Reflections on Two Years of Research on Fighting Cancer with Chinese Medicine: Gains and Losses

Over the past two years, my research on fighting cancer with Chinese medicine has had its gains and its losses.

August is the dog-days period; every year in August there are fewer patients consulting and visiting than in other months. In August I organized a great deal of patient data, reviewed their treatment courses, reflected on the gains and losses within, sought out my own biases, and so as to improve my future approach and raise efficacy.

First, let me discuss the shortcomings.

The first shortcoming is that over these two years I have relied too much on my own experience.

Over the past two years, most patients who came to me were referred by word of mouth; patients who arrive this way show a fairly obvious concentration of disease types, because they basically all learned of me within the patient community.

Among the patients who frequently come to me for help, the most are lung cancer patients, then pediatric neuroblastoma patients, then liposarcoma patients, then ovarian, cervical, and breast cancer patients, and then lymphoma patients.

Because the patients are fairly concentrated, I myself have come to rely on past experience, giving each patient a fairly similar medication plan. In reality this committed the error of empiricism, leading to unsatisfactory results for some patients. When I look at the medical records of some patients with unsatisfactory results, I myself feel that switching to other plans might have worked better.

But after working a long time, one easily forms a mental set; seeking similar treatment plans for similar patients is an error doctors easily make, and it is also the inner expectation of patients and families. Many patients, seeing that a fellow patient has had success with a certain formula or drug, are eager to try it themselves, always feeling that if the doctor does not give them the same drug, the effect may not be as good as that fellow patient's.

In reality, each patient's concrete situation is somewhat different; copying the medication plan of a successfully treated patient is a practice of mental laziness. Usually, the first few patients I treat for a given disease have the best results, while later patients do not do as well as earlier ones. Perhaps this is because, with a newly encountered disease, I spent great effort studying it, and that effort offsets the drawbacks of inexperience. On the contrary, once experienced, I easily, by committing the error of empiricism, reduce the time I spend thinking about new patients, leading treatment to be biased.

So in future I must step out of the error of empiricism and, for each patient, carefully analyze his concrete situation and adopt a corresponding treatment strategy.

The second problem is that I have excessively pursued lowering treatment costs.

Two years ago I set a goal: to try to bring a child tumor patient's monthly cost down to under 1,000 yuan, and an adult tumor patient's monthly cost down to under 2,000 yuan. To achieve this, I have been trying to prescribe fewer or none of the more expensive Chinese herbs.

In addition, to lighten the patient's burden, I also tried to reduce the frequency of follow-up visits, setting the interval too long—generally a follow-up once every three months. During these three months I basically guided the patients remotely and free of charge in adjusting their medication plan; for some patients with less serious conditions this may be right, but for some seriously ill patients it is inappropriate.

In reality, these goals deliberately set to lower the patient's spending were very unreasonable. Blindly pursuing low prices and a relatively good reputation among patients can also delay the treatment of some patients. In an age of constant currency depreciation and rising prices, to treat cancer at such a low cost one ultimately has only to bypass some effective but expensive drugs. Treatment should still use drugs according to the patient's actual condition; one should not too deliberately pursue low cost.

A woman who once worked with me told me that I try my best to save money for patients, but the money a patient's family should spend they will spend anyway. If not spent on the drugs I prescribe, it will be spent on drugs and treatment prescribed by other doctors or hospitals. My single-minded pursuit of saving money was influenced by my background of growing up among the poor.

I now have to admit her evaluation of me is correct; whenever I prescribed slightly more expensive medicine, if the drug fees for a patient reached over three thousand a month, I felt full of guilt toward the patient's family. But in reality, the patients reduce very little in other medical expenses.

Privately, I also lowered treatment costs to avoid unnecessary doctor-patient disputes. Some patients, when visiting, feel my prescriptions are too cheap, worry about efficacy, and actively ask me to prescribe somewhat more expensive, more effective drugs; I am also not very willing to. The root reason is still that I worry that if treatment fails and the family has spent more, conflict easily arises.

This problem is a very real one doctors often encounter, not one imagined out of thin air. The doctor-patient relationship is very sensitive and, because it involves economic issues, disputes often occur; I myself do not dare to touch the high-voltage line of doctor-patient disputes. I only dare to prescribe precious drugs to patients of fairly good quality, higher income, and good rapport.

Excessively pursuing lower treatment costs and lower treatment risk ultimately results in lowering efficacy. A patient family member who works in hospital management once told me that, in her own hospital, she watched doctors, to avoid future medical and economic disputes, adopt an attitude of giving up on some patients who might still have hope; she understood her colleagues' approach. But when her own child faced the threat of death, she knew full well these hidden rules deep in doctors' hearts; watching her own child also be given up this way, she was powerless to change it, and it pained her greatly.

This is a very cruel reality. Cancer patients and their families are deeply pitiable; in order to survive, many cancer families spend hundreds of thousands or even millions in hospital, are impoverished by illness, and some cancer patients' families are thereby torn apart. To escape their own burden, some patients' spouses choose divorce, parents abandon children, or children abandon parents—I have seen all these things. So I have a deep understanding of cancer families coming into tense relations with doctors over economic reasons.

So I understand deeply, and feel deep sympathy for, any behavior of people under the threat of cancer—even toward those who abuse me without cause. I believe that if they had not encountered such a life problem as cancer, they would not have been unreasonably rude to such a degree. Of course, understanding is one thing; taking precautions is still another.

