FAQs: Frequently Asked Questions
Integrative cancer therapies pose many practical, legal and ethical questions for patients and practitioners. We welcome your comments.
How can I convince my mother to try integrative therapies?
Question: My mother is 74 years old. She was just diagnosed with stage 3 breast cancer. She only wants to do conventional therapies. I am aware that some integrative therapies—diet, stress reduction, exercise, social support and the like—might enhance her quality of life and potentially extend her life. How can I convince her to try them?
ML: Broadly speaking, I wouldn’t try to change your mother’s mind. I often get these questions. It is your mother’s cancer and your mother’s life. If you really want to help her in meaningful ways, ask her—or intuit—how you could truly be most useful. Love is the greatest healing force. Spending meaningful time with your mother may matter far more to her than trying to convince her to eat an organic plant-based diet. Moreover, the evidence for life extension with intensive health promotion practices is not strong enough at this point to warrant an exceptional effort. Also, the effort it takes—to engage in an effective program of diet, stress reduction, exercise and finding a good support group—is very significant. Your mother isn’t drawn to it. That said, there may be specific interventions that don’t require great lifestyle changes and might interest your mother. The evidence on CBD products (cannabis) for anxiety and pain is one example. My core belief is that it is best to support your mother in what she chooses to do as long as it is not actively harmful.
CBD isn't legal in my state. What should I do?
Question: I have a friend who is in significant pain from bone cancer. I am aware of the negative side effects of many of the mainstream pain medications. CBD products (cannabis) have an excellent safety profile and there is a substantial literature on its benefits for cancer pain. It is legal in adjacent states but not in my state. I could readily drive over the border to obtain some for my friend, who is eager to try it, but that would be illegal. What should I do?
ML: Welcome to one of the core ethical and legal dilemmas of integrative cancer care. First, none of us working on BCCT will ever recommend that you do anything illegal. Second, the dilemma you face it an ancient one. Does your friend have the ethical right to do what he chooses to do with his own body? Does the state have an absolute interest in interfering with that right? Do you have an ethical obligation to help your friend? Do you choose to commit an act of civil disobedience in support of your friend’s putative ethical right? Here is the great English philosopher John Stuart Mill’s view of this subject:
On Liberty is one of the most important, and widely-read, articulations of liberal philosophy in the history of political thought. The single object of the essay, writes Mill, is to assert the principle that “The only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant…. Over himself, over his own body and mind, the individual is sovereign.” Mill thus disqualifies other reasons that are often used to justify interference with individual liberty. The harm principle excludes paternalism, or constraining an individual’s freedom for the sake of what one believes to be that individual’s own benefit. Instead, Mill argues that each individual should be able to decide what constitutes his or her own good and how he or she will pursue it. Similarly, actions cannot properly be constrained on the grounds that they will cause offense, rather than harm, to other people. My own interests and possible offense to others may provide me with reasons to persuade someone else to select one course of action over another, but they cannot justify coercion..1
You are considering obtaining a plant medicine that has been found beneficial from time immemorial. That plant medicine is again legal in a growing number of US states, but illegal in your state. Your ethical purpose is helping your friend exercise his fundamental right—according to John Stuart Mill—to decide what to do with his own body if in so doing he does no harm to others. Note that this right is not absolute. In the case of childhood vaccinations, the calculus of harm to others from failure to vaccinate children is, for example, infinitely more complex. This same calculus of diverse claims of interest in personal intention, ethics, and the law is widely applicable to other integrative cancer therapies. We won’t seek to resolve these questions, but to clarify their claims on you and your friend.
Should we take the legal risk of using and try one of the psychedelic substances for healing?
I just finished reading Michael Pollan’s book “How to Change Your mind: What the new science of psychedelics teaches us about consciousness, dying, addiction, depression and transcendence.” Inspired by Pollan’s book, I read James Fadiman’s “The Psychedelic Explorer’s Guide: Safe, Therapeutic and Sacred Journeys.” My wife has breast cancer and is quite depressed. She has a life history of depression following experiences of abuse in childhood. Pollan makes a powerful research-based case for the benefits of MDMA, psilocybin, and even ayuahasca as ways to address cancer, depression, and PTSD. Fadiman’s collection of key writings from others as well as his own observations provides further reinforcement for my sense that the risk is low if one proceeds carefully and the potential benefits can be life transformative. Yet these substances are Schedule 1 drugs, strongly disapproved by the FDA.
Should we take the legal risk and try one of these substances for her healing—and mine?
ML: You’ve asked the big question—and upped the ante on the question from our previous guest about obtaining cannabis-based CBD for his friend. While cannabis for therapeutic and recreational use is rapidly becoming legal in the US, psychedelics are far behind and the penalties are more severe. Yet tens of thousands of people use MDMA—or ecstasy—as a party drug every year, and use of psilocybin and ayuhuasca are widespread as well. What are your choices? One question is how seriously enforced these stringent laws are—clearly, not very stringently in most jurisdictions. A second question, given their illegality, is how people obtain pure and not adulterated substances. And a third question, if you decide to proceed, is how seriously you take the strong evidence that “set and setting” matter immensely to the experience. Some people believe that a very experienced guide is needed. Others believe that a sane and grounded friend can safely act as a “sitter” for such an experience. We should recognize that ayuhuasca is a far more challenging experience than MDMA and psilocybin for most people. In that case, an experienced guide seems even more necessary. In our experience, people differ remarkably not only in their appraisal of the ethical and legal questions you are asking, but also in their interest in undertaking such a journey. So a primary question is whether your wife is as drawn to this as you appear to be. If she shares your sense that this experience would be valuable, and if you can satisfy yourself regarding accessing pure substances and having a sufficiently experienced guide, then your dilemma is the same one that John Stuart Mill addressed and that I quoted for the previous guest. If this journey (for it is a journey) is unlikely to harm others, and unlikely to harm either of you, then you must balance your respect for the law with your sense of whether choosing what to do with your own body is a profound ethical principle. It would involve an act of civil disobedience. No one else can make that decision for you. Ram Dass has a great quote about psychedelics. He says that cannabis use should require a driver’s license but psychedelics should require a pilot’s license. I agree. These are very powerful medicines. Their highest and best use is for sacred and life-changing experiences.
Why doesn't BCCT address childhood cancers?
My son’s 8 year old son has leukemia. BCCT does not seem to address childhood cancers.
Why this omission?
ML: Fair question. It is one thing to address integrative cancer therapies for informed adults. It is quite another to assess them for children. It is not that integrative cancer therapies are not relevant for children. The issue is the heavy burden of responsibility that treatment of childhood cancers represents for both practitioners of conventional and integrative therapies. We’re just not ready to go there— yet. Its hard enough to get integrative therapies right for informed and consenting adults. We wish your son well—and his son—and your whole family.
How do you address the issue of expense and access?
Many of these integrative cancer therapies are expensive—and not reimbursed on health insurance. Beyond that, there are millions of low-income people for whom they are completely inaccessible. How do you address the issue of access?
ML: This is a tremendous concern. Many of these therapies are expensive. But some of the most powerful ones are accessible to anyone who has the time and energy to explore them. Our seven healing practices are eating well, moving more, managing stress, sleeping well, creating a healing environment, sharing love and support, and exploring what matters now. They aren’t free in terms of time. Some of them bring ancillary expenses with them. Yoga, meditation, qigong, tai chi and other practices can be learned inexpensively. We are as concerned with inequity in access to life-saving conventional therapies as we are about inequities in integrative therapies. Integrative therapies are generally far less costly than conventional therapies. A caring society would provide access to both. A more equitable society would lower health risks for everyone across the income spectrum.