Conventional medicine has lost its battle with cancer. But that doesn't mean the war is over. Let me explain why we may finally be heading in the right direction.
I just returned from TEDMED, an extraordinary gathering of brilliant minds from science, medicine, business and technology--a veritable intellectual orgy. During the conference, there was a theme that emerged: synthesis.
Instead of dividing everything into diseases and labels, emerging science is pointing to a different way of thinking about diseases. The thread that ran through the conference was that disease is a systemic problem and we have to treat the system, not the symptom; the cause, not the disease. This completely redefines the whole notion of disease. The landscape of illness is changing.
At TEDMED I spoke about a new way to define disease, to navigate the landscape of illness. It is called functional medicine, which is a systems-biology approach to personalized medicine that focuses on the underlying causes of disease. That definition of functional medicine is a mouthful. But in a word, it is the medicine of WHY, not WHAT.
Conventional medicine is focused on naming diseases based on geography, body location and specialty, instead of by the cause, mechanism or pathway involved. Doctors say you have a liver, kidney, brain or heart disease. But this approach to naming disease tells you nothing about the cause, and it is quickly becoming obsolete as we understand more about the mysteries of human biology.
Instead of asking what disease you have and what drug should be used to treat it, we must ask WHY the disease has occurred--what are the underlying causes that lead to illness and how do we look under the hood to find out what's going on. Modern medicine is like trying to diagnose what's wrong with your car by listening to the noises it makes without ever looking inside to see what's going on. Functional medicine allows us to look under the hood. It gives us a method for identifying the conditions in which disease arises and shows us how to begin changing those conditions.
This shift toward a more functional, systems-based, environmental approach to treatment is happening in cancer research right now, and this change was one of the main topics explored at TEDMED this year.
Looking at Cancer a New Way: Treatment in the 21st Century
The problem with conventional cancer treatment is simply this: We look at the disease the wrong way. This reality was illustrated over and over again by the leading thinkers in the field of cancer treatment at TEDMED.
For example, Greg Lucier, Chairman of Life Technologies, talked about how thinking about specific cancers is essentially flawed. How we label cancer is no longer synced up with what we know about the origins of cancer or the fact that two people who have cancer with the same name--like breast cancer--can have two completely different diseases which require different treatments. Just because you know the name of your disease, it doesn't mean you know what's wrong with you or what to do about it.
Classifying tumors by body site--lung, liver, brain, breast, colon, etc.--misses the underlying causes, mechanisms and pathways involved in a particular cancer. The fact that cancer appears in a given region of the body tells us nothing about why the cancer developed in the first place. What's more it gives us no information about how it manifested in a given patient. Two people with cancers in different parts of the body may have developed it for same reasons. Similarly, two people with cancers in the same part of the body may have developed it for different reasons. A patient with prostate cancer and one with colon cancer may have more in common with each other than two patients who have colon cancer. Historically we have practiced medicine by geography--where a disease occurs in the body. That doesn't make scientific sense anymore. Now we have the potential to treat illness by understanding the underlying mechanisms and metabolic pathways.
These and other misconceptions about cancer and cancer treatment are leading to terrifying results. From the perspective of curative and preventive therapy, we have lost the war on cancer. Clinton Leaf explained how fancy statistics manipulate the data to show that cancer deaths are going down, while they are in fact going up. Overall cancer rates or incidence is significantly increasing. Deaths from cancer are also increasing. In 2008, there were 565,000 deaths in the U.S. alone. One in three people will get cancer in their lifetime. While few are aware that solid tumors grow slowly for 30 years before they can be detected, 17 million Americans are walking around with cancer somewhere along the continuum from initiation of a cancer cell to detectable tumor.
In the "war" on cancer, we are fighting a losing battle for one simple reason: We're focusing on the wrong target. As a physician I was trained to focus on the tumor--to burn, poison or cut it out, and then wait, watch and pray for the cancer to stay at bay. Newer gene-targeted treatments will help to improve chemotherapy and improve survival rates, but they won't prevent cancer in the first place or even prevent it from coming back once you've had it. Hope is not the only way to straddle the scary territory between remission and recurrence. There is a different way of thinking about how to treat the system, not just the cancer that holds promise for a proactive approach to helping both prevent occurrence as well as recurrence.
