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What's the truth ? It's all so confusing. Between Covers, an Anticancer Infomercial - An Illusion of Control ?

livealive's picture
livealive
Posts: 127
Joined: Feb 2012

Interesting, what does one believe ?

An illusion of control ?

http://www.nytimes.com/2008/10/07/health/07book.html?_r=1

By ABIGAIL ZUGER, M.D
Published: October 6, 2008
NY Times

The famous name and the impeccable scientific credentials don’t hurt, but David Servan-Schreiber’s “Anticancer” rides mostly on the sincerity of his pitch. It is worthy of the finest in nighttime television infomercials, where among all the financial advisers, kitchen gadget guys and acne specialists is one with a story so personal, heartfelt and sensible that you suddenly need exactly what he has to sell.
William Duke

Anticancer: A New Way of Life
By David Servan-Schreiber, M.D. , Viking. 258 Pages. $25.95.
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Not that Dr. Servan-Schreiber is peddling a product (other than his book). Rather, it is a way of life he wants you to buy into, a guide to staying cancer-free (or, if he has reached you too late, fighting off your cancer) by paying careful attention to what you eat and how you behave.

Like all the best pitchmen, he offers his own story of redemption as testament (he once was lost but now is found, was blind but now he sees). Son of the noted journalist and politician Jean-Jacques Servan-Schreiber, he left France for Montreal as a student, then went on to the University of Pittsburgh. There he embarked on a research career in psychiatry and neuroscience, cruising the city on a motorcycle, a young intellectual on top of the world.

Then one day a research subject failed to show up for a scheduled M.R.I. scan, and Dr. Servan-Schreiber took his place in the scanner. Utterly by happenstance, the scan showed a walnut-size brain tumor.

Unnerved but undaunted, Dr. Servan-Schreiber underwent the recommended surgery and returned to his usual routines. His life remained a high-stress, low-exercise affair; lunch was a bowl of chili, a bagel and can of Coke. Five years later the tumor recurred, and in the course of enduring a second surgery and a round of chemotherapy he saw the light: the red meat, white flour and soft drinks were going to help the cancer do him in. He had to detoxify his body.

Here his story segues smoothly into a lucid discussion of cancer immunobiology, in which the bad cells can be tamed by manipulations of their environment. And then we are in the kitchen, reviewing its contents from the specific perspective of cancer prevention.

This familiar terrain encompasses the antioxidants, the good fats, the whole grains and the green teas. There are the combinations essential to maintain (you must take your turmeric with pepper) and the ones to avoid (no milk with your dark chocolate). Cancer “feeds on sugar” but supposedly not on agave nectar; on omega-6 trans fats but not the omega-3s. The blanket of body fat in the obese creates a giant repository of fat-soluble carcinogens.

We hear the story of Lenny, who adopted a diet heavy on cabbage, berries and dark chocolate, and survived pancreatic cancer for an impressive four and a half years. We meet vegetable-fed mice, who seem more active and curious and have slower-growing tumors than their chow-fed brothers. And Dr. Servan-Schreiber himself, of course, is still doing well at age 47 — 14 years after his initial diagnosis.

For each of the foods on his anticancer shopping list there is a shred of scientific evidence — usually from experiments done on cells in culture, sometimes from studies of mice with cancer, and occasionally from small studies on actual human beings. For none is there the kind of data that would support, say, the licensing of a new drug.

Extracts of garlic, onions and leeks, for instance, will demolish all kinds of cancer cells in a culture. Whether these vegetables are still active in the busy metropolis of the body, with thousands of cellular processes going on at once, is another question: once the leek is chewed, swallowed, demolished by intestinal enzymes and absorbed into the blood, how likely are its molecules to brush up against a cancer cell, let alone engage it in armed combat? No one knows.

Among the militant foodists, Dr. Servan-Schreiber is something of a moderate. He warns against rejecting standard medical treatments for food-based therapy, and admits that much is unknown about exactly how powerful his vegetables are.

