RICHARD E. FREEMAN MD MPHLOCK HAVEN UNIVERSITY2013

TOMAKE MAN WHOLE

CASE OF DR. FREEMAN AND

MRS. ANDERSON

COMPLEMENTARY MEDICINE VS.ALTERNATIVE MEDICINE COMPLEMENTARY MEDICINE -

therapies, treatments, products that are employed to complement or be used with conventional medicine

ALTERNATIVE MEDICINE – therapies, treatments, products are employed to take the place of conventional medicine

INTEGRATIVE MEDICINE

INTEGRATIVE MEDICINE- comprehensive, evidence-based approach to care that addresses ALL participants at ALL levels of their being and experience

INTEGRATIVE ONCOLOGY CARE A COMPREHENSIVE EVIDENCE BASED

APPROACH TO CANCER CARE THAT ADDRESSES ALL PARTICIPANTS AT ALL LEVELS OF THEIR BEING AND EXPERIENCE WITH DEFINABLE AND DESIRABLE OUTCOMES IN PREVENTIVE, SUPPORTIVE AND ANTINEOPLACTIC SPHERES

BASED ON or INCLUDING: WESTERN MEDICAL PRACTICES CONVENTIONAL MEDICINE COMPLEMENTARY MEDICINE ALTERNATIVE MEDICINE

SPHERE OF ACTION-THE LADDER PREVENTION

PRIMARY, SECONDARY, TERTIARY

SUPPORTIVE SYMPTOMS, SIDE EFFECTS

ANTINEOPLASTIC DIRECT ACTION

WHY INTEGRATIVE ONCOLOGY?? POSITIVES:

Significant decrease in death rates ~70% patients with 5 yr survival Technical and therapeutic advances

-diagnostic and treatment Screening program successes Population education Oncological expertise advancements Public Health/Environmental

Improvements

WHY INTEGRATIVE ONCOLOGY?? NEGATIVES:

HIGH COSTS-THIRD PARTY PAYER DEPENDANCY ~$200 BILLION/ YEAR

~ $70 BILLION/ YEAR – DIRECT MEDICAL ~$30 BILLION/YEAR – INDIRECT MORBIDITY COSTS ~$100 BILLION/YEAR- INDIRECT MORTALITY COSTS

LIFETIME CANCER RISK STILL HIGH MEN – 50%; WOMEN – 30%

CUREENTLY – 10 MILLION + CANCER SURVIVORS SPECIAL NEEDS- MEDICAL, PSYCHOSOCIAL,

LIFESTLE LOSS OF THERAPEUTIC RELATIONSHIPS ONCOLOGIST – NOT TRAINED IN NON-

CONVENTIONAL APPROACHES MISTRUST OF THE MEDICAL ESTABLISHMENT

RESULTS:

BILLIONS SPENT OUT OF POCKET ON CAM TREATMENTS

UNDER UTILIZATION OF BENEFICIAL CHEAPER PROVEN CAM MODALITIES-PREVENTION AND SUPPORT

DANGEROUS INTERACTIONS BETWEEN CAM-CONVENTIONAL TREATMENTS

DELAYS IN SEEKING CONVENTIONAL TREATMENTS

PROVIDER BURNOUT

CANCER SURVIVORS

PRAYER AND SPIRITUAL PRACTICES 60%

RELAXATION TECHNIQUES 45%

FAITH AND SPIRITUAL HEALING 40%

NUTRITIONAL SUPPLEMENTS 40%

SOLUTION-HEALING IN ADDITION TO CURINGALL PARTICIPANTS ALL LEVELS OF BEING

PATIENTS FAMILIES PROVIDERS COMMUNITIES SOCIETY

MIND THOUGHTS, FEELINGS,

EMOTIONS, INTELLECT

BODY BIOLOGIC, CHEMICAL,

ENERGETIC BEING

SOUL PERSONAL EXPERIENCE

OF SELF

SPIRIT ONE’S UNIFYING

/UNIVERSAL APPROACH TO LIFE

THE PRECAUTIONARY PRINCIPLE A LACK OF SCIENTIFIC CERTAINTY SHALL

NOT BE USED AS A REASON FOR NOT ACTING IN A WAY THAT PREVENTS HARM TO HUMAN HEALTH OR THE ENVIRONMENT.

