Forty Years of Experience with Cancer; What Have I Learned?

I'm delighted to be with you tonight and to share with you this beautiful evening. Also, I feel privileged to be asked to speak to you and I'm very thankful to the organizing committee and to Mr. Ayoub for inviting me. 

Today, I'm going to focus on my experience as a physician, and more specifically, as a cancer physician, and how this experience has helped me shape a new vision and a new philosophy towards life. This philosophy is not based on the abstract, it is based on the harsh realities of life; it is based on a real and intense personal experience with disease, pain, suffering, agony, dying, and death.

I was born on July 13, 1941 in a small village called, Bterram, of El Koura District of North Lebanon. My horoscope is cancer. In that very same year, Memorial-Sloan Kettering Cancer Center, where I was to go later in life and study, was also established. I received my elementary education at the Elementary School in Bterram. Thereafter, I studied at the Bishmizeen High School and in Tripoli. At the age of 16, I joined the American University of Beirut and I graduated from its medical school in June, 1965. Before I entered medical school, I majored in Philosophy. I did not study medicine because I thought it was a good, prestigious, and glamorous job. I went to medical school with the objective of helping the sick, and with the deep conviction that medicine is not a job, but a noble mission. The early 60's were the days of ideology and idealism in Lebanon. At that time, I was a young, idealistic and a pure student. After graduating from medical school, I did three years of training in internal medicine. At the same time, I was studying philosophy at the American University of Beirut, and I was also teaching biology at the Lebanese University. I decided to study cancer in 1966. That decision was based on a painful personal experience with a friend who died of cancer. At the same time, I felt that in those days, cancer was treated only by ignoring it. People who developed cancer then, were left to suffer with pain and die with indignity. In June, 1968, I arrived in New York to study at the Memorial-Sloan Kettering Cancer Center. I was convinced that within the coming forty years, cancer would be conquered. I was wrong. At that time, Memorial-Sloan Kettering was the Mecca of cancer therapy. And thus, I was privileged to treat many famous, rich, and powerful people. It was there where I discovered that being famous and rich does not mean being happy. After spending two years at Memorial, I went South for a third year of training at the M.D. Anderson Cancer Center in Houston, Texas, which eventually, has become my professional home in America. In 1971, I returned to Beirut with the objective of establishing the best cancer treatment and research center for the Middle East. When this was done, war erupted in Beirut. In the early days of the war in Beirut, nobody ever dreamt that this war would last sixteen full years; but it did, and I lived in Beirut through the war. Thus, it was my destiny to witness the cruelty of nature via a disease like cancer for forty years; and also to witness the cruelty of man via a war in Lebanon for sixteen years. I left my beloved City, Beirut, for the last time in 1985 and I was forced to come to America in January of 1987, where I joined M.D. Anderson Cancer Center. Since 1991, I have been in charge of the cancer research program at St. Luke's Episcopal Hospital in Houston, Texas. I'm here tonight to tell you of the lessons I have learned from this experience; with disease and with war.

Lesson #1:       Life is a privilege, not a given. Life begins with an accident of biology. We are here by accident and not by design. Being here is a privilege that was given to us, and not a privilege that we have earned. We are also here for a specific period of time and eventually, we wither and die. The challenge is to make maximum use of this privilege. Enjoy life, carve some depth and some meaningfulness into it, carve a path and a mission worthy of you, think about the wonders of life and the universe, and the millions of questions that remain without answers as to the origin, direction, and fate of the universe. We are tiny little things in this unlimited and infinite universe, yet, each one of us is an infinite universe by himself/herself. Whatever direction you take; whether it is space or biology, the line will be infinite. Joy, in my opinion, is the essence of life. To achieve joy, you have to achieve peace with the world and peace with yourself. My advice here, is to enjoy every day of your life. To do that vertically and in depth, and not horizontally and superficially. Your joy should be part of the joy of the world and part of a noble mission. 