He is less reserved in a discussion of “the anticancer mind,” an enthusiastic re-creation of the archaic theory that a “cancer personality” — passive, saintly and repressed — enables tumors to flourish, while self-actualization makes them recede. Susan Sontag, who spent much of her intellectual muscle arguing exactly the reverse, would have had a field day with this section.

Still, this book is destined to sell widely and will probably become a bible in some homes. This fact alone makes it worth considering, not so much for what it says as for the clarity with which it illuminates the need it so deftly fills.

It is that old primal need to gain some control over a random and malevolent universe, the one (as any toddler’s relatives can attest) often won on the battleground of food. The popularity of books like this one makes it clear that for many adults there are two such universes to contend with: the malevolence of illness and that of orthodox medicine, somehow now perceived as conjoined enemies of health.

So these folks find control by heading determinedly to the supermarket and the refrigerator and the stove, the support groups, the treadmills and the massage tables. When it comes to cancer, these comforts are unlikely to hurt much, but the evidence is still out for whether they help.

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

Abigail Zuger, author of this objective, unbiased, insightful review of the book "Anticancer" summarises her appraisal thus:

"this book is destined to sell widely and will probably become a bible in some homes. This fact alone makes it worth considering, not so much for what it says as for the clarity with which it illuminates the need it so deftly fills."

Her review is worth reading for the clarity with which it illuminates the need of the medical and pharmaceutical establishments to find apologists to rubbish anything that threatens their vested interests. She writes beautifully but the absence of any real content in what she says is hardly surprising, coming, as it does, from a hack churning out column inches for a newspaper across innumerable different areas of medicine in none of which she has any relevant expertise. Here she is writing about a book concerned with cancer written by a man who knew a great deal about it but, as someone who specialises in infectious diseases, and, in particular, HIV, she is comfortable with the conviction that she knows better.

The sneering tone, the patronising phrases, the damning with faint praise all serve to camouflage the lack of any serious attempt to engage in evaluation of the scientific worth of the book. From the very outset her intention is clear as she speaks of "his pitch", talks of tv 'infomercials' and seeks to associate him with questionable financial advice, kitchen gadgets and acne. The transparency of her crooked presentation is striking. She describes him as "peddling" because he wants you "to buy into" a view different from her own.

Texas_wedge's picture
Texas_wedge
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It shouldn't be too difficult to program a semantic and stylistic analysis that would save one the time wasted in reading stuff like this. So, "pitchmen" "(he once was lost but now is found, was blind but now he sees)" "he saw the light" all while avoiding any scientific discussion of the merits of the claims made in the book. Much easier to indulge in urbane condescension "cruising the city on a motorcycle, a young intellectual on top of the world." And on we go with "This familiar terrain" "supposedly" "We hear the story of".

If a 'fair-minded' concession is to be made, it can be couched like this: "For each of the foods on his anticancer shopping list there is a shred of scientific evidence" where, given the normal occurrence of the phrase, the reader may register 'there isn't a shred of evidence' but if paying rapt attention will take it as 'there are only shreds of evidence'. Moreover, the argument runs, these can be dismissed because some are based on cells in culture, mice and "occasionally from small studies on actual human beings. For none is there the kind of data that would support, say, the licensing of a new drug." and, of course, we all know that that sort of data is of unquestionable and unassailable authority.

The nearest thing we get to a scientific approach is her allusion to garlic etc. where she, oh so cleverly, poses the wrong question and then triumphantly declares "No one knows." We are then immediately back to her stock-in-trade with "Among the militant foodists" and "his vegetables".

There is an interesting debate to be had as to the validity of her pleading in her cause the work of Susan Sontag in demythologising stigmatised diseases and combatting the tendency of patients, and the snake-oil hucksters who seek to exploit them, to seek some supposed deficiency that makes them to blame for their illness. That sense of personal failing does still, inevitably, beset people like kidney cancer sufferers such as you, Raj, who wonder what they can possibly have done wrong to deserve being dealt this hand. It is necessary to correct this self-destructive thinking but not, as she would have us accept, by going to the extent of ceding all responsibility and decision-making to the all-knowing consultants and the drug company experts whose authority to decide what is best for us is not merely paramount but unchallengeable.

