Medical Cannabis Debate

May 20th, 2019

 Today there is a debate in Parliament addressing the fact that not a single NHS prescription has been written for any patient in the UK in the 6 months since medical cannabis was rescheduled.

Officially specialist doctors can prescribe it, but where are they?

The House of Lords criticised the British Government for failing “desperate” patients needing legal access to medical cannabis.

Prescriptions can be obtained privately, but this is too costly for most. Some families break the law and risk a criminal record by smuggling the drugs they need for their children from the Netherlands and there are several publicised cases of children’s life-threatening seizures with epilepsy being dramatically reduced, at a cost of £1500 for the medicines.

Medicinal cannabis is available in several other countries, and Dame Sally Davies Chief Medical Officer stated last summer that there is conclusive evidence that cannabis-based products are effective for certain medical conditions. And yet the guidelines for NHS doctors to prescribe it have been set too high and there appears to be little urgency to provide adequate training.

Personally, I have not been able to get chloroquine prescribed on NHS, despite my oncologist’s belief that it can be remarkably successful in killing cancer cells or delaying their development. Medics risk losing their licence if they prescribe outside the NHS protocol which is very narrow, and only accepts randomised controlled testing as “evidence” of safety and effectiveness. This explains why our survival rates for late stage cancer are the worst in Europe. Other countries are more open to off-label drugs and supplements which are well tolerated and have much evidence of effectiveness in use. But there is no money to be made by pharmaceutical companies out of drugs which they can’t patent.




First catch your shark 

 I had a list of drugs and supplements from Jane McLelland to manage my particular metastasised breast cancer. She is the author of How to Starve your Cancer and a great authority on off-label drugs and supplements.

 The problem is getting hold of some of these in the UK. Shark liver oil for example. Easy to find shark cartilage oil online, but not the liver oil.

 Knowing that it often easier to buy drugs and pharmaceuticals OTC in other countries I thought I would try my luck in Barbados, where I am currently on holiday. I had some success with the supplements. The pharmacies here are fantastic. Huge range of products and knowledgeable staff. 

 The drugs were a different story. I managed to buy chloroquine, by telling the pharmacist what dosage level I needed. (I suspect nobody really knows.) in the UK my oncologist thought that chloroquine was a great idea and claimed to have seen fantastic results from it. It promotes autopaghy. My GP wouldn’t prescribe it without the oncologist directing it, which he did by letter but didn’t specify a dosage.

 It was early December when I tried to get chloroquine. Early February now and I still didn’t have it , with no guarantee if, when or how to get it in the UK. But I could buy it here.

 The other drugs are more troublesome. They would need a doctor’s prescription and I don’t have time as the doctors who are knowledgeable about cancer are fully booked. And the pharmacists I asked hadn’t heard of Artemesinin, Dipyridamole or Mildonium.

I will get them somehow. Either from a private clinic in the UK or online from something like a Russian site. But all of this Is extremely time consuming (and expensive). I realise that we are in uncharted waters when it comes to fine tuning these supplements and drugs. And I take so many that we’ll never know which ones have or haven’t made a difference. I can’t take them sequentially because I would die first. 

 It shouldn’t be this hard. When are all the CAM (complementary and alternative) going to get their act together? Pool knowledge, including from other countries, and provide the best authoritative guidance. If you look hard into academic papers such as PubMed there is often information about some trials that look promising. But without a commercial incentive most of these are not followed through with bigger trials in humans.

 It will take time and probably a grass roots movement as the public become aware of the options they are not told about. I hope I live to see it.


Just in time for Christmas

Yesterday this was in a Sunday Times article:

It is often an excuse for an amorous encounter at Christmas parties, but now mistletoe is being touted as a potential treatment for cancer.

NHS patients in Scotland are being treated with an extract of the plant in the hope it can boost the body’s immune system and put cancer into remission.

