Low Dose Chemo – Part 2 – An Oasis of Healing
TO WAR AND BACK AGAIN

“First, do no harm.”

—Hippocrates

First, do no harm is more than just a quote credited to an ancient Greek physician and philosopher. It is a crucial component of an oath that physicians pledge to patients as a part of the Hippocratic oath, usually taken at medical school graduation. This pledge is not to themselves, not to the medical industry, health insurance industry, or to some regulatory body, but all future patients. This well-known phrase is not likely an exact Hippocrates quote, but more likely is a summary of some of the original Hippocratic oath statements:

“…abstain from whatever is deleterious and mischievous.”

“I will give no deadly medicine to any one if asked, nor suggest any such counsel…”

“…will abstain from every voluntary act of mischief and corruption.”

Honestly, I think it would be better to use these original oath statements, unfortunately that might disqualify most taking the oath. Sadly, whether by summary or by original wording, this pledge of oath to patient safety is rarely required in medical training in word or in medical practice in action. But of course, this points to some of the underlying current of problems in medicine today.

History and traditions point to Hippocrates as a physician that practiced and advocated for physicians to approach the treatment of patients from a more holistic perspective. This perspective was counter to the non-holistic approach to the treatment of patients that was prominent at the time—not too different than today. All quotes and ideas accredited to Hippocrates can probably not be attributed to him alone, but to the combination of both the historical physician Hippocrates himself and the collection of manuscripts called the Corpus Hippocraticum.

 As interesting as Hippocrates is, the topic of this blog post series is not Hippocrates or the Hippocratic oath, but chemotherapy. So what is the connection? I believe them to be a paradoxical connection. The Hippocratic oath advocates to avoid “deleterious” and “deadly” acts. Chemotherapy is, in fact, “deleterious” and “deadly”. This particularly applies to maximum tolerated chemotherapy or dose to toxicity chemotherapy. Connections are not always the result of synonymous harmony. It is hard to see something along the lines of chemotherapy being accepted by Hippocrates or followers of Hippocrates. It also points to the same debate of holistic versus conventional that exists today. If we know and learn from history, it has a way of repeating itself time and time again.

BIGGER IS NOT BETTER

Medicine has a history of over-shooting the target. I spent a lot of time in Texas growing up. Texas is big. Texas is huge! Texas has a saying, “everything is bigger in Texas.” Some of that is true, but bigger, larger, or more is not always better. More stress, higher obesity rates, bigger calorie intake counts, and more dis-ease is not better. When it comes to cancer, more, bigger, or extensive is not better either. According to the Prospective Urban Rural Epidemiology (PURE) study, cancer is now the #1 cause of death in high-income countries [1]. That is bigger. That is more extensive. But, #1, no matter how you slice it, is not better.

History always tells the truth. That is why so many try to re-write history. Remove knowledge of history, and there will be no knowledge of the truth. As a result, truth and reality then become something that is fluid to be re-written. Look to the three pillars of modern cancer treatment, chemotherapy, radiation, and surgery, for evidence of repetition of truth in history.

Surgery

Take surgery in the treatment of breast cancer, for example. More surgery equals more potential side effects, more complications, and the potential for higher mortality. No matter how routine surgery is, sometimes unexpected complications and even death can occur. According to the British Medical Journal, medical error is the #3 cause of death [2]. I can attest to personal experience; surgery is where some of the most significant opportunities for major medical errors can occur. Initially, the surgery of choice (gold standard) for breast cancer was the radical mastectomy. Radical was a good adjective for this surgery. This surgical approach was truly radical. But, as it turned out, it proved to be a radically brutal affair for these women. Just because you can do something radical doesn’t mean you should.