Dr. Zuger's paradigm is to regard any attempt by a patient to exercise what influence they can over their own health as "an old primal need" which must be stamped out for challenging "orthodox medicine" as one of the "enemies of health". How shallow can you be? So, Dr. David Servan-Schreiber is tarred with the same brush as the rest of us cancer survivors as deluded and naive "by heading determinedly to the supermarket and the refrigerator and the stove, the support groups, the treadmills and the massage tables." She KNOWS that there is no evidence whatsoever that diet, exercise, support groups and the like sillinesses have any effect on cancer.

[If you think I don't have much time for articles of such quality then you've caught my drift.]

livealive's picture
livealive
Posts: 127
Joined: Feb 2012

You know T - how cynical I am of corporate structures to begin with, but I was at a loss after reading her review, because I am reading the book, and there is at-least some basic common sense stuff I can do. The book talks of wounds that don't heal, the inflammation process (read the constant hydronephrosis) - and now they tell me they have to take the stent out, but then I asked "Doc, what about the hydronephrosis ?", and he says he does not know, but he has to take the stent out, so OK, he at-least said he does not know. The stone, "maybe" you will pass it ? Well, how ? What about the UPJ obstruction ? I got a "don't know" again.

So, I am at, these guys are very education, and intelligent, but I feel the wisdom is lacking, somehow I feel, they have to see it more holistically, then so much at the cellular level.

I think if the book and the guidance from it does no harm, then, what's the harm ? I am wary of the illusion of control, i.e. of feeling - at-least I am "doing" "something", which is why I am taking all this while to decide on the trial. I have seen a lot of people more damaged from the drugs, then from the disease itself.

You critique of her critique was worth reading.

So let me just say this for your surgery, and I know, you know this, that my sincere gratitude, and m best wishes are and will be with you as you step into the OR, remember, a lot of the people you have so well helped, are sending you their best wishes, prayers (from the believers), and good feelings.

Raj.

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

Thanks Raj. Yes, you're right, I do know that and it's a source of great comfort.

I'm glad you found my onslaught on the 'review' worth reading.

You are quite right that in SOME cases the cure is worse than the disease. Happily, you are not in the position that you have to commit yourself or risk imminent demise. You have ample time to make a well-considered decision about further treatment/surveillance.

The only caveat is that postponing a decision must not be at the cost of extending the period over which you worry yourself into a bad state. If you hold off for the moment, with suitable monitoring, either something starts to go amiss, in which case the decision may make itself, or, and much more likely, the sky doesn't fall and this confirms that you are pursuing the right course. If nothing is going wrong, you must rejoice in that, not worry excessively but gladly keep on with the monitoring.

livealive's picture
livealive
Posts: 127
Joined: Feb 2012

Tex - worry comes with the territory, some brains are formed a certain way, and I have the need to learn techniques that help acceptance. I need to make a decision, so I was back online reading about prognosis / recurrence, and while I stayed away, I was less anxious.

The old NY people still have not provide the films to determine the growth rate, which in itself is frustrating, leave aside the medical implications of not knowing.

I have been asked to visualize "positive outcomes", which practically I am finding "overtly forced", the negative is quick and implicit - does that make sense ? She says I need to learn cognitive restructuring, the difference being, in the risk management world, you have the means to control / eliminate risk, whereas in this world, you don't. Well, maybe some, with food, exercise, and worrying less. 2 out of 3 so far, working on the 3rd - maybe Fox will share his wisdom. I like Garys personality, which I think goes a far way.

