Let’s Talk Prevention...As The Doctor Will See You Now
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for free. So to join Lenovo Pro, visit lenovo.com and unlock new AI experiences with Lenovo's ThinkPad X1 Carbon powered by Intel Core Ultra processors. This is Let's Be Clear with Shannon Doherty. Hi everyone, this is Let's Be Clear with Shannon Doherty. Please welcome Dr. Lawrence Pirro. Dr. Pirro, I brought you my best friend.

And she was a stylist. She was fantastic. I loved her. She taught me how to travel. We went to St. Bart's every year. Like we had a very, very, very tight, tight, tight relationship. And she ended up getting cancer. I'm obviously not asking you to, you know, divulge anything, but her cancer, you know, was more advanced than mine at that time. And I remember that.

Her describing certain symptoms that she had. And I would like two days later, by the way, just talking about it right now. Makes you. It gets me just talking about it. I'm starting to get those weird, nice things that'll go away the minute I stop talking about it. It's so bizarre. But you kept saying to me, like, you cannot associate pain.

your cancer with hers. They are two different cancers. And if you look at her path, then you're going to walk her path. Like you have to walk your own path and she has to walk her own path. And when you first like sat me down and really had that conversation with me, I was like, wow, like I heard that. And then the pains like went away. It was all a mental thing. And I remember actually

The first time I said that to you was before you ever, or at least before you ever verbalized anyway. Yes. Experienced some of the same things. I just knew to anticipate that. And I said that you cannot compare yourself. The minute I understood what her scenario was,

I knew that you would look at that scenario and assume that that was your path. Because everybody does. Fortunately, many people are, everybody's exceptional in some ways, but we're all very common in other ways in terms of our human reactions. We're all very common because we're all part of the same community, same gene pool, same organism. And so I knew that that would be a thing. And

And it was, and each step of the way, you know, so then we had to keep repeating, especially because you were, you know, you were a very good friend. And so when you're a very good friend, you spend time talking. You know, it's kind of like support groups. I mean, support groups can be so great, but they have to be refereed carefully. And the composition of a support group has to be chosen carefully because it's

you know, sometimes it can do damage instead of help if it isn't, you know, refereed carefully and the people in the group are not common enough. Because if you're, you know, if you're someone with adjuvant breast cancer and, you know, with a 85 or 90% chance of cure and you're in a group with metastatic breast cancer patients, you know, you may be

seeing a picture that is so frightening that it's hard psychologically. The sharing, the group share thing, the individual share thing is very complicated, and especially in today's day of social media and all that because anyone can reach out to you and share with you, and again, you're not really validating their data. In this case, if you're a friend, of course, you were, but if someone meets you on the internet

and is sharing data with you, you can't really validate their data. And we all leave pieces out of stories.

I mean, even when we're not talking about cancer, right? If you're talking about, you know, your friend who did something to you one day about, you know, what happened at a party or something like that, people by nature tell their side of the story, right? So sometimes that leaves out a couple of beats that might change other people's view of it. But when they're telling their cancer story, they do the same thing. They sometimes leave out some beats because

No one wants to be on the pathway that's leading to the bad outcome. Everyone wants to be on the pathway leading to the good outcome. And so you sometimes leave things out and therefore the person listening can't really adjudicate the story straightforwardly.

Right. And also there are, you know, people you said earlier, there are people that they're just like warriors when it comes to their protocols and it doesn't matter. They just keep on a protocol, you know?

I think there was only one protocol that I complained about. Every other protocol, it didn't matter what, that we were on together. Yeah. Didn't matter what the side effects were. I was okay. And then there are other people like my friend who, you know, blew through protocols incredibly, incredibly quickly. It was like, if, if,

If there was anything sort of uncomfortable, there are people that with a little bit of discomfort, they don't want to stay on a protocol as opposed to realizing that like the more protocols you blow through, the less options you have because there's only so many protocols.

