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Mondanite Magazine

Dr. Salem’s Interview
Mondanité Magazine
Beirut, Lebanon

November 2009

"It would be impossible to know the true Philip Salem without appreciating the strength of his attachment to the land and the people of his birth. Indeed, throughout his life, the little village of Bterram where his life story began has remained his spiritual and emotional anchor.

I can still remember when I traveled from Australia to meet with him one summer while he was visiting his family home in Bterram, he told me quite candidly that it was here, among the limestone houses and the olive and fig trees, that he was happiest. At that point, he had been living outside of Lebanon for almost 20 years and yet the allure of his birth place had not faded.“

Frances Mourani
Editor of a new book entitled “Philip Salem, the son of Lebanon”

Q. Dr. Salem what does it mean to you to be of Lebanese Origin?

A. I have always said that if I were not Lebanese, I would not recognize who I am. I am in love with Lebanon and its people, and I am very proud of being Lebanese. Although I live in America, and I travel all over the world, the only land I feel is my land is Lebanon.

As a doctor, of course, I feel I am a citizen of the world.  The whole world is my home, and all mankind is my family. However, my political and cultural identity is Lebanon.

Q. Tell us about your childhood and youth memories in Lebanon?

A. Until I was 14 years of age, my village, Bterram, was the whole world to me. By now I have been in America some 23 years, but whenever I visit Bterram, I feel that every tree and every stone recognizes me, and welcomes me. I feel very fortunate to be born in a village. You cannot possibly know the truth of Lebanon if you have not lived in a Lebanese village.

I was also very fortunate to have the parents I had. My father believed in the importance of reason, education and hard work. My mother on the other hand believed in the importance of love and giving. My father emphasized the power of the mind, my mother emphasized the power of the heart. I was fortunate to inherit their genes. The family house in which I lived in Bterram remains the most sacred place to me in the whole world and it is the center of existence for me.  Only in that house, I am 100% myself. I have had only love, joy and happiness in that house. Until today, there is no place on earth that could give me the warmth and the peace that I need more than that house.

Q. How did you choose to be an oncologist?

A. I graduated from the Medical School at the American University of Beirut in June of 1965. From 1965 to 1968 I trained in internal medicine, and I was preparing myself to be a kidney specialist. However, one incident changed my whole life. A woman, who was very close to me, developed ovarian cancer and I accompanied her through her journey with the disease. I was very traumatized by that experience. That experience made me decide to be a cancer doctor rather than a kidney doctor. I loved the challenge and I had all the passion for it.  When I discussed this decision with my family, friends and teachers, very few encouraged me to do so, but I was convinced down to the bone that this is the best thing that I could do. I never regretted that decision.

Q. Can you tell us something about your journey with cancer?

A. In June 1968 I joined Memorial Sloan-Kettering Cancer Center in New York and my boss was David Karnovsky, the founder of cancer medicine. Six to seven months into my training at Sloan-Kettering, Dr. Karnovsky and I bonded like father and son. He, himself, developed cancer and I took care of him. Before he died he visited Iran and on his way he stopped in Beirut and visited Bterram for three days. He stayed in our house in Bterram all that time and when he returned to New York he told me that this was the most fascinating trip he ever made. I had told him so much about Bterram that he felt the urge to visit and meet its people. He was very moved by the reception he had in the village.

After I finished my training at Memorial Sloan-Kettering I went to the M. D. Anderson Cancer Center in Houston and I did an extra year of training. I returned to Beirut in 1971 and I joined the staff of the American University of Beirut (AUB).  From 1971-1986 I was in charge of the cancer program and I trained 23 physicians; 20 of whom I eventually succeeded to bring with me to the United States and to train in the best cancer centers. Some 5 to 6 of these are now national leaders in cancer research. This is probably one of my biggest achievements having trained all these doctors and eventually seeing them flourish to become world leaders in cancer research. In addition to being in charge of the cancer program at AUB, I was also the president of the Lebanese Cancer Society and I did many campaigns to educate the public about cancer.

