Dr. Jamal Dagash is an integrative physician, who is board certified in family medicine and is duly trained in integrative and supportive cancer care. We asked Dr. Dagash, who was also the director of a home hospice service in Northern Israel to talk about the reasons why Arabic speaking patients often seek out herbal medicinal solutions for their cancer. First of all, it's very, very close to their nature, their environment. It's there, and traditionally it's accepted through a command and even to give advice to somebody, you can use it. This is the way people express their love, their care about other people, and at the same time, in face of devastating disease, when there is no answer, there is no cure, people will look for something that can maybe can make a difference or magic. So, it's natural way people will use what they heard someplace or read about some kind of herbs that may prolong their life or help them to overcome this crisis that they have. So, I think it's natural everywhere to look for answers more than what we in the conventional medicine we offer for people. Is your impression with Arab patient is that the herbal medicine is like a port of entry into their health belief model? Is that the way you can enter into their heart in a sense? It's built-in in their life and acknowledging that and giving it a really appreciation that's make difference. Sometimes it's surprising for people, and they would love that and they will be much more open for that and when it's coming from us doctors, conventional doctors, it makes much more bigger difference. They will use it and enforce it much more in their life, and they will be much more close to deal and to negotiate with you the treatment plan or the therapy plan about the next steps of what they are dealing with. So, yeah, it makes much more a open relationship to be willing to take you what you are offering them and to to be much more curious and open to ask more questions. We asked Professor Frenkel to discuss the cross-cultural aspects of care, which the integrative physician needs to consider during the consultation with the oncology patient. Beside being a nonjudgmental listener, I assume that you're proactive as well in terms of your giving that advice, use that herb and that herb. You initiate that as well, if I understand correctly. It's not just that you provide consultation about what the patient takes, but you initiate that as well? I think so because when you come in, I have a list of common herbs that I think that they are safe, and there is some background information that might be beneficial. Not great evidence as you would like to see in randomized control trials, but there is something there and that they are safe to use. Sometimes they are used as herbs, sometimes they are used as spices and they are safe to use. I try to direct patients to use that, but patients that are coming from Arabic tradition, there are tendency to use specific herbs that are coming from the Middle Eastern area are going to be very high; and if you're going with them and suggest to them some of those specific herbs that belong to that area, they'll really appreciate your advice. When you're talking about people that are coming from India and they're looking and you give them some advice about ayurvedic herbs that are safe to use, that there is no major toxicity to them, they would really appreciate that you are in tune with their background, with their culture, with what they do. So, it's really depends on the patient that comes to you, and it's very important to address who's coming and build the plan according to the patient that is coming to you. So, there's no same plan to everybody that comes with breast cancer has to take all this, this is the plan, this is the actual integrative medicine approach to breast cancer. You have to do some tweaks in the plan. So, it's more complicated than what other people are looking from the outside into integrative oncology. In order to better understand how to communicate with patients on the use of herbal medicine during cancer care, we spoke with Professor Gil Bar Sela, the Deputy Director at the Department of Oncology at the Rambam Medical Center in Haifa, Israel. Professor Bar Sela is board certified in oncology and palliative medicine, and has extensive training in anthroposophic medicine, a leading integrative oncology modality which will be discussed in the later chapter of this series. I think from the first point of view is trying to see what's the motivation of the patients of taking these kinds of supplements. Sometimes, or most of the times, I think the motivation is unknown or unclear. It's not the situation that the patients have a problem, nausea, for example, and now she'll looking for other drugs for nausea. It's more easy to understand and it more easy to help her. Usually, it's something very general. I want to improve my immune system. All the people around me say that it's very important. So, then you start to ask her, "Why you think that your immune system is not working well? Why you have any kind of problem? You have infections. You had many infections in the past that you are more prone to infections." Somehow, why? In most of the cases, it will not be a real reason, it would be something general, that the surrounding and it's important and all of it, or she or he personally think it's important but not really something that they are really in consciousness way think why should this product should help me. Then, it's very easy to find out if there is no real knowledge that you can help it, maybe you may avoid it just for the couple of months to see how the new treatment is working, that will not be in the situation that something, new drugs are developed and it's given to you and it will not work and then we would not know. Maybe there was some interactions that we will not really understand and it will be a reason that it's not working. So, wait a little bit, see what's happen, see if you really need it. Maybe there would be no side effects. Why to add it now? Maybe everything will go right. Side effects are starting, then we can see what's she really need, and since there's a lot of movement into complementary medicines that it's not really a small forms of fears of the patients, or from their concerns before treatment and less of treating real problems that's actually coming out of the treatment. I think the attitude should be like palliative and supportive care. It should be part of the palliative and supportive care. It's part of the tools that we have. If there is a problem that it's starting to rise or it's getting on for a long time, then we should see what's the treatment can be. It can be a drug from the regular drugs, but maybe it have side-effects. Maybe we can use something from the complementary or some kind of therapy, and it will be with less side effects and less problems. Why not to try it if it's still in the beginning. So, the attitude is a clinical attitude. The same ways that you use regular medications in palliative supportive care, you should use complementary medicine, and not separate your mind because this is complementary and this is allopathic.