At first, I thought this was new news, but in fact:

NHS Greater Glasgow and Clyde said that in the past two years, 47 patients had been referred for mistletoe therapy at its Centre for Integrative Care at Gartnavel hospital. NHS Lothian said it had sent 42 patients to the clinic between April 2014 and March this year.

In England, two clinics are listed by the website Mistletoe Therapy UK as offering the treatment with possible NHS funding.

Mistletoe therapy has been available for some time in this country, but it is good to see NHS making it available. In Germany and Switzerland extracts of mistletoe are the most commonly used adjuvant to conventional cancer treatments.  

It was Rudolf Steiner who first suggested mistletoe for cancer treatment in the early 1920s, but it has been used as a medicinal plant since ancient times. The tradition of kissing under the mistletoe started in ancient Greece.

I have been taking mistletoe for about two years. Firstly, as Iscador drops, prescribed by the Royal London Hospital for Integrated Medicine. NHS England recently withdrew their funding for this, and other homeopathic medicines. Recently I have privately been using injections, under medical supervision. The ampoules come from Germany and must be kept refrigerated. I inject myself three times per week.

As with any complementary therapy I will not know if it is working. It may enhance the effectiveness of chemotherapy or radiotherapy, or even have some direct effect on reducing the cancer itself and prolonging life. Which is also the case for other complementary drugs and supplements that I take.

I’m very encouraged that the NHS is not ruling out mistletoe therapy. Maybe we will slowly see more complementary treatments becoming mainstream with NHS blessing. That would be a marvellous Christmas gift.

Review of Yes to Life Conference 1.12.18

I over-reached myself last Saturday to attend the Yes to Life annual conference in London. I was utterly exhausted, but glad I went.

As their website says, Yes to Life empowers people with cancer to make informed decisions about their cancer care options. We provide information to guide people through the confusing options for care and lifestyle choices.

They don’t recommend foregoing NHS treatment and drug regimes, but want to increase knowledge of what complementary tests, treatments and supplements are available which may make conditions harder for cancer cells to thrive. This is very close to my heart as I soon realised that as a Stage 4 patient the NHS protocols were only expected to keep me alive for a very limited period.

While there are many excellent books, charities and other organisations imparting this knowledge my frustration is that they seem to plough their own furrows rather than working collaboratively to bring greater awareness into public knowledge and trying to affect medical opinion. It is hard for cancer patients to get the knowledge they need, and complementary therapies are certainly not endorsed by GPs and oncologists and often their use is discouraged.

Other advanced countries take a different view and have better survival rates than the UK.

The Yes to Life conference brought several different perspectives into the room.

The morning session was chaired by Patricia Peat, Founder of Cancer Options and whose book The Cancer Revolution provides information about treatments and therapies available in the UK and around the world.

Dr Ashwin Mehta updated us on developments in the US in integrative medicine, and the work of the Society for Integrative Oncology. From a country where doctors are financially incentivised to refer patients for chemotherapy, and “heads in beds” is seen as a healthy bottom line, this was welcome news.

Dr Abdul Slocum of the Chemo Thermia Oncology Centre in Istanbul told us about the results they obtain with their combination of therapies. They use Metabolically Supported Chemotherapy which means they can use lower doses of chemotherapy to improve treatment results and reduce side effects. Additionally, they use other treatments tailored to the patient’s metabolism, including hyperthermia, hyperbaric oxygen therapy, off-label drugs and supplements and diet. Dr Slocum showed many examples of patients they had treated successfully. For anyone with cancer who has the financial resources and can travel to Istanbul this would be worth looking into.

The afternoon session focused on developments in the UK.

Ally Jaffee and Iain Broadley were so shocked at the tiny amount of nutrition and lifestyle education on the syllabus of medical schools that they were motivated to found Nutritank, an information and innovation hub for food, nutrition and lifestyle. They work at grassroots and interprofessional levels. There are currently over 15 Nutritank Societies in medical schools increasing the knowledge of nutrition and lifestyle amongst medical students, the student population and the wider community, and increasingly in schools.