What's really interesting to me is all the suggestions. I think, and I've spoken to you about this, that I get from people, you know, the chemo or the this or the that is killing me, Western medicine, that I need to be on, you know, CBD or I need to, you know, if I just go on a raw diet or if I just do this or I just do that. Oh, my friend took...

you know, ivermectin and they're completely cured of cancer. And I'm like, yeah, but they were also in a clinical trial. Like, how are you saying it's the ivermectin as opposed to the clinical trial? Like, you know, it's such an interesting, and I think a lot of people with cancer probably have this conversation with themselves and I've had it with myself and I've had it with you. There's a vast amount of misinformation around

and just information in general that's really hard to sift through because there are so many stories and proclamations that this alternative medicine cured somebody of stage four cancer. And so your brain...

has this very curious moment where it's like, well, should I be using a dewormer like they use on horses? Is that what's going to cure me? Like that was the latest one I got recently. And then you just start sort of knocking your head going, stop it. You know, like science is science. There's so many levels to that. I mean, first of all, you're a hundred percent right. I mean,

On the surface of that kind of conversation, people could say, well, gee, I don't know, my doctor treats me like a statistic. He says, we're going on this protocol and it has, you know, 42% effectiveness. And yet I talked to this person and they're talking about this alternative stuff. And they tell me about people that have been cured. But the reason the doctors don't

talk about just people who've been cured, 'cause those are anecdotes. You have to study something in a disciplined way to find out if it's random or if it's an actual effect. And most of the alternative things are not studied.

and they're all driven by anecdotes and not to dismiss those and they can feel empowering to a person who's in a bad situation. I get that, but at the end of the day, you're vulnerable. And when people are promising you things effectively, I mean, they're effectively kind of promising you this by saying this one person had this. I mean,

they're hanging out there the possibility that that might be you. It's in some ways, not intentionally, it's meaning to be helpful, but it's kind of preying on your vulnerability in some ways. And then if you choose not to do any of those things, 'cause you decide I'm gonna be sensible and look at the data and all that, but then if you decide not to do those things and your outcome isn't good, then you self-flagellate yourself. Well, maybe if I had done the eye of Newt,

and all of that, right, that you would have been okay. And so it also has that second layer of difficulty and judgment and all of that's difficult. You know, I didn't realize, despite a long career, I didn't realize just how pummeled people get with suggestions until I took care of Farrah Fawcett. And when I was on the journey with Farrah, you know,

So many people, strangers, were writing to her just left and right and whatever, like with you. And she said, she just told all of them, just send this to my doctor and he'll sort this out. So you realize that besides 8,000 additional emails a day that I got, my office was filled to the ceiling with packages of emails

bottles and pills and things and blankets and prayers and whatever, which is moving to see how many people care. It was just beautiful moving, but it was a morass in terms of any patient, if they were actually trying to sort out all of that stuff. And what people don't fully realize is each time you have to open your thinking to another thing which might work, you're reliving your diagnosis. Right.

It's reliving the whole initial process of the diagnosis and what might work when you're having to tear into each of these individual suggestions. And when it's thousands, it's overwhelming. Yeah, I mean, that part doesn't bother me because I don't really like ever relive the diagnosis. But I think...

What I more worry about is I understand enough to look at some sort of suggestion that somebody gives me and either research it myself or have the conversation with you. Because a lot of times, great, you know, I believe in also natural medicine. I believe in homeopathic. Like, I think that's fantastic. I love it too. Yeah, you just have to make sure that the properties that are in that homeopathic

herb or whatever isn't counteracting what your normal cancer med is then doing. Like that's a big thing that people who give you the suggestions don't realize is that there is natural stuff out there, but it can literally kill essentially what your chemical medicine is. Rule one on that is anything you're doing should be in addition to and not instead of. Right. Right. And then rule two is what are the drug interactions?