Thankfully, history records the truth. The move was away from the bigger is better approach to less and targeted is more. The radical mastectomy was replaced with a modified mastectomy. The modified mastectomy was replaced with the simple mastectomy and then to the lumpectomy—called breast conserving therapy. This evolution was also seen in the historical migration of lymph node dissection from the removal of all associated lymph nodes to now just the sentinel node (first lymph node draining the tumor area). Now that is a radical reduction.  More equals radical mastectomy with removal of all lymph nodes and less equals lumpectomy with the removal of the sentinel lymph node. Of course, the extent of cancer present can effect the choice. A recent study of early stage breast cancer found lumpectomy to be equal to mastectomy in overall survival, with or without radiation [3]. History declares the difference in outcomes. How many radical mastectomy’s with complete lymph node dissections occur today versus how many lumpectomies with sentinel lymph node biopsy’s occur today? History records the truth.

Radiation

The same historical truth of surgery is evident with radiation. More radiation equaled more side effects, more metastasis, and more mortality. Large-field radiation was not better than narrow field radiation. The targeted, often lower dose, more narrow-field, stereotactic approach to radiation treatment in cancer has proven to provide equal to better results with fewer side effects compared to large-field radiation. Using the war analogy again, it makes perfect sense to use the laser-targeted missile attack approach versus the mass carpet-bombing approach. One hits the target directly while limiting collateral damage—the other provides mass destruction to everything bad and good in the surrounding area. As with surgery, history records that less is best with radiation. History has much to teach if there are ears to listen.

Chemotherapy

The paradox in this journey of historical truths in the pillars of cancer treatment is chemotherapy. The current dogma is that maximum tolerated chemotherapy or treatment to toxicity is the only acceptable approach in treating cancer with chemotherapy? But, I must warn you, be very careful not to counter this narrative, no matter how much evidence there is the contrary. The dose to toxicity approach to chemotherapy is the current standard of care. This idea of dose to toxicity is lunacy! How about a new approach to life-based on this philosophy? Work to toxicity. Eat to toxicity. Drink to toxicity. Exercise to toxicity. That is toxic! And stupid! I didn’t say that is was going to make any logical sense; but that is the current standard of care.

What is the standard of care? Is it a heavily scrutinized, openly debated, researched approach to the care of patients that weighs risks versus benefits? Or is it merely just what everybody is doing declared from a small group of “experts” somewhere on high? Of course, the latter is true. Standard of care looks and sounds more like teenage, schoolyard peer-pressure than scientific debate and application. There is no room for different ideas, let alone the debate of ideas. Where are the adults in the room?

I think it is obvious what Hippocrates would say about this dose to toxicity approach. I wonder what history, yet to be recorded, will have to say about it? Fortunately, there is no need to wait for that future truth. It is evident and documented today. It is just yet to be written in this blog series. History will, and is, recording the truth that less chemotherapy is best, better, and safer. Those that bow at the alter of the FDA should know that they agree as well.

FROM DISEASE DEPARTMENT TO WAR DEPARTMENT

What are the origins of chemotherapy?

The cancer war analogy points to the origins of chemotherapy—war itself. The origins of chemotherapy have its lineage back to World War I and World War II. It is incredible how many people have made so much money off the willing destruction of innocent life. And I am not just talking about innocent life during the time of declared war. The ripple effects have continued through time as the focus of war moved from the battlefield to the cancer field.

You may not realize that we are currently in a time of declared war. This has been a 50 year war that was first declared by President Nixon in the State of the Union address in January, 1971. The President formalized this war when the signing of the National Cancer Act on December 23, 1971 [4]. To support this move to a war footing, the biological warfare facility at the Army Fort in Detrick, Maryland was converted to the Frederick Cancer Research and Development Center. This war footing is present in origin, in declaration, and in thinking. Chemotherapy’s origin is from war and the thinking that guides the use of chemotherapy is from the same war mindset.

The analogy of going to war with cancer is common in cancer marketing. Though I get the sentiment, I think it is missing an important point. Cancer is a part of the body, not a normal functioning part, mind you. Cancer is the most dysfunctional part, but it is not a foreign body or some alien implanted into some unsuspecting victim. Thanks for that imagery Ridley Scott! Cancer is borne out of a need for cells to adapt to survive due to an inhospitable environment in the body. Going to war with cancer is going to war with the body, which is actually going to war with the same source and potential to heal. This war is not just at the origin of chemotherapy, but also a mindset.

