evidence informed is more in keeping
with the definition that you just gave. I do, I do, And
(06:49):
I think it gets us away fromthis rigid locked step that if you can't
prove it's absolutely true, it's absolutelynot useful and absolutely should not be used,
or worse, it's harmful. Andsometimes I think when the conventional system
assess assesses integrative medicine, the standardsare kind of distorted. In other words,
(07:14):
it's not enough. I mean,first, you know, premium nonnecessary.
First, do no harm. That'swhat we took our socratic oath for.
And so I think things should havea really robust evidence or sense of
safety, and beyond that, withno evidence of harm, then evidence of
effectiveness or efficacy is useful. Buteven if you have the indication that it's
(07:38):
helpful, that may be enough,or you have other data that's indirect that
may tell you, inform you asit were, that this could be helpful.
You know, once you know it'ssafe, you have a lot more
leeway to let your clinical experience guideyou. Yeah, and I agree with
what you're saying. I think Iwould add to that too that for me,
(07:59):
when I think about evidence informed medicine, I think about something which to
your point, always takes into considerationsafety versus potential harm. But also maybe
the evidence isn't you know, thebest most well designed randomized clinical trial.
Maybe the evidence is more you know, early clinical trials, or maybe in
(08:20):
some cases there's no clinical trials,just have you know, jud dish trusts.
And in those cases, you know, I think it gets a little
more difficult. That's where you reallyhave to go back to your point,
to that first definition, and usethe judgment of a well trained practitioner to
that body data and say is thereenough data here? Is there potential harm
(08:43):
here? And then of course takeinto account the patient's desires. So I
think, you know it, really, this evidence informed medicine, I think
really becomes important when there's a lessrobust body of evidence. True, it's
astonishing how much we don't have,frankly, really rigorous evidence for you know,
(09:03):
you think if you're having a heartattack, everybody would say, oh,
bypass surgery, that's definitely a thingto do, and you'd be surprised
at how very little direct evidence thereis for that. Evidence that that's the
best thing, that's better, forexample, than very robust medication use.
So that's just one example that wedon't always know what we think we know
(09:24):
when you look right into it.So yeah, that's very true. So
you know, with respect to integrativeoncology, evidence is king. I mean,
you know, these ecologists are usedto looking at vast, huge trials
that have been replicated in many differentplaces before they step foot into the ring
(09:45):
with the therapy. So how doesthat then work with integrative oncology kind of
uniquely? Yeah, I mean whatdoes that sort of position integrade of oncology
if you will. Yeah, thinkit's interesting here to contrast how evidence is
looked at in regular in conventional oncology. I don't want to say regular,
(10:05):
like what we do is not regular. I think what we do is exceptional.
But if you think about it fromconventional oncology, you know, it's
always a risk benefit analysis. Issomething low enough risk or is there a
high enough benefit? Et cetera.And for cancer care, for cancer treatment,
conventional cancer treatment, that's a veryThe therapists have to walk a line
(10:31):
because the therapies they're given are forgranted toxic. You know they're toxic,
you know they're going to cause harm, and you hope that they cause more
harm to the cancer than they causeto the patient. That's the whole rationale
for chemotherapy in a nutshell, thatit attacks the fastest growing cells, and
you hope those are the cancer cellsyou expect that they are, but fast
(10:54):
growing normal cells will also get affectedas well. So they're very focused on
the evidence of benefit. Right.They know they have higher risk, so
they feel like they have to havereal solid evidence for benefit. On the
other hand, our kinds of therapyis in integrative oncology, I think,
(11:16):
are quite different because we have thebenefit of a strong safety a safety data,
you know, in other words,for example, I use honey for
mucositis. That's about as benign asa therapy can get. Right. Therefore,
I don't feel like I need thesame piles and piles and piles of
(11:37):
data proving benefit because my therapy isso non harmful. Therefore, if the
patient feels benefit, if they dowell, that's good enough for us.
You know, it's very madic ina way, and it really is for
me. The way I practice extremelystrongly on quality of life. You know,
I'm really about making the intervention thatthey're taking as non toxic as possible,
(12:03):
so that they get the full benefitof the of the Western medicine,
which is which is modern, thenegative effect of which the harshness of which
is modified by the kind of therapiesI like to employ. And I think
that gives you the best of bothworlds, and why not, you know,
yeah, why not? In fact, I would even take that a
step further. I think your exampleis a good one because natients who are
(12:26):
getting certain chemotherapy or chemo radiation treatmentscan develop such a significant degree of nucositis,
which for listeners who aren't familiar withthat term, refers to ulcerations and
the mouth, tongue, throat.Those ulterations can get so severe that their
conventional treatment might need to get dosereduced or stopped prematurely, in which case
(12:48):
they're not getting the benefit of thetreatment. So if we can step in
and provide something that is going tobe helpful for that symptom, it actually
supports the conventional treatment. I thinkis a really important component in creative ecology
specifically, absolutely absolutely, and alsoyou know, in that case, when
the mouth gets so sore. Sometimespeople it's so painful they can't even eat.