Lesson #2:       Health is the greatest gift. Although health is determined to a large extent, by genetic factors, the greatest wealth that you may achieve is to maintain that health. It is true that the inheritance of your genes was not done by your choice, but it is also true tht it's your choice and your responsibility to maintain your health. Many diseases are preventable, and if not, are treatable. The most important basic right to man, is the right to medical care, because this right is the first step towards good health. Without health, there is very little that could be achieved in life. Health is the major cornerstone for living, and living well, and with meaning. Most people understand their rights to freedom, liberty, education, and other basic needs, but very few people appreciate their rights to health. The keys to health include the following: 

1. Public health education. You do not realize your basic rights in health, because you are not educated about health. It's only when people get educated about these rights, that they become aware of their significance. Health education is a major key to health. It is time to incorporate health education in our school and college curricula. It is no longer permissible for a woman to graduate from college without knowing some basic information about cancer of the breast. The difference between knowing this information and not knowing it, is the difference between life and death. 
2. The second key is the availability of good medicine. When you are sick, you do not need only medicine, you need good medicine. Quality is the key in medicine, without it, there is no medicine. When you need a doctor, go to the best. After being in medicine for forty-six years, I can honestly tell you that when I'm sick, I'd rather see a physician who is knowledgeable and would charge me $1,000., rather than a physician who is not knowledgeable and who would not charge me at all. One great lesson that I have learned from my experience with medicine, is that I would rather pay with dollars, rather than with blood and life. America is now embarking on an adventure in medical care, that will eventually lead nowhere, but to a scandal. You must have heard a great deal in the last three years of cost-effectiveness; cutting costs, accessibility to medical care and managed care. All this will eventually lead to a major victim, quality. Without it, American medicine will plunge to levels unimaginable and undesirable.   
3. Medicine and politics are intertwined. Without moral and courageous politicians, it will be difficult to institute the real health policies we need. The 21st Century is on our doors and yet, even in America, people are allowed to buy severely toxic and addictive substances like tobacco. Politicians know that every year, tobacco kills three million people all over the world. It is the influence of industry, money, and lack of courage that make them unwilling to take radical moves to stop this crime against humanity. Politicians know that dumping nuclear and chemical waste on the shores of the Mediterranean, the Pacific, and other shores of the developing world, will eventually lead to hundreds of diseases in these areas. They do so for financial reasons, without the slightest respect for the moral implications involved. It is Khalil Gibran, the Lebanese poet and author who said, "If you kill one person, you are a criminal; if you kill a nation, you are a hero." One would add now, if you kill many nations, you are a super hero. In regard to health, my advice is, if you are healthy, try to maintain it; if you are not, seek the best medicine.

Lesson #3:       Disease, not man, is the major enemy of man. There is no enemy that belittles man like disease. There is no enemy that humiliates man like disease. In the last twenty Centuries of recorded history, man has waged war against man. Shall we dream that man in the 21st Century will at least start to transcend this level of vision to a higher one where all mankind will unite against a major enemy called disease? The real enemies to man at the moment are: AIDS, cancer, heart disease, and infectious diseases. Man may not be convinced that disease is his major enemy until, (and hopefully, we will never witness that), a global outbreak of infectious disease occurs. I have little doubt that twenty Centuries from today, man would look at us as primitive people who believed in nationalism, primitive people divided by boundaries of geography and political ideologies. It is only a pity that man continues to devise technology and science in order to kill man. All over the world, nations invest in technology and ideology to fight other men, rather than in major programs for healthcare and education. I would only hope that eventually, man would mature enough to realize that man is his brother, not his enemy, and that the real enemy is disease. 

