PROVIDING INTEGRATIVE CARE II
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Presenters: Mitchell Gaynor, M.D. and Jeremy Geffen, M.D.
Moderator: Joseph Lamb, M.D.
Commentator: Robert Wittes, M.D.
Session: Sa4; June 12, 1999I. Abstract
Dr. Gaynor and Dr. Geffen described their integrative programs at their respective cancer centers. Both programs take the best that medical science has to offer and combine it with aspects of therapy that are outside of the traditional Western medical cancer regime. These complementary therapies reflect the understanding that a person with any illness must be treated wholly. The physician must be as attentive to issues surrounding the mind as to bodily processes. Dr. Gaynor’s program at the Strang-Cornell Cancer Prevention Center relies heavily on data analysis and focuses primarily on cancer prevention through nutrition. Dr. Geffen’s program rests on changing patient and physician attitudes and intentions towards administering care of cancer. Both programs have broad goals such as increasing the patient’s self-awareness and sense of empowerment through the treatment of cancer.
II. The Cancer-Related Issue Addressed by Dr. Gaynor
Dr. Gaynor’s work at the Strang-Cornell Cancer Prevention Center addresses the need for physicians to treat patients as whole entities. The program for integrative medicine uses the best that medical technology has to offer along with an in-depth mind/body program. In addition to utilizing guided imagery and meditation techniques, Dr. Gaynor also pulls together vast quantities of research on nutrition as a preventive tool. He uses food and supplements to bolster his patients’ immue systems to make them more sensitive to responding to tumors.
III . The Program Discussed by (Dr. Gaynor)
A. Philosophical Background
It is not fair, any longer necessary, to make patients choose between "alternative medicine" and the best of medical science. We can use our scientific, analytic tools to determine the most effective alternative therapies and implement them along with conventional therapies. By including these complementary therapies, we bring back the element of the mind into medical discourse.
In medical school, students learn about the science of the human being. They learn anatomy, pharmacology, physiology and pathology, all of which are crucial to understanding disease and treatment. What medical students do not learn in lectures or in textbooks is how to attend to the minds of their patients and how to teach them to live one day at a time. It is from patients that doctors learn about intangibles such as the resilience of the human spirit. The emphasis that modern medicine has on science and technology has left the field cold and icy where it was once full of compassion and warmth.
When a physician presents a diagnosis of cancer, they must deal not only with the diseased organ or system but also with that patient’s emotional states. It is to address the fears that accompany such a diagnosis and to teach their patients how to become centered. It as critical to teach people the importance of living in the moment and how to live with adversity as it is for them to outline an effective therapeutic regimen. Here lies the two-pronged approach for treating patients--healing and curing. Healing involves teaching people how to experience the fullness of their being and how to live a day at a time. Curing is the act of solving a physical problem on a physical level. Both are critically important for a return to health.
Dr. Gaynor uses guided imagery and meditation to help his patients focus inward. These techniques are good ways for people to center themselves and to overcome fears. When someone has cancer, there is a tidal wave of fears--fear of dying, of losing their hair, of the side effects of the chemotherapy. When these fears lie unaddressed, they become a stress that can interfere with becoming well. Guided imagery and meditation do not rid patients of their fears. Instead these techniques allow them to find a safe place inside themselves where they can face adversity and become unafraid. This place is called ‘essence’ or ‘core’. It is a place within all of us where we can have a different perspective about our adversities.
To facilitate entry into deep meditative states, Dr. Gaynor uses the sounds of Tibetan bowls and quartz bowls. The Tibetan bowls have rich array of tones and overtones. People are able to release trauma through these mediations. Some patients say that having had cancer was one of the best things that happened to them. On a fundamental level, adversity such as cancer can truly open people up to all their potential. It is empowering for people to realize that they can be dealing with adversity and still enjoy each day. They can look at their fears and anguish from a different perspective. In addition to this approach to healing, Dr. Gaynor focuses on developing nutritional regimens for his patients based on extensive scientific research.
B. Details
By the year 2000, one in three people will be diagnosed with cancer. Medical research needs to focus on cancer prevention. Studies underway now in chemotherapy prevention (i.e., nutritional cancer prevention) will make significant contributions to decreasing the amount of cancer-related deaths.
