Robert A. Buckman, M.D., Ph.D.
Adjunct professor, Behavioral Science
The University of Texas M. D. Anderson Cancer Center
Dr. Buckman:
When we last met on the ward last
week, I went over the results with you. You know that this is a
lymphoma and that it's of the kind that, unfortunately, we call the,
well it is known as a high grade lymphoma: it's a very aggressive
disease. But with chemotherapy, we've got a reasonable chance of curing
it forever. And I told you all about the side effects of the
chemotherapy which it's quite hard therapy. It's a sort of hard going
for you. So I guess there are 2 questions. We wanted to start with the
therapy this afternoon. And there are 2 questions. Firstly, how have
you been in the last week?
Patient:
Basically, still as tired as I was before.
Dr. Buckman:
Yeah.
Patient:
I'm still having the fever, the chills...
Dr. Buckman:
Oh, the night sweats and stuff like that?
Patient:
Right.
Dr. Buckman:
Yes, okay.
Patient:
So nothing's really changed.
Dr. Buckman:
Okay, and I guess the second
question is, is there anything that I didn't explain to you accurately
on the ward last week about the treatment or about the disease that
you'd like to chat over before we start the therapy in a couple hours?
Patient:
Well, I understand what you've said
about the disease, yeah. And I did take the weekend and spent a fair
bit of time reading about it.
Dr. Buckman:
Okay.
Patient:
As well as checking the internet and
seeing what options are available and I have booked an airline ticket
to go down to Mexico to try the holistic approach down there.
Dr. Buckman:
Okay, now you've made up your mind
really. Am I correct that you want to try the therapy in Mexico? Now
firstly, what kind of treatment have you read about in Mexico and most
important of all, what do you expect it will do against the disease:
the lymphoma?
Patient:
Well, first of all I expect a full cure.
Dr. Buckman:
Okay, that's what you expect.
Patient:
And I understand it's a combination of cleansing the entire body...
Dr. Buckman:
Oh yes, okay.
Patient:
...the diet, teas, herbal teas...
Dr. Buckman:
Yes, yes.
Patient:
...particularly the laetrile.
Dr. Buckman:
Yes.
Patient:
And there are other things that are wrapped up in that type of...
Dr. Buckman:
Yes, indeed. You're going to the place where they do the visualization and the...
Patient:
That is correct.
Dr. Buckman:
...the thought thing...
Patient:
With the belief that the mind is stronger than the body.
Dr. Buckman:
Yes, right. Now what you've read Mrs. Taylor makes you feel that you've got a pretty high chance of being cured by this?
Patient:
I don't see any numbers that have proved that I don't have a chance.
Dr. Buckman:
Okay, okay.
Patient:
And if you could tell me the chemotherapy was that way, it might be a different story.
Dr. Buckman:
Well, I'll tell you what. Let's do
it in sort of 3 chunks. Let me tell you about the chemotherapy first of
all and then let's talk about what going to Mexico will do for you and
then separately what it may or may not do for the cancer. And so
perhaps the best thing is if I answer for the chemotherapy. The
chemotherapy which I talked about last week is undoubtedly tough stuff.
I mean, I said to you, it causes nausea and vomiting and probably
weight loss, and will make you feel very tired and make you lose your
hair for a time. Your hair will grow back again. It will make your
blood count low and it may give you sores around your mouth, and that
will go on for, you know, 12 weeks. And you won't feel even sort of
halfway back to normal for probably a few weeks after that. That, in
other words, is the sort of the downside of the treatment. However, as
I have to explain, and I must be honest about this, the treatment
probably offers a 50 percent chance only of being cured. So that means
that the best case scenario, you know best case scenario, is you have
the treatment, maybe it won't be so bad for you and you'll feel a bit
lousy but not very lousy. And you know 6 months from now, you're
actually cured and you know, 2 years, 5 years, no problem at all. The
worst case scenario from conventional therapy is that you might have a
lousy time from it. You might feel terrible, and sadly, it might not
work and it might not actually cure you of your disease. So you go
through the weeks of therapy and the feeling lousy, and still the
disease is there and eventually it will make you succumb to it. It will
eventually cause your deterioration and death. And that's the worse
case scenario.