Dr Marie Polley told us exactly what Social Prescribing is, and progress being made to enable GPs and other frontline healthcare professionals to refer to a local link worker who can make referrals to support organisations, often in the voluntary and social sectors.

One of the themes for the day running through several presentations was meeting the patient where they are, often using motivational interviewing, so that they can devise a treatment plan which will work for their individual needs.

Robin Daly’s session on developments in Personal Health Budgets showed an example of how this can work in practice for people with continuing healthcare needs.

The final presentation was from the very lively Jonathan Liebling. Political director of the United Patients Alliance Deliberately not using the c word (cannabis) in its title, the Alliance advocates for medical cannabis to be legal, and works closely with the Centre for Medical Cannabis . Jonathan claims that there are currently 1.1m medical cannabis users in the UK, and that GPs on the frontline are supportive but can’t say so. With the increased prominence of the issue and the recent legalisation of medical cannabis he says that influential people now come to him, where previously he had been rejected. Jonathan was understandably very upbeat about recent changes, but it seems to me that progress towards patients actually being able to access medical cannabis is disappointingly slow and it is unclear when or if it will be licensed for use by cancer patients. But encouragingly Jonathan seems to have the ear of the right people.

Another theme for the day was that our health service needs to be more about health than treatment. In cancer that means the focus should be on healing the person, not just killing the cancer. This conference gave me hope that progress is at last being made towards this happening.


Medical Cannabis legal but only in very restricted cases

Today is the day when the law changes to allow the prescribing of medical cannabis. What will this mean in practice?

What is clear today is that the use of medical cannabis will be extremely limited.

From The Times

Doctors advised to refuse cannabis for MS sufferers

Thousands of people with multiple sclerosis will be denied cannabis medicines despite the drug being legally available for the first time today on the NHS.

Guidelines issued to doctors said that cannabis-based medicines were “not recommended” for chronic pain sufferers such as people with MS.

The MS Society condemned the guidance for being too “restrictive” and “ignoring clear evidence”. Genevieve Edwards, of the charity, said: “Today should mark a key milestone for people with MS. However, we’re really concerned that nothing will change in the short term for the one in ten people with MS who could get relief from pain and muscle spasms by using medicinal cannabis.



As of Thursday cannabis-based products can be prescribed, but only by specialist hospital doctors in a small number of cases, and not by GPs.

New NHS guidance for doctors in England says it should be prescribed only when there is clear published evidence of its benefit and other treatment options have been exhausted.

The treatments can be prescribed in cases of

§  Children with rare, severe forms of epilepsy

§  Adults with vomiting or nausea caused by chemotherapy

§  Adults with muscle stiffness caused by multiple sclerosis

If a patient is not already in touch with a specialist doctor they can be referred to one by their GP if the doctor deems this appropriate.


I wonder who these specialist doctors are? How many? Will medical cannabis be approved for a wider range of conditions in future.

Again, it comes down to what is accepted as evidence of benefit. Thousands of patients in the UK and other countries can provide testimony of how cannabis has helped them. But these are not clinical trials. For cancer the only allowable treatment is for vomiting or nausea caused by chemotherapy – but there is plenty of “evidence” to show that patients have benefitted in wider use. Similarly pain relief for other conditions. And what about Parkinson’s?

It seems that in the UK medical cannabis will be so tightly controlled that thousands of patients will be disappointed by not being able to access it.

Medical cannabis panel is failing us, families tell Sajid Javid

This was the heading in today’s Times.

I wondered how broadly the access to medical cannabis would be under the new licensing system. Would it be broad enough so that people with chronic illnesses such as MS, Parkinson’s, Huntington’s disease and cancer could benefit? Not to cure their condition, but to ease symptoms and potentially extend life.

My fear was that the review would only recommend medical cannabis for cases of the rare form of epilepsy in children, such as Alfie Dingle and Billy Caldwell whose cases had extensive media coverage. Both had shown dramatic improvement by having access to the drugs they needed in other countries.