A carcinogen that has not been detoxified by the body can cause DNA mutation and problems with DNA synthesis and repair mechanisms. Any of the above effects of a carcinogen can eventually lead to a malignant cell that has metastatic potential. Our bodies have two groups of enzymes that work in opposition with regards to the handling of carcinogens. One group activates carcinogens and the other group detoxifies these carcinogens. Phase I enzymes activate carcinogens. Substances like nitrosamines in the stomach and benzpyrenes in the lung are turned into compounds that wreak havoc on delicate cellular structures by phase I enzymes. Natural inhibitors to these phase I enzymes, such as garlic and green tea, prevent the activation of these potentially harmful substances. Phase II enzymes, the most common of which are UDP-glucuronosyl transferase and glutathione S-transferase (GST), break down carcinogens. Certain nutrients enhance the activity of these detoxifying enzymes. Phase I and phase II enzymes are found in virtually all organs of the body. They are most abundant in the liver, which reemphasizes the liver’s crucial role in detoxification. These enzymes are inducible by a variety of chemicals ranging from drugs to nutrients.
The goal of nutritional therapies for cancer prevention would be to increase the consumption of those foods that will inhibit the action of phase I enzymes and decrease intake of anti-nutrients that lead to an increased activity of these enzymes. By the same token, the therapy would call for an increased intake of nutrients that cause an increased production of phase II enzymes, while decreasing the ingestion of substances that prevent the production of these protective enzymes.
C. Mechanisms of Action and Research
Prostate cancer makes up a third of all cancers in men whereas breast cancer makes up a third of all cancer in women. It is not a coincidence that Asian men living in Asia have one-thirtieth the incidence of fatal prostate cancer that American men do. A study in Journal of Urology was an autopsy series where researchers looked at men aged 40-49 who died of other causes. The investigators looked in the prostate gland and found that 60% of those men had either a pre-malignant lesion or a malignant lesion of the prostate gland. We know that 60% of men don’t go on to develop clinically malignant prostate cancer. What we should focus on is finding suppressive nutritional agents that can suppress the growth of these already developed cancers. In Asian autopsy studies, they have the same rate of occult cancer in their prostate gland that American men do, but the mortality rate of Asian men from prostate cancer is significantly lower than the mortality rate of American men. Also Japanese women have one-seventh the rate of fatal breast cancer than American women. Their rate changes to the American rate once these Japanese women adopt a western diet. Anywhere from 10-70% of cancers are related to diet. A 1998 British Medical Journal study suggested that up to 80% of the more common cancers such as breast, colon and prostate are related to diet. Nutritional elements such as soy, green tea, Vitamin E, carotinoids, sea weeds, omega-3 fatty acids that are present daily in the Asian diet are absent in the American diet. This nutritional difference may account for the difference we see in the development of clinical cancer.
Anti-carcinogens in food act through a variety of mechanisms. Some prevent free radical damage (Vitamin C, Vitamin E, the phenols and polyphenols in green tea, and agents in soy). Others are blocking agents which induce detoxifying enzymes (agents in green tea, flavinoids, isothiocyanates, things in red grapes and cabbage, the indoles, and selenium). Suppressing agents decrease the expression of abnormal genes and decrease cell duplication (carotinoids, retinoids).
Cruciferous vegetables such as broccoli, Brussels sprouts, cauliflower, and cabbage, have a number of important detoxifying compounds in them. One is called sulforifane. It induces a range of detoxifying enzymes. Another compound, called indole-carbinol, works synergistically with tamoxifin in breast cancer. Indole-3-carbinol is the only compound known that shifts the type of estrogen that predisposes one to cancer (16-hydroxy-estrone) to the 2-hydroxy-estrone which is a biologically less powerful estrogen metabolite. A number of studies in animals and humans show this effect is readily demonstrable by eating broccoli. Protocol now is developed at the Strang-Cornell Cancer Prevention Center to give a pill form of these compounds to women with high risk of developing breast cancer. The results of this study will not be available until after a few years, however, it is reasonable to recommend eating cruciferous vegetables on a daily basis.
Another nutrient that appears to have a protective effect is lycopene. It is the anti-oxidative pigment that gives tomatoes and watermelon their red color. In May a small study was presented that needs to be confirmed. Men with prostate cancer who were awaiting surgery were given 30 mg lycopene for three weeks preoperatively. One can of Campbell’s tomato soup contains about 22mg of lycopene. In this study the men were given the lycopene in supplemental form. Seventy percent of the men had downstaged. The numbers of this study were small and a larger study will need to be performed to confirm these results. However, in a study published in the 1995 Journal of the National Cancer Institute, researchers found that men who were consuming ten or more servings of tomato-based products per week had a 45% lower rate of prostate cancer. This study has been included in a recent meta-analysis of 72 different studies that looked at the effects of consuming tomato-based product. This meta-analysis found that the rates of prostate cancer, breast cancer, lung cancer and stomach cancer were decreased.