Just as real war provides no real solutions, but massive destruction, carnage, and death, so to the dose to toxicity chemotherapy war on cancer have brought massive destruction, carnage, and death. It is time to rethink this strategy. It is time to change this war mindset. Thankfully, a growing, large body of evidence points to signs of hope. We will begin to discuss the specifics of this paradigm move in the coming blog posts on the evidence supporting low-dose chemotherapy.

Remember, as I reviewed in the previous post, Paul Ehrlich gave us the treatment of disease with chemicals. As crucial as Paul Ehrlich was to the origin use of chemicals to treat dis-ease, the baton was passed to Fritz Haber, who is considered by many to be the “father of chemical warfare”. Fritz Haber was intimately involved in the launch of the first battlefield use of chemicals in warfare on April 22, 1915, with the onset of the “chemist’s war”. In fact, he was called the “doctor death”. Yet, he was awarded a Nobel prize in Biochemistry in 1918 for his invention of the Haber-Bosch process for ammonia synthesis.

The problem is that the world’s war industrial complexes in World War I decided to make war with chemicals. In a way, they were treating the very existence of humankind with chemicals through warfare. I guess if one has a warped view of humans as a disease, this would appear to be the first use of chemotherapy against humans. During World War I, tear gas (xylyl bromide and ethyl bromoacetate), chlorine, phosgene, mustard gas, and other toxic chemicals were employed on both sides. No side was innocent.

“What Fritz [Haber] has gained during these last eight years, I have lost, and what’s left of me, fills me with the deepest dissatisfaction.”

—Clara Haber nee Immerwahr

As so often is the case, chemotherapy’s collateral damage is unintended and far-reaching. History records that Clara Haber, the wife of the Fritz Haber, committed suicide in part to his development and research in using chemicals for war in WWI [5]. War is war. More specifically, Fritz Haber said, “death is death; however, it is inflicted.” Even in the beginning, history documents unintended death and destruction as a result of chemotherapy.

The origin of modern-day chemotherapy in the treatment of cancer was not from World War I use. The origins are actually from a German air raid on Allied ships in Italy. This 1943 raid destroyed ships covertly carrying mustard gas bombs  in World War II. Never heard of it? That is because it was quietly swept under the collective allied forces rug, but history records this event as the “little Pearl Harbor.” Fortunately, due to the Geneva Protocol of 1925 [6] which prohibited the “use in war of asphyxiating, poisonous or other gases, and of all analogous liquids, materials or devices,” chemical warfare was agreed to be excluded (wink, wink) from WWII. However, its use was continued in many wars to follow.

FROM WAR DEPARTMENT TO CANCER DEPARTMENT

 Everything seems to have a story life cycle. The normal life cycle appears to be beginning, middle, and end. What if the story life cycle had no end? What if the three parts to the story were, in fact, beginning, middle, and beginning. A perpetual recycling of the same story-line. We, in fact, see this with chemotherapy.

The Geneva Pact of 1925 should have been the end of using chemicals in the warfare of any kind. Like an unforeseen, twisted Stephen King novel, chemical warfare was not dead but was only about to take on a new directive as highlighted in The Great Secret: The Classified World War II Disaster that Launched the War on Cancer [7]. Though Lt Col. Stewart Alexander’s discovery that Allied forces’ mustard gas from the American ship John Henry, which was destroyed by a German bombing raid, was the source at the heart of the deaths at Bari in the Mediterranean should have been the end of this story; it was just the new beginning…the next chapter…the recycling of the story-line…the new warfare that targeted the body this time. Lt. Col. Stewart Alexander’s investigative report of the incident at Bari published on December 27th, 1943, inspired Col. Cornelius P. “Dusty” Rhoads, who was chief of the Medical Division of the Chemical Warfare Service, to change the target of chemical warfare from the battlefield to the medical field. Colonel Rhoads sought out and was able to convince Alfred P. Sloan Jr. And Charles F. Kettering “to endow a new institute that would bring together leading scientists and physicians to make a concentrated attack on cancer.” Replace the words physicians and cancer from this quote with generals and enemies, and it sounds just like a new conventional war news headline. This is now one of the larger U.S. cancer hospital systems, that carries their names, located in New York City.