drug interaction. And I'll tell you, I took care of a young man who was

really an amazing, incredible young man and scholar. And he unfortunately developed a very difficult cancer situation. And his girlfriend at the time of diagnosis, and then they married during the course of his care, someone in her family together, they decided he had a feeding tube at this particular point in his journey. And they decided that they would

try to be helpful to him, they would stop feeding him the liquid diet that was the well-balanced diet and all that, and they would feed him just like yogurt mixed with antioxidant berries and different things. And I always told this young man that if you are scared, just call me and I will come. If you're scared of what's happening, just call and I will come. And so

One day he called me and he said, "I think I'm dying." I said, "Why?" And he said, "Because I'm bleeding from my nose and I'm bleeding from my mouth and I'm bleeding from everywhere." And this was somebody in his 20s, right? And he had seen all these horror films where that's what happens. And so he could only conclude that that meant he was dying. So I said, "I'll be right there." And I drove there and I walked into the room.

And I looked at the scenario and I, it was interesting because something else I did, which was kind of interesting. There was so much, the room was so amped up and I, I lifted up the sheet, you know, so his feet were there. And I asked the nurse, we had like round the clock nurses. I said to the nurse, do you have some lotion here? And I was actually wearing, it was a summer and I was wearing like G20s.

jeans and flip flops and a t-shirt or something. I don't think the nurse knew I was the doctor. So I walked in the room and said, lift up the thing exposing your feet. I said, do you have lotion? I think the nurse was so confused. So I just squirted some lotion on his feet and I started actually, you know, massaging his feet because he,

I knew he needed to calm down, so we could sort this out, 'cause he was just petrified. So I thought, well, and I'm asking questions, well, I'm just putting this lotion on his feet and massaging his feet, which if you ever get a foot massage, it makes your whole body just calm down, all the tension go away. So I'm asking questions, well, what about this and what about that, and what have you been feeding, have you been taking these, and I'm asking about all the people in the room.

And that's when they told me that they had changed the diet. And I said, well, I said to him, listen, you have vitamin K deficiency from your diet. That is why you're bleeding and you're gonna be fine. I sent his mother to the pharmacy to get some vitamin K that I'd called in and prescribed. He took the vitamin K, all the bleeding stopped.

and he was okay for that moment. I mean, he still had obviously cancer and cancer treatment, the ravages of it, but the point is, is that a very, very well-meaning and well-intentioned change in things without fully discussing it resulted in a very, very scary moment for this young man. That's a poor thing, which is a really interesting segue because...

I was going to talk to you about the fact that like, maybe the white coat doesn't know everything. And then I hear that story and I'm like, maybe they do. You know what I'm saying? Like, because you do understand, you know, drug interaction and you do understand vitamin deficiency and you do understand what somebody is needing in their feeding tube. Um,

And, you know, you do understand the different protocols and how they're going to help. So it's not necessarily, SEGU isn't necessarily about that a white coach doesn't know everything because I think

they know quite a bit. I think it's more that it's okay. And it's what I love about our relationship, right? Is that I've never felt as if I couldn't question something. I never looked at you and thought,

I just need to accept what he's saying to me and putting in front of me, keep my mouth shut and do what he says. I've always engaged with you and said like, hey, but I was just looking at this and there's this and this and this and this as other additional data. And you're like, well, yes, but that data then comes with this data. Like you have to do a little bit more digging or you have to do this or that, right?

I don't think enough people have a healthy conversation with their doctor. And some doctors, not you, but some doctors, I think, make a patient feel as if they don't have the time for the questions. But I also think that the patients don't demand the time.

And if a doctor doesn't know that you are needing that time desperately, then he's not going to give you that time because he's got 50 other patients to go see. Right. So that it's perfectly okay to respectfully, but strongly have a conversation and demand more time and, and, and do your own research and,

and push back up against an opinion because ultimately it is our lives and our bodies and our decision. So we have to be comfortable with everything and have no regrets going forward. - So when the internet came into being prior to that-- - Well, now everybody's a doctor. I mean, I have a friggin' degree, don't you know? - Prior to the internet, all medical knowledge was in medical books.

