We make decisions every day. Some decisions are just over trivial matters. For some people, their decisions can be a “mother” of all decisions – especially if you or your loved one is being diagnosed with dreadful diseases like cancer.  The consequence of your decisions can be a matter of living or dying.  I always say this to cancer patients, Listen to whatever comments or advices others give you, but remember that at the end of it all, you and you alone are going to bear the consequences of that decision. YOU suffer or you die, NOT them. 

Out of curiosity, before setting out to write this article I “googled”, How to make decisions to increase your odd of winning. The returns obtained were about roulette, blackjack, poker, betting, slot machine and investment, nothing about cancer!

The reality is that obtaining a cure for cancer is just like “striking the jackpot” (quoting a well known oncologist in Singapore).  His statement implies that undergoing cancer treatment is not much different from going to a casino.  The outcome is as uncertain as rolling the die. There would be losers and winners. And we know the odd of winning is very low indeed.  In fact, any honest and seasoned oncologist would not even use the word “cure” for cancer treatment – they only talk about remission.

Researchers, scientists, doctors, etc. follow different protocols when making decisions. But the essential element is the same – it must be based on research data. By studying the data we hope to be able to increase our odds to win.

Theorist Versus Frequentist

Professor Stephen Schneider (in The Patient from Hell) explained this very well.

“In every course I teach I like to demonstrate the difference between two ways of thinking by using the example of a coin toss. I flip a coin onto the back of my hand and cover it. “What is the probability of the coin under my hand is heads?” “One-half”, someone always shouts out. “How do you know?” “Well, the coin has two sides”. You’re a theorist!

“Suppose you didn’t understand the coin toss theory and didn’t realize that there was an equal chance of flipping heads or tails? You just keep flipping it and count the number of heads and tails. You’re a frequentist! You want to put together a frequency chart … make a table with a column for heads and a column for tails and them you want to flip the coin multiple times. If you flip it often enough and the coin is unloaded, you’ll end up with frequency statistics showing an approximately 50 percent chance of flipping heads or flipping tails.”

“This is how scientists like to work: They like to have masses of data they can use to create probability distributions that depict the likelihood of potential outcomes… then scientists can make estimates that have high confidence levels. It’s the same in medicine. Doctors like looking at data from clinical trials performed on hundreds of patients over many years, which can provide clear evidence as to whether certain treatments are effective, on average.”

“Unfortunately, the questions … can’t be solved using … frequency data, because they involve many components of deep uncertainty.”

Professor Schneider concluded:

“Some scientists, including many medical doctors, still seem to be living in the nineteenth century in this respect, thinking that for any question, infinite sets of replicable experiments should be performed, providing them with data from which they can calculate probabilities … and “scientifically” tackle the problem at hand. Unfortunately, in the real world, as topics of inquiry become increasingly complex and involve questions about the future, scientists do not always enjoy the luxury of extensive, comprehensive and reliable frequency data when they need them.”

Intuition and Commonsense

At CA Care, I have a different view about how to solve problems.  While data based on clinical trial is a good way to indicate our chances of obtaining certain benefits or survival, etc., the data need NOT apply to you as a patient. For example, if you undergo chemo, the 5-year survival rate is 30%. You may belong to that 30% who survived or you may belong to the 70% who don’t survive. Nobody can tell for sure which group you belong to. So research data like that only provides you with a confidence level, saying that what you are going to do has a certain degree of probability that you are right.

So at CA Care I tell cancer patients to make decisions based on intuition and common sense.  Experiences show that at times certain thing happens beyond the understanding of science, yet the “heart” seems to “sense” it. Patients come to me asking if they should undergo chemotherapy or not. My answer is: What does your heart say? I do not ask, What did your doctor say or what did your relatives or friends say. My advice is, Follow your heart or the Inner Voice within you.

This does not mean that I ask you to ignore scientific data. Bear in mind that I was once a researcher and a scientist. But I also know that science deals only with the physical realm. You and I and life are made up of the sum total of the physical and spiritual realms.  The spiritual realm is superior to the physical realm. The spiritual realm impacts the physical realm. Science believes the opposite – the physical is everything and the spiritual does not exist and is totally ignored.