(13:13):
And a conventional oncologist will often bevery aware of how bad that it
is for the patient, but theysay they're taking the long view, and
they say, look, if yousurvive this cancer, whatever pain you have
now is worth it for survivorship,for cure. And I don't take that.
I don't lose that perspective. ButI also maintain the perspective that how
(13:37):
you get through something is as importantfor how how much of a shock it
is your system, how much ofa stress it is for you, how
hard it is for the rest ofyour family, you know, And so
I want you to get through thisand feel like you were in the name
of your show, thriving every day. I think you should strive to be
(13:58):
as well as you can poss willbe regardless, you know, no matter
what the circumstances are. And that'sthe key thing of integrative oncology, for
sure, I think for sure.And we also do have evidence that there
are times when a therapy may anon conventional therapy may make the chemotherapy work
(14:22):
better. You know, There's beenevidence of that with certain herbs and even
antioxidants there's a sense that there aresome things that we call radio sensitizers.
For example, if you take certainherbs, I think her cumin might fit
in this perspective where it makes thecells that are the abnormal cells more sensitive
to the radiation, so it makesthe radiation even more therapeutic. Milk thistle
(14:46):
has been used like this for abladder cancer radiation during bladder cancer treatment.
So I do think that you canactually hunt and peck. And we're beginning
to find more evidence about ways inwhich the interaction in between chemotherapy and natural
products is actually beneficial to conventional therapy, and that's one of the most exciting
(15:07):
areas of this research that's being done. I'd like to see much more of
that so we could really understand howto interdigitate things better. That would be
brilliant, It would be absolutely Andyou know, I want to go back
the example of using natural therapy toaddress potentially a side effect, because there
are situations like, for example,nausea from chemotherapy. Frankly, conditional anti
(15:33):
emetics or anti nausia work really thebest. So yeah, you know that's
I would recommend my patients take.But there can still be breakthrough nausea,
in which case we have therapies likeginger, for example, that actually has
a pretty strong clinical research base.So I think the other yes, I
think there's also this sort of ideathat you know, it's not necessarily always
(15:58):
natural is better. But it's likeyou're suggesting, let's how do we better
and I love that word interdigitate thesetherapies, how do we really determine,
given what we know, given whatthe patient's experience, given the options available,
how do we make the best decision? Yeah, and a good example
taking your nausea and vomiting example ondonstrone is the conventional medication. And you
(16:23):
know, for people who whose familymembers had chemotherapy, let's say a generation
ago, fifteen years ago, whennausea was just debilitating, these really are
like a life saver. But thereare times when people either are somewhat sensitive
to them, or they can makeyou constipated, or the patient just doesn't
(16:45):
like the way they feel on them, and so they want to limit the
amount of time they use those.That's a great time for ginger because ginger
can help with a little bit ofthat full, that relentless, little under
the surface feeling which is that's ascientific term bloup, which you'll recognize,
(17:07):
and and so that's terrific. Youcan use acupuncture too. You can change
the pattern and the way you eat. For example, eating protein more in
the morning will make you more lesslikely to have more nausea and vomiting and
maintain nutrition in a better state.There's lots of lots of little techniques like
this, and that's that just quickoverwall tells you. That's a good example
(17:32):
of how integrative therapy looks like.I've also used aroma therapy in this but
in this position, smelling things likepeppermint or citrus smells can often help relieve
an acute nausea episode. So youmight have a multiple different things. You
load up the patient's tool belt withall these different routine things that they can
try, and they will come backand tell you this one worked the best
(17:56):
for me, or you're right aboutthat that I really like the best,
and that I think is another thingthat's important about integrated moncology, which is
that we empower the patient to bea participant in their care rather than a
passive recipient of care who's on,as I like to say, the worst
roller coaster ride of their life,no control. Every surprise is a bad
(18:18):
surprise. It's just going to getmore and more horrible. And so they
just really want they want a sensethat they can contribute to getting better,
that they have some choices they canmake, and that they that they are
not helpless, that they are activeparticipants. So yeah, I think a
really good way to a good agood goal. Yeah, yeah, yeah,
(18:44):
it's a great, great scenario thatyou laid out. So you've been
in this for a while, severaldecades. What have you seen. Would
you characterize how the evidence based forspecifically integrated moncology, how's that changed over
the past three decades? You know, it's it's actually a really hopeful story
because I started doing this probably inthe early nineties, nineteen nineties maybe,
(19:10):
and so, oh my god,that is a while ago. So I
and I actually when I first started, I was dragged into it by my
patients because I'd been I had anintegrated medicine clinic and I was happily treating
menopause and back pain and knee painand high cholesterol. And then my patients
started inevitably having cancer, and theysaid, look, you were my doctor
(19:33):
when I had all these other things. Why can't you participate now? And
I really thought, yeah, youknow, why can't I participate now?