Tending Your Garden: Treating the Soil in Which Cancer Grows
Dr. Anna Barker, deputy director of the National Cancer Institute, explained how new groups of researchers are collaborating to think differently about cancer--to understand and treat it as a systemic problem.
The problem with cancer--one which almost no oncologists think about--is not the tumor, but the garden in which the tumor grows. In caring for a garden, if the weeds get too big, we pull them out, just as we do with cancer using conventional therapies such as chemotherapy, surgery or radiation. But then what?
Traditionally, we have focused on late-stage curative care, and in doing so, we have missed the thinking and the treatments focused on changing the underlying conditions that led to the cancer in the first place. Diet, lifestyle, thoughts, and environmental toxins all interact with our genes to change the landscape of our health.
We have been asking the wrong question about cancer. We have asked "what": What tumor do you have? What kind of chemotherapy, surgery or radiation is needed for that tumor? What is your prognosis? Instead, we need to be asking "why" and "how": Why did this cancer grow? How can you change the conditions that feed and support cancer-cell growth? How did the terrain of your garden become a host to such an invasive weed?
Surprisingly, scientific literature is abundant with evidence that diet, exercise, thoughts, feelings and environmental toxins all influence the initiation, growth and progression of cancer. If a nutrient-poor diet full of sugar, lack of exercise, chronic stress, persistent pollutants and heavy metals can cause cancer, could it be that a nutrient-dense, plant-based diet, physical activity, changing thoughts and reactions to stress, and detoxification might treat the garden in which cancer grows? Treat the soil, not the plant. It is a foundational principle of sustainable agriculture, and of sustainable health.
In my oncology rotation in medical school, I asked my professor what percentage of cancer was related to diet. Expecting a gracious but insignificant nod to the role of diet as a cause of cancer, I was surprised when he said that 70 percent of all cancers were related to diet. The 2008-2009 report from the President's Cancer Panel found that we have grossly underestimated the link between environmental toxins, plastics, chemicals, and cancer risk. They have yet to acknowledge how thoughts, emotions and overall stress impact that risk--but it is sure to come. The facts that gravitate around cancer support evidence that will motivate us all to take a deeper look.
Consider this fact: Sixteen percent of all cancers are new, primary cancers in patients who have already had one cancer, not recurrences. This means that people who have cancer are more likely to get a second and independent cancer. Could it be the garden? I recently saw a patient after her third cancer, wondering what she could do to prevent cancer rather than waiting around for another one.
Consider this fact: The lifetime risk of breast cancer of those with the "breast cancer gene" or BRCA1 or 2 is presently 82 percent and increasing every year. Before 1940, the risk of getting cancer for those with the cancer gene was 24 percent. What changed? Our diet, lifestyle, and environment--both physically and emotionally. Might these factors be a better place to look for answers on how to address our cancer epidemic?
Cancers arise from a disturbance in your physiological state. Addressing that disturbance is the foundation of future cancer care. This approach might be called milieu therapy. Rather than treating cancer per se, we treat the milieu in which cancer arises.
And this is manageable. We can enhance immune function and surveillance through dietary and lifestyle changes, nutrient or phytonutrient therapies. We can facilitate our body's own detoxification system to promote the elimination of carcinogenic compounds. We can improve hormone metabolism and reduce the carcinogenic effects of too much insulin from our high sugar and refined carbohydrate diet. We can help the detoxification of toxic estrogens through modulation of diet, lifestyle and elimination of hormone-disrupting xenobiotics or petrochemicals.
We can also alter how our genes are expressed by changing the inputs that control that expression: diet, nutrients, phytonutrients, toxins, stress and other sources of inflammation. And we can focus on less divisive and more generative thoughts that, in turn, create more uplifting emotions--all good fertilizer for the soil in the garden of our body.
The future of cancer care must use medicine's understanding of the mechanisms of disease and we must use this information to create physiologic and metabolic balance, to design treatments that support and enhance normal physiology. The future of cancer care lies not in finding the best cocktail of chemotherapeutic agents, the right dose of radiation, or a new surgical technique, (all of which are still important and will continue to be refined) but in finding the right way to personalize treatment according to the individual imbalances in each person.
The pieces of the puzzle that hold the answers for cancer prevention and treatment are strewn about the landscape of medical science. They need only be assembled into a story that can guide clinical care. The time is ripe to accelerate this process. Thankfully, more scientists are now exploring the story of how to tend the gardens of our body, mind and soul.
To your good health,
Mark Hyman, MD