Patient:
Yeah, I understand that.
Dr. Buckman:
That's fine. Now, the point is that
a lot of patients nowadays are talking about complementary medicine and
almost all of them feel better for doing it. And many patients feel
they've got to do it. They've got to sort of , there's a sort of
compulsion to go to somewhere wherever it is, Mexico, Switzerland or
elsewhere in the United States, even in this city in fact. And if
they've got to, in some respects that, that's what they have to do.
Patient:
Can you offer me the same here though?
Dr. Buckman:
That is a good question. Actually,
that's not the first time I've been asked that question either. The
honest truth is, I think the honest truth, there's no, I can't say
unfortunately. I would if there was real proof that this stuff actually
had an effect against cancer and that adding this stuff to our therapy
really did improve the outlook better than the conventional therapy,
and then we'd do it. We really would. It would then be part of
conventional medicine, but there's no that it's the macrobiotic diet
and the laetrile and the ozone therapy and the visualization, even
coffee enemas some of the patients are having in Mexico. There's no
evidence that those actually improve the situation, but the people feel
better. So I think I'd say we've got a 50 percent chance with
chemotherapy. The complementary medicine makes you feel better, but
there's no evidence that it actually hits the cancer. So in some
respects I first need to ask you, I mean you've booked your airline
ticket.
Patient:
Yeah.
Dr. Buckman:
This is a done deal. You've made up your mind.
Patient:
I have.
Dr. Buckman:
Yeah. Even if I wanted to, I
couldn't dissuade you. I mean there's no police force I could ring up
and say, "Hey, hold on to Mrs. Taylor. She mustn't go down to Mexico."
Of course you must go. If you want to go, you must go. What really
matters is, as it were, what you're hoping for when you go and how your
attitude will be when you come back. And with quite a few patients I've
made a sort of contract that said, "You've got to go. Go please. Do
whatever you need to do down in Mexico, but come back and let me start
the conventional treatment if there has not been a miracle, if you're
not miraculously cured, in say 4 weeks or so." And 4 weeks would not be
a -- that's not a lethal delay. You won't die of your lymphoma because
you delayed 4 weeks. There are some cancers that would be dangerous,
but not this particular situation.
Patient:
Will that give me an adequate period of time to know if the laetrile and the holistic approach works?
Dr. Buckman:
A very important question. Of
course, it isn't really a question I can answer with authority. You'll
have to think about that when you ask them in Mexico, but by and large,
laetrile was reputed to release this stuff. It releases cyanide,
actually, which poisons some cancer cells. And if there is any effect,
which I'm not convinced there is, it's likely to be fairly instant and
the cells are likely to die in a week or so. So if you are not
miraculously cured at 4 weeks, I think that's fair dues from the
laetrile point of view.
Patient:
Right.
Dr. Buckman:
If the laetrile -- this happened
with one of my patients in Greece actually. I claimed that I cured the
patient with treatment afterwards. And there was, as it were, a dispute
in the patient's mind between whether it was the previous treatment she
received in Athens or our treatment. If she's completely cured, who
cares? I mean we're not going to have a big argument about it. Exactly,
if we've got a cured patient, you know, were not going to have a big
argument. So would you be willing to, if I'm willing to delay 4 weeks,
would you be willing to come back in 4 weeks and start the therapy?
Patient:
I would have to say yes.
Dr. Buckman:
Okay, then like all good
compromises we each accept something of what the other person wants and
believes. I think that's a great thing and I wish you joy. I really do
wish you joy. I hope you come back. The worst thing that can happen and
it's probably -- you know, you'll come back feeling great. That's
absolutely fine. It may not have any effect on your cancer, but you'll
feel good and that can only help you when we start the conventional
therapy. So I'm not worried about that nor should you be.
Patient:
Okay.
Dr. Buckman:
So we have a deal? And we'll meet again in 4 weeks.
Patient:
Thank you.
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