The threat of death, the enormous economic pressure, and the extreme grief and depression have caused many cancer families to lose their normal state. They also bring great pressure to many doctors treating cancer; the outside world does not understand the pressure that oncology doctors face, and there is much public resentment against oncology doctors, so many doctors flee oncology not long after entering it.

My son once told me he does not want to study and practice medicine as I do; if forced into this line, he would rather kill himself. Unless one loves medicine, I do not think I would have held on until today. So I respect my son's choice; I had him learn some medicine only so that he could live more healthily in future, not necessarily to force him onto the medical road. Unless his interests change and he comes to love medicine, I think the family's line of studying and practicing medicine will end with his generation.

Whether out of sympathy for patients or out of avoiding medical disputes, lowering treatment costs should be kept within limits. Since the price of precious medicines such as Beijing Tongrentang's Xihuang Wan rose, I have basically stopped using it, except for occasionally prescribing it to one or two patients; that is somewhat excessive.

The third problem is that I did not set a good boundary of competence for myself and refuse some patients with low treatment value.

If I could draw a line of competence for myself, knowing when I should clearly tell patients and families that I am helpless and ask them to seek someone more skilled, then the psychological and physical pressure on me would be much less, and I could treat those patients with treatment value more efficiently. At the same time, I would avoid some families of patients who have lost treatment value suffering unnecessary economic losses.

Of course, as Atul Gawande, author of Being Mortal, says, doctors do not easily know where the boundary of their competence lies, because medicine carries great uncertainty. A seemingly severe patient creates a miracle, a seemingly mild patient progresses rapidly—these are all common things.

The line of competence a doctor draws for himself can only, on the basis of his own life experience, be an estimate—not a fully accurate boundary. We cannot, as patients and families hope, always help them make the right judgments and decisions, nor help all who seek us solve their problems. When to admit one is helpless cannot have a clear standard.

For a doctor, one seriously ill patient usually consumes more time and energy than ten-plus mildly ill patients, and the results are far worse; and the risk in treating a serious patient is many times higher than in treating a mild one. So drawing such a line of competence is very helpful both to the patient's family and to the doctor himself. Taking in every patient regardless is not appropriate.

These are the three main problems I need to resolve in the days ahead; resolve these three, and I believe my therapeutic results and professional experience will rise to a new level.

Of course, these two years were not only 'losses' without 'gains.' Some patients have still benefited from the new approaches I have tried over the last two years.

Cancer is very stubborn; most cancer patients treated by Chinese medicine have already been patients beyond Western medicine's power. Now some voices in society criticize Chinese medicine, claiming that some TCM physicians are deceiving cancer patients into trusting Chinese medicine and abandoning Western medicine. I strongly object to this claim; it is all the result of people imagining things out of their own heads.

Not only myself, I believe the great majority of renowned senior TCM professors also receive cancer patients who have mostly been given up on by Western medicine. In reality, more than 80% of cancer patients who turn to Chinese medicine have already undergone Western treatment without effect and are near death. Even the other ten-plus percent who are in better condition are mostly simultaneously undergoing both Chinese and Western treatment.

These patients only come to Chinese medicine because they are unwilling to be helpless; those who truly seek Chinese medicine without first undergoing standard Western treatment are extremely few. In modern society, Chinese medicine is in decline and does not have so great an influence as to brainwash cancer patients. As for the patients I myself receive, the great majority also came only because the patients around them improved with my help, not because they were attracted by publicity. For patients for whom other therapies work, I do not encourage them to abandon the effective treatment they are receiving for mine.

So for such seriously ill patients, under TCM treatment, the condition improves and life is prolonged—that is a very gratifying thing.

Treating such patients is extraordinarily difficult. Of the patients for whom my routine treatment approach fails, some have kept begging me to keep finding ways for them. It is precisely that I continually broke through the routine to find a way to live for such patients.

When a person studies any discipline, the hard part is not copying the gourd; the hard part is, after learning, breaking through the mental set already formed within that discipline and blazing a new path. To explore on roads no predecessor has walked requires continual thinking and practice, continual summarizing and induction.

It is very necessary, drawing on modern medicine's understanding of cancer, to rebuild the TCM methods of pattern and disease differentiation for cancer. It is also very necessary, drawing on modern pharmacological knowledge and absorbing traditional TCM formula-building experience, to build, without being bound by the ancients, formulas that truly solve problems. Everything should take actual efficacy as the standard of right and wrong, rather than blindly following the classics.

Over the last two years I have done a great deal of exploration in rebuilding the TCM approach to cancer pattern and disease differentiation and rebuilding the approach to building anticancer TCM formulas; not following the beaten track, I have met with criticism from some colleagues. But many of my patients have benefited; their condition has been relieved and their lives prolonged, and examination by modern testing methods proves that this treatment approach has a certain reasonableness.

I have already published many medical records of my treatment; they can be found in my public articles, and the others I will gradually organize and publish as well.

I hope these reflections of mine have some reference value for other colleagues. I also venture to ask some TCM colleagues to be broad-minded and not to view these new attempts through colored glasses. Most of the medical records I publish carry the patient's examination or hospitalization numbers at the various hospitals, and can be queried in the data systems of those hospitals.

My purpose in doing this is precisely to ensure the authenticity and traceability of these records; I can calmly accept the supervision of my colleagues in the medical community, rather than fabricating false records to fool people. Of course, to protect patient privacy I have not published patients' personal information. This balances the traceability of the patients' treatment results and the protection of their personal privacy.

In future I will continue to explore along this direction, building as best I can the best medication plans for the various problems of cancer patients, and at the same time overcoming the empiricist errors I have committed and some errors in my treatment principles, so as to better serve my patients.