In January 1987, I returned to the United States and I served on the faculty of M.D. Anderson Cancer Center as a professor of cancer medicine and research. In 1991 I established Salem Oncology Centre and until now I am the president of this center, and the director of cancer research at St. Luke’s Episcopal Hospital. St. Luke’s Episcopal Hospital where I have privileges, established a chair in my name, the “Philip Salem Cancer Research Chair“, in recognition to my contributions to cancer medicine.  I am very humbled by this honor.

Q. What are the latest research results and treatment to cure cancer?

A. First, let me tell you in simple terms that if we exercise all knowledge we know about cancer, we can eradicate at least 75% of all cancers. The major problem today is that we are not able to exercise the knowledge that we have accumulated about prevention and treatment of cancer. Only very few patients (probably less than 5%) receive appropriate treatment and this is the major problem.

At the same time we cannot say that the problem of cancer has been conquered. Although we can cure a minimum of 40-50% of patients, we still lose too many.  However, research is making a lot of progress and it now revolves around two major concepts.

The first concept is developing drugs which target only the cancer cells and do not harm the normal cells. We already have several drugs like this. One of these drugs is Gleevec which is only a pill that a patient takes. Patients with chronic myelogenous leukemia may even achieve cure by treatment with Gleevec.

The second concept is that a chronic infection may eventually lead to cancer. When I was a professor at AUB, I published extensively on a disease that afflicts people in the Mediterranean countries and the Middle East. This disease was a model of how an infection in the small intestine may eventually lead to the development of cancer. I did not realize the significance of that concept then. But a few years later, this concept became the cornerstone in the development of a new field in cancer research called chemoprevention. Take for example cervical cancer in women; we now know that an infection by the Human Papilloma Virus may lead to cancer of the cervix. If we prevent this infection with the vaccine Gardasil, the cancer will never develop. This is a model of how we can develop strategies to prevent infection and consequently prevent cancer. I am proud to say I was one of the very early researchers in the seventies who came up with this concept. You can imagine if we identify all kinds of infections that could cause cancer and we develop strategies to prevent them, we can probably cure or prevent a lot of cancers. I strongly suspect that many cancer diseases could be the result of chronic infections.

Q. How can we prevent cancer?

A. One of the biggest challenges to mankind is tobacco smoking. The cigarette kills a minimum of 5 to 6 million people a year worldwide. There is no war that would kill that number of people annually. Although this is a huge problem, its prevention is not that difficult. The major obstacle here is the interfacing between politicians and the tobacco industry. In America most politicians are supported by the tobacco industry. Approximately 1/3 of all cancers that afflict man are tobacco related.

It is difficult to say in few words all the strategies for the prevention of cancer. The best advice I can give to people is to identify one day a year for a check up. This is the most important advice that I can give to the public. This is so important because most cancers are curable when diagnosed early.

Q. Do you believe that cancer can be cured by a supernatural miracle?

A. I have 42 years of experience in cancer medicine and research and I have not yet seen a single patient who has been cured of cancer from outside the miracle of the mind. Only God can make miracles, and God has created the human mind which is capable of acquiring knowledge and with knowledge we can conquer disease. I was on several committees that relate to the authentication of miracles, and every “miracle” I had examined was not a miracle. I only believe in the miracle of the mind. At the same time I would like to say that I cannot believe that there is anyone who has more faith than I do. I thank the Lord everyday. I am a great believer in his power. I believe it is only He who can make miracles; no one else can.

Q. You say I believe “when you treat cancer we need to remember that we are not treating the disease in vacuum, we are treating the human being who has the disease there is a big difference between giving a good treatment and giving a good care” can you explain this?