And medical books were only sold in bookstores to doctors and medical people. So not only, I think the Merck's Manual or something like that was maybe the only real authoritative type of a book that lay people had. So the doctor was viewed as the keeper of all medical knowledge. And there were no other vehicles. When the internet came into being, I remember so vividly

doctors being so inflamed because a patient would walk in with a printout of, you know, 75 pages. And instead of saying, I have joint pains and rash, I think I have

What is that? What is joint pains and rash? Could it be lupus or could it be Lyme disease? - They were self-diagnosing. - They'd walk in and plop down 75 pages and say, "I have Lyme disease and here's why," right? When maybe they more likely had lupus or something. Doctors were so insulted by that, they would grab the papers and throw them in the trash in front of the patient and say, "This is what I think of the internet." Boom, like that. They were just enraged.

And so I watched that going on and I realized that I was living through a sea change and that medical knowledge was now going to be widely available to everyone. And people were not looking for me to be a professor. And you see, this is where the white coat comes in. That white coat is symbolic of somebody being a professor and a sign of authority.

And I realized people didn't want me to be a professor and the keeper of authority. They wanted me, they didn't want to be on my team. They wanted me to be on their team. That's correct. What a beautiful way of saying it. And that's when I took off my white coat and I've never put it back on because I think it's too strong of a symbol of an old time role for a doctor. And I think everybody's on their own journey. And as long as

you accept responsibility for your decisions, I will go with you on your journey. Now, I'm going to try in every way I can to talk you into what I think is the best thing based on the data and everything I understand and to tell you why. But at the end of the day, even if it's alternative or not, not typical or not the best choice, I'll go on that journey with you as long as you understand that we're deviating. And I think one of the reasons why you and I have that

you know, relationship from the beginning is that I try always when I'm telling someone about what we should do, I try to always say we have three options here or four options here or two, whatever, so that

Even though I've already made up my mind based on the data, so what I think would be best, I'm presenting the field of view of how I went through my decision-making process. And I share my decision-making process with you as you and I have done many times, right? I say, so here's the four paths.

I like this one for this reason and that reason. I like this one for that reason, whatever. And then I've rolled out these and these, and that leaves us here. And between those two, one spares hair and one doesn't. So let's spare hair or whatever. I mean, however the situation is. And I think that, you know, people...

Doctors try to sometimes grab the authority because it's kind of what the job teaches you to do. But if you actually give the authority over to the patient, they very quickly give it back to you, right? Yeah, well, because it's human nature, right? Like human nature is to want to be in control. And especially if you're sick, you want to feel like you have some semblance of control. So if you're given that control, right?

the way that you do it, you definitely give it back because then you don't need to like fight for it. Exactly. And if you ever do want to really exert it in opposition to what his or her recommendation is for you, you know that they'll gladfully give it back to you. Like you're handing it back

saying, okay, now you've proven that you can handle the authority for me. But if I want my authority back, by the way, it's just on loan to you. So I'm going to take it back if I get to a different place and a different set of decisions. I also think that what's really unique about you as a doctor that I really encourage the listeners to, and it doesn't matter if you have breast cancer, any other kind of cancer, any sort of illness, or you're just

you know, going to a general doctor. I really encourage you to, you know, get to know your doctor. Like, it doesn't mean you have to go to Italy with them, but that might be an extreme. But, you know, engage and get to know and be very honest with your doctor about your lifestyle and everything else because at the end of the day, it allows more leeway in that relationship. And for instance, you know,

the infusions that I'm currently on, right? Like there came a point where I said, hey, I want to try something. I want to try not getting the anti-nausea. I think it's prolonging my sickness. Once I get the infusion, I don't want 14 days of feeling like I have to throw up or 12 days. I just want to throw up and get it over with. Maybe this will work. Maybe it won't. And I

