4 questions | Applied Sciences homework help

1. Evaluation of autopsy data of treated patients who died. 5. Cooperation with other investigating organizations such

as the NCI, the FDA, and the Memorial Sloan-Kettering Cancer Center. Questionable methods are broadly classifiable as corrosive agents, plant products, diets and “dietary supplements,” drugs, correction of “imbalances,” bio- logic methods, devices, psychologic approaches, and worthless diagnostic tests. Many promoters combine methods to make themselves more marketable. The next few pages provide examples of these types. Although Chapter Sixteen Cancer 337 some are no longer marketed, their histories still illustrate the nature and variety of cancer quackery. Corrosive agents. Many salves, poultices, and plas- ters have been applied directly to tumors with the hope of burning them away. Turpentine is an old favorite. It has been claimed that some corrosive agents “draw out” the cancer. The Hoxsey method (see Historical Perspec- tive box) included a product of this type. In recent years scientists have found chemicals that can destroy some superficial skin cancers. Except for these, however, cor- rosive agents are worthless against cancer. Plant products. Most folk remedies fall into the plant category. Brews, such as a tea from red clover, are drunk or used to wash external cancers. Mucorhicin, said to be produced by cultivating mold on a nutrient, was composed of yeast, salt, whole wheat, and sterile water. Historical Perspective Some Notes on Cancer Quackery—Cont’d. obtained from several patients and were able to culture the virus from one specimen—suggesting that blood infected with the virus had been used to prepare IAT treatment materials.39 Burton died in 1993, but his former medical director continued to operate the clinic (renamed ITL Cancer Clinic). The Personal Glimpse box on page 342 describes how trick- ery may have been used to make patients think they had been helped by IAT. Powdered shark cartilage is purported to contain a pro- tein that inhibits the growth of new blood vessels needed for cancer to spread. Although a modest effect has been observed in laboratory experiments, it has not been demonstrated that feeding shark cartilage to cancer patients significantly inhibits blood-vessel formation. Even if direct applications were effec- tive, oral administration would not work because the protein would be digested rather than absorbed intact into the body. Nevertheless, in 1993, “60 Minutes” promoted the claims of biochemist/entrepreneur I. William Lane, Ph.D., co-author of Sharks Don’t Get Cancer. The program highlighted a Cuban study of 29 “terminal” cancer patients who received shark- cartilage preparations. The program showed several doing exercise and reported that most felt better several weeks after starting treatment. The fact that “feeling better” does not indi- cate whether a cancer treatment is effective was not mentioned. Nor was it mentioned that sharks do get cancer, even of their cartilage. National Cancer Institute officials who reviewed the Cuban data called them “incomplete and unimpressive.”40 Figure 16-3 shows how a major health-food–industry book distributor mentioned the “60 Minutes” broadcast in an ad plugging Lane’s book. In 2000, Lane Labs-USA, Inc., Andrew J. Lane, Cartilage Consultants, Inc., and I. William Lane agreed to settle FTC charges that they had made unsubstantiated claims that their shark cartilage product (BeneFin) and another product were effective against cancer. The settlement required Lane Labs to pay $550,000 to the FTC and an additional $450,000 to subsidize a clinical trial of shark cartilage co-sponsored by the National Cancer Institute.41 That trial, which was reported in 2005, found no benefit.42 Today, due largely to the Internet, cancer scams are pitched to huge audiences at minimal expense. Government agencies are very active, but the number of scammers greatly exceeds the government’s capacity. has been promoted as safe and effective, clinical evidence indicates that it is neither.32–35 When subjected to enzymatic breakdown in the body, it forms glucose, benzaldehyde, and hydrogen cyanide. Some patients treated with Laetrile have suffered nausea, vomiting, headache, and dizziness, and a few have died from cyanide poisoning. Tests of Laetrile in at least 20 animal tumor models have found no benefit either alone or together with other substances. Studies of human case reports have also been uniformly negative. In 1975 a class-action suit was filed to stop the FDA from blocking the distribution of Laetrile. Early in the case, a federal district court judge ruled that cancer patients could import a 6-month supply of Laetrile for personal use if they could obtain a physician’s affidavit that they were “terminal.” In 1979 the U.S. Supreme Court ruled that it is not possible to be certain who is terminal and that even if it were, both termi- nally ill patients and the general public deserve protection from fraudulent cures. In 1987, after further appeals were denied, the affidavit system was terminated. Today few sources of Laetrile are available within the United States, but it still is utilized at Mexican clinics. In 2011, a Cochrane review concluded that there is no reliable evidence for the alleged effects of Laetrile or amygdalin for curative effects in cancer patients.36 Zoologist Lawrence Burton claimed that his immuno- augmentative therapy (IAT) could control all forms of cancer by restoring natural immune defenses. He