USE WHEN DATA IS LIMITED OR NON-EXISTANT

ONLY WITH INFORMED CONSENT PERCEIVED BENEFITS OUTWEIGHT RISKS PREVENTIVE/SUPPORTIVE INTERVENTIONS JUDGEMENT CALL-

CAM/IM – “RED FLAGS”

“CURES”-OFFERED CAN NOT PROVIDE EVIDENCE- BASED DATA FDA NOT APPROVED USES “TESTIMONIALS” FOR PROMOTION

PHYSICIANS, INFLUENTIAL INDIVIDUALS DEROGATORY/ DEGRADING COMMENTS

ABOUT CONVENTIONAL THERAPIES REFUSES TO WORK AS A TEAM RISKS OF THERAPY NOT ADDRESSED REFUSE INSURANCE – CASH ONLY MOST IMPORTANT – “GUT FEELING”

SPHERE OF ACTION - LADDER PREVENTION

PRIMARY, SECONDARY, TERTIARY

SUPPORTIVE SYMPTOMS, SIDE EFFECTS

ANTINEOPLASTIC DIRECT ACTION

TYPES OF INTERVENTIONS

ADJUNCTIVE/ALTERNATIVE SYSTEMCHINESEACUPUNCTURE

MIND/BODYSPIRITUALMEDITATION/YOGA

NUTRITIONAL SPECIAL VEGETABLEHIGH FIBER

PHARMOCOLOGICAL/BIOLOGICALBOTANICALSHERBSVACCINESHORMONES

ALTERNATIVE&

ADJUNCTIVESYSTEMS

ACUPUNCTURE

SUPPORTIVE: WELL ESTABLISHED AS A MEANS TO

CONTROL CHEMOTHERAPY RELATED NAUSEA AND VOMITING.

PROBLEMS: NOT ENOUGH PRACTITIONERS

AYURVEDIC Medicine

India:

Balance of Body, Mind Spirit

CHINESE MEDICINE

CHINA & EASTERN ASIA:

BALANCE OF TWO FORCES:

HOMEOPATHY

VERY SMALL DOSES OF A SUBSTANCE

TRIGGERS BODY TO HEAL ITSELF

NATUROPATHIC MEDICINE

SEVERAL “NATURAL” MODALITIES

ENHANCING “SELF HEALING”

MIND – BODYMODALITIES

RELAXATION TECHNIQUES PROGRESSIVE RELAXATION YOGA TAI CHI/ REICHI/THERAPUETIC TOUCH MEDITATION HYPNOSIS IMAGERY BIOFEEDBACK STRESS MANAGEMENT/Creative

outlets

SUPPORT GROUPS

Shown to: Reduce anxiety/depression/

loniness/suicide Provide resource for education

Improve nutritional/physical wellbeing

Reduce the dependency on providers/caregivers for support

Reduce caregiver burden

SPIRITUALITY

MOST POWERFUL COPING TOOL yet MOST UNDERUTILIZED- PATIENT/PROVIDER AMBIVALENCE SHOWN TO: Improve overall QUALITY OF LIFE

through creation of a positive mental attitude, hope, and sense of well being/inner peace.

Healing Attributes- Spiritual Belief System

ATTRIBUTES: Decrease anxiety, depression, anger and discomfort Decrease sense of isolation and suicide risk Decrease alcohol and drug usage Lowers blood pressure/decreases co morbidities Aids in adjustment to cancer and treatment Increases ability to enjoy life during treatment Freedom from regret/satisfaction with life

May extend life!!! Spiritual Distress- harder to cope

SPIRITUAL ASSESSMENT

EXPLORES SPIRITUAL BELIEFS/PRACTICES

HELP PREDICT COPING MECHANISMS OPENS DIALOG PATIENT-PROVIDER

SPIRITUAL ASSESSMENT INCLUDE QUESTIONS REGARDING:

DENOMINATION BELIEF OR PHILOSOPHY OF LIFE & DEATH SPIRITUAL PRACTICES/RITES/RITUALS USE OF RELIGION AS SOURCE OF STRENGTH INTERNAL RELIGIOUS SUPPORT STRUCTURE CONFLICTS BETWEEN BELIEFS AND TREATMENTS PRAYER AS PART OF TREATMENT LOSS OF FAITH/TRUST/ABANDONMENT INTERACTIONS BETWEEN PROVIDERS AND SPIRITUAL

LEADERS-CONFIDENTIALITY END OF LIFE PLANNING

NUTRITIONAL SUPPLEMENTATIO

N MODALITIES

FIBER AND CANCER HIGH FIBER DIET – PREVENTIVE 1

DECREASE IN TRANSIT TIME LESS TIME FOR BACTERIAL ACTION-

METABOLITES LESS TIME FOR MUCOSA CELL TOXIN

EXPOSURE USUALLY HIGH IN ANTI-OXIDANTS LESS NITROSAMINE INGESTION

AFRICANS AND SEVENTH-DAY ADVENTISTS- Burkitt / SDA Studies

Vegetarian/Vegans

NURSES HEALTH STUDY-HARVARD

ANTIOXIDANT THEORY

MECHANISM OF ACTION: Controversial Free radicals produced by normal metabolism Radicals – genetic mutations Antioxidants – scavanger of radicals Transit time theory

FOODS: Green teas, mushrooms, green/orange vegetables, Omega 3 FA, walnuts, flax lignans

Lycopene-containing foods VITAMINS: A,C,E Minerals: selenium DEBATE: USE WITH CHEMOTHERAPY

PROPONENTS- LESSENS SIDE EFFECTS DETRACTORS- TUMOR PROTECTED DURING CHEMO

DIETSGONZALEZ/GERSON REGIMENS

SPHERE: SUPPORTIVE/ ANTINEOPLASTIC INGREDIENTS:

