Some Humble Views on Cancer Patients Seeking Medical Care

When we face darkness, only we ourselves can rub our eyes bright and find the light.

— Epigraph

Having stayed long in cancer circles, I have gradually seen more long-surviving patients. These patients are fortunate, having lived on after cancer. Among them, certain regularities in seeking treatment are fairly shared. I offer a few humble observations based on what I have seen.

First: what kind of cancer doctor is trustworthy?

In today's world, advertising and self-promotion are so excessive that people are at a loss and can hardly choose rightly. Finding a trustworthy cancer doctor is the first lesson a cancer patient must learn.

Humanity has conquered space and walked on the moon, yet still has not conquered the so-called "incurable diseases" within its own body. Medicine is a peculiar discipline: an improper treatment plan harms the patient's life and health. Therefore many medical ideas cannot easily be experimented on like other natural sciences; the ethical issues in medical experimentation are too sensitive, and so even now human medicine remains unsatisfactory.

If you roughly read medical works across time and place, you find that even today a considerable part of medical theory is still only "hypothesis." By hypothesis I mean something not yet verified as truth; the most cutting-edge medical theories are no exception, and many remain hypotheses. The global medical community's understanding of the causes of major diseases and its treatment plans are still in the research-and-exploration stage, which is why we so often hear that some disease remains an unsolved problem for world medicine.

I practice medicine with constant anxiety, feeling I am conducting human experiments. Old Dr. Li Zhonghui, who taught me some Western medicine, told me she had practiced clinical medicine all her life and had been doing human experiments all her life. She said that essentially every doctor, in carrying out medical activities, is experimenting on patients.

I do not know what a good doctor looks like, but the common features of bad doctors are obvious. The most obvious is glib talk. If a person cannot recognize that medicine's power is limited, even regards the world medical community as ignorant children, touts his own art as omnipotent, claims great certainty against terminal diseases like cancer, and presents his purported successes lightly as if it were child's play—I for one firmly do not believe him and firmly keep my distance.

Then there are doctors with too strong a sectarian bias: those who belittle other arts to elevate their own school, or belittle other doctors to elevate themselves, are not good doctors.

Some TCM doctors talk glibly, believing Chinese medicine treats cancer with ease. With respect, I have read the great TCM works past and present, at home and abroad, and the descriptions of diseases akin to today's advanced cancer are basically things like "death, not treatable," "a hundred contract it, a hundred die," "dies in thirty days," "dies in a hundred days." Those TCM fans who claim to have discovered great miracles in TCM theory are often followers without practical experience; they themselves cannot tell whether what they believe is true or false, yet love to talk big.

Such people do not strike me as clinical practitioners; if they themselves got cancer one day they would panic more than anyone. Real clinical workers are not like that. TCM theory, like Western theory, still contains too many hypotheses—one could even say that the whole foundational theory of TCM is still one big hypothesis. A hypothesis cannot be used as truth or theorem. What we need today in inheriting TCM is exactly serious, careful textual research of that hypothesis: verify one point, and that is one point; what has not been verified should not be used to fool people.

TCM speaks of "observing the exterior to know the interior." Some people extend this principle without limit: they observe mountains and rivers and then declare sudden enlightenment about how qi and blood circulate in the channels. Some so-called famous physicians take on disciples by first asking them to contemplate mountains and rivers in order to grasp the great Way of the circulation of human qi and blood. When I see such nonsense I throw the book away. Medicine cannot generate new theory from subjective fancy; doing that only leads to demonic deviation.

Some Western doctors, especially young people new to Western medicine, dismiss TCM, even write it off as worthless. As an asthma patient who has benefited greatly from TCM, I do not find such people mature or responsible.

China has produced quite a few academicians in TCM, and quite a few Western experts who turned to TCM (such as Academician Shen Ziyi). Zhong Nanshan, China's renowned Western-medicine respiratory specialist, has repeatedly said in public that TCM is of great value. Most of those who dismiss TCM as pseudoscience are precisely people lacking clinical experience, the great majority of them outside the medical profession—like Fang Zhouzi, who has never practiced.

My own asthma was ultimately conquered by my own integrated means that excluded Western medicine, and TCM played the largest role. I believe anyone who has had asthma understands the pain of seeking doctors everywhere and never being cured.

