Actor Patrick Swayze, a life-long heavy smoker, died of pancreatic cancer on September 14, 2009. The next day his Stanford University treating oncologist, Dr. George A. Fisher, was interviewed on Larry King Live (transcript | video clip at top).
"He continued to smoke. Was that a bad idea?" asked Larry King.
"I think at the point that one is already diagnosed with cancer, there's little additional harm in it," replied Dr. Fisher. "And if it -- it seems to provide him some comfort or partly identity of who he is, I certainly have no objections to that."
Little harm in cancer patients smoking? No objections? How many cancer patients heard Dr. Fisher's unqualified "smoking's okay" assertion? How many seized upon it as justification to relapse to smoking? Needless to say, researchers and physicians were stunned by Dr. Fisher's comments.
"Although I can understand why the oncologist made those remarks I think it was irresponsible," says Dr. Gert S. Maritz, a South African biosciences professor at the University of the Western Cape, whose research focus is nicotine's impact upon the body. "Nicotine is a cancer promoter. It may also interfere with cancer treatment."
"Dr. Fisher's response to Larry King's question is not only totally wrong, but dangerously misleading," contends K.H. Ginzel, MD, a retired University of Arkansas pharmacology and toxicology professor, whose research dating back to 1953 helped pioneer our understanding of nicotine. "Especially for smokers who are diagnosed with cancer, any type of cancer."
"Tumor growth occurs when the critical balance between cell proliferation and programmed cell death (apoptosis) in normal healthy tissues is disturbed," wrote Dr. Ginzel in a 2007 journal article. According to Dr. Ginzel, whether nicotine arrives via cigarette smoking or NRT it promotes unregulated tumor growth and accelerates cancer's migration. He cites research findings showing that nicotine inhibits programmed cell death, and stimulates proliferation of endothelial cells and the formation of new blood vessels (angiogenesis), a basic requirement for tumor growth.
A comprehensive review of medical literature associated smoking and quitting among cancer patients was published in the journal Cancer in 2006. It asserts that, "Continued smoking after cancer diagnosis has substantial adverse effects on treatment effectiveness, overall survival, risk of second primary malignancies, and quality of life."
Dr. Fisher reportedly began treating Swayze shortly after being diagnosed with stage IV pancreatic cancer in January 2008. Swayze claimed he could easily have quit smoking.
Was his decision to continue smoking influenced by Dr. Fisher's belief that there's little harm in cancer patients smoking?
Barbara Walters of 20/20 interviewed and asked Swayze about his continued smoking in January 2009. "Will stopping smoking now stop anything, change anything?" countered Swayze. "No! But when it looks like I may live longer than five minutes I'll drop cigarettes like a hot potato."
How long would Patrick Swayze have lived had he given cigarettes the hot potato treatment when first diagnosed with cancer twenty months ago? No one knows for certain, including Dr. Fisher.
While reported that Swayze's pancreatic cancer was relatively small when diagnosed, tumors were identified in other parts of his body, including his liver. Advanced and inoperable, his best hope was chemotherapy.
Hildegard M. Schuller, DVM, PhD, is a University of Tennessee comparative pathology professor who has written extensively on cancer's neurotransmission. Dr. Schuller co-authored a March 2009 journal article on how nicotine stimulates pancreatic cancer.
"Nicotinic receptors stimulate the development and progression of the most common human cancers, such as cancer of the lungs, breast, colon, pancreas, prostate and others by several mechanisms," says Dr. Schuller. They include "the formation of daughter cells (a process called 'cell proliferation'), the ability of the cancer cells to migrate into adjacent and distant organs (a process called 'metastasis'), the formation of new blood vessels that supply the cancer with nutrients (a process called 'angiogenesis') and an inhibition of controlled cell death (a process called 'apoptosis')."
"These effects of nicotinic receptors on cancer cells are activated by nicotine and by nitrosated nicotine products (called 'nitrosamines') that are formed in tobacco and in the human organism," states Dr. Schuller. "Smoking after diagnosis of cancer and during therapy therefore makes it harder for any type of cancer therapy to work because the cancer continues to be stimulated by the activated nicotinic receptors."
"If you want to stop your car you do not press both the accelerator and the brake because that would make it harder for the brake to work. You take your foot off the gas pedal and push only the brake. The same strategy applies to cancer," explains Dr. Schuller.
"If you want to beat this disease you change your lifestyle and remove anything that is known to stimulate cancer, especially smoking, so that the therapy that you are receiving can work better," states Dr. Schuller. "This is particularly important in cancer cases that are detected at an early stage because smoking would cause the cancer to progress."
Dr. Ginzel contends that "as an oncologist, Dr. Fisher ought to know that, on the one hand, cigarette smoking is responsible for approximately 30 percent of all cancers, and secondly, that cancer patients undergoing treatment should avoid exposure to carcinogenic insults from the environment, among which cigarette smoke containing over 60 well established carcinogens is unquestionably the most notorious offender."
"Placing an additional burden on the organism, such exposure is likely to worsen the success and outcome of cancer therapy," asserts Dr. Ginzel.
Dr. Fisher's suggestion that Patrick Swayze smoked for comfort evidences little understanding of nicotine dependency. Long-term daily smokers don't smoke because they like smoking. The smoke because they don't like what happens when they don't smoke, the gradual onset of the anxieties of nicotine withdrawal.
It wasn't that Patrick Swayze or any smoker can't quit. It's that they don't.
Dr. Fisher was perfectly positioned at one of health history's most teachable moments. He was given the opportunity to share with smokers the importance of ending all nicotine use upon diagnoses. He was handed the chance to teach the most fundamental nicotine dependency recovery lesson of all, "The Law of Addiction."
But how could he? The root solution to America's leading cause of premature death isn't taught in medical school. Instead, new doctors entering practice have been brainwashed by pharmaceutical influence into believing that the cure for addiction to nicotine rests in ineffective NRT products that replace nicotine, or life-threatening pills that imitate it.
Still, Dr. Fisher could have advised smokers that within 72 hours of ending all nicotine use that they'd move beyond peak withdrawal and reside inside a nicotine-free body and mind. Instead, he took the easy way out and joined the thousands of other physicians who have so far refused to master the recovery insights needed to treat the entire patient.
There's little to debate. Dr. Fisher dropped the ball.