The outcome seems to be even worse than I had feared. Alfie had already been approved before the expert panel was set up, Billie’s licence was approved on the day the panel was announced by Sajid Javid. Only one other licence has been issued, because the panel requires very difficult conditions to be met.

Evidence must be provided of exceptional clinical circumstances. They are asked if the product has already been effective for the patient – since it is illegal here this would have had to be in another country. Not an option for many families. There should be evidence that no suitable medical product is available in the UK – but there are about 20 anti-epileptic drugs and it would take a long time to try them all without success. Medicinal cannabis would be cheaper and not harmful, but doctors and NHS trusts are fearful of accepting clinical responsibility for prescribing it and parents have been unable to obtain the medication without their support.

Rather than radical change in the availability of medical cannabis for many people it seems we have a system which blocks change for all but a trickle of exceptional cases. Why don’t we learn from the experience of other countries where it is legal?

As the world’s largest exporter of cannabis for medical and scientific use providing nearly half of the world total it seems hypocritical not to allow UK patients to benefit. At the very least we should be doing research into effectiveness for different conditions and optimal dosage. But pharmaceutical companies can only make money if they can manufacture a new formulation – there is no money in natural remedies. Universities don’t seem to be doing any meaningful research into medical cannabis. Why isn’t there a publicly funded body to investigate this and a range of other treatments which are not commercial money spinners but could help patients and save NHS money?

The Care Oncology Clinic is a private clinic researching a combination of repurposed drugs which seem to be helpful for cancer. Metformin, Atorvastatin, Doxycycline and Mebendazole. These are all licensed for other conditions but seem to be helpful in blocking the processes used by cancer cells. Searching PubMed, I found a drug, Memantine, which might be helpful in reducing the impact of neurocognitive decline after brain radiotherapy. But not enough research has been done on it, and there is no commercial incentive for it.

The NHS expensively sells us late stage cancer patients short. We need to fund research and gain acceptance for integrated oncology treatments in the meantime. Sadly, medical cannabis so far does not seem to be the door opener.

Broadening the range of treatments for patients with secondary cancer

Today the NHS is 70 years old. And Parliament is going to review the guidelines on medical cannabis.

Lots of debates to be had about how good the NHS is, where it fails and how to spend the additional funding of £20bn recently announced. While I am benefiting from excellent care and expensive treatments from the NHS I want to focus on what more can be done additionally to help late stage cancer patients like me to have symptom relief or life extending treatments in addition to those they can access through their oncologists. Because we know that the UK lags behind almost all advanced economies in the 5-year survival rates for cancer. For breast cancer the UK results rank 23rd in the world.

The NHS provides no guidance on these complementary and adjunct drugs and therapies. Worse, in many cases the doctors and oncologists actively put people off trying them. The argument is that there is no evidence that X or Y will work for cancer patients.

It is understandable that GPs and oncologists will err on the side of caution. They don’t want to give false hope. They have no knowledge of the treatments (or curiosity it seems!) They might fear litigation. They prefer to deal with drugs and treatments where they have knowledge and control. And they don’t like their authority being challenged.

So, the question is: what counts as acceptable evidence? Randomised Control Testing (RCT) of drugs, funded by the pharmaceutical companies is the gold standard that the medical profession will accept. But for many practical and financial reasons it isn’t possible to do this kind of testing on cannabis, curcumin, repurposed drugs such as aspirin and metformin, diet or mindfulness meditation, to name but a few.

Sometimes stories can trump data and capture the public imagination. This is what has happened recently with the media coverage of the cases of Billy Caldwell and Alfie Dingley where their epileptic seizures were shown to be massively reduced by cannabis oil. Is this evidence? Obviously, evidence in these cases, but how widely will our legislators open the goal posts for medical cannabis for other conditions, such as MS, Parkinson’s or Cancer?

Absence of evidence is not the same as evidence of absence of effectiveness.