A true cancer doctor, in clinical practice, understands that every art of medicine has uncertainties and shortcomings, yet every one is genuinely useful. In the works of many doctors I have read accounts of how, during treatment, they spend working hours with patients and writing prescriptions, and off hours poring over references, studying the patient's disease, and thinking through strategies.

So a serious, responsible doctor need not be famous, but must be diligent and objective. He will view medical theory from practice rather than from theory. As Einstein put it: in theory, theory and practice are identical; in practice, they are not. This is even more true in medicine: to trust the medical books completely is worse than having no medical books at all.

The best way for a patient to find a doctor is to go into the patient community and listen to word of mouth, rather than choosing by titles, fame, or age. Once you find a doctor and meet him, feel out his character yourself and make your own judgment. I have met quite a few cancer patients who have survived ten-plus years; most of their treating doctors were not big names.

Second: how to get along with the doctor. Cancer patients need long-term treatment—once you have cancer, you fight it for life. After a cancer patient finds an effective doctor, he should trust and value that doctor, not grow fickle and roam after more famous ones. Changing doctors often leads to quicker death, because every doctor, with a new patient, needs a period of trial and error. All medical theory is only theory; every patient is a new research subject requiring integrated medical knowledge to understand and treat.

Seeing many doctors for one-off treatment is riskier than no treatment at all. Patients put too much faith in a doctor's experience and in his ability to prescribe on the spot; that is a fearful thing. Doctors need to practice while researching the patient's disease in order to achieve better results. If a doctor is willing to treat a patient while looking up references, that is the patient's good fortune.

Ideally, however experienced a doctor is, for every critically ill patient he should consult a large body of literature to seek the best solution. Medical knowledge becomes outdated very fast; evidence-based databases are overhauled every two or three years, because new clinical practice overturns old understandings and produces new reports. A doctor must keep learning all his life to achieve good results. A doctor is human, not a god; his knowledge is limited, and only by constant study can he accumulate richer medical knowledge to solve more complex problems.

A patient's distrust of his doctor is a major taboo in treatment. The late Shanghai master physician Qiu Peiran once said that the harmony of doctor and patient is the key to treating major illness. He told of a patient he treated in which he tried many approaches to no avail, yet the patient trusted him completely and let him research further, until at last the problem was solved.

Treating disease, especially stubborn illness like cancer or asthma, costs the doctor a great deal of heart's blood. Doctors often must work into the night, poring over medical books, constantly learning, thinking, and exploring, to better solve a given patient's problem. Each doctor can probably devote his main energy only to patients who follow him long-term. Among the cancer patients I have seen, the long survivors almost without exception have never changed their treating doctor. Those who frequently change treating doctors are restless, adrift, and in their desperation chase any doctor; in the end it is their own health that suffers.

Once a person falls ill, all aunts and uncles come recommending doctors and folk remedies, easily shaking his confidence. Our country has not yet built the community-doctor, family-doctor, personal-doctor system of Europe and America, so patients easily flit about like headless flies trying new doctors—it is very irrational. Some doctors survive cancer for a long time precisely because they understand medicine and the basic rules of the profession; by following those rules and not rushing about wildly, they live long. Professors He Ren and Pan Mingji were both anti-cancer doctors and cancer patients themselves; they lived for decades with cancer and died in their eighties or nineties. Cancer is only a chronic disease; with proper treatment there is every hope of living a long time with it.

I have had my own experiences. Some patients I treated became very stable, but when a check showed the tumor still present or slowly growing, they went off to find other doctors. Several months or half a year later, when we met again, they were on their last legs, overwhelmed with regret. Now when patients who are stable on other doctors come to consult me, my first golden rule is: if it works, do not change the doctor. We must view cancer and asthma rationally; treating such diseases is hard. If a doctor has already achieved results, that is remarkable—do not risk switching. A new doctor may not research the case as conscientiously; most doctors, to satisfy the patient, are forced to try new approaches, which is a gamble.

Shi Jinmo, one of the four great late-Qing/Republican physicians of Beijing, once saw a patient who had been treated by another doctor with lukewarm results. Anxious, the patient came to Shi, who cured him. When the patient came to thank him, Shi told him he should thank his previous doctor, because Shi had merely copied the previous doctor's prescription. The patient was astonished, because the two formulas looked completely different. Shi smiled and explained he had played a small trick: since Chinese herbs often go by several names, he had simply substituted alternate names for all the previous doctor's herbs.