Other important dietary elements include fiber and vitamins. Dietary fiber can bind free steroid hormones, estrogen and testosterone in the gut and consequently lower the levels of these hormones that are absorbed into the blood stream. Many studies have demonstrated that people with lower levels of anti-oxidant vitamins in their diet have an increased risk of developing gastric, lung, and prostate cancers.
Another category of nutrients is the fatty acids, which includes saturated, monounsaturated and polyunsaturated fats. Saturated fats are solid at room temperature, and people who consume a lot of them have higher cholesterol levels which puts them at risk for developing cardiovascular disease. Monounsaturated fatty acids can be found in vegetable products and olive oil. Olive oil also contains a phytonutrient called squalene. Epidemiological research has determined that women who live in the highest olive oil-consuming countries have one-third the breast cancer of the United States. Researchers suggest that this difference may be partly attributed to the squalene in the olive oil. Some data suggest that squalene inhibits the enzyme HMG-CoA reductase which is required for an enzyme that activates the ras oncogene.
Polyunsaturated fats come in two forms, omega-3 and omega-6. Omega-3 fatty acids can be found in fish, mainly deepwater fish such as salmon, cod and tuna. It is also found in flax seed oil. People who do not eat fish regularly may want to include a tablespoon of flax seed oil with their cereal or salad. Data show that women with node-positive breast cancer have a higher ratio of omega-6 to omega-3 fatty acids in their breast tissue.
In an animal study at the Strang-Cornell Cancer Prevention Center, researchers fed three groups of rats different diet. One group received a fat-free diet, the other received a corn oil diet rich in omega-6 fatty acids, and the last group was fed a fish oil-supplemented diet high in omega-3 fatty acids. In rats fed the omega-3 fatty acids, there was an increased expression of the protective enzyme GST in the liver. Many other studies show how green tea, cruciferous vegetables, and omega-3 fatty acids induce the expression of detoxifying enzymes.
Trans fatty acids are anti-nutrients. They are not found in nature and appear as a result of the hydrogenation process that makes margarine from vegetable oils. They appear to be associated with an increased risk of heart disease and cancer.
With regard to breast cancer, studies have found that for every 10% above ideal body weight, the risk of breast cancer increases. Insulin-like growth factor is one of the most powerful tumor promoters. Consuming foods that are rich in sugar or carbohydrates that are broken down into sugars causes the pancreas to secrete insulin. At the same time, the liver releases insulin-like growth factor (ILGF). To study the effect of a high-fat diet on cancer cell proliferation, researchers put human prostate cancer cells into mice and fed them different diets. Those mice on high-fat or high-carbohydrate diets showed significant proliferation of the cancer cells. In both of these groups, the proliferation was associated with increased levels of ILGF. This protocol and these results were published in the Journal of the National Cancer Institute.
Some important minerals to include in chemotherapy prevention are zinc and selenium. Zinc is important in immune function as it is a cofactor for many detoxifying enzymes. The ability to absorb zinc from the diet decreases with age. In a 1996 study in the Journal of the American Medical Association, researchers wanted to see if giving 200 m g/ day could decrease the recurrence rate of people who had basal cell or squamous cell carcinomas. It did not decrease the recurrence rate, but there was a 55% lower risk of prostate cancer, a 62% lower risk of colorectal cancer, and a 41% decreased rate of death due to cancer overall. Selenium is difficult to obtain in the diet and over 400 m g/ day can be toxic, causing diarrhea and hair loss. Some naturally occurring sources of selenium include in Brazil nuts, cashews, and in eggs. Studies that examine soil content from different states found that states with the lowest selenium contents in the soil had twice the cancer incidence as states with the highest selenium contents.
In the December 15th issue of the Journal of the National Cancer Institute, a study was published where researchers compared women who drank two glasses of soy milk a day to women who did not drink soy milk but who had an otherwise identical diet. In three months, the group of women who were drinking soy milk had a 23% lower estrone level and a 27% lower estradiol level. An April 1999 paper in the Annals of Internal Medicine suggested that women with breast cancer had higher free estrogen and higher free testosterone levels. Compounds in soy block estrogen receptors on the surface of breast cells, inhibit tyrosine kinase an enzyme that is involved in cancer cell development, and act as natural angiogenesis inhibitors. Soy is available from soy milk, tofu, and soy cheeses. Soy sauce has no isoflavones, so the benefits of soy are not achieved through the use of soy sauce.