Unfortunately for now there is not much between the narrow NICE review of evidence and cost effectiveness, and the plethora of anecdotal stories, documented case studies and the large number of self help information groups, such as closed groups on Facebook. How are patients to wade through and evaluate all this information, sifting through the suppliers of supplements and regimes promoted on YouTube, some of which are excellent, and some are questionable.

A number of organisations are actively trying to promote integrated oncology, through conferences, interviews, books etc. These include Yes to Life, College of Medicine, CANCERactive and the British Society for Integrative Oncology (BSIO). Excellent stuff, but while there is great consensus at their conferences they don’t seem to be having any meaningful traction in broadening the NHS view on what they might sanction for their patients, so that they might stand a chance of living a bit longer and managing their cancer as a chronic disease. Why not? I don’t know, but I suspect it is due to a combination of factors. Amongst the different organisations no one body takes the lead – nobody is driving the bus and the individual voices are less strong than a united front with an activist agenda. MPs are heavily reliant on doctors to advise on any changes, and the medical profession is heavily influenced by the pharmaceutical companies. While I don’t believe that all Big Pharma is wicked, it’s certainly true that it is not in their commercial interests to support investigation into off-licence drugs which seem to have good effect in tackling cancer. (Off-licence doesn’t mean they are illegal – simply that they have a licence for one condition such as diabetes, but did not go through RCTs for cancer, so while there may be epidemiological evidence of effectiveness this is not “evidence” the NHS will accept.)

Where are the voices of other parts of the medical world and patients themselves? Hospices, palliative care specialists and nurses all may have a broader view of what is helpful, based on what they see helps patients.

I don’t expect any of the complementary drugs and therapies that I use to cure me of cancer. But if I want to live longer than the NHS drugs normally achieve I need to look outside their protocol. I hope to live long enough to take advantage of the emerging approaches of individual treatments, based on DNA profiling of the patient’s tumours.

If medical cannabis becomes available on the NHS, then the basis of what counts as acceptable evidence will have been challenged. It is my hope that this will lead to other drugs and treatments being investigated – they won’t need a change in the law, but permission for oncologists to recommend trying them or at least not discouraging patients from trying them would be a big step forward.

It is my view that the kind of culture change necessary in the NHS would take a generation to achieve. I would like to see an authoritative body to be set up, equivalent in status to NICE, which can firstly propose ground rules for what can count as evidence and then go on to investigate the very many options available to cancer patients. Particularly late stage patients, who might then have a realistic chance of living longer.

Some no-brainer cases showing why medical cannabis should be legal in UK

Billy Caldwell had up to a hundred seizures a night until his mother took him to America where he was prescribed cannabis oil. His seizures stopped, and his autism improved. When she ran out of money they returned home to Northern Ireland and her GP prescribed medicinal cannabis for 13 months. Then the GP received a letter from the Home Office and a warning at a meeting with drug enforcement officials telling him not to repeat any more prescriptions.

Billy’s mother went to Canada to legally buy the cannabis oil, but when she attempted to bring the bottles back into the UK they were confiscated at Heathrow. She begged Nick Hurd, a Home Office minister, to give her back the medicine but was told to apply for a licence which would take many months and could cost £100,00.

She insists that the medicinal cannabis oil is anti-epilepsy medicine, not a dangerous drug that could be used recreationally. He had a fit last night after missing his dose – his first in more than 250 days.

Many families face the same predicament, including six-year-old Alfie Dingley whose case I forwarded to my MP. His seizures reduced from 3,000 a year to 20 when he received the oil in Holland. Theresa May met his parents and said she would help, but nothing has changed so far. It is still classed as a schedule 1 drug and illegal to buy in the UK.

Surprisingly, Britain is the world’s largest exporter of cannabis for medical and scientific use. 44.9% of the world total. It is grown by one company, GW Pharmaceuticals, with a licence from the Home Office. The political angle is that the husband of Victoria Atkins, the Home Office minister, is responsible for this farm. Furthermore Philip May, husband of Theresa, is a relationship manager at Capital Group which part owns GW Pharmaceuticals.