I waited for you and you, I texted you and you came in. I go super early in the mornings. As you know, I'm a weirdo. I go at like six 30, seven o'clock in the morning and you, you know,

looked at me and said, if that's, but you know me now. Like, that's the difference is that we now know each other and we have a shorthand and you know that- I know that you know your body like no one else. I've seen it over and over again. Well, I mean, that's true of everybody, but you're like a savant in that regard. And what you're wanting to do is completely antithetical. Like,

There's no reason to think taking a three-day anti-nausea injection is like prolonging the nausea

I mean, just like antithetical to traditional medical thinking. But I've seen time and time again, you have weird reactions to medicines and you figure it out for your own body. And when we do it, it works out. I'm like, that's again, we're like, I said to the nurse, she will take responsibility for this decision if it doesn't work out well. There's no, there's no wish to hear. If you get very sick, you just have to, like, you have to come in. We're going to have to get you on an IV drip, like, because you have to stay hydrated.

And I remember I called you and I was like, "I think it's working. "I'm not as sick for as long." - But we tried all different anti-nauseas, we tried steroids, we tried-- - We did relaxers. - Everything, yeah. And so why not? Because you have this instinct and you were right. And most people know that, but it's the same thing I always laugh about when patients always have to get their blood drawn before the doctor's appointment and some phlebotomists will insist

that they're going to draw somewhere because it's the best vein. And the patient will say, that vein doesn't work. I'm telling you that vein doesn't work. You need to go over here. And they won't listen to them because it's like, I'm the phlebotomist and I know the right veins, whatever. And listen, if a patient demonstrably tells you where to draw their blood, do it. Because they know their body.

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When you treat patients for years, does it take a toll on you when you lose them? The second part is, or are you able to stay detached? And I know that that's a no from you. Right. So the thing about this topic that I feel so strongly about is that I have an obligation to bring the best knowledge, the best individualized thinking, the best strategic thinking

and all the best resources anywhere in the world to a patient's journey of healthcare or cancer treatment. But at the end of the day, their outcome is encoded in the universe. And so my job above all else is to make sure that they have a journey that's closest to the journey they want to have, as close as I can make it. And that is where I derive my

sense of gratitude and sense of joy from is making sure that as we go on that journey, after having brought all the best resources and the best strategic thinking and all that, that's just the basic program to me, that I can make the experience as much what they want it to be as possible. And that includes the dying process. You enter alone and you leave alone.

You can't really help someone enter well, you can just try to catch them. - Right. - But you can help someone fly away well. And everyone has very different ideas about what that process should be for them.

But as a doctor, I think the most important thing is to listen to them and talk about it and try to even make that part of their journey. If you think about the most vulnerable position that there is in the world is when you're flying away. And if you don't have people around you who will listen to you and try to help you make it the way you want it to be, what a terrible, terrible tragedy and closure that is.

So I am thrilled that I've been able to treat people who've gotten cured from diseases. I'm thrilled that I've been able to develop medicines that have cured some people and very much prolonged the lives of other people. But I'm equally honored to have helped people die well because it's one of the most intimate things you could do in life as a doctor.

And in all your years of treating patients and being in the medical world, have you ever witnessed like a true miracle? Well, you know, that's a funny word. I certainly have seen people have responses that exceed anything you could expect. That seem miraculous.

And I'm a big, you know, I have a big spiritual presence as a person. You know, like I really very much, you know, part of me lives in

in that kind of spiritual existence. So I don't know, I mean, it's a complicated word for me because when I think of miracle, I almost think of like somebody somewhere, you know, waving a wand and making magic and making something happen, you know, and I don't understand like what it looks like behind the curtain, you know,

you know, of miracle making. So I don't know if things are really miracles, but I do know that I've seen unexpected results. I do know that a person harnessing their spiritual and creative and loving energy can change the course of disease.