claimed to ac- complish this by injecting blood serum proteins isolated with processes he had patented. However, experts concluded that the substances he claimed to use could not be produced by these procedures and do not exist in the human body.37 In 1979 Burton received an enormous boost when CBS- TV’s “60 Minutes” gave him favorable publicity. A prominent physician stated that one of his patients treated by Burton appeared to have miraculously recovered. The patient died within 2 weeks after the program was shown, but “60 Minutes” never informed viewers of this fact. Burton’s literature included a booklet summarizing the experiences of 35 IAT patients and their status as of February 1988. However, Dr. Wallace Sampson, a cancer specialist who examined the data, concluded that the sampling of cases was not meaningful and that 30 of the patients had standard or near-standard treatment prior to IAT. 38 In 1985 public health officials found antibodies to the AIDS virus in vials of serum Part Four Personal Health Concerns338 Essiac is an herbal tea that was prescribed and promoted for about 50 years by Rene M. Caisse, a Canadian nurse who died in 1978. Several reports state that the formula contains burdock, Indian rhubarb, sorrel, and slippery elm, but there may be additional ingredients. Animal tests using samples of Essiac have shown no antitumor activity,43 nor did a review of data on 86 patients per- formed by the Canadian federal health department during the early 1980s. Hulda Clark, an unlicensed naturopath who died of multiple myeloma (a bone marrow cancer) in 2009, claimed that (a) all cancers, AIDS, and many other diseases are caused by “parasites, toxins, and pollut- ants”; (b) cancers can be detected with a blood test for ortho-phospho-tyrosine and a device that identifies diseased organs and toxic substances; (c) cancers can be cured by killing the parasites and ridding the body of environmental chemicals; (d) black walnut hulls, wormwood, and common cloves can rid the body of over 100 types of parasites; and (e) the amino acids ornithine and arginine improve this recipe. Her book Cure for All Cancers contains 103 case histories of her supposed cures. However, judging from her descriptions, (a) most did not have cancer and (b) of those who did, most had received standard medical treatment or their tumors were in early stages.44 Pau d’arco tea, sold through health-food stores and by mail, is said to be an ancient Incan remedy prepared from the inner bark of various species of Tabebuia, an evergreen tree native to the West Indies and Central and South America. However, stories about its origins contain a variety of geographic and botanical errors. Proponents claim that pau d’arco tea is effective against cancer and many other ailments. Tabebuia woods con- tain lapachol, a chemical that has been shown to have antitumor activity in a few studies on animals. However, human studies have found that as soon as significant blood levels were attained, undesirable effects were severe enough to require that the drug be stopped.45 Diets and “dietary supplements.” Many dietary ap- proaches have been recommended as cancer treatments, including fasting, megadoses of nutrients, consumption of raw foods, and various complicated dietary regimens. The grape cure promoted by Joanna Brandt involves eating large quantities of grapes for 1 or 2 weeks, then adding sour milk, raw vegetables, other fruits, nuts, honey, and olive oil. The macrobiotic diet, discussed in Chapter 11, is a semivegetarian approach claimed to cure cancer and many other health problems.46 Anthony Sattilaro, M.D., who wrote Recalled by Life, told how he underwent standard treatment for prostate cancer but claimed that macrobiotic eating placed him in “permanent remission.” However, he died of his disease a few years after the book was published. The Gerson diet is claimed to accomplish “detoxifi- cation” with frequent coffee enemas and a low-sodium diet that includes more than 1 gallon a day of juices made from fruits, vegetables, and raw calf’s liver. Ger- son protocols have also included liver-extract injections, ozone enemas, “live cell therapy,” thyroid tablets, royal jelly capsules, linseed oil, castor oil enemas, clay packs, Laetrile, and vaccines made from influenza virus and killed Staphylococcus aureus bacteria. This approach was developed by Dr. Max Gerson, a German-born physician who emigrated to the United States in 1936. The treatment, available at clinics in Mexico and Hun- gary, is still actively promoted by Gerson’s daughter Charlotte through lectures, talk-show appearances, figure 16-3. Within weeks of the “60 Minutes” broadcast, many manufacturers began marketing shark-cartilage products. The false claims in this ad (and the book) would be illegal in marketing products, but freedom of the press protected the authors, and the advertiser merely described what the book said. Chapter Sixteen Cancer 339 and publications. Although Ms. Gerson claims high cure rates, these claims are not based on systematic monitoring of patients after they leave the clinic.47 Three naturopaths who visited the Gerson Clinic in 1983 were able to track 18 patients over a 5-year period (or until death) through annual letters or phone calls. At the 5-year mark, only one was still alive (but not cancer- free); the rest had succumbed to their cancer.48 Green has concluded that the Gerson rationale is unfounded because (a) the “poisons” Gerson claimed to be present in processed foods have never been