A. When we treat cancer, we are not only treating the disease. There is a human being behind the disease who has concerns, fears, and anxiety. He is threatened by death and is in a state of shock. He should be recognized as a total person, and the need to alleviate his fears and to address all of his concerns is of extreme importance. Doctors who only treat diseases are failures. It is only when you love your patient and you treat the patient as a whole, you can cure him. Also, I want to emphasize that when we treat patients, it is not only the medical treatment which is important, but supportive treatment as well. Supportive treatment is what we give along with chemotherapy to prevent the toxicity of chemotherapy and to make the patient live as close to normal as possible. In addition to supportive care, good care means easy accessibility to the doctor and to the nurses, it means continuity of care on Saturdays, Sundays, and holidays, and it means that the doctor is always ready to sit down and talk to the patient.  In the climate of medical care we live in today, doctors are only interested in treating diseases. They have no time for the human being behind the disease. Taking care of the whole patient is time consuming and some doctors are not willing to give a lot of their time. This is a major challenge for medical care, not only in America but all over the world. In the treatment of cancer, compassion, love, caring, understanding, and human warmth are as important as the basic medical treatment. This is why I am in the process of finishing a book on cancer treatment, entitled “Knowledge alone is not enough”

Q. What are the most important factors that determine the cure of a patient?

A. This is an extremely important question because unfortunately more than 90% of patients do not receive adequate treatment that could provide them with cure. The factors that determine cure are the following:

  1. The exact nature of the cancer and how malignant it is.
  2. How far advanced the cancer is.
  3. The adequacy of the treatment the patient receives.
  4. Courage and perseverance, not only on the side of the patient but more importantly on the side of the doctor. Many cancer patients die because their doctors give up on them very early. Those doctors do not have the courage and perseverance necessary to go forward. Also, if the patient does not have enough courage and perseverance, he may choose to stop treatment early. The only people who win the war are the ones who go to war fully charged and prepared to win.

Q. You deal with life and death, hope and disillusionment, courage and fear, where do you get your strength from?

A. I believe in the power of hope and I believe in what I am doing.  I believe treating the cancer patient is the most noble thing in the world. I cannot think of a job more noble than mine. My strength originates from my belief in the power of science and knowledge. Also, I believe in the power of love and compassion. My motto has always been “the doctor who does not love his patient cannot cure him”. There is no joy greater than the joy of curing a cancer patient and I must tell you that I have cured hundreds of patient whom I did not think I could cure when I started their treatment. It is the power of courage and perseverance that eventually led to their cure. We should never forget that a patient, who is not curable today, may become curable tomorrow. As time passes by, new drugs emerge and a drug which is not available to us today may become available in a few months; therefore, you can rarely say that this patient is not curable. One should never lose hope and faith. My philosophy is to do my utmost and only after I do my utmost, I would pray to God and I would ask him for help. I never ask for help before I make sure that I have done my very best.

Q. You say “here in my clinic I am closest to God. Here I feel the awe of responsibility, the responsibility of life and death. Also here I feel the awe of nobility and sacredness?”

A. A cancer doctor’s work and his relationship with his patients are sacred. To achieve sacredness, the doctor should rise above himself.

Q. Can you tell us more about the sacred responsibility?

A. This is an extremely important concept. I do not believe that my relationship with my patient is a relationship between a doctor and his client. This is not a business relationship, nor a legal contract, as it is thought here in America. Medicine is above business, above law, and is above everything else. The relationship between me and my patient is sacred because it is partially divine. Only God can give life, and I am here with God’s hand touching mine to help me cure my patients. This is a kind of recreation of life; conquering death, salvaging life; a divine act which is something from God. It is something sacred, and this is not a normal relationship between one human being and another. It is a relationship between a human being who is threatened by death and another human being who is working hard to salvage his life.

When I say that the doctor should rise above himself, I mean, as I always say, the difference between a great doctor and an ordinary one is that an ordinary doctor thinks of his interests when he sees the patient, while a great doctor thinks of the patient’s interests and not his own. When you are a doctor, and you are treating patients, the focus should be the patient, not you, not your prestige, not your business, not your income, not your name, and not your reputation as a doctor. The only one who is of importance is the patient and his life. This is why I always emphasize that the doctor should keep his ego at home before he goes to work.