So for any life and death decision, I believe you cannot ignore your spiritual self. Also, I urge you to use your commonsense. There is a saying, Educated men need not be wise, and wise men need not be educated. Each of us is capable of making wise decision – you don’t need to be a scientist to make wise decisions. In order to guide you to make decisions, I say you need to consider the pros and cons –  a more scholarly term is to carry out a Cost-Benefit Analysis. Count your costs and weigh them against the benefits. Decide for yourself what you really want out of this life. Doctors have their own perspectives of what is good for you. Their value judgment may differ greatly from yours or may be even opposite of yours.  Following totally the doctors’ advice means you totally agree with their value judgment. Is this what you really want?

The function of CA Care is to provide you with honest, unbiased information of the various options available to you. Having done that, it is up to you to make your own decision based on what you think is right for you. We do NOT talk the language of doctors. We don’t think like them too. But this does make us anti-doctors. CA Care is not anti-doctors.  Everyone who comes to see us is advised to consult his/her doctor first.  If you want to do chemo, radiotherapy, etc.  and etc., go ahead and do it. The only thing we tell you is, You are responsible for the consequences of your decisions. Don’t use our herbs your scapegoat. If is most unfair to come back and blame us when things go wrong. Unfortunately some patients do that.

I am not alone in advocating such practice.  Let me quote Professor Schneider again:

“What is “dangerous” is a value judgment …  It is the policymakers  who need to decide whether risks are acceptable … or should be ignored …. We scientists can provide policymakers with information on which they can better make these decisions. In a medical setting, the science comes from medical research studies and doctors’ opinion based on their experience with data on, and knowledge of the subject. The “policymakers” are the patients, who, working together with their doctors, must make value judgment about what health risks to take.”

Experience of a Near-Missed Flight

Let me relate what happened to us a few days ago while wanting to fly home from the US. Our flights involved Delta 1097 from Raleigh-Durham (RDU) to Los Angeles (LAX) – Taipei – Penang. It does not take a scientist to know that if Delta 1097 is delayed, we would have missed the other connecting flights. I knew where the “weakness” was. And we must be well prepared for it.

From the Airline’s website, we studied the history of Delta 1097. For the past eight days (Table below) DL 1097 had always left RDU at about 8 pm and arrived LAX by about 10 pm.  Since we have to be at the check-in counter of China Airlines by about 12 midnight for the connecting flight to Taipei, I figured out I have ample time. So our risk of missing the connection is very slim. There would be no problem!   So my daughter bought the Delta ticket with full confidence that everything would be alright.

Somehow on the evening of 25 June, I did not feel good about our flight home on 27 June. Something in me – my intuition – was saying that something was going to go wrong.  I requested our daughter to find an alternative flight – probably taking the flight a day before or a flight in the morning on the same day. This would mean we could be in Los Angeles well ahead of time. I was fully aware that my request made my daughter “go crazy.” Daddy must be mad to cook up something like this. Why push the panic button unnecessarily? This is what they call “borrowing worry.” But anyway, we tried to “fix” my concern the next day. Unfortunately we could not find any slot in spite of the many possible flights out of RDU.

Looking at the flight data above, the worse delay that had ever occurred so far was on 22 June. The flight was delayed by about an hour due to poor weather in Atlanta – thus causing a chain reaction. My son (in training to be a scientist too, doing Ph.D. in Cancer Biology at M.D. Anderson!) assured me that based on the above data, there should NOT be any reason why I should lose my sleep. He predicted the flight would go as schedule. The previous delay was due to weather condition. But in my case, the weather was fine.  Disruption by weather condition in summer is rare.  So in theory the odd against serious flight delay is minimal in my case.  So, we made a “scientific decision” just like oncologists do when they give patients chemotherapy or radiotherapy.