And people living in a dark and negative and critical and unhappy place can change the course of disease. So I do believe that there are factors beyond our control. And whether they're all biologic and physiologic or where some of them are also universe and spiritual, I personally believe very much in an order of the universe. And I believe that the universe is

that we are mindful people, and sometimes we allow our mindfulness to think that we know best for ourselves, but I'm quite well aware that there seems to be an order in the universe, and if you turn yourself over to the order in the universe, you often wind up in a way better place than you would have had you continued to plow forward your own path.

you know, limited thinking about where you belong. And so I try to always, you know, turn my will over to the universe and follow the clues to get to the place where I think maybe I'm supposed to belong. And I try to always, you know, help patients, you know, on that same journey too. So with all the money pouring into cancer research, why is chemotherapy, and actually is it still the go-to treatment when it causes cancer?

obviously a lot of weakness, a lot of pain, a lot of side effects. Well, chemotherapy is largely derived from natural sources like the taxanes or other sorts of things. And some were chemically modified and some were synthesized, but they were all focused on kind of interfering with DNA or other critical pathways to make a cell die. And in fact, they're very effective at doing that.

But the necessary side effect is that other cells that are dividing can also die that causes the side effects, right? So the side effects are caused by like a lot of times when people get mouth sores and ulcers or diarrhea, rectal pain, that sort of thing. It's because the mucosal lining of the bowel are cells that are always turning over. So they die more readily in response to chemotherapy. In fact, we've had an amazing, you know, revolution in

in two areas, molecular treatments. So in sequencing the human genome and identifying, you know, mutations that are existing in cancers and then identifying drugs that affect those mutations, that's been miraculous at creating a non-chemotherapy pathway. And immunotherapy has been an unbelievable breakthrough with drugs that

allow the immune system to see cancers in a way they were overlooking them before and now can actually kill them and clean them up. And they all have their other different side effects because you can't rev up the immune system to cancer cells without expecting that they might actually

attack some other cells too. Right, some of your good cells. Exactly. And so there are different side effects than chemotherapy where there are side effects on the left. So whenever we're going to be manipulating with physiologic processes, we're going to get side effects. There are even vaccines now for cancer. And what was interesting to me is when one of the first vaccines that ever showed benefit to advanced cancer patients, which is called Provenge for prostate cancer,

It was interesting how little, all anybody ever said was, why don't we have a vaccine for cancer? And then a vaccine was developed and how low the adoption rate was of it for a whole variety of reasons that are probably beyond the scope of this discussion. But there are many different lanes. There are huge breakthroughs. And cancer has become a chronic illness. It used to be

pretty much you're cured or it's a fatal illness in a fairly short period of time. And now people can live for years and years and sometimes decades with low-grade cancer being manipulated from time to time with various pills or infusions. And immunotherapy, I know that you and I have discussed immunotherapy a lot. I always really liked the idea because sort of the way that I looked at it was

It was basically like the Navy Seals of cells going in and just killing all the bad cells. But yes, they do sometimes knock off some other really good cells. Someone like me... Your particular set of characteristics...

a breast cancer doesn't respond very well to immunotherapy and then your particular markers beyond that, there are specific markers that tell you if your cancer might be likely to be susceptible. So even if you have a cancer that's not that susceptible, if you show these immune markers that say it would be susceptible, then there might still be a chance, but your immune markers are even say your tumor wouldn't respond. Now that doesn't mean that with, you know,

other immunological advances that are coming down the lane. - That that's not an option. - That that's not an option. Because there are some situations where cancers respond even when they have the markers that say they won't respond and combinations sometimes work. So there's more stuff coming. Every single day, we're understanding new ways to use these genetic defects and molecular markers. And every single day we're learning how to manipulate the immune system more.

