I am the professional product of the two highest-ranking cancer centers in the United States, and probably in the world: Sloan-Kettering Cancer Center in New York and M.D. Anderson Cancer Center in Houston. In June 2018, I completed 50 years in cancer medicine and research and I have spent 40 of those years as Director of Cancer Research. In 2010 Baylor St. Luke’s Medical Center established a chair in cancer research that carries my name in tribute to my contributions to cancer medicine, and also in February 2018, that center established the annual Philip Salem Oncology lecture. Here are the arguments I want to advance in my book:
- Knowledge alone is not enough. There is no doubt and no debate that medical knowledge is the crucial and necessary component in the treatment of the cancer patient, but I have learned in my 50 years of experience that knowledge alone is not enough. The cancer patient needs a lot more than knowledge to achieve a cure. This is what he needs:
- To be embraced by love and compassion. He does not need sympathy. He needs positive love, the love that empowers him to fight the battle against the disease, not the love that would make him succumb to the disease. This kind of love is crucial to establishing a bond of trust between the doctor and the patient. Without this bond, it is extremely difficult for the patient to fight this war. My motto is “in cancer medicine, a doctor who does not love his patient cannot cure him.”
- Patients must have easy access, 24 hours a day/7 days a week/52 weeks a year to the doctor, nurse and every health professional taking care of him. This access has been significantly hampered in the recent past.
- Cancer patients and the doctors who treat them must have a lot of hope and perseverance. It is of utmost importance that the cancer patient has hope and perseverance. However, I would like to emphasize that the doctor who treats the patient should have more hope and perseverance than the patient. Many doctors and patients lose hope early and consequently lose perseverance and as a result, the patient dies prematurely.
- Education of the cancer patient and his family is an integral component of therapy. Without education, the patient will not cooperate with his doctor and will not be able to have the hope and perseverance he needs. However, such education demands a lot of time not available to most doctors. Doctors have recently been immersed in regulatory rules and insurance demands that leave them with less time to educate or even talk to patients.
- The best product America has is not Coca-Cola; it is American medicine, but the government and insurance in America are trying their best to destroy this product. Insurance companies interfere at every level in diagnosis and therapy, and impact negatively the decision-making by physicians. The ultimate objective of insurance companies is to make money, but the ultimate objective of the doctor is to cure the patient. These two objectives are difficult to reconcile. Laws must be enacted in order to ensure that the doctor can make the best decision for the treatment of the patient without the interference of insurance. Also, regulatory rules and litigations in America have eroded the trust between the doctor and the patient. Doctors spend a lot of time trying to comply with rules, with the law and with legal matters. Thus; the doctor’s time has been absorbed and little time has been left for the doctor to tend to patient’s needs. Nowadays, doctors and nurses spend more time with computers than with patients.
- Supportive therapy is an extremely important component in the treatment of cancer patients. It is the kind of treatment given to patients who are receiving anti-cancer treatment to abort, or significantly reduce the toxicity of treatment and consequently make patients live a quality of life as close to normal as possible. It is extremely difficult to embark upon proper and adequate anti-cancer therapy without supportive therapy, but supportive therapy is not usually covered by insurance. Therefore, the bulk of patients in America do not receive this kind of treatment. I would like to emphasize that severe toxicity from treatment which could be aborted by supportive therapy is one of the major reasons patients stop treatment and succumb to their fate.
- The misconception of standard therapy has done a lot of harm to patients. Standard therapy is what a group of experts agree upon as an acceptable treatment. But this does not necessarily mean that this treatment is the best. In my opinion, among the most efficacious treatment options, standard therapy could be considered the least effective. Also, the concept of standard therapy has restricted the delivery of more sophisticated treatments to patients for fear of litigation. I strongly believe that the patient should receive what the treating physician believes is the best treatment for him, whether this treatment is considered standard therapy, or not.
- Patient who do not have evidence-established treatment for their diseases should not be deprived of treatment. They should be treated with the best treatment as judged by the treating physician based on his experience.
- The biggest mistake cancer doctors do is starting therapy immediately after the diagnosis is made. Patients with cancer should not be treated before staging and group consultations. Starting treatment before staging and group consultation may have severe negative impact on the outcome of treatment.
- The most important human right should not be the right to free speech or the right to education, or the right to assemble, or the right to choose your own religion. The most sacred human right should be the right to live. This can only be achieved by making the right to healthcare the most important and sacred human right. Consequently, the Charter of the United Nations should be changed to emphasize this right. All human rights listed in the UN Charter fade in significance compared to the right to live. People have to live first to enjoy the traditional human rights. Those rights mean nothing to the sick or the deceased. Life comes first.
* Philip A. Salem, M.D.
Chair, The Philip A. Salem, M.D. Chair in Cancer Research
Baylor St. Luke’s Medical Center
Salem Oncology Centre