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Review: A Renowned Cancer Physician’s “Letter to the Cancer Patient”

by Raye L. Alford, PhD
July 9, 2018

Knowledge Alone Is Not Enough

by Philip A. Salem, MD
Hardcover, 176 pages. Quartet Books. £15.

I first met Dr. Philip Salem in October 2015. A mutual friend, Dr. Lois DeBakey, introduced us. She knew Dr. Salem wanted to publish a book for cancer patients that would relate, in a practical and accessible manner, what he has learned during his 50 years of experience in cancer medicine and research. Lois knew how difficult this mission had become for Dr. Salem because of the many demands on his time. She thought I might be able to help him finally accomplish his goal.

Upon meeting Dr. Salem, I was struck immediately by his devotion to his patients. He is wholly committed to doing everything he can to save the lives of his patients; the proof can be heard in every conversation about his work and ambitions. Defeating Cancer: Knowledge Alone Is Not Enough is an unambiguous demonstration of this determination.

Defeating Cancer epitomizes Dr. Salem’s view that “doctors treat people, not diseases.” His stated intent with this book is to give cancer patients “the best chance for a cure.” He reaches toward this objective by imparting, in clear, concise language, the education, guidance and support that he has found to be indispensable components of the care he provides to his patients. Throughout the book, he interjects poignant case stories from his own experiences to illustrate many of the lessons he has learned over the years.

Written in two parts, the first chapters of Defeating Cancer, are focused on the diagnosis and treatment of cancer. The tone of Dr. Salem’s writing in these chapters is thoughtful and caring and the prose is directed primarily to patients and families. The aim of these chapters is to give patients a head start on the information and knowledge they need to able to partner with their doctors and be active and engaged participants in their medical care. As Dr. Salem states, “the patient who does all these things is already on the way to a cure.”

From being certain that the diagnosis of cancer is accurate to knowing whether and how far the cancer may have spread, Dr. Salem skillfully guides readers through the process and pitfalls of diagnosing and staging cancer. He then walks readers through the steps involved in preparing for treatment. First, he discusses the vital importance of effective communication between all the physicians who will be involved in treating the patient, and between the physicians and the patient. He expresses the value he has found in group consultation meetings that bring the entire clinical team together before initiating treatment of a patient. As he writes in chapter 4, the point of the group consultation “is to devise the best possible strategy for treating my patient and his or her cancer.”

Next, Dr. Salem details for readers how he prepares his patients for the initiation of treatment. He meets with patients to chart the route forward and talk about the treatments that are planned. As Dr. Salem sees it, the patient and treating physician, usually a medical oncologist, are the central, ever-present characters in a dynamic cast that will include, from time to time, other physicians, various medical and non-medical professionals, and family members and caregivers. As he states, “the main participant in the planning meeting is the patient. The primary purpose … is to talk about what is to come.”

Dr. Salem spends the next few chapters, with the help of a guest chapter from Dr. Bin Teh, describing the various types of treatment that cancer patients undergo. Throughout all these early chapters, Dr. Salem acknowledges the difficulties patients often face during cancer diagnosis and treatment and offers guidance and support by suggesting ways in which patients can advocate for themselves to obtain the services they need. Among these services, Dr. Salem is particularly passionate about medical supportive therapy. As he defines it, medical supportive therapy involves the use of medications and drug-free interventions to minimize the effects of cancer and its treatment and give patients a daily life that is as close to normal as possible. As he states, “medical supportive therapy is a critically important part of caring for my patients.”

Readers will also find that Dr. Salem feels strongly about the power hope, perseverance, love and compassion have to impact cancer patients positively, and the significance of quality of life. He considers these to be integral to the care of cancer patients because they contribute to a patient’s emotional and psychological well-being and to the will to keep up the fight against cancer. Across two chapters, Dr. Salem identifies a variety of circumstances that can threaten each of these elements and shares insights on how patients can nurture these throughout treatment.

In the second part of the book, Dr. Salem switches gears and introduces a collection of essays. Through these essays, he highlights a few of the challenges that he considers to be among the most significant problems facing the practice of medicine today. Although still highly relevant for patients and families, readers will notice that these issues also affect providers and Dr. Salem has shifted the tone of his writing a bit to include physicians and other health care professionals in the audience for these discussions.