Before going to the airport, I was tracking the flight schedule at home. Everything seemed to be okay. With confidence, on 27 June, we drove to the airport to catch our DL 1097. It was about 5 pm then and we were about to arrive at the airport. My daughter’s mobile phone rang. She picked it up. Then there was a sober silence.  I asked,  Delta called? Flight delay?   Irene (a Clinical Psychology Ph.D. intern at Duke University), being a very gentle lady that she always is, said, Papa, please don’t panic. Yes, the flight was delayed until 9.15 pm! In actual fact, it was not really 9.15 pm. The flight only took off at 10 pm.  This was the worst delay ever recorded. I told my daughter, My intuition turned out correct. We will take it easy. This thing happened for a reason. But it  not as critical as those cancer patients whose lives have been turned upside down and inside out after being told they have cancer. Take it positively.

In theory this delay put the probability of us missing our connecting flight as extremely high. I remember thinking what would happen to all those cancer patients who wanted to see me on Friday, I July afternoon. They had bought their tickets to fly in from Indonesia and Singapore hoping to see me.  They would be disappointed.

Our “fighting” instinct took over.  We were supposed to go for our dinner first before arriving at the airport. We had already checked in on-line. Because of what had happened we drove straight to the airport. We talked to the Delta people and asked for possible alternative routing or airline. Unfortunately, there was no other option left. We still have to take Delta 1097 and bet on our luck.

Imagine the predicament I would face – what was I to do after landing in Los Angeles in the middle of the night? Where to go? How to find another flight to come home?

To cut the story short, we did not miss our connection! On Wednesday 27 June we landed home safely in Penang as scheduled. How did we pull this off?

These are the reasons why.

1. We did not panic and kept our cool. Instead of cursing Delta, we accepted the situation.
2. We started to take positive actions to solve the problem – taking the bull by the horn! We drove to the airport right away instead of going to dinner first. We had to find the solution to our problem and did not allow the problem to revolve by itself or taking it “lying down.”
3. We talked to the Delta staff. David, the gentleman who handled our case, was very helpful but he could not offer any alternative flight. They were either all full or not suitable.  But one thing David did right, which I believe helped increased our odd at “winning”. David offered to transfer our baggage from Delta to China Airlines without us having to wait at the baggage area and collect it personally. This is something the airline does not normally do because we have separate tickets for both flights from different airlines. No doubt about it, if we have to wait to collect our baggage, we would definitely miss our connecting flight.
4. Then, we worked out a back-up plan, should we miss the connecting flight. This provided us with peace of mind. We knew exactly that we would have to do. The fear of being left stranded in the big Los Angeles airport in the middle of the night evaporated. After this was sorted out, we went for our dinner. I ordered an extra-large bowl of Vietnamese noodle – and there were no butterflies in my stomach!
5. Looking at my watch before the plane was about to land in Los Angeles, I felt we would miss the connecting flight. I made another move.  I relayed our problem to the flight attendants and asked for help.  I requested to pick up my hand-on and let us be the first ones to get out of the plane. The male steward listened to my request and shrugged his shoulders. Either he did not understand me or he was dumb or was not the helpful type. I then talked to the female attendant in charge and she understood me.  She made an announcement requesting other passengers to hold on to allow us to leave first.  I looked at my watch again. We only had 10 minutes to get out of the plane and rushed from Terminal 5 to Terminal 3 where China Airlines is. That was a big deal.
6. My daughter took another positive step. She informed the China Airline counter about our problem. So when we arrived at the check-in counter at 12 midnight, we were attended to right away.
7. Three weeks earlier, when my wife and I arrived at the Los Angeles airport, I did my homework. In preparation for such anticipated problem, I took time and walked around to study the layout of the airport. I made sure I know how to get to the International terminal from the Delta terminal.  I had to turn left not right! So I have done my homework well ahead of time.

What a relief after being given the boarding pass by China Airlines. There was no more fear that we would miss our flight!  My wife and I went through the security check.

Feeling relieved, I became complacent. I blindly followed other passengers to the boarding gate and couldn’t careless to check what our depart gate was, as printed on our boarding pass. After all the planning and rushing, you believe that Chris Teo would do such a silly thing? We ended going to the wrong end of the terminal. The China Airline boarding gate was on the opposite end of the terminal.  I should have checked first and turned right instead of left. I did not do that and was complacent. I should not have followed other passengers blindly! Again, it was a mad rush. The plane took off about 30 minutes late, not because of my fault though – it was a full-load and that took time to get everyone on board.