Lesson #4:       Love, not power is the greatest force in the world. Although I deal with the body, with the concrete, with the visible, my experience with diseease has led me to believe that it is love and not power which is the greatest force in the world. Without love, there is little meaning and there is little joy. It is indeed love that makes life worth living. It is unfortunate that in America love has been reduced to its pure physical component. This is indeed a tragedy. The breakdown of love is responsible for the breakdown of the family and the breakdown of friendships, and the breakdown of moral values in America. It is this fierce philosophy of materialism in America that I'm afraid will eventually lead to the collapse of American civilization. America can win the whole world by technology, science, and war, but it will lose the major war, if it does not win the battle inside America. Children are being taught every day, that the index of success is material wealth; at any cost. Values and moral directives are being eroded for the sake of accumulating more wealth. To love your parent, to love your grandparent, to love your brother, to love your friends, to love people is a basic need. The major motto of America now is "I love you because I need you". We need to make a major effort to reverse this motto for another motto which says, "I need you because I love you". Without love, there is no joy and without joy, there is not much sense in being and in living.

One of the greatest joys is giving. The major emphasis in America today is on taking, and not giving. It is the joy of taking; it is the joy of promoting the self. Everything is now centered on the self. What is in it for me is the motto. It is time to teach our children and to teach in schools, the art of giving, the art of selflessness. It is only when you extend yourself to your friends and to others, that you experience real joy. I was personally privileged to experience the joy of giving the best that you could ever give, and that is life. There is no joy which is superior to giving life. That should be the reward of the physician.

Lesson #5:       The triangle of glamour, money, and power is poison. I have been privileged to see during my professional career, a large number of people who have been plagued with this triangle. And I have seen how sad and miserable they are. Most people work very hard to achieve this triangle, and once achieved, they realize that it is a mirage. Power, money, and glamour are wild horses, if you do not know how to reign them in, you will eventually fall off their backs. It takes character to reign in these wild horses. Power is poisonous and corruptive, unless you are really powerful from the inside and you realize that it should be used for the service of others. Money is dizzying, unless it is used to help people. Glamour is toxic to the brain, unless accepted with humor and humility. It is only when you get close to death, you realize what life is about, and the depth of the meaning of being alive. It is only when you get close to death, you see and you see very clearly, that power, money, and glamour are at the periphery rather than the core of being.

Lesson #6:       Courage is the fuel of life. What I have learned from my patients is courage. It takes a lot of courage to fight disease and despair. In cancer, where treatment is intense, prolonged and sometimes, physically and emotionally mutilating; only those who had courage to go through a difficult journey achieved cure. This is also true of life; only those who have courage to face life and its cruelties will eventually make it. When you see cancer patients struggling with pain and agony; and suffering with dignity and courage, how dare you not have the courage to say the truth; how dare you not have the courage to live by your beliefs; how dare you not have the courage to stand up and refuse to accept what is unacceptable; how dare you not have courage and be yourself?

Lesson #7:       Perseverance is the key to success. No cancer patient would have made it to cure without perseverance. And no cancer researcher would have achieved a breakthrough without perseverance. Those who give in easily, fall off in the beginning of the journey. Only those who work hard and persevere reach the end of the line. To my mind, the three essentials for success are: hard work, perseverance, and courage. Genius comes second to these three essentials. In my daily work and fight against disease and death, it always takes perseverance on my side and perseverance on the side of the patient, to achieve cure. Patients who give up, die. Physicians who cannot endure, fall. The key test to determination is perseverance. 

Lesson #8:       Arrogance is sickness, humility is power. I have learned humility from my experience with cancer research. Research taught me how little I know; and how infinite is that, that I do not know. I have also learned how important it is to change my mind. Those who are arrogant and who think that they know almost everything will never make progress and will never achieve anything. The truth needs humility; progress needs the ability to change your mind constantly and adjust to new realities. I want to dare to tell you tonight that the major objective of science and research is really not to discover the truth and new realities, as much as it is to train the mind and make it malleable and innovative. The objective of science is to eradicate arrogance, since arrogance is a disease which plagues the human spirit and human mind. I was most arrogant when I was a chief resident of medicine in 1968 in Beirut. As I matured in research, the arrogance in me has decreased steadily. The more I have learned about cancer and disease, the more I have realized how little my knowledge is, and how vast the unknown remains. The deeper you plunge into research, the greater becomes your wonder about the world, the universe and the creation. Whether you study the cell or the universe, both are immense and limitless. How can you not be humble when you realize how little you are in this boundless universe? How can you not be humble when you realize that the cell which is the smallest structural unit of the living is also boundless, immense, and limitless.