Thx.

foxhd's picture
foxhd
Posts: 1876
Joined: Oct 2011

Boy, I am not sure how to teach what is probably a personality trait. After all, We have gotten cancer in spite of ourselves. I can share some insights I've observed. Again after 35 years in health care, I have known, seen, and worked with tens of thousands of sick people. Probably have known several thousand who have died.I have seen hundreds and hundreds of diagnosis. From the common to the rare. I cannot read the obit section of the paper and not know someone who has passed away on a weekly basis. So, first of all, I know that we will all die. some easy, some hard. Some die young and some old. No one is immune. We just don't want it to be us. Not yet. I accepted my diagnosis and surgery as just a matter of fact. I did not see my demise as likely. Then just returned to normal living.... 6 months later when I was told I had aggressive mets and may not make it through this spring, That hit harder. I did cry when I told my wife (the nurse)( with far greater experience with death and dying than me). I knew she would learn to deal with it. I didn't want to miss my granddaughters growing up as we are very close.It would have been a very difficult and life changing ordeal for them . That did depress me. Only briefly. I then had plans to make for treatment. Good fortune got me here so far.

Now, when I look back at all those people I have been exposed to, I can say that some lived and died miserably. Anger, meanness, greed, guilt, egocentricity. The negative vibes are astounding. Regardless of religion, they have been consumed by the devil. Long before their death. The negativity in their existence surrounded them. So sad.

On the other hand, I've watched "good" people with nothing but bad luck, disease, trauma, personnal and family suffering maintain a smile for others. They are thankful, gracious,and appreciative. They carry a glow of warmth and love. As bad off as they are, they make you feel good just to be around them.

I will expose myself here. I am not religious. I do not believe my fate is being determined by any higher being. I do not believe in prayer. I believe that we are each responsible for all of our actions and destiny. So by the time I was 20, I had decided who I was going to be. And how I was going to live. I conciously eliminated negativity in thought and expression. I have NEVER said, " Not bad" when asked how I was. ALWAYS "Excellent, wonderful, or such. I have used this model for all my living, patient care and interpersonal interactions. ( except with salesman) Here is my rare negative. I Hate anyone trying to take advantage of another person. So I will avoid such people as best I can because I don't have the energy to expend in that wrong direction. I refocus to make it a battle of wits.Which I can do with positive energy.

foxhd's picture
foxhd
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So by decision, I have chosen to not be one of those miserable people. I remain with a positive attitude.I live it every day. No mood swings here. It's how I can work with patients in the morning, golf with lawyers in the afternoon, and hang out at a biker bar in the evening. None of it is out of character for me. I just smile a lot.

livealive's picture
livealive
Posts: 127
Joined: Feb 2012

I understand some of it, may have to re-read now that I have been asked to do "cognitive restructuring" :-) (and may still not restructure)..

About religion, I am not sure either way, I don't have evidence either way. However, Brian Weiss I find interesting (past life regression therarpy psychologist), intrigues me.

I believe we learn, so you writing despite not being sure you could teach a personality trait is much appreciated. Thank you.

Raj.

Olsera's picture
Olsera
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Joined: Dec 2011

Fox,
I like your attitude & the way you think. There are a couple of people I know that could use an atitude change but it is unfortunate they choose to continue being negative & miserable. Keep smiling & I will too!

Texas_wedge's picture
Texas_wedge
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Joined: Nov 2011

When you can write as brilliantly as that I think it's a pity you don't write at length more often Fox. However, I realise that you are in the business and have been expressing that outlook for 30 years or so to countless people in your professional capacity, so doing it in your spare time too is a bit much. Now all you really need to do is keep right on leading by example.

Texas_wedge's picture
Texas_wedge
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Joined: Nov 2011

When you can write as brilliantly as that I think it's a pity you don't write at length more often Fox. However, I realise that you are in the business and have been expressing that outlook for 30 years or so to countless people in your professional capacity, so doing it in your spare time too is a bit much. Now all you really need to do is keep right on leading by example.

You're right about personality types. I played 16 this morning. It came on to rain heavily and my partner's legs were aching so we headed to the Clubhouse for an early lunch. A couple of older chaps we hadn't seen for a while came over to exchange pleasantries and my pal commented that we hadn't seen them recently. The older one said it was his first game for several months. He was pleased he'd played 10 holes to get going again which he thought acceptable since he has 5 stents and celebrated his 90th birthday last week!! His companion said he can't play anymore, after a stroke 3 years ago and a triple by-pass. He commented that he still enjoys the golf club ambience and added, all smiles of joie de vivre, that he constantly bumps into people much worse off than he is. I'm sure we'll see plenty more of those two in future.