And there's these certain kind of immune system where we take T cells out and T cells out of your body, immune cells, and we, in the laboratory, make them into warriors against your cancer and then infuse them back into you called TIL cells and there are other version of CAR T cells and all that. And there's just huge amount of research going on with that. And they're quite miraculous treatments in some cases and in other cases not, but we're learning how to

empower them differently so that maybe in the cases where they're not affected, they will become so. And so that whole field I think is really, really important. And if someone can live longer in a remission or a partial remission for a period of time, that may be something that really comes to roost for their particular situation that isn't available today. And then tons of these, like I said, molecular markers. And even as we talked about earlier in your case,

We didn't think of HER2 expressor. We didn't really think that much about that category as being anything important, but it turns out HER2 expressors respond to the drug antibody conjugate that's targeted to HER2. And we had unbelievable results with your situation. And to talk about what you were mentioning earlier about our decision to stick with it, the situation was that

we had cancer in some critical places that if it were to get out of hand,

it could cause us to lose precious time that we might not regain in terms of, because when cancer is growing in an organ, it can cause that organ to dysfunction. And if that organ dysfunctions, that could be game over. And so you're always at this juncture where is the amount of cancer in that organ such that if we keep going on this, when we're not sure if it's working,

we're hoping that it's stable, like we're seeing the same amount of disease because we stopped it into stability and now we're gonna turn around into response. But there's also the possibility that it was like a brief pause and it's gonna keep growing. And then if it keeps growing, are we gonna get to that place where the tumor burden is so great that the organ just functions and then we lose precious time or we're out of the game?

And that's where we were talking about a little bit to some extent, not exactly that situation, but somewhat that situation. We were talking earlier about whether to stick with this treatment. And we had scans that were showing us not as much response as we would have expected by that time. You were having a lot of side effects, but yet the tumor markers were going down. And so we said, look, we're going to assume that the tumor markers are telling us the story and the scans are lagging.

and we turned out to be right. But we also had that challenge too of, and are we getting enough brain penetration

that it's really gonna work there as well. - Right. - And that was really the most concerning part to me is that that scenario, like a little something showed up there and so we're like, does that mean it's failing? And it turns out, no, it ultimately responded. It just took time. - Yeah, it needed a little bit more time.

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I mean, there are numerous amounts of different cancers, right? There are vaccines for some that you mentioned. There are kind of cures for some. There are definitely cures for some. Hodgkin's disease is a very curable disease. So the ones that are extremely tough to cure, lung cancer, for instance, right? Listen, melanoma, the answer to your question, am I hopeful of a cure? Absolutely. Absolutely.

I mean, this would be a challenging business if you didn't have optimism. But the Angels Clinic is a very renowned center for many things, but chief among them, melanoma and immunotherapy and us having played a substantial role in the opening and beginning of the field of immunotherapy. And there's a time period when stage four melanoma was a universal disease.

Death. Nothing more than that, right? And stage four melanoma people can be

of all the disease disappear and live for years, maybe being cured. I don't know if they're cured or if we just reduce the cells down to such a low level and harness the immune system and whatever that they never come out again. But the point is, is they can now live their whole entitled life in some ways. And I mean, that's, we never thought that we would see that in a disease. I don't know if, I mean, like,

20 years ago in melanoma or 30 years ago in melanoma, doctors would say, you know, like, what's your favorite place in the world? Oh, Hawaii, you should go there. You should go there immediately. Get your will set up before you go. They literally said that to people with this kind of melanoma. And now people, even with brain metastases and melanoma are, you know, completely disease-free for decades and therefore, you know, perhaps not cured. We're always, you know, as a doctor, you don't want to hold out false hope. And so we're always...

hesitant to say that cure word, you know, in some situations just because we don't want to be misleading, but we are eternally hopeful.

So we know that obviously we just discussed that not all cancers are curable, but early detection is always the best chance you have. Is there a test that you recommend that is comprehensive? And obviously that depends on the kind of cancer that you have. Like for women, breast cancer, I'm assuming it's a mammogram.

is the first place you start. What about for other forms of cancer? Well, if you're a smoker, there's something called a screening lung CT, and those have been shown to be effective in picking up early cancers. So if you're a non-smoker,