And so I had to go backand read a million papers and it was
very hard to find good data.You had to sometimes look at traditional medicine.
What did a Chinese practitioner do?What did you know? An artlist
(19:57):
do? What did and I Evadisdo? And there was the data was
scanty, there wasn't a lot ofit. And then I'm happy to say
over the ensuing time, we there'sjust been so much more information. In
two thousand and eight, I wrotea big review about dietary supplements help or
(20:18):
harm to look at all the dataI could find, and I was able
to fit it into one article orthe overwhelming majority of it. I don't
I think it'd be hard to fitit in a book. Now. That's
how much more information we have,and that's terrific. That is terrific because
the more we know, the betterwe quip we are to help one hundred
(20:41):
and you know, yeah, it'svery exciting actually to see all the new
data that's coming out and infect thequality of the research. I mean,
it still varies. There's some badstudies but there's some really good studies too,
and even analyzes and systematic reviews thathave taken the body of data and
analyzed it. Yeah, you comea long way, baby, as they
(21:02):
say. And I love your storybecause it was your patients who said,
hey, yeah, I wanted tobe my I'm going through the s cancer
experience. So how would you characterizethe role of the patient in creating an
evidence based approach to their answer?Do they have any responsibility in this?
Well, that's that's a very interestingquestion. And I think in a really
(21:26):
a very robust and caring relationship betweena provider and a patient, that is
the first little atom of research.That's the first little bit of data.
You know. They call it theend of one, one person's experience,
and really all the clinical trials isa very rigorous way to eliminate bias and
(21:52):
sum up everybody's little ends of one, you know. But I think a
clinician is often very much educated bytheir experience a patient at a time.
They have all this information they've learnedand all the studying they've done. And
a physician of any type, orhealthcare provider, any type, an alternative
(22:12):
provider, however you want to putthe label on that. We all have
an expectation of what will be beneficial, and then we tell the patient that,
we tell them why we recommend wetell them how to use something,
and then we watch and then theycome back and say yes or no,
or it worked like this or thisdidn't work. And so that's the beginning
(22:33):
of research. Really is a practicea provider listening to a patient with an
open mind and an open heart andreally ready to hear what that was like
for that particular person. And yeah, I think they have everything to do
with this. Actually, you know, of the way I answer that question,
I think that's so true. Ican't tell you how much I've learned
(22:55):
from my patients, because like saying, we make recommendations based on what we've
worndarned, but it's really only thevicarious observation of how people experience or recommendations
that we really learned, you know. Then we get to explain the nuances.
Okay, I'm giving you this becauseit's going to help with your feed
(23:15):
and given what my patients have experienced, this is going to take about two
weeks to work, you know,or whatever the case might exactly. Yeah,
so that patient reporting is really critical, really respects, really critical,
really critical, And I think Ithink the patient also has a responsibility to
tell us what they value. Iwas working with a patient just the other
(23:38):
day and we were sorting through acomplex decision about how to approach this particular
They've just been diagnosed, and theyhave some choices to make. Yeah,
if surgery, what kind of surgery? And if you do more radical,
what's the benefit here and there?And I was thought, I was really
struck by how this patient was goingthrough and organizing their thinking. And they
(24:03):
said the question the two questions Iasked themselves, I thought were brilliant.
What am I most afraid of?And what do I value most? And
then ranking the things that they learnedabout, and out of that kind of
matrix, I think the decision emergedfor them. And that's a great example
of how to how to how toapply evidence informed medicine because the exact decision
(24:30):
he had to make surgery alone.But a radical surgery versus, you know,
a less radical surgery with chemon radiationhad not been compared head to head
in a clinical trial, so therewas no one study that was going to
tell the answer. But this patientfound their way to the answer through a
(24:52):
very I just was knobsmacked by watchingthem do that. That was just brilliant.
So and your patients always tell you, And this was the most explicit
telling of this I had seen ina long while. And I think it
allowed this person to come to thedecision with a great degree of comfort that
(25:14):
everything had made everything had been thoughtabout, you know, and we like,
for example, the chemo portion ofthis might be taught difficult to tolerate,
but I could step in and say, I can lighten that part for
you, and and that way itallowed this person to balance out all the
choices for themselves. So what aboutthe oncologists, the conventional ecologists, but
(25:41):
also the integrative either you know practitioneror integrative oncologists. How what's their responsibility
and how do you like what's yourI guess prescription for how we can not
triangulate patients because it's still quite commonfor patients to receive well thought out recommendations
(26:03):
from an integrative practitioner, present thoseto their and essentially be dismissed. So
what do we do? How dowe resolve this? That is that is
difficult? And I I'll give youthe experience I had in my time at
UCLA. When I first got there, integrative oncology really wasn't a thing yet.