Texas_wedge's picture
Texas_wedge
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Joined: Nov 2011

We sometimes think ourselves so unlucky when, in reality, we don't know we're born compared with some folks. Roam around some of the other forums on CSN to see what I mean.

There are people who have a number of organs removed for cancer, with a kidney as a minor item - almost just an afterthought. Some tumours make ours look like a joke. One poster on the sarcoma forum was posting 2 years on, having had a 28cm high grade retroperitoneal liposarcoma tumour removed along with left kidney and 15 months later, following recurrence a second tumour removed - 30cm high grade together with a large portion of spleen, upper and lower intestines. This was at UCSF and was followed by, at the time of posting, 7 CT scans and a further full course of 25 radiation treatments. The poster had just returned to a desk job "and recovering slowly but surely."

Another there had a 32cm liposarcoma weighing 22lbs removed followed by 7 months of chemo then 5 weeks radiation therapy and was posting six years later. None of this alters our situations but it does no harm to try to keep things in perspective.

livealive's picture
livealive
Posts: 127
Joined: Feb 2012

So what I am trying to say is - seeing someone else whose suffering is greater than mine, does not lessen mine. I don't know how suffering can be quantified. To someone a pin-prick might be a big deal, and to someone else, a bullet wound be - "hmm, whatever", so perspective is formed on the basis of the objective suffering and the one who experience it "the subject".

I like the perspective you bring, and without a shred of doubt, I am grateful to you (you already know this), but, really, that's all it is - perspective, but it's more than a word. I think you are right, personality types, I had offer my penny.

R.

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

Raj,

Could we maybe take stock of where you've got to?

Your otherwise very good prognosis has been rendered a little more uncertain because of the renal vein involvement and you've done all the analysis you can of possible outcomes, predicated on the various choices you can make. You've got 'scared to death' over the not very helpful stats you've been given. However, you're smart enough to realise that the survival nomograms are fairly meaningless for the individual (for a variety of reasons).

Meanwhile, you've recognised that there are actions you can take to shift the odds more in your favour, despite the bland, ill-informed asseverations in the rubbish article by Abigail Zuger (above) and you've acted accordingly. You're optimising your diet and you're taking some exercise (what is the stent situation now, by the way?).

Also, you've expanded your concept of self and you've discovered that helping others (which you're becoming pretty good at) also helps you. You're helping others with perspective and getting things in proportion. You're not just 'being nice' to them, you're giving them information and assisting them in seeing that their plight is not as bad as they may fear it to be. There are several aspects to that. One is provision of information to dispel unfounded fears. Another is to help change mindset - the old glass half full v half empty.

One thing is certain - some anxiety is unavoidable and a certain amount of anxiety is desirable but excessive anxiety is destructive. Too much anxiety is bad for us in so many ways. It pushes up BP which is bad for cardiovascular health, kidneys, etc etc, it is counter-productive in a surgical context. If a dramatic illustration is required it can be seen in the matter of contrast administration where elevated anxiety can have a markedly deleterious effect.

You need to reduce your anxiety levels by whatever means are most useful. The key insight is that anxiety is not 'a condition' from which we suffer but is something we do to ourselves by our mindset. This is doubtless why you have been advised to achieve some cognitive restructuring. One of my golfing buddies points to another golfer who is forever "losing it" on the course and remarks that he is "wired up wrong". Jerry White also talks of "rewiring" oneself (and, while Jerry has, in IT lingo, worked "closer to the metal" than anyone you will ever meet, there's not much you could teach him about ERM).

In short, your prospects are pretty good but they will be substantially better still if you can manage your anxiety more effectively.

livealive's picture
livealive
Posts: 127
Joined: Feb 2012

Yes T. No argument there. Thank you as always.

livealive's picture
livealive
Posts: 127
Joined: Feb 2012

Yes T. No argument there. Thank you as always.

livealive's picture
livealive
Posts: 127
Joined: Feb 2012

Still have the stent, he wants to take it out, without giving me adequate answers on the underlying situation, so that one's still a struggle.

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