Q. Seeing so much pain and suffering of so many human beings, does this affect your faith, what have you learned?

A. I always wondered whether there has been a human who has seen more cruelty than I. I have seen the cruelty of disease against man in my 42 years of experience with cancer and I have seen the cruelty of man against man in the war in Lebanon. I believe the cruelty of man against man is more cruel than the cruelty of disease against man. My experience with death and suffering has taught me the importance and the beauty of life and health. It is a pity that people start thinking about their quality of life when they get close to death, and it is a pity that people at large take life for granted. Life is the greatest gift we have and I cannot think of a greater gift than the gift of health. If you have health, you have all the wealth. This is why my sympathy does not go to the poor. The poor who are healthy do not have my sympathy. My sympathy, compassion and love are all focused on the sick. My motto has always been, “if you are healthy you have no reason to complain”.

Furthermore, I must tell you that my knowledge of the human body and how the body functions makes me a great believer. You cannot see the beauty of the human body and how this body functions and not be in awe of the creator. The more you know about life and the biology of life, the more you realize that life cannot be the product of an accident. It is by a power far beyond us. I am one of those who believe that scientific knowledge is the way to God.  The more you know about man and about the cosmos, the more you should realize that this could not have possibly been a result of a physical accident.

Q. What about your political engagement?

A. As much as I am committed to the struggle of man against disease, I am committed to the struggle for the resurrection of Lebanon. I lived the Lebanese war, and during the war I treated many of the big political players in that massive tragedy. I knew what the problem was. The problem in Lebanon has always been the lack of a political leadership. Since the creation of Lebanon, Lebanon has never witnessed or had an intelligent political leadership. The Lebanese leadership has always been incompetent, and in most cases very corrupt. I am a great believe in leadership. If the best people in the world do not have a leader, then nothing can be achieved. Leadership is what takes people to the peak of glory.

Also, I would like to say that Lebanon has been the victim of its geography and its politicians. In regard to geography, Lebanon is chained between Syria and Israel. Israel does not want Lebanon because it is the anti-thesis of Israel. Lebanon is a pluralistic culture and society where Islam and Christianity coexist, where the East and the West can have dialogue. Israel is a country carved only for an ethnic and religious group. It is the only country in the whole world which is based on ethnicity. On the other side Syria has always believed that Lebanon has been severed from greater Syria and it would like to recapture it back. This is the reason why Syria never recognized the independence and sovereignty of Lebanon. Also, when I say that Lebanon is the victim of its politicians, this in, my opinion, is probably the root of the Lebanese crisis. The bulk of our politicians have no loyalty whatsoever to Lebanon. They are always ready to trade it for anything that would bring back wealth and prestige. There are very few Lebanese politicians who could rise above their own personal interest. When Iraq invaded Kuwait over a period of many months, the Iraqis could not identify more than 6 or 7 Kuwaitis that would cooperate with them. In Lebanon, if Syria goes into Lebanon and occupy it the next day, three quarters of Lebanon would be with Syria. If Israel invades Lebanon, thousands of Lebanese would ally with Israel. This question of loyalty is an extremely important factor in the continuing drama of the Lebanese crisis. There is no country in the Middle East that has the resources of Lebanon, not even Israel. In spite of that, look where we are. When you have a leader and loyalty, like Dubai, you can see what a leader had made out of the sands. Out of nothing he made a paradise, while we here in Lebanon we had a paradise, but we did everything humanly possible to make it hell.

Q. A personal message to the Mondanité readers?

A. My message is the following:

Life is not something you have earned, it is something that is given. Please treat it as the best gift you will ever have.

Most people work hard for a mirage. People believe that success and money are the basic objectives in life, and many times when they achieve them, they realize that their hands are empty. In Lebanon, and the Arab world, people believe in appearances. It is a culture of appearances, but what is important is this internal journey you make inside of yourself. You know that you have succeeded only when you are proud of the person you see in the mirror; and only when you achieve that internal peace and comfort between you and yourself.  The real journey in life is inside you and it is not in the public eye.

The third message is that people should be trained to give, and the easiest form of giving is to give money. I encourage you to give of yourself. Only by giving you reach fulfillment and joy. Please support life, support a sick child who is poor and cannot afford medical care. Support charitable organizations that support life. Be part of the war against disease and against suffering and pain. Be part of the real world. Giving gives your life a meaning. We need to change the motto in the world from “I love you because I need you” to “I need you because I love you”.