GW makes Sativex, an oral spray for multiple sclerosis, which is the only legal use of medical cannabis in the UK. It sells for £125 for 10 ml. Anyone using any other form of medical cannabis theoretically faces a 14-year jail sentence.

The Home Office says that cannabis “in its raw form, it currently has no recognised medicinal or legitimate uses beyond potential research”. And yet thirteen European countries, thirty American states, Canada and Australia have found ways to legalise medical marijuana. Why can’t we? Is it because of the vested financial interests, or because of the lack of what the medical community here consider to be sufficient evidence of effectiveness? How can you gather evidence for something that is illegal? There is ample evidence of effectiveness from case studies around the world, but no UK based randomised controlled testing.

What counts as evidence? Tricky question which I hope to address in future blogs.

A surprisingly good meeting with my MP

I met my new (to me) MP, Jeremy Quin this afternoon.

I had emailed him off the back of a petition about Alfie Dingley, a six-year-old boy who has around 30 seizures per day but had 27 days free from seizures when his parents took him to the Netherlands and he could access medical cannabis. They want to have a special licence to enable Alfie to get this here, but our rules say he can’t.

I sent the suggested letter and prefaced it with some information about my interest in this as a person with terminal cancer. He replied with the expected outline of the status quo. Cannabis is not recognised in the UK s having any medicinal benefits, products must be thoroughly tested by the Medicines and Healthcare Products Regulatory Agency before they could be made available for medicinal use, so the Government would not issue licences for the personal consumption of cannabis.

I wasn’t expecting a positive response to what I wanted to tell him. This problem is wider than just cannabis – there is no recognised authority to say that any off licence, complementary or alternative treatment approaches, diet or supplements may be beneficial for cancer treatment.

It was news to Jeremy that there was lots of evidence that cannabis oil with THC kills cancer cells. And that off licence drugs such as those prescribed by the Care Oncology Clinic, or even aspirin, can make conditions tougher for cancer and so prolong life and perhaps enhance the effectiveness of chemo or ameliorate the side effects.

He told me that MPs are very dependent on what NHS medics tell them, as MPs themselves lack specialist knowledge. They are told that (except for Sativa, the one licensed drug) there is no evidence that cannabis is effective medically.

So what is evidence? The NHS currency is randomised controlled tests (RCT). Exceedingly expensive and normally funded by the big pharma company in their quest to find innovative profitable drugs. There is no commercial advantage for any organisation to do the research into drugs which are out of patent, and how could you provide RCT evidence for diet or cannabis?

He already knew that our performance for cancer survival is poor compared to other advanced countries, but he was genuinely surprised that epidemiological evidence exists for non-NHS treatments. He was very interested in whether my medical team supported my complementary treatments (they do, but most NHS oncologists are very constrained in what they can say outside of the usual protocol, and instead of being neutral they are often actively dismissive or hostile). He was interested as to how medical cannabis could be legalised without risking legitimising other forms of cannabis and increasing the risk of side-effects. Medical cannabis is, of course, a long way from street skunk and it would be easy to put in place adequate checks and balances.

He has undertaken to contact two MPs who have an interest and good knowledge in this area and agreed to do so with an open-mind. He feels that if the NHS is wrong in their approach things need to change. My view is that it would take far too long to bring about any change from within the NHS. What we need is a parallel body for integrated oncology, providing authoritative information about drugs and other treatments, and developing a framework for good evidence that isn’t RCT.

Let’s see what happens.

Shortcomings of the NHS for Cancer Care

I’m a big fan of the NHS, and very grateful for the treatment I am receiving for my grade 4 secondary metastatic breast cancer. Since being diagnosed I’ve made it my business to learn as much as I can about cancer treatments, both mainstream and complementary, in the UK and elsewhere in the world.  What I’ve learned has opened my eyes. We like to think of the NHS as a National Treasure. Best healthcare system in the world. 