In reality we may not be lucky enough to meet a sincere doctor like Shi Jinmo, who followed the old precepts of "if it works, do not change the formula; if it works, do not change the doctor" to safeguard his patients' health. Seriously ill patients are fragile and cannot withstand much tossing; after three or five trials their bodies decline, and it is very hard to turn back. So patients who frequently change doctors generally do poorly; until death they hardly understand that it was their own inner restlessness that drove them to the dead end.

Third: how to face the various attractive anti-cancer theories.

In business, diversification is said to be the most feared thing, because it means scattered energy and ultimately nothing achieved. In treating illness, what is most feared is the variety of anti-cancer theories and folk remedies circulating online. Once a person has cancer he is bound to take an interest in such theories; with today's online spread, a smartphone delivers tempting anti-cancer doctrines to his eyes every day, laying siege to the cancer patient. Those who cannot resist temptation decide to try them.

Harmless anti-cancer tricks are one thing; what is frightening are the harmful ones. Among the new anti-cancer ideas peddled by various gurus, few are truly harmless. Eating this, doing that, cauterizing oneself, or chanting the Buddha's name—some of these violate the natural workings of the body; others, though less harmful, waste the patient's treatment time and cost the chance to survive. For all things, excess is as bad as deficiency; once obsessed, one is easily poisoned. Whether spiritual or material nourishment, more is not always better; too much causes disorder, and disorder leads to demonic deviation.

Cancer patients are like the Tang monk's flesh—fair game not only for every wandering character in society but for unscrupulous medical institutions as well. Many new medical methods are, from a professional standpoint, immature and unsuitable for promotion, yet in our country they abound and are heavily promoted. Ordinary medical technology, renamed and repackaged in fancy terminology, becomes a high-end "new technique" for which patients willingly beggar themselves.

Fourth: beware both overtreatment and excessive undertreatment.

Cancer must be treated, but few existing anti-cancer routes leave the body unharmed. Surgery, radiotherapy and chemotherapy, Chinese medicine, and various natural therapies often cause bodily damage. Cancer cells are mutations of the body's own normal cells; the immune organs do not easily detect them, so cancer is not as easy to handle as infectious disease, and treatment inevitably damages normal cells and tissues.

Cancer treatment must be moderate. Excessive treatment inevitably damages the body too much and backfires. Some cancer patients receive especially heavy radiotherapy and chemotherapy, and then metastasize especially fast. Patients desperate to survive are easily tempted to try every means. Normal immunity plummets during such treatment, giving cancer cells a golden opportunity to spread through the blood, portal, and lymphatic systems. Thus there are patients treated with exceptional vigor who nevertheless metastasize with abnormal speed; such overtreatment wastes money and resources and accelerates death.

Excessive undertreatment—relying merely on so-called willpower or mood regulation to fight cancer—is also nonsense. A very few cancer patients do spontaneously recover, but their reasons are wildly varied and cannot be replicated. Most patients, if untreated, decline rapidly. The belief that spiritual power or religious faith can defeat cancer is deeply problematic. Many people have suffered heavy losses in such practices: their bodies collapse, and in the end their finances and spirit collapse too. Being brainwashed is a terrible thing.

We often say one should eat only to seven or eight-tenths full; with cancer, the best plan is to treat to seven or eight-tenths, then rest and recuperate for a while, observe, and deal with the specific progress case by case.

The tumor mass can be removed, but cancer cells cannot all be exterminated; as long as any remain, recurrence is possible. Apart from a few early in-situ cancers cured by radical surgery, and some early-to-intermediate cancers of low malignancy that do not recur after integrated treatment, I have rarely seen cancer patients who stay recurrence-free after treatment. The tumor removed today grows back before long. If you destroy the tumor at all costs through overtreatment, you pay an unbearable price.

Having cancer is deeply unfortunate and deserves sympathy. For a cancer patient who wants to live, there is no way but calm composure. This world holds both good and evil; how to choose, the patient must first settle his own heart, then rub his eyes bright and find the light himself.