The only cheap and universal cure.
—Abraham Cowley, The Mistress. For Hope. c. 1647
I was visiting my friend in the hospital the other day. She had a port put in under the skin of her chest for chemotherapy. The whole story is unfair. She’s a terrific person, with a great husband and an adorable son. She’s also doing remarkably well. But that’s not today’s story.
Another friend wondered if maybe she should recommend a macrobiotic diet or something, anything, to help stop this stupid disease. Now, you can substitute anything for “macrobiotic diet”—reiki, acupuncture, homeopathy—it doesn’t matter really, because all of it rests on misunderstanding, fear, and compassion. Fear and compassion are very powerful, and in the face of helplessness, any lifeline seems like a godsend, even one attached to an anchor.
Here’s the basic problem. We understand cancer very well (and the same goes for many diseases). When a patient or other caring layperson is looking for hope in the face of overwhelming circumstances, it’s tempting to go with common sense. Common sense says that a “healthy” diet should help fight cancer. But, while it’s important to maintain a good nutritional status (keeping up strength and avoiding weight loss), cancer is not a disease of abnormal nutrition. Cancer is basically a disease at the genetic level. Cells lose their normal regulatory mechanisms, and reproduce abnormally and forget to die when they are supposed to, and while cells certainly count on nutrients to survive, cancer cells can’t be killed off by proper nutrition. Nutritional changes also won’t help your immune system to hunt down and kill cancer cells more effectively. Once your cells have become cancerous, it’s too late.
Still, this stuff couldn’t hurt, right?
Cancer is a full time job. Between diagnostic studies, treatments, and emotional support, cancer patients are very, very busy. Keeping track of everything that needs to get done, especially at a time when you are emotionally vulnerable and perhaps just a little bit distracted, is tough. If a friend has a bone scan in the morning, a blood draw at lunch time, an appointment with a surgeon and an oncologist in the afternoon, and dinner with her family in the evening, adding in a bunch of “alternative” (read “non-science-based”) therapies is a burden without benefit.
Certainly, if someone finds a way to build massage, meditation, or other relaxing activities into their schedule, this is probably a good thing. But when you have a serious disease, all of your friends become experts. Out of love, fear, sadness, and a desire to regain control, they pepper you with suggestions about doctors, therapies, gurus, diet, and anything else they think will help you stick around.
Remember, though, that your friend with cancer is fighting like hell, and there are no miracle cures “they” don’t want you to know about. There is no cabal of researchers sitting on some treatment reluctant to share their success. Cancer is hard work, and since it’s a full time job, patients are often looking for islands of normalcy in their day.
But of course you have to take cues from your friends. If they seem like they want advice, then they probably do. But please remember that their doctors are pretty damned knowledgeable. If there were a miracle diet, a magic pill, or any other way to help their patients, they’d already be using it.
Hope is palliative. It is a treatment in and of itself, but it is not without serious side-effects. Truth is also palliative, in small doses. Sometimes, when a friend is ill, the best bet is to be the best friend you can. If you truly think that they are getting sub-par medical care, you have to speak up. But chances are, if you come up with a great new idea, it’s not as new as you think, or it’s not as great as you think. This happens to doctors all the time, which is why we temper our hope with a dose of cold, hard science. We get attached to our patients and would do anything to help them—but then we make ourselves remember that “everything” isn’t always the best thing.
Doctors have a lot to learn from patients and their loved ones. We learn that everyone wants to help, and we need to actively acknowledge that. There are many things cancer patients need every day, from rides, to child care, to hugs. As an internist, I can direct family and friends to give these tangible gifts. The love of family and friends is hope—no voodoo required.