PANCREATIC ENZYMES-(FREEZE-DRIED PORCINE)-MAJOR COMPONENT ELIMINATE ABNORMAL CELLS, TOXIC WASTE PRODUCTS & ABNORMAL

PROTEINS COFFEE ENEMAS-

2x / DAY – DETOXIFICATION- LIVER- IMPROVE FUNCTION/EMPTY GB NUTRITIONAL SUPPLEMENTS-

VITS, MINERALS, TRACE ELEMENTS, AMINO ACIDS & ORGAN EXTRACTS(COW THYMUS)

SPECIAL DIET- 10 BASIC AND 90 VARIATIONS BASED ON UNBALANCED METABOLIC PROFILES

MECHANISM: see above EFFICACY: CONFLICTING TRIALS: one ongoing FDA STATUS: PPE – new and under investigation; rest dietary

supplement

MILK THISTLE SPHERE: ANTINEOPLASTIC SOURCE: MILK THISTLE-

SILYMARINS-SILYBIN, ISOSILBIN, SILYCHRISTIN, SILYDIANIN

MECHANISM:ANTIOXIDANT CELLULAR MEMBRANE STABILIZER STIMULATES DETOXIFICATION PATHWAYS-LIVER STIMLATES REGENERATION OF LIVER CELLS INHIBITS GROWTH OF SPECIFIC CELL LINE CYTOTOXIC TO CERTAIN CANCER LINES, INCREASES EFFICACY OF SOME CHEMOTHERAPT

AGENTS

TRIALS: obgoing FDA STATUS: DIETARY SUPPLEMENT

PHARMACOLOGICAL AND

BIOLOGICAL MODALITIES

COENZYME Q 10

SPHERE: PREVENTIVE 1,2,3/SUPPORTIVE(ADJUNCTIVE)

SOURCE: Made naturally in the Human Body(Decrs c Age) HEART, LIVER, KIDNEY, PANCREAS

MECHANISM:ANTIOXIDANT CELLULAR –AEROBIC-METABOLISM IMMUNE STIMULANT

LOW LEVELS SEEN IN CANCER PATIENTS CARDIO-PROTECTIVE (CHEMOTHERAPY-

ANTHRACYCLINES) EFFICACY: POTENTIAL

TRIALS; NONE FDA STATUS: DIETARY SUPPLEMENT

CARTILAGE (SHARK & BOVINE) SPHERE: ANTINEOPLASTIC INGREDIENTS:CARTILAGE-SHARK/COW MECHANISM:

DIRECTLY KILLS CELLS STIMULATES IMMUNE SYSTEM

Collagens /glycoaminoglycans Anti-inflammatory/ immune stimulators – may tumor cell

toxic BLOCKS ANGIOGENESIS

Angiogenesis inhibitors - chondrocytes No blood vessels in cartilage

EFFICACY:

TRIALS: ONGOING – animal and human – oral, topical, enema, SQ

FDA STATUS:DIETARY SUPPLEMENT ONLY

AMYGDALIN/LAETRILEMANDELONITRILE SPHERE: ANTINEOPLASTIC SOURCE:

FRUIT PITS – APRICOTS, PEACHES LIMA BEANS, CLOVER, SORGHUM

MECHANISM: Cancer cell inhibitors CYANIDE(cyanogenic glycoside)- CYANIDE POISONING (orally) PRUNASIN & BENZALDEHYDE

EFFICACY: Animal – very little; human- NONE HISTORY: Russia – 1840’s; US – 1920’s;

Usage stopped 1970- FDA – Not safe nor effective 1970’s –challenged & legalized in 20 states 1980- US Supreme Court overturned lower courts- Laetril – illegal

in US

TRIALS: NONE FDA STATUS: NOT APPROVED IN US

Common in other countries - Mexico

ANTINEOPLASTINS-Bruzinski SPHERE: ANTINEOPLASTIC SOURCE:

ORIGINAL-HUMAN URINE- SYNTHETIC- mixture of amino acids, peptides and derivatives

MECHANISM: Antineoplastins are part of normal “surveillance” system of

body necessary to switch abnormal cells to normal state of differentiation

Nonimmunological process Peptides act as information carriers- Antineoplastics are deficient in the cancer patient

EFFICACY: Specific to the Antineoplastin (many subtypes) and tumor type

IV, IM, PR, TOPICAL,INTRAPLEURAL, BLADDER INSTILLATION, PO,

TRIALS: NO RANDOMIZED TO DATE NONRANDOMIZED TRIAL AT DEVELOPERS INSTITUTE

FDA STATUS: NOT APPROVED

BOTANTICALS & CANCER

FOODS AND CANCER

GREEN /BLACK TEAS SOY OMEGA 3- FATTY ACIDS LYCOPENE

Great clinicial and patient resources http://www.cancer.gov/cancertopics/

cam http://cam.cancer.gov

QUESTIONS?