It is here that readers come to appreciate Dr. Salem’s dedication to the treatment of cancer and the practice of medicine. He reflects upon his concern that the treatment of cancer is becoming ever more impersonal and lacking in humanity. He explains why, in his experience, this is particularly problematic for cancer patients and why he believes it is essential that doctors and medical professionals take the time and care to educate cancer patients effectively, communicate compassionately and tell cancer patients the truth about their diagnosis, treatment and prognosis with thoughtfulness and sensitivity.

Dr. Salem also voices his frustration with the intrusion of third parties into the doctor’s decisionmaking process. He bemoans the impact of insurance and regulatory oversight on the doctorpatient relationship and on how doctors practice. He makes a compelling case “that a doctor should have the liberty to treat patients as he or she thinks best and practice without fear of litigation for failure to comply with arbitrary standards and guidelines that may not be appropriate for every patient.” Although he proposes few remedies that would change things on a systemic level, Dr. Salem presents individualized recommendations and a forthright, insider’s perspective that will benefit readers as they navigate diagnosis and treatment of their cancer.

In the final essay of the book, Dr. Salem asserts his view that “the right to adequate health care should supersede any other human right.” He argues that the United Nations’ Universal Declaration of Human Rights should be amended to enumerate the right to health specifically and to delineate the right to health “as the most fundamental human right of all.” In making his case, Dr. Salem persuades readers to contemplate the potential effects of such a move by the United Nations, but he stops short of defining a viable path to delivering worldwide access for all to quality health care services.

At its core, Defeating Cancer is a communiqué from the heart; its purpose is education and its message is one of hope and compassion. Dr. Salem believes education is “the most important weapon we have against cancer,” but also “that knowledge alone is not enough. Patients need love, care, hope, compassion, accessibility to the doctor and time to talk about their fears, anxieties and concerns.” Readers will quickly recognize that Dr. Salem has committed his life “to increasing [his own] knowledge, to furthering general medical knowledge, and to taking care of and educating [his] patients.” With this well-thought-out and readable book, he offers what he feels is “the best gift [he] can give to any cancer patient.”

Philip Adib Salem, MD

Dr. Salem is renowned as an accomplished and compassionate cancer physician and researcher. In 1965, he received his Doctor of Medicine degree from the American University of Beirut School of Medicine in Beirut, Lebanon. He subsequently undertook postgraduate training at the American University of Beirut Medical Center, Memorial Sloan Kettering Cancer Center in New York, New York, and MD Anderson Cancer Center in Houston, Texas. From 1971 to 1987, he was a member of the faculty of the American University of Beirut Medical Center. In 1987, he returned to the United States and joined the faculty of the MD Anderson Cancer Center. Since 1991, Dr. Salem has served as president of the Salem Oncology Centre, a private cancer treatment facility that he founded, and as director, now director emeritus, of cancer research at the Baylor St. Luke’s Medical Center, CHI St. Luke’s Health, in Houston, Texas.

Dr. Salem is also a productive author and renaissance intellectual. He has published more than 100 scientific papers and chapters that chronicle his pioneering work on immunoproliferative small intestinal disease (IPSID) and the relationship between infection and cancer and his innovative approaches to the administration of chemotherapeutic drugs to patients. He has published numerous articles on philosophy, religion, human rights and Lebanese and Middle Eastern affairs.

Throughout his career, Dr. Salem’s humanitarian instincts have led him to a variety of leadership roles including service, from 1989 to 1994, on a White House advisory committee on health care. His achievements have earned him a number of recognitions including the Ellis Island Medal of Honor from the National Ethnic Coalition Organizations, the Khalil Gibran International Award from the Arabic Heritage League, the Solidarity Award from the Foedus Foundation and honorary doctorates in Humane Letters from the Lebanese American University and Notre Dame University of Lebanon. He was bestowed the rank of Commendatore of the Order of the Merit of the Italian Republic and, from 2001 to 2007, he was named by the Castle Connolly Guide as one of America’s Top Doctors.

In recognition of his enduring contributions to cancer medicine, the Baylor St. Luke’s Medical Center established, in 2010, the Philip A. Salem Chair in Cancer Research and, in 2018, the Philip Salem Annual Oncology Lecture. Several books have been published about Dr. Salem, the physician, scientist, visionary and philosopher.