REDWOOD: What are some of the ways you've brought together people from different worlds?
GORDON: I think that the most recent and ongoing example is the Comprehensive Cancer Care conferences. [See our book review section for a review of Dr. Gordon? new book, Comprehensive Cancer Care]. We just finished our third annual conference. What happens at the conference is that we're able to bring in the people who are doing the most exciting work, work that has not yet even been looked at by the traditional oncology community, people who a few years ago were persona non grata among oncologists. We're able to bring those people together with leaders of the cancer establishment?he leadership of the National Cancer Institute, and researchers and clinicians from some of the major cancer centers in the country?nd get them to talk together and think together about how to best study some of these approaches and how to integrate them into cancer care for everyone. So that's a significant example.
Another is that I've worked in D.C. since 1971, first with runaway and homeless kids and then with kids from the Latino and African-American communities, using a holistic approach to help these kids and their families deal with stress and trauma. I've worked with a variety of mind-body therapies, with yoga, meditation, Tai Chi and martial arts, nutrition, and exercise, teaching these kids, and their families and teachers in many instances, how to help themselves.
Then there's the other work that we?e been doing in Kosovo and Bosnia for the past three years, bringing this holistic approach to people who are either in the middle of a war or in a post-war situation, to help them deal with stress and trauma. We?e shared what we know, not only with doctors and nurses but also with teachers and leaders in the women's community in Kosovo, helping them to then help the mass of the population. These are just three examples of the way that I've tried to bring different worlds together and to offer these approaches to people who would not ordinarily have access to them.
REDWOOD: One of the critiques of alternative medicine has been that it is largely a middle and upper middle class phenomenon. You're talking here about models for branching out far beyond that.
GORDON: It has to happen. I think the receptivity is just as strong among people who don't have much money, and it? certainly there among people who are not white because in many instances they?e much closer to this kind of healing and this kind of medicine than white upper middle class people. Their mothers or grandmothers were practicing some of these approaches. I've also worked over the past 10 years with about 5000 HIV-positive addicts in New York City, teaching a mind-body and holistic approach in a program that a friend of mine started. The receptivity is very, very high. Our work is to serve people, not just to serve people with money.
REDWOOD: Based on the scientific evidence now available, what complementary methods can cancer patients use with confidence?
GORDON: There are several areas in which there is enough evidence for me to recommend that every cancer patient use these approaches. The most important thing, I would say, which goes beyond any of the specific approaches, is to tell cancer patients that you can make a difference in your own health care, that you are not totally dependent on the oncologist. So the first thing is to help people see that they can help themselves. The second is mind-body approaches. There is clear evidence that, at the very least, such mind-body approaches as meditation, biofeedback, and guided imagery, can significantly reduce stress, enhance immune function, and help deal with pain a'd the nausea and vomiting of chemotherapy. That should be included in everybody? cancer care. Third is the use of nutritional therapies, including a basic program of supplementation that can improve people's chances for good health and for preventing recurrences, and that also can probably be used to help prevent cancer altogether. ***
There was a recent study in the New England Journal of Medicine, which showed that 70 percent of all cancer is related to environmental factors of one kind or another. Only 30 to 40 percent tops is genetics. Environment is pollution, environment is what you eat, it's how you think, what your life is like. The evidence is becoming clearer and clearer. So a basic program of nutrition is very important here.
Next would be a program of physical exercise. It's also clear that exercise enhances mood and can enhance immunity. We?e going beyond the old myth, which was that cancer patients shouldn't do very much. Of course, the old myth also said that cancer patients should eat whatever they want to eat, which is also not a terribly good idea.
REDWOOD: Can Chinese medicine be helpful?
GORDON: Yes, and this is true of both Chinese herbs and acupuncture, in the hands of someone who is knowledgeable. With Chinese herbs, it's not a matter of saying this herb enhances immunity so let's grab it off the shelf. If you have cancer, you really need to find someone who knows about Chinese herbs, and ideally someone who knows about Chinese herbs in the treatment of cancer. It can make a big difference, and there are a number of studies indicating this.
REDWOOD: Are there many such practitioners spread widely throughout the country?
GORDON: There are increasing numbers of them. One of the things the commission has to do, which relates to our work on the cancer conference, is to find out who they are. There are people who are licensed as acupuncturists who don't know that much about herbs. In most states, you don't have to be an herbalist to receive an acupuncture license. But there are people who are becoming expert in both. There are a few in this area, the Washington, D.C. area. I know there are some in New York, some in Boston, and other major metropolitan areas. For those people who don? have access, there are some more general Chinese herbal therapies for which there is pretty good evidence.