identified, (b) frequent coffee enemas have never been shown to mobilize and remove poisons from the liver and intestines of cancer patients, (c) there is no evidence that any such poisons are related to the onset of cancer, and (d) there is no evidence that a “healing” inflammatory reaction exists that can seek out and kill cancer cells.49 The American Cancer Society50 advises that although dietary measures may help prevent certain cancers, there is no scientific evidence that any nutrition-related regi- men is appropriate as a primary treatment for cancer. Brooks51 has noted: No one will argue with the idea that eating a healthy, balanced diet is important for general health. However, there is no logical reason to believe that dietary supplements or special diets can improve immune system function in people who are not malnourished. Nor is there any evidence that dietary supplements can “boost” the immune system to produce cancer regression. Drugs. Iscador, an extract of mistletoe, was pro- posed for the treatment of cancer in 1920 by Rudolf Steiner, a Swiss physician who espoused occult beliefs. Steiner founded the Society for Cancer Research to promote mistletoe extracts and occult practices he called anthroposophical medicine. A 1962 report by the society claimed that the time of picking the plants was important because they react to the influences of the sun, moon, and planets. Various mistletoe juice preparations have been studied with the hope of finding an effective anticancer agent. However, in 1984, the expert working group of the Swiss Society for Oncology concluded that there was no evidence that Iscador was effective against human cancers.52 Since that time, two well-designed clinical trials have found no benefit.53,54 During the past decade, oxygen-rich substances (germanium sesquioxide, hydrogen peroxide, superoxide dismutase, and ozone gas) have been utilized by many promoters of questionable cancer regimens. Their use is based on the erroneous notion that cancer is caused by oxygen deficiency and can be cured by exposing cancer cells to more oxygen than they can tolerate. Although these compounds have been the subject of legitimate research, there is little or no evidence that they are effective for the treatment of any serious disease, and each has demonstrated potential for harm.55,56 Germa- nium products, for example, have caused irreversible kidney damage and death. The FDA has banned their importation and seized products from several American manufacturers. CanCell, originally called Entelev, is a liquid claimed to cure cancer by “lowering the voltage of the cell structure by about 20%,” causing cancer cells to be “digested” and replaced with normal cells. Accompa- nying directions have warned that bottles of CanCell should not be allowed to touch each other or be placed near any electrical appliance or outlet. CanCell has also been promoted for the treatment of AIDS, amyotrophic lateral sclerosis, multiple sclerosis, Alzheimer’s disease, “extreme cases of emphysema and diabetes,” and several other diseases. In 1989 the FDA reported that CanCell contained inositol, nitric acid, sodium sulfite, potassium hydroxide, sulfuric acid, and catechol.57 Subsequently, its promoters claimed to be modifying the formulation to make it more effective. They have also claimed that CanCell cannot be analyzed because it varies with atmospheric vibrations and keeps changing its energy. Laboratory tests conducted between 1978 and 1991 by the NCI found no evidence that CanCell was effective against cancer. The FDA has obtained an injunction forbidding its distribution to patients.58 In the mid-1970s hydrazine sulfate was proposed for treating the progressive weight loss and body deteriora- tion characteristic of advanced cancer. Based on animal data and preliminary human studies, it was also claimed to cause tumor regression and subjective improvement in patients. However, three trials sponsored by the NCI found that hydrazine sulfate was no better than a pla- cebo.59 In one study, nerve damage occurred more often and the quality of life was significantly worse in the hydrazine sulfate group. Cases have also been reported of liver and kidney failure and encephalopathy following hydrazine sulfate administration. Beginning in 1995, Kathy Keeton, wife of Penthouse magazine publisher Bob Guccione, achieved widespread publicity with claims that hydrazine sulfate had enabled her to recover from stage IV metastatic cancer after doc- tors gave her only 6 weeks to live. However, she died of her disease in 1997. The 5-year survival rate with such a cancer is 12% to 20%. A 2-year survival is certainly not impressive.60 “Antineoplastons” is the name given by Stanislaw R. Burzynski, M.D., to substances that he claims can Part Four Personal Health Concerns340 “normalize” cancer cells. He has published many pa- pers in which he claims that antineoplastons extracted from urine or synthesized in his laboratory have proven effective against cancer in laboratory experiments. He also claims to have helped many people with cancer get well. In 1982 two Canadian experts visited Burzynski’s clinic and asked for information on the patients he felt best demonstrated that his treatment was effective. After reviewing the status of about a dozen cases, they concluded that all who were still alive had either had slowly growing tumors or had received effective treat- ment before seeing Burzynski. In a report to the Canadian Ministry of Health they stated: We were surprised that Dr. Burzynski