Cancer and Psychedelics in the Medical Machine

A few months after my diagnosis, I traveled to see the world's leading physician for my tumor type. I felt like Dorothy. Taking a long journey. To see the Great Oz and consult the wizard who surely held answers that local doctors couldn't provide.

My biggest question wasn’t about treatment options. Or my prognosis. I went with a single searing question that had kept me awake for months: Why did this happen to me?

So I asked him. Sitting across from this renowned expert, I posed the question as if he might actually have an answer: Why me?

He paused. Considered. Then gave me the most honest response available: We don't know. Possibly genetic factors. Possibly environmental exposures. But fundamentally, we don't know.

In retrospect, I'm rather embarrassed that I asked such an impossible question. But his inability to answer felt like seeing Oz behind the curtain—this towering figure of medical authority suddenly revealed as just another human working within the same limited framework as everyone else.

That not-knowing compounded my existential distress. Because pain with purpose is noble. But suffering without meaning is absurd.

Twenty years later, after eleven surgeries and seven months of chemotherapy, I've learned something crucial: the medical system that saved my life was never designed to address that kind of suffering. Not because individual clinicians don't care. But because the system itself operates on different principles.

The Doctor Who Studied Philosophy

I recently sat down for a podcast conversation with Manish Agrawal, founder and CEO of Sunstone Therapies, one of the most active psychedelic research sites globally. But before Manish built Sunstone, he spent nearly two decades as a practicing oncologist—and before that, he took an unusual path through medical training.

During his medicine residency at Georgetown, Manish simultaneously completed a master's degree in philosophy, studying questions about meaning, suffering, and what it means to be human.

"What became clear is we weren't really trained how to talk about the things that were the most relevant in the room," Manish told me. "When you have cancer and you walk in: Yeah, you want to talk about treatment, side effects and prognosis. But the other things that come up are questions like, why did this happen to me? What am I going to do with my family? What's the meaning of life? I don't want to die. And believe it or not, nobody really talks about that in training."

Consider what that means: medical education systematically avoids the questions that patients most need to explore. Not because educators are cruel. But because the curriculum reflects what the system values and what it knows how to address.

Grateful and Frustrated

Before going further, I need to state this clearly: I am profoundly grateful for modern medicine. The chemotherapy that destroyed my quality of life for months also gave me twenty additional years. The surgeries that left permanent scars also removed tumors that would have killed me. The modern medical system, despite every frustration I'm about to name, saved my life.

But gratitude doesn't preclude critique. And being honest about systemic limitations doesn't diminish the dedication of individual healthcare providers.

Here's what the medical system does extraordinarily well: it measures quantifiable outcomes to guide scalable treatment decisions. Tumor size. Survival rates. Lab values. These metrics matter tremendously. They represent the difference between life and death. And they need to be used in data-driven treatment decisions. 

The system has been engineered—brilliantly, efficiently—to extend quantity of life using evidence-based interventions that can be standardized, replicated, and scaled to serve broad populations. 

But quality of life? Human suffering? Fear of death? Those outcomes are much harder to quantify. Much harder to standardize. Much harder to reimburse through insurance billing codes.

Manish described this as medicine's materialistic framework: "When you go to the doctor, you never think about talking about love or about death or God or these esoteric concepts that don't necessarily have material metrics. And yet those are probably the things that give you meaning and carry you through everyday life. But they're sort of outside the context of medical practice."

The system doesn't ignore suffering because it's malicious. It simply overlooks suffering because suffering doesn't fit easily into the operating system.

What Tools Are Missing

After nearly two decades in clinical practice, Manish noticed a persistent gap: "Over time, what I saw was that even though I was able to take care of people and help give good cancer treatment and shrink the tumor, the suffering was caused by these other things and I didn't have very good tools to deal with that."

He could extend survival. He could reduce tumor burden. But he couldn't adequately address the suffering that defined his patients' daily existence.

"I didn't have very good tools," he continued. "And so I would give people bad news or talk to them, but then they sort of are left on their own."

That gap—between treating cancer and addressing suffering—eventually contributed to Manish's own burnout. "I was actually just...depressed, you know, just from my own suffering to see that."

This isn't about individual competence. It's about systemic design. The medical machine prioritizes outcomes it can measure. But existential distress doesn't show up on imaging studies. And that inability to address what’s really important can lead to poor outcomes for patients and healthcare providers. 

When Psychedelics Name the Unnamed

Manish's introduction to psychedelic research came through a specific observation: "Psychedelics talked about the thing and named the thing that was the most common, what we saw every day in oncology, that we never talked about. Existential distress and suffering and anguish from having cancer. Not only did they talk about it, they said that they actually might do something about it."

Might. Possibly. Based on early clinical research showing promise.

Manish remained skeptical initially—as any good scientist should. But after conducting his own trials and observing patient outcomes firsthand, he noticed something he'd never seen in his medical career: "[Within] three or four days, people were really different."

Not cured. Not fixed. But meaningfully different. "I had never seen anything in medicine that was so powerful so quickly."

He described one patient's transformation: "They were really stuck in fear and distress, and then they would have this eight-hour [psychedelic] experience with a lot of support. I'm not saying it's magic. But it's like they were stuck in a ditch, and they were starting to move again. Not that things were fixed, but there was a real change in perspective."

Could psychedelics give healthcare providers tools for addressing suffering the system has long acknowledged but rarely treated effectively? Early research suggests this possibility. And if validated through continued clinical research, it might empower physicians who've felt helpless watching patients suffer beyond what standard interventions could address.

What This Means for Cancer Care

I'm not suggesting psychedelics will cure cancer or shrink tumors or eliminate suffering. I'm not suggesting they work for everyone or should replace existing cancer treatments.

But I am suggesting this: the medical system might benefit from treatments that address outcomes beyond tumor size and survival rates. Treatments that help patients address existential distress, connect with loved ones and find meaning in our suffering—the psychological dimensions of cancer that often determine whether life feels worth living. Yes, the medical system might benefit from psychedelic medicines. 

The medical machine saved my life. I'm here because oncologists shrunk my tumors, surgeons removed diseased tissue, and the entire infrastructure of modern medicine mobilized on my behalf.

But survival isn't the only thing that matters. Quality of life matters. Relationship with mortality matters. Finding meaning in suffering matters.

These aren't luxuries. These aren't secondary concerns. For many cancer patients, these psychological and existential battles define our daily experience more than physical symptoms do.

Manish left clinical practice to build Sunstone Therapies—creating infrastructure to study how psychedelics might address the gaps he witnessed in conventional care. That work is still in progress. The questions outnumber the answers.

But the fact that we're finally asking these questions—finally naming existential distress as something worth treating with the same rigor we apply to tumor reduction—that feels like progress.

The machine works. It keeps people alive. But maybe the machine could also learn to address what makes that life meaningful. Maybe it’s time for the modern medical machine to embrace psychedelic medicines. Maybe. Just maybe. 

Let's journey together.