Some of this work was presented at the Comprehensive Cancer Conference. Sophie Chen's work on prostate cancer, using a formula PC-SPES, looks very promising, as does Alexander Sun? work on non-small cell lung cancer. He's got a pretty good series of cases and is doing some more research. Both of them are developing formulas for other kinds of cancer as well.
Ideally, you find someone who can individualize the herbal treatment to your particular situation. That? the best way to do it. But if you can't, then there will be more general formulas. Debu Tripathy, an oncologist at the University of California at San Francisco, is now doing some excellent work in this area. So, I think increasingly for those people who don't have access, or don't know who the best trained Chinese herbalists are in their neighborhood, there will be formulas available that will have been tested in clinical trials.
And then, finally, there is group support. The evidence for group support being helpful not only in quality of life but in prolonging life for people with cancer, is as good as the evidence for a number of chemotherapies. I think group support should be available and recommended for every cancer patient. Not just a group that comes together occasionally, but a small group in which people are really helped to understand themselves and to help themselves.
REDWOOD: Are you talking about group support facilitated by a professional?
GORDON: Yes. I'm not saying other groups can? be helpful. I'm saying that the specific research, and certainly my experience here at the Center for Mind-Body Medicine, is working with small groups of 8, 9, or 10 people at most. We meet together over a period of weeks and the people with cancer have an opportunity to talk about their concerns and issues. At the same time, they're taught a variety of mind-body approaches and ways to help themselves.
The several approaches I've mentioned can be included in everybody's cancer care. Beyond that, there are techniques and other approaches that may be extremely helpful for some people but where we don't know enough about them to recommend them to everybody and in every situation. Many of those are presented in Comprehensive Cancer Care. Mistletoe, for example, is a very strong immune stimulant that is being used in Germany and other European countries quite a bit, and may have a major role to play in cancer care. Or some of the therapies like Burzynski's therapy or Gonzalez?therapy, which also may have important roles to play.
REDWOOD: Is it true at this point that no CAM methods have been shown to cure cancer?
GORDON: I'd say that? generally true. But on the other hand, there is data accumulating to show that some of the approaches are significantly prolonging life. We don't have follow-ups for long enough periods to know if it cures them, but that may just be a matter of time. If Nick Gonzalez [Nicholas Gonzalez, M.D., practices in New York City] has patients with pancreatic cancer who are alive four or five or eight or nine years later, do we count five-year survival as a cure? For five-year survival, yes, there are some [CAM therapies] that are showing that now. But cure means that you live as long as you would if you didn't have cancer, and we just don? have the statistics for that yet. But there are there are definitely therapies that are significantly prolonging survival of people with cancer, including Chinese herbal therapies used in combination with radiation and chemo. In that instance, it's a complementary therapy, but it's making a real difference in how long people live.
REDWOOD: How would you characterize the current degree of integration of alternative medicine in medical education?
REDWOOD: What else needs to happen?
GORDON: The first thing that needs to happen is that the people who are teaching in medical schools need to have both a personal experience and an intellectual experience of the efficacy of some of these therapies. Once that begins to happen on a wider basis, then I think they will begin to integrate these therapies more into the curriculum. At least in Western allopathic medical schools, it's extremely hard to change the basic curriculum. Even if you want to change a single lecture in biochemistry from one lecture to another, you may need months of curriculum meetings to do it. So to bring in a whole different worldview and a whole variety of other healing approaches is a major effort.
The state of the art is that in probably three-quarters of medical schools there is at least some kind of elective on alternative approaches to health care. It's there because large numbers of students and small numbers of committed faculty want to have it there. What I think is going to happen, in significant part because of the NIH push in this direction, is that a number of medical schools are going to come up with more comprehensive plans to integrate these therapies into all aspects of their curriculum.
I've worked on the Georgetown Medical School application for the NIH grant. Because the grant was available, some interested faculty (including some very prominent basic science faculty) thought, "This is a great idea, let? do this." So I worked with them on the grant, and we were able to get support from the dean's office and from a number of different departments. We have a plan, a way to integrate this approach into all years of the medical school curriculum. Until now at Georgetown, I've been teaching a lecture here, a seminar there, or an elective course. Our plan is to have required education in CAM therapies in all of the major parts of medical education. So I think in the next few years we?e going to be taking a big step ahead.
REDWOOD: So the increased funding available through NCCAM and other federal sources is really helping to catalyze the expansion.
GORDON: Exactly. It's money and it? also the support and the imprimatur of the NIH. I mean, money always talks, but it talks much more coherently when it's the NIH that? giving it out. Because of this, many academics have felt much more comfortable expressing their own interest and being willing to take on a project in this area. I've seen this at Georgetown, where there are people who are very interested in this area, but they were previously interested on their own or in isolated research projects. Once the money and the opportunity became available, they were really ready to step up and be extremely helpful.