In a study published in the 1998 Journal of the National Cancer Institute from Ohio State University, authors examined the effects stress had on the immune system in women who were recovering from breast cancer surgery. They found that women with the highest level of stress as determined through careful psychological profiles had the most profound depression of a variety of aspects of their immune systems, which are thought to be important in preventing a relapse of cancer. A different study by Spiegel published in the Lancet compared women with stage IV breast cancer. Half the women were doing guided imagery and meditation, and the other half served as a control group which received standard chemotherapy. The women receiving the chemotherapy with the guided imagery and meditation lived twice as long as those undergoing chemotherapy alone. The emerging field of psychoneuroimmunology examines how stress, depression, frustration and pessimism can literally depress every aspect of immune system. Papers in this field are focusing not only on cancer research, but also on heart disease, Alzheimer’s and various neurological diseases.
A recent study in the New England Journal of Medicine found that women with stage II breast cancer who were receiving conventional therapy as well as complementary or alternative therapy did worse than women just receiving conventional therapy. The women who were receiving any type of alternative therapy had more stress and depression. Dr. Gaynor stated that this study was poorly done. The investigators linked all the alternative therapies into one category--nutrition, guided imagery, acupuncture, and yoga. They didn’t control for who was receiving the alternative therapy. Was it an MD in an institution? Was it someone who does this on a regular basis together with conventional medicine at a cancer center? Was the person licensed? Was the person designing a nutrition program a registered dietitian or clinician? Essentially, the credentials of those administering the care were not included in the study.
A study at Johns Hopkins in 1998 compared women with and without breast cancer. It found that women with lowest level of the phase II enzyme GST had a four-fold increased risk of developing breast cancer.
II. The Cancer-Related Issue Addressed by Dr. Geffen.
Dr. Geffen’s program is an in-depth mind/body cancer treatment. He combines medical science with his own brand of cognitive psychotherapy to care for patients holistically.
III. The Program Discussed by Dr. Geffen
A. Philosophical Background
Dr. Geffen’s program has seven steps. These steps provide a road map for patients and their family members to ensure that they have the best chance of healing. Curing the cancer must happen along with a deeper transformation that is brought about through greater self-awareness. The foundation of this mind/body/spirit medicine is rigorous medical treatment that is based in science. The conventional medical treatment is where the process of healing begins, but it is not the end and it is not complete. To experience healing on a deeper level, Dr. Geffen and his staff teach this seven level program to help move patients to a place of greater self-understanding.
B. Details
The first level of this program is "education and information". When people are diagnosed with cancer, there is an avalanche of fear and questions that overcome the mind. What is this cancer? How did I get it? How will it change my life? Does my doctor know what she’s doing? Am I going to lose my breast? A flood of questions swells, not only in the minds of the patients, but for their families. Until we take the time to sufficiently address these questions in a way that is satisfying to each person, two things will not happen. First, the patients will not be able to make informed decisions about their care. Consequently they will not be able to get the maximum benefit from their treatment. Second, they will not be able to enter the deeper dimensions of healing and transformation. This notion of education requires caregivers to shift their focus from being a technologist of the body to being an educator.
Level two is called "psychosocial support". Many studies show that social isolation is a risk factor for mortality. This factor is crucial for enabling healing, but is often overlooked while physicians focus onchemotherapy and the radiology. Physicians need to consider the social support that their patients have or lack. Patients should be encouraged to get involved in support groups or programs that help establish a supportive social network. Studies also show that psychosocial interventions such as participating in a church group or joining an outdoor club, according to an individual’s interests, have profound effects in improving quality of life. Three studies even suggest prolongation of survival due to these interventions.
The next level is viewing "the body as garden." In the West, we view the body as a machine and the physician as a mechanic. In the East, the body is thought of as a garden and the physician, a gardener. To arrive at a healing experience in the treatment of cancer, it is necessary to transform how we view our bodies. The actions of care may be the same, but the metaphors and the energy that come with the actions are different.
Tto have a healthy garden, one needs to fertilize the soil. The diet can be seen as an anti-cancer treatment or as fertilizer for the body. Telling people that they should take chemotherapy, vitamins and vegetables does not serve them as well as encouraging people to see these elements as fertilizer- something that allows the garden to be enriched. What people eat is nourishment for the garden of their being. They create the environment, the soil, through which a healing transformation can occur. They create the conditions in which the opportunity for healing can appear. We should get away from images of whipping our bodies, of demanding that they act according to our will. Instead of demanding that our bodies change, we should learn to care for and nourish the garden of our being.