Every advanced economy in the world except for the USA has a universal healthcare system. That’s more than 30 countries. They differ in the drugs, treatments and therapies they fund, but all have something in common. Their cancer survival results are strikingly superior to the NHS.

This winter especially we’ve all read about the long waits in A&E, cancelled operations, and staff shortages. And now the government has plans to increase funding, perhaps with a designated NHS tax. Good! Because we’ve been underfunding our health service for many years. We currently spend 9.1% of GDP on healthcare, while the EU average is 10.1%. We’re far behind the Netherlands, (12.9% of GDP), France 11.75% and Germany 11.3%. 

Our poor spending record shows up in our survival rates for cancer.  You might expect us to be world leaders, given all the excellent research we do. But we are at the bottom, not the top, of league tables for cancer survival. 

According to a UK 2020 report, The UK Health System – An International Comparison of Health Outcomes, in breast cancer the UK ranks 23rd in the world for five-year survival. Sweden is the best country, and if UK performed to Swedish standards it would save 4,242 lives a year.

Why do other countries do so much better than us, when the same treatments and drugs are available to all? Partly it is down to what is authorised for access under the healthcare system in each country. In the UK NICE controls the purse strings, and sometimes effective drugs are not permitted on the NHS which would be available to patients in other countries. Additionally, I have come to believe that the medical establishment in the UK is too narrow in its view of what is appropriate treatment. Unless there is a sufficiently robust evidence base, NHS doctors will not endorse treatments, drugs or therapies outside of their approved protocol. So, what is sufficient evidence? Randomised controlled tests are the currency acceptable to the NHS establishment. Fair enough, but there are many, many approaches where this level of evidence is not possible. And rather than remaining neutral about them, most NHS doctors will at best caution their cancer patients and at worst actively discourage their patients from trying them.

If the NHS protocols produced outstanding results this might be acceptable. But the standard approaches of surgery, chemotherapy and radiation followed by extremely sophisticated and expensive big pharma developed drugs are quite simply not good enough. At least for late stage cancer. They may be lifesaving and the best option in the short term despite the often-horrendous side effects, but the extraordinarily expensive drugs are not expected to provide a lasting solution. They last on average a few months until the cancer finds a way to outfox them. Now a few extra months when you are told that you are not expected to live for much longer is very welcome, but wouldn’t it be better to also use other approaches which might make things more difficult for the cancer and thus prolong life, even if not actually providing a cure?

In future, advances such as immunotherapy and individualised treatments may provide much better outcomes. But for now, there are many things which terminal cancer patients can usefully do which might buy them additional, precious quality time. These range from adjunct drugs which are licensed for other conditions but have beneficial actions in cancer to supplements, diet changes, medicinal cannabis, homeopathic remedies and alternative treatments such as acupuncture, reflexology or Reiki. Most of these will not make the cancer disappear, but they may enhance the effectiveness of the mainstream treatments, alleviate the nasty side effects, make conditions more difficult for cancer to thrive, strengthen the immune system to better deal with new cancer development and generally help the patient to feel better both physically and mentally, which has a beneficial systemic effect in the body. 

These complementary and alternative treatments are not easily testable in randomised controlled tests. Off patent drugs have no profit motivation for further research by big pharma companies. Terminal cancer patients don’t have time to try one treatment alone and wait to see if it works before trying another. How would you provide reliable evidence for diet, apart from case studies? And for cannabis, which is still illegal in the UK?

So, the medical establishment doesn’t provide guidance on any of them and it is up to the patients to do their own research. 

There must be a better way. We need a way to evaluate these integrated oncology options so that the medical establishment can either endorse them or at least stop being negative about them. 

I would like to explore opinion from people in different parts of the system to see what they think works now, what doesn’t work and potential ways forward to get better outcomes. I’ll write these up as blogs over time on this website. If I am successful in confounding medical expectations about how long I can expect to live, especially now that I have brain metastases, I may even be able to collate all the results into a second book. Watch this space!