Lesson #9:       Do not sell yourself for success. Most people look at success and progress as a ladder that they have to climb, and unfortunately, every step they climb, some sell parts of themselves to others to make the step. By the time they arrive at the top, they have already sold everything they had, and whatever they had achieved of material wealth, power, fame, and image, will be totally meaningless and empty. If I have a message for you tonight, it is to beg you not to ever lose yourself. Climbing the stairs should not be made at the expense of selling yourself.   The greatest mistake you could ever make is to lose yourself for the sake of accumulating wealth or brightening your image. Neither wealth nor image would have meaning without "yourself". At the end of the day you go back home and you will be alone; And if you had sold yourself, you would be a terribly lonely and miserable person.

Lesson #10:     The ladder of progress is only a mirage. If I have learned anything from my experience and journey, it is that this imaginary ladder of progress is nothing but a mirage. The journey that you have to make in life is not upwards; it is inwards. It is not a journey to achieve something outside you, it is a journey to achieve something inside you. It is a journey to recapture yourself. The ultimate objective of life is to be at peace with yourself; to be respectful of yourself; to be proud of yourself and to be in joy with the world. If you do not realize that, at the end of the fight, at the end of the journey, and at the end of the day, you will regret it tremendously.

Ladies and gentlemen.....I would like to apologize to you for this sermon, but I thought you might be interested in knowing what a man who has been at war with disease, cancer, and death for forty years, has to say. I thought you might be interested in seeing the other side of the coin. You always have the opportunity to hear the healthy, the successful, and the powerful speak. But I come here to you to speak out of pain and out of my experience with disease. I'm somebody who has seen the other side of life. I thank God for showing me the light, for curing me from the common diseases of man: greed, power, money, and glamour; and above all, for giving me the strength to serve the weak, the sick, and the dying.

I must tell you that my journey with disease has been very enriching. It made me closer to my elements. It has taught me that the greatest joy is in giving; It has taught me that the greatest power is in serving.   May God give you the power to see, the courage to believe, and the gift of living the life which is worthy of your living. 

Thank you.

Forty Years of Experience with Cancer
What Have I Learned?

1. The joy of being.
2. The importance of health.
3. Love as the greatest force.
4. Courage to face disease.
5. Perseverance as the key to success.
6. Teamwork.
7. Research teaches you that you know so little; teaches you humility.
8. Disease is a major enemy of man.
9. Lack of public health education.
10. The myth of money, fame, power triangle.
11. The joy of giving, rather than the joy of taking.
12. The need for love rather than love for need.
13. When you struggle to go upstairs, do not lose yourself. The stairs are a mirage. Do not feel criticism. Don't let praise go to your head. Do not let success corrupt you.
14. Don't take life or health for granted; Enjoy every minute.

• 2015 Universal Declaration of Human Rights
• AN ADVENTURE WITH CANCER: THE JOY AND THE PAIN
• Annual Philip A Salem M.D. Oncology Lecture - December 20, 2023
• DR. SALEM’S ACCEPTANCE SPEECH FOR THE FOEDUS AWARD
• Forty Years of Experience with Cancer; What Have I Learned?
• Michael Debakey - The Real Man Behind the Genius by Dr. Philip A. Salem
• MY MESSAGE TO THE GRADUATES
• Rene Moawad Foundation Award
• The invitation to the AUB Founder's Day (144th)