Along with fertilizer, plenty of water is necessary--six to eight glasses of fresh spring water a day is recommended. Sunshine and oxygen are also required for a healthy garden. Getting outside in nature and exercising are two important ways to center one’s mind and to stimulate immune function. Instead of telling a patient that he or she needs to stimulate their immune function through daily exercise, a doctor may tell his or her patient that their garden needs sun and oxygen to be healthy. The tone and expression of this metaphor are more emotional. Now patients are not exercising only because some study told them that women who exercise have a decreased incidence of relapse in breast cancer. Patients can see this exercise as a way to take better care of themselves. People will be doing the same exercise, with a different intention and a different spirit.
Everything recommended to patients is based on the scientific evidence of its benefits. The difference is in the tone. Patients can see their personal responsibility in creating the optimum environment for wellness. This metaphor of the body as garden allows patients to take an active and joyful role in their own care. Instead of being the objects of therapies ordered by a team of physicians, they become active subjects. They experience their therapy as a form nourishment and care, instead of as a punishment. The quality of the experience of those undergoing cancer therapy is different based on the different metaphors of the body. Although as yet unstudied, Dr. Geffen asserts that if the experience is more nourishing at each step along the way, the outcome will be better. How he defines ‘better’ is unclear. It could mean prolongation of life or improved quality of life without prolongation. He states that even if prolongation of life does not occur with the use of this metaphor, he would still continue to do it as it creates a more joyful and less fearful experience of cancer therapy.
The fourth stage is "emotional healing". Up until now, the focus has been directed outward. This stage is where people must go inside into the deepest corners of their hearts to discover and release profound emotions that invariably accompany a diagnosis of cancer. The family and the patients should go through this as well. This level occurs in support groups and much more commonly in private therapy. It is a private, intimate process. It is often overlooked in the frenzy of logistics surrounding therapy regimes. Amidst concerns about what chemotherapy to receive or how many acupuncture visits are necessary, patients can move their conscious selves away from their emotions. Healing can occur only when we move that awareness back inside. Physicians should provide some network where this can be accomplished in a group or in private.
The "nature of mind" is the fifth stage. The mind creates the reality that we perceive. Patients and family members are filled with thoughts and meanings that they give to events that determine the experience of those events. The interpretation of events leads to real physiologic responses. A person who views chemotherapeutic agents as poison will have a different response to their hospital visits than someone who sees it as analogous to an IV infusion of Popeye’s mighty spinach. When a physician relates a diagnosis of cancer, an avalanche of thoughts and emotions produce different profound physiologic responses. It is vital to teach people the nature of their own minds to help them understand their feelings. It is necessary to understand a patient’s beliefs about cancer, their beliefs about why they got it, and their beliefs about their therapy. Physicians should take time to work with patients to help them find meanings of their cancer and therapies that will be empowering instead of disabling. These meanings allow the patients to better understand themselves.
The next stage, "life assessment", is where patients must think about the meaning and purpose is in their lives. Questions include: What are the most important goals for the next year? Are you doing the things today that are the most important? How do you want to be remembered? When people know how they want to be thought of, this can transform how they currently live.
The final level is the "nature of spirit." This is the most important and most precious part of the program. Physicians and patients acknowledge the timeless and dimensionless parts of themselves. Throughout history this has been given a name by all major traditions in the world. When patients are given the space to experience "this ocean of our being," they can become transformed. When caregivers give them an anchor into this spiritual realm, the process of healing is enhanced.
IV. Limitations
No limitations were noted.
V. Comments by Dr. Wittes
Dr. Gaynor’s articulation of what constitutes an integrative program that deals with mind/body relationships and also tries to implement what we know about nutrition was sensitive and sensible. It is hard to implement programs with nutrition because the data are complex, sometimes contradictory and model-dependent. It seems that researchers at the Strang-Cornell Cancer Prevention Center have tried make recommendations for people that are as close as possible to underlying scientific information. We do have nasty surprises such as the beta-carotene study. Studies like that one show we are never as smart as we think we are. They also demonstrate the difference between causation and causality. The main impetus for conducting the beta-carotene study was the epidemiological association between low levels of beta-carotines in populations and increased cancer incidence. The supposition was that if one could supplement the population with beta-carotines, one could lower the incidence of cancer. This implied the existence of an underlying causative relationship between the beta-carotines and the incidence of cancer. In the beta-carotine study, within the subset of smokers, those supplemented with beat-carotine actually had a higher incidence of developing lung cancer than did the control group.