They didn't have its own name.And now it's a much more it's
(26:25):
becoming, you know, like itit's it's it's so much like a thing.
You can look it up and Ihave a Google alert for it on
my on my email. So butI I The first thing was that the
patients the doctors were yeah, wedon't know exactly what you do, just
like, yeah, you know whatever. And then my patients started doing really
well. They didn't have to havetreatment reductions. They were generally quite cheerful.
(26:51):
They got through all their therapy,and and in that in the the
most the most hot crucible of therapy, the chemotherapy, everybody was talking to
each other because my patients weren't thrownup and those patients were or my patients
still look good after three treatments,and the other patients look really like they'd
been had been through a hard time, and so they started talking to each
(27:12):
other about what they were doing.This got back to the physicians, and
I'll never forget one of the breastcancer therapists called me up one day and
said, you know, I reallydon't know what you do, and frankly,
I don't really want to know toomuch because I really it's the whole
new thing. But your patients alwaysdo better. So I would like to
just send my patients to you.You do your thing. I understand that
(27:34):
you understand what I do. You'llstay out of my way, and that's
all I have, and then youmake them better and we'll be fine.
So I think it's a matter ofthem getting used to you, understanding that
you really do know what the workof the oncologists is and you really do
appreciate that risk benefit calculation I talkedabout before, and that you're not going
(27:56):
to you won't do anything to makethe therapy less effected because then patients get
all the toxicity and less benefit oftherapy. So you know, so I
think once they get I would encourageyou to introduce yourself. To know who
your therapists, who your oncologists are, and for them to know who you
are, for them to see youas a serious minded person. You can
(28:18):
volunteer to give presentations. They shouldall be you know, evidence referral,
evidence base. You talk about theevidence, you show them where the studies
are there's citations on the slides,et cetera. And that way they get
to trust you. And once theytrust you, honestly, it's much less
of a problem. And I hadthe benefit of working at UCLA. We
(28:40):
were all kind of organized together,so we sort of had to get along.
But it still does happen. Andwhen that happens, I say to
the patient, you know, letme try talking to your doctor if that
soul isn't very effective. And thenwe sit down and we say, look,
we have to make up our mind. And you know, the doctor's
not going to be the one athome feeling terrible, so let's go through
(29:03):
this and maybe we'll pick out thethings they like the least, but we
can certainly do all these other things. And that's I don't like to be
dishonest, but I think sometimes youhave to be asked for forgiveness. But
if you didn't get permission, youknow, right, well, unfortunately we're
almost out of time, and soI will actually ask you one final question
(29:26):
in a minute or less. Ifsomebody interests a patient is interested in the
therapy and they don't have an integratedoncologist to guide them, yes, where
should they research this well. Ithink that's difficult question, because if they
have access to a medical library,they can do that. There's integrative oncology,
a good book by Donald Abrams,your book and Carolyn's book by five
(29:51):
to Thrive, and everything on yourwebsite is a terrific resource that I strongly
recommend people go to. And evenif they don't have in an oncologist who's
also integrative, they can find someonelike me who has been doing this,
an internist or a natural path There'sTheology A A n P, the A
(30:14):
and P, the Oncologue Association ofNatural Pathic Physicians. That's another place to
look for references. S I O. I think I think has a recommendation
for therapists, and so I thinkthat there are places where you can find
someone to help you. This isa complicated thing to work through on your
own, right, I mean,I think that's a really important point.
(30:34):
It's complicated. Get advice from qualifiedpractitioners. Mary, it's been a great
show. Really appreciate your time.Do you have a quick website like to
share with the listeners? You know, I don't, but I've been doing
some of these conversations and I'm goingto start a website. I hope to
talk about this in a way thatpatients can have a better so we can
(30:55):
be able to say go here toget that information. I don't have it
yet, but all right, wellwe'll look forward to it. And that
wraps up the episode. I haveto Thrive live again. We thank our
sponsors n FH, the professional supplementline bridging the gap between nugceuticals and evidence
based medicine, Consistance Toticoline to helpenhance memory and attention, Immuse a post
(31:17):
biotic for immune support, and Doctoror Heroes Probiotics award winning pre and probiotic
formulas. Thank you all for joiningus. May you experience join, laughter
and love. It's time to thrive. Everyone, have a great night.
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