by Carlos M. Garcia, M.D.
Questions to Ask
What is my diagnosis and are you planning to get a second opinion before we start anything? When will that be done please?
Mainstream medicine, including oncology relies on a tissue diagnosis. The illusion presented to the general public is that biopsies are 100% accurate. In …78 Japanese patients with ampullary tumor were retrospectively reviewed to investigate the clinical implications of endoscopic biopsy … Biopsy accuracy of carcinoma (group 4 or 5) was 70%..1. Whereas, I could refer to other studies to drill this point home, the bottom line is that practitioners limit medical accuracy be they physicians, assistants or technicians, we all make errors, myself included. All people involved in medicine, have an error value, which may decrease with experience or may increase in advance age. This is practitioner specific. Thus as with any other industry, the practice of medicine is only as accurate as the degree of mistake made and left uncorrected through a lack of oversight. When pathology renders a diagnosis, they are issuing an opinion limited by their experience.
All diagnosis is opinions limited by experience. However, mainstream medical protocols are based on this alleged infallible process, the tissue pathological diagnosis. It has been my experience that rarely is a second opinion requested by an oncologist. In those when a second opinion is requested, a previous interpretation (opinion) has been provided, thus tainting or skewing the bias of the second opinion. In my opinion, a second opinion should not provide any previous diagnosis.
What caused my cancer or what is / are the origin(s) of my cancer questions:
Was it genetic?
Genetics 101: Think of genes as a wardrobe. If you elect formal wear for an event, then we only see, or you are only expressing, that set of clothing. Although your closet has other selections, no one can see them because by choosing your formal wear, you have also chosen NOT to express your beach wear. Thus expression of a gene also involves suppression of other genes. Additionally, as in the wardrobe analogy, when you do not have supporting genes, as when you do not have supporting accessories for an outfit, circumstances may prohibit your ability to select that garment or express the gene. The biology of genetic expression is very convoluted and not easily explained. Many of the headlines and news snippets refer to a laboratory condition which, when compared to the human body, are extremely limited and do not accurately represent all the innumerable variables, which occur within every one of our cells, let alone our body.
I tell my patients, if it has not occurred since birth, then the practitioner has to evaluate the event that caused your body to express that condition. Thus if the practitioner wants to hide behind the genetic curtain, the why was the gene expressed at this time. An example: The BRCA gene associated with breast cancer. Some women have it. They are born with it. Then in their late, 20’s, 30’s, 40’s and even 50’s they develop breast cancer. A genetic study confirms the presence of that gene within that gene pool. Pathology then goes to further confuse the issue with estrogen, or progesterone positive or negative receptor stimulation, or HER2 (human epidermal growth factor receptor 2) positive or negative breast cancer, which may promote the growth of cancer cells.
Do you think my diet caused my cancer?
Whereas many alternative sites will lobby that stress, diet and toxins result in cancer, I tend to make them minor players. Why? If diet were a major cause of cancer, then a reasonable person would expect 3rd world nations, and those suffering famine, malnutrition and or mal-absorption to have a high incidence of cancer. However, this appears not to be the case. The top 11 countries [1-10] with the highest cancer incidence, per 100,000 residents, are: Australia, New Zealand, Ireland, Hungary, USA, Belgium, France, Denmark, Norway, Netherlands and Canada. I do not consider any of these country substandard with a poor food pipelines. 2,3
Do you think pollution caused my cancer?
The top 10 country polluters as of January 2019 [1-10]: Qatar, Kuwait, United Arab Emirates, Australia, Turkmenistan, Oman, United States, Saudi Arabia, Canada and Kazakhstan 4. Again comparing the highest cancer incidence to pollution generation, we see that Australia, USA and Canada have certain things in common.
Do you think stress caused my cancer?
Stress in an interesting feeling. As with any other feeling, we self-generate stress. A bit of searching attests that the following are the 10 most stress countries according to world atlas [1-10}: Nigeria, South Africa, El Salvador, Mongolia, Guatemala, Colombia, Pakistan, Jamaica, Macedonia, and Bolivia. Forbes top 10 [1-10} were: Greece, Philippines, Tanzania, Albania, Iran, Sri Lanka, USA, Uganda, Costa Rica, and Rwanda. 5
Irrespective of research, the bottom line is that when it comes to stress, you are the one who generates it. There appears to be an inverse relationship between unfamiliarity (anything outside your comfort zone) and stress generation. The more familiar you are with a topic or environment, the less stress you generate. The more unfamiliar you are with a topic or environment, the higher your stress generation. Who decides familiarity? You do. Thus stress is self-generated. I often hear people stay: I had no option… Incorrect. One always has at least one option, always. For example: one always has the option of doing nothing. Another way of saying this is: The more insecurity you feel the more fear you generate. The more fear you generate, the higher your stress level.
How long has it been growing in my body?
Is this a fast growing or slow growing cancer?
These questions cannot be answered with any certainty. Cancers are usually found by accident, known as an accidental finding. When found they have been present from 3 months to 3 years. Any answer provided can only be based on the oncologist’s experience, but most often the answer is based on literature statistics. Thus the answer is generic and not specific for your particular cancer.
As for the speed of growth, this speculation is often used a motivator designed to pressure the patient to capitulate to the generic formulary for the diagnosis. Regrettably, some practitioners prefer high-pressure sales tactics. Remember, mainstream formularies (cancer treatments) are diagnosis specific, not customized for patients or you. Alterations in the preconceived dosage and frequency occur after the patient develops adverse effects to chemotherapy.
What treatment do you recommend?
How did you decide on the treatment regimen for me specifically?
One of the many canned answers includes: your kind of cancer responds well to these medications. Followed by a success percentage usually in excess of 50%. With few exceptions, of Hodgkin’s Disease and testicular cancer which have a 5-year success rate between 35-42%, all other cancers respond to chemotherapy less that 12% of the time. Overall, chemotherapy’s efficacy is less than 2.5% -.6
Can I do alternative or complimentary treatments along with chemotherapy?
The agreed upon answer applicable to many if not most oncologists is, “No”. Other choices include: if that were any good, don’t you think we’d be using it? Actually not! The answer as to why it is not being used is because insurance has decided not to issue a reimbursement code. Another favorite answer is that it interferes with chemotherapy. However, ask to see the research for this unsubstantiated claim, it does not exist.
Have you ever treated anyone with cancer using just alternative remedies?
What are your first-hand experience using natural or holistic medical treatments?
As you have figured out by now, doctors, as any other human or professional, also have comfort zones and when asked to deviate from it, they appear to do just about anything-possible not to budge. Please remember, doctors are human after all.
What drives this mind set? Many answer, it’s the money. Few consider the paradox of choice. The paradox of choice may be defined as: when more choices are available choosing becomes more difficult and less satisfying. Let’s apply the paradox of choice to cancer.
When there are 3 choices: chemotherapy, natural treatments designed to fortify the patient’s immune system and doing nothing, choosing appears less certain than when given just 2 options, namely, chemotherapy or nothing.
Stay tuned for next month’s Part IIl of How to Interview Your Oncologist