Cancer is not the only medical field where these nasty surprises crop up. Cardiologists were suppressing ventricular arrhythmia after myocardial infarction. This later proved deleterious to patient health. There was general acceptance of the fact that suppressing arrhythmia was the proper action, so little suspicion arose when patients were doing poorly.
Whenever evidence is correlational, we must be careful how we apply the information. For example, one could look at the relationship with stress and immunosuppression. Because an increase in stress in associated with a depressed immune system, it does not necessarily follow that relieving stress will increase immunoreactivity. With a correlation, reversing one side of the correlation will not necessarily lead to the reversal of the other. It is critical to study the underlying mechanisms to determine the causality before making claims about the efficacy of a treatment.
With regard to Dr. Geffen, it is clear that what he is trying to do goes well beyond traditional concepts of twentieth century Western medicine. The goals of a program like Dr. Geffen’s are very broad. The healthy life goals designed for his cancer patients are goals which may be adopted by anyone. The goal of his therapeutic setting seems to be an increased quality of life through an increased self-awareness. How necessary is it to study whether or not sound and a sense of spirituality increase the quality of life? Support groups are self-evidently beneficial for certain types of people. Even if support groups don’t prolong life for one day, that is not the most important thing about them. How much of these life-enhancing programs does one have to study in order to establish their validity?
It is important to generate information about validity, because practices can be publicized and made available to others. You have a firm basis for using a particular therapy, not just anecdote. This information may be used to convince Medicare and the private payer sector that these therapies are something for which patients need to be reimbursed. The program that Dr. Geffen describes must be very expensive and personnel-intensive. If the clinic’s goal is to get patients to become self-aware, Medicare will be unmoved. It is not in the enabling legislation of Medicare, nor is it in the mission statement of private payers to help people actualize their visions of themselves. Consequently we have a larger societal obstacle. We live in a society where people with mental illnesses are not being reimbursed for their care to the same extent that as people with non-mental illnesses. It is evident that such issues stem out of societal ideas--ideas of what constitutes illness and what therapies the society pronounces beneficial.
VI. Resources
No resources were mentioned.
VII. Audience Questions
What is the reimbursement protocol for a program like Dr. Geffen’s?
We have a societal problem because Medicare does not see this as a valid treatment. Physicians can easily use $60,000-70,000 on a ninety-year-old person with advanced state lung cancer to extend their life for a few months, but they cannot give a young troubled person a fraction of help from a mind/body program. Dr. Geffen makes less money working in his clinic than he could at a more conventional center. He sees less patients because the process is time intensive. He also works with a team of caregivers; they share the burden and the responsibility. Support groups do not cost a lot. Having a nurse hold a class is not costly. They offer meticulous medical care in a setting that is keenly attuned to making the experience of the patient a nurturing one. The staff at Dr. Geffen’s clinic values their particular approach to medicine. So they search for less costly ways to implement their plan. People need to write to their lawmakers and demand reimbursement for these beneficial programs.
Are there any negative long-term effects of drinking soy milk?
The actual amount of isoflavones is low in two glasses of soy milk (109 mg). It is a surprisingly low amount to see that kind of physiological effect. But if we look at figures from countries that do consume a lot of soy, such as Japan, we don’t see a higher incidence of cardiovascular disease, osteoporosis or other conditions associated with estrogen depravation.
Are genetically engineered soy beans less nutritious than natural soy beans?
No data show that genetically engineered soybeans have less isoflavones than the natural variety. However, Dr. Gaynor states that we may not know the extent of damage that we do through the seemingly beneficial genetic engineering of food until many people have been affected. It may take decades before we can understand the complete ramifications of our actions.
Is it unethical for Dr. Geffen to withhold the commencement of scientific cancer therapies while he works on the emotional stages of this seven step plan?
Dr. Geffen asserts that there are two purposes of medicine--a relative purpose and an ultimate purpose. The relative purpose is to fix the body, diagnose the disease, and treat the symptoms in an efficient and cost-effective way. The relative purpose is incomplete. The seven levels address the ultimate purpose of medicine, which involves healing on a deeper level. Although the stages of the program were described linearly, they in fact can occur simultaneously. Level one is education and information. Physicians have to bring patients into a comfortable space before you introduce an IV and start chemotherapy. These other levels occur in an organic way. Both the relative and ultimate purposes must be addressed to optimize healing.