There is an eerily ironic identifier to the date of this announcement, August 7, 1945. It is a date that lives in the infamy of medical warfare. Most don’t know about it. Remember, history tells the truth, whether we want to hear it or not. Both the announcement by Alfred P. Sloan Jr. And Charles F. Kettering of the funding for their institute for cancer research and the announcement to the world of the atom bomb drop on Japan was on the same day—August 7, 1945. This is the date that chemical warfare moved from the battlefield to the medical field. This is the date that soldiers were no longer the target, but cancer was the target. This is the date that civilians were no longer the unintended casualties of war; now patients became the unintended casualties of a new type of war—the war on cancer. Chemical warfare was at a new beginning. You will not read of any historical declarations of war by Congress. This new declaration of war on cancer was a declaration of war on the human body by physicians prescribing chemicals born out of world war for the purpose of mass casualty.

Don’t forget about the 1971 war footing move highlighted above. War mentality begets war mentality. It doesn’t matter if the war is with chemical weapons or the war is with chemotherapy. It is still war. The thinking is the same and the results are the same.

 FROM CANCER DEPARTMENT TO WAR ON THE BODY

 War, whether local, regional, or worldwide, is not acceptable and should be the action of last resort. All it does is leave a trail of death, destruction, and despair. There are very few that benefit; most suffer. This is the obvious reason to avoid war at all costs. History has repeated this truth, time, and time again. Insanity is often defined as doing the same thing over and over, yet expecting a different result. Likewise, waging war on cancer with chemicals that have their origins in war is not the right approach. Isn’t it interesting that almost everybody would agree that waging world war is not the right approach, but waging war on the body with chemicals born out of world war is? In fact, it is the national standard. Worse, it is the international standard. According to the Geneva Protocol of 1925, chemical warfare was deemed illegal and unethical by the world, yet, the same chemical warfare with treatment to toxicity is viewed as ethical as defined by the standard of care. Disney popularized the ‘circle of life’ with the Lion King. It appears that conventional medicine is trying to popularize the circle of destruction. That is insanity. After all, we should be about healing the body, not killing the body.

Next week, I will highlight the details of the science behind the how of low-dose chemotherapy.

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[1] Dagenais GR, Leong DP, Rangarajan S, et al. Variations in common diseases, hospital admissions, and deaths in middle-aged adults in 21 countries from five continents (PURE). Lancet. 2020;395(10226):785-794. doi:10.1016/S0140-6736(19)32007-0

[2] Makary Martin A, Daniel Michael. Medical error—the third leading cause of death in the US. BMJ 2016;353:i2139

[3] Merrill AY, Brown DR, Klepin HD, Levine EA, Howard-Mcnatt M. Outcomes after Mastectomy and Lumpectomy in Octogenarians and Nonagenarians with Early-Stage Breast Cancer. Am Surg. 2017;83(8):887-894.

[4] P.L. 92-218, 92nd Congress. The National Cancer Act of 1971.

[5] Friedrich B, Hoffmann D. Clara Haber, nee Immerwahr (1870–1915): Life, Work and Legacy. Z Anorg Allg Chem. Mar 2016;642(6):437–448.

[6] McElroy R.J. (1991) The Geneva Protocol of 1925. In: Krepon M., Caldwell D. (eds) The Politics of Arms Control Treaty Ratification. Palgrave Macmillan, New York. https://doi.org/10.1007/978-1-137-04534-8_4

[7] Conant J. (2020)The Great Secret: The Classified World War II Disaster that Launched the War on Cancer. WW Norton & Co.

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