It's a little more difficult because routine chest X-rays don't necessarily show much benefit. And what about like prostate cancer? Prostate cancer, we have the PSA test in blood and it's a very sensitive test. And when that shows an increase, then people are able to get an MRI of the prostate. I think having regular doctor visits and getting, there's a whole kind of

template of screening tests, you know, depending on your gender and both your assigned gender at birth and your acquired gender and all of those, you know, different things. There's a whole set of things that you can do

from screening CTs and pap smears and HPV tests. I think one of the biggest preventative things people should be doing is getting HPV vaccinated if you're not. I mean, the HPV virus accounts for 5% of all the cancers in the world. Cervical cancer in women, anal cancer in men and women, mouth cancer in men and women, penile cancer in men,

5% of all the cancers in the world caused by a virus infection, that if you get vaccinated against the nine most common cancer-causing strains, you can prevent that. Right. So that's an incredibly important prevention item.

I think in terms of overall prevention, I think achieving your ideal body weight is incredibly important because body fat creates an inflammatory state that contributes to heart disease, diabetes, and cancer. A lot of people like to focus on dietary composition, and I love that and it's important, but the truth is dietary composition

It's not that important if you have way too much body fat. I mean, get your body fat down because that's going to control the inflammatory condition. And then at that point, then the value of your dietary composition becomes super important, right? Because you've eliminated that inflammatory thing. If you have this massive obesity inflammatory state, it almost doesn't matter how much kale you eat. You've got this inflammatory state that's totally pro-cancer all the time. So that...

And exercise seems to have an independent protective component separate from just its weight loss component. So I'd say exercise regularly. Look, we were meant to move. We were meant to move. And it changes that whole physiological structure. And then there are various anti-inflammatory things that you can take and do.

you know, from, you know, turmeric, baby aspirin, if you don't have reasons why you can't take aspirin and other kinds of things. So I think, you know, I think there's something to that whole anti-inflammatory scenario for people in prevention. And, you know, there are other things from there, but yes, there are things that can be done. And being honest with yourself and with your doctor, like don't ignore signs. If something doesn't feel right,

go have a conversation with your doctor. - Oh, 100%. - That to me seems to be a very important one. - If you have anal bleeding, don't let somebody just chalk it up to hemorrhoids. Have somebody look. And if you're having a colonoscopy, here's the most important tip. If you're having a colonoscopy, you say to your doctor, "I want you to be sure and examine my anus."

Okay, now that sounds like a strange thing to have to request. But the truth is, is that a lot of times doctors just put the scope in and look and they don't actually examine that area. And anal cancer is one of the things caused by HPV. And it requires a visual exam and a finger exam. And you can completely miss the anal area with the scope. Right. And by the way, a lot of...

It's very embarrassing for a lot of women because they feel like if you get anal cancer, it means that you were having sex there. Women can get anal cancer never having had anal sex because vaginal secretions that are affected by the HPV virus can pool in that area and infect that area. So don't let anybody embarrass you into not asking for the right exams and screens so you don't have that.

So that's what happened. You heard it here, guys. Let's be clear. What a way to end. We started at the top and we ended at the bottom. The bottom. When they went high, I went low. Yeah.

Dr. Pirro, I love you. And, you know, your brain is impressive and you're a wealth of information. And I deeply appreciate our relationship as doctor patient. And I deeply appreciate our friendship, which is a total other side thing. Thank you so much. I love you as well. I adore you. You're amazing. And every day you're an inspiration to me.

Well, thank you. I know you're just, you know, going to keep plugging away until, you know, you want me to live to like 90. I know that.

At least a couple of more trips to Italy. For sure. Sardinia is next, right? Exactly. We have to get to the places we missed. Exactly. All right, you guys, thank you so much for listening in to Let's Be Clear with Shannon Doherty and with my very, very, very special guest, Dr. Lawrence Pirro of the Angelus Clinic.

Check it out. It's a pretty phenomenal place. I know that a lot of my fans have actually contacted him and I saw one in his waiting room. And it makes me very happy because I think he can answer a lot of questions and be the kind of provider, the care provider that so many of us need. All right. Bye. Thank you for listening to Let's Be Clear.

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