Lessons We Can Learn

I have never been in such a predicament before. But I must say, my predicament was not anywhere near what cancer patients experience after being told that they have cancer. I am also not saying that the way I solve my problem is the best way. You may have your own way – so be it. Nevertheless, I believe there are some basic ingredients in every successful endeavor – whether missing a plane flight or having cancer.  These are some important points to remember.

1. Don’t panic when confronted with a problem.
2. Everything in life happens for a reason. Later on you may want to find that reason but for the moment, it is not the time to find that reason. No need to ask why. No need to find a scapegoat.
3. Take positive actions to resolve the problem. Give your best shot. This is your problem. If you do not show much interest to help yourself, don’t expect others to help you.

I receive e-mails from patients every day. Indeed I felt disappointed reading some of them. Many like to throw their problems at me and expect me to solve their problems while they sit in front of their computers at home! My answer has always been: If I can help you, please come and see me. If you cannot come and see me, how do you expect me to give you my full attention?

Please read the e-mails below.

• Hi Dr Teo, Thank you for your prompt response. I am from Singapore. In fact, I had placed an order for Rodent Tuber capsules from one supplier in Malaysia as my mother had problem taking the grinded fresh rodent tuber plant since she complaint of biting on the tongue and throat. Besides this plant, she is constantly seeking TCM treatment.

Reply: That stuff cannot possibly be from CA Care. We don’t do things like that. Patients need to come and see me with all the medical reports before we give out our herbs.

• Thanks for your reply. I had gone into your homepage. In my mom’s case, there was no biopsy done. It’s merely from the X-ray done that the doctor concluded that it’s advanced stage lung cancer (both sides). If I can get hold of the X-ray results and emailed to you, is it possible for you to give some recommendation?

My reaction: How serious or valuable is her mother’s life? Sitting in front of a computer is not going to help much.

 4.    Formulate a back-up plan in case the first plan fails. This is the reason why I often tell patients, If you do not get any better or benefit after two weeks of taking the herbs and changing your diet, please go to someone else for help.  

Goh is a 58-year male with multiple myeloma. He received 22 cycles of chemo and suffered a relapse. He was asked to undergo 32 cycles more of chemo. After 6 cycles of the second round of chemo, he gave up due to severe side effects. What does commonsense tell you about such a case?

5.    Share your problems with others. There may be opportunities that you may not know about.  If presented courteously, those in the position to help may offer extraordinary help to solve your problem. In my near-miss flight, David at the RDU airport and the female flight attendant had contributed positively. Without their help I am sure we would have missed the connecting flight.

6.    Do your homework. This again is one thing that upset me after reading e-mails from patients. People who wrote me did not read our website carefully enough. Most of the things you need to know about cancer and how to go about it, can be found in our website. What you need to DO is just read them – and I know most of them don’t read. They want me to serve them the information on a silver platter. Remember that knowledge is power. There is a Chinese saying: Dig your well before you become thirsty. Do that if you are wise.

7.    Don’t be complacent. I almost had to pay for my own foolishness. Many cancer patients become complacent after they get well – they think they have already solved their problem. Such people would then go back to their old ways and fall into the same hole again. Cancer can recur. To me, there is no such thing as a permanent cure for cancer.  So don’t be misled.

Let me give you one example. There was this elderly lady with colon cancer. She refused chemotherapy and was with us for more than three years now. She was doing very well. Lately, she told her family that she was fed up taking the herbs besides having to take care of her diet. She and her family came to see us. I gave her a big smile and laughed. And I said, It is fine with me. It is your life and if you wish to “go home early” that is okay too.  After all many of us believe that living in this world is nothing else but suffering. But if you want me to agree to what you want to do, I must say you are foolish. Why do you want to change something that has made you well in the first place? Anyway, if the cancer comes back, you can always go for chemo. You have not done that yet!  The problem with cancer is that we do not know when it will strike back again. There is no room for complacency.