Читать книгу Bridging the Gap - James Eugene Munson - Страница 9

Foreword

We generally live in oblivion to what is actually happening to us. We rarely remember that we breathe, and we must do so, or have a heart-beat, which is obligatory for our life. We are happy with that silence. We notice it only when the silence is broken, by exertion or unfortunately through illness. Mostly, only then do we turn our attention to how the silence was broken. Medicine is the study that attempts to view and understand the silence, how it is broken and what can we do about restoring the silence or fixing what is broken.

Cancer is probably the best example of a disease that manifests many years following the initiation of the cancerous process, carcinogenesis, a process we still mostly don’t understand. Nowadays, we diagnose many cancers because we screen for them through their silence with visual (mammograms or colonoscopies), molecular technologies (PSA for prostate cancer, or CA125 for ovarian cancer), or genetic analysis (BRCA gene mutation). When patients come to us with symptoms, and when finally we may diagnose the patient with cancer, for the most part these symptoms are not exclusive or specific to cancer, and frustrate patients, families and medical personnel alike. Cancer remains silent even when it rears its head.

The cancerous process from initiation, development and potential progression and spread (metastasis) involves invisible processes and interactions. Cancer is defined by cellular transformation (mutations), changes in shape (morphology), uncontrolled growth (neoplasia) and lack of obedience to structural and architectural determinism (invasion and metastasis). This description is fully modern, since we really didn’t look at cells and defined their structural and molecular differences until recent decades. The technologies allowing us to interrogate cells, their parts and the substances that control their fate are all but modern. These processes take years to become visible even with the best of technical abilities.

As practitioners involved in cancer treatment and the care for patients with a cancer diagnosis, we learn another important lesson about medicine; the appreciation of time and the importance of vigilance. It takes many years to realize that immediate responses to treatment, like the complete elimination of a tumor, are only a suggestion to what might happen, and the fact that we cannot see or foresee what will happen next. With experience in cancer care comes a strange confidence in the need to attempt to translate the anxiety of the unknown and the anxiety of what we know might happen with practical vigilance. We generally view time as the progression from the past that happened, to the present that is, toward the future that will. In cancer vigilance we wish to transform the cause in the future, to change the past. This is a strange view of determinism. But, if we believe the only way to reverse the irreversible process of mutation in carcinogenesis is by elimination, we need to ask, elimination of what?

We now know how to harness and manipulate physiological processes such as the immune system and the endocrine system, or target cellular processes, such as growth and division signaling in the treatment of cancer. I remember just two decades ago when we were highly doubtful the immune system had anything to do with cancer control, while nowadays it is one of the only areas funded in cancer research. It is only three decades ago that we referred to cancer care as slash, burn and poison. Going back to my point above, we are still shy, arrogant and ignorant of what does it mean to eliminate cancer.

Chinese medicine developed a unique view of physiology, pathology and treatment modalities. Their system involved physiological concepts of invisible properties such as vitality, energy and spirit, viewed as both physical and non-physical. Or, organs that do not exist anatomically, such as the triple burner, or physiological functions ascribed to organs that do not correlate with our current view of organ functions, like ascribing metabolism to be mostly controlled by the spleen. Lack of instrumentation was not unique to Chinese medicine, and European medicine was modelled mostly after Greek tenets, although multiple empirical, non-theoretical practices co-existed. Plurality of practices with no theoretical coherence existed in China as well. When introduced to European anatomical and pathophysiological work from the 15^th century on, Chinese scientists and physicians were divided as to how to reconcile the new knowledge with the traditional, or with the question whether they should all together abandon Chinese medicine.

In the early 20^th century Chinese medicine was banned in China. Chinese medicine survived by a stroke of luck, when communist China faced the fulfilment of the promise to provide medicine to all, without a sufficient number of physicians or availability of medicines and facilities. Although the communists embraced the slogan of ‘out with the old’ and promised to follow only ‘science and technology’, they had no choice to at least temporarily keep and even promote Chinese medicine. In the Chinese experiment communism and nationalism merged, and Chinese medicine was now a source of national pride, and a subject for development. Scientific and clinical attempts to better describe the function, utility and modern basis of Chinese medicine were attempted with vigor. Again, an exuberant discussion developed between the traditionalists, who claimed Chinese medicine should be practiced as existed, with personalized tailoring of treatment and multiple component medicines, the modernizers, who wanted Chinese medicine to transform into modern medicine by examining the functionality and utility of the medical concepts and therapies under biomedical terms and the modernists who wanted to abandon Chinese medicine all together, attempting to show the superiority of biomedicine.

For three decades I tried to educate practitioners of Chinese medicine about the known, the imaginary, the wrong and mainly the unknown in cancer care, both Chinese and biomedical. I also tried to take the treasure ‘buried in broad daylight’ in the Chinese pharmacopeia to develop a new form of medicine based on traditional uses and functions and modern biomedical molecular functions. Merging my appreciation of science, with the belief, developed through clinical observation, that addressing multiple pathophysiological systems simultaneously is more akin to how the body works, and how we might get to the ‘cause of the future’ was an important attempt for the future of cancer care. I got frustrated with both. I never felt that I was a good teacher, and I was not able to secure funding for any of the new drugs, despite scientific success.

The current work is an attempt by two American practitioners of Chinese medicine, in the relatively narrow field of oncology, to describe their work and the utility found in the combined or exclusive use of Chinese medicine in cancer care. It is hard to shy away completely from the debates of superiority, or the attempts to find theoretical equivalence between tenets. Yet, it is clear that their experience and humanity in the approach to cancer care, including attempts to fulfill the multiple needs of our patients, beyond this or that specific indication, shines through. I remember the evolution of Chinese medicine in cancer care starting from a view that it is quackery, to not effective, to not scientific, to unknown potential side effects, to unknown interactions, to where it is today; no debate, just do what is accepted by the cancer establishment. I’m so happy to see that Dr. Di Giulio and Dr. Munson describe this current state in integrative oncology, and yet, take the clinical utility and application of the modalities employed in Chinese medicine to educate practitioners and patients of their usefulness. Hopefully this work will re-ignite a useful debate and provide the necessary funding, that is not just lip-service, or a method to anchor careers, to study various modalities with methodologies akin to them and the patience to follow the slowness of progress afforded to any biological science. More so, I hope this work will provide benefits to patients in need.

Isaac Cohen, DOM, Ph.D.

Oakland, CA

November 2019