would show us such questionable cases. We were left with the impression that either he knows very little about cancer and the response of different tumors to radiation and hormonal measures, or else he thinks that we are very stupid, and he has tried to hoodwink us.61 In 1988 talk-show host Sally Jesse Raphael fea- tured four patients of Burzynski whom she described as “miracles.” The patients stated that Burzynski had cured them when conventional methods had failed. In 1992 the television program “Inside Edition” reported that two of the four patients had died and a third was having a recurrence of her cancer. (The fourth patient had bladder cancer, which has a good prognosis.) The widow of one of Raphael’s guests stated that her husband and five others from the same city had sought treatment after learning about Burzynski from a television broad- cast—and that all had died of their disease. Saul Green, Ph.D.,62 a biochemist who worked for many years at Memorial Sloan-Kettering Hospital investigating the mechanisms and treatment of cancer, found no evidence that any of the substances Burzynski calls “antineoplastons” had been proven to “normal- ize” tumor cells. In 1998, the Texas Attorney General secured a consent agreement stating that Burzynski (a) cannot distribute unapproved drugs in Texas; (b) can distribute “antineoplastons” only to patients enrolled in FDA-approved clinical trials, unless the FDA approves his drugs for sale; (c) cannot advertise “antineoplastons” for the treatment of cancer; and (d) must include a dis- claimer on his Web site, promotional material, and ads that “antineoplastons” have not been established as safe and effective. The agreement also called for Burzynski to pay $50,000 to reimburse the State of Texas for the cost of its investigations.63 The Cancer Letter subsequently noted that although Burzynski set up many “clinical trials,” they do not conform to usual standards.64 714X is a chemical solution produced in Quebec by Gaston Naessens, who also operates the International Academy of Somatidian Orthobiology. In 1956, in con- nection with an alleged cancer remedy called GN-24, Naessens was convicted of illegal medical practice and ordered by a French court to pay the maximum appli- cable fine. He was prosecuted again in 1964 after another alleged cancer remedy he administered in Corsica was proven not to work. Naessens claims that 714X can “fluidify the lymph” and “direct nitrogen into the cancerous cells in order to stop their toxic secretions which block the organism’s de- fense system.” The Canadian Health Protection Branch has found that 714X contains a mixture of camphor, ammonium chloride and nitrate, sodium chloride, ethyl alcohol, and water. The agency has received no scientific data to support claims that 714X is effective. However, as a result of a court ruling, it permits physicians to ap- ply for special access to prescribe it on a case-by-case basis.65 PC-SPES was said to be a centuries-old Chinese remedy that could fight prostate cancer by boosting the immune system. It showed some evidence of effective- ness but turned out to have been spiked with an estrogen- containing drug that is known to be effective in some cases of prostate cancer.66 After the truth was disclosed, the sellers withdrew it from the marketplace, entered “no contest” pleas, and signed consent agreements to settle criminal and civil charges. Correction of “imbalances.” Revici Cancer Control (also called lipid therapy) was based on the belief that cancer is caused by an imbalance between constructive (anabolic) and destructive (catabolic) body processes. This approach was developed by Emmanuel Revici, M.D. (1896–1998), who practiced in New York City. His formulations, which varied from visit to visit, were based on measurements of the specific gravity, pH (acid- ity), and surface tension of single samples of the patient’s urine. Revici also claimed success against AIDS. Revici’s method of urinary interpretation was not valid. The specific gravity of urine reflects the concentra- tion of dissolved substances and varies with the amount of fluid a person consumes. The acidity depends mainly on diet and varies considerably throughout the day. Thus, even when these values are useful for a metabolic evalu- ation, information from a single urine sample would be meaningless. The surface tension of urine has no medically recognized diagnostic value.67 In 1993, after a lengthy battle, New York State’s licensing authorities revoked Revici’s medical license. Chapter Sixteen Cancer 341 Today, the most common approach to alleged “im- balances” involves claims that cancer thrives when the blood is acidic and can be cured by using dietary mea- sures and supplements that make it alkaline. Proponents suggest testing the acidity (pH) of saliva and acting accordingly. There is no scientific evidence or reason to believe that blood pH is a factor in cancer growth. Moreover, the body’s homeostatic mechanisms keep blood pH within a narrow range that is not influenced by the dietary strategies advocated for curing cancer.68 Biologic methods. “Vaccines” and similar products have been prepared from various substances including pooled cancers, the patient’s own blood and/or urine, animal blood and/or urine, and cultures of germs. Vir- ginia Livingston, M.D., who died in 1990, postulated that cancer is caused by a bacterium that invades the body when resistance is low.69 To combat the cancer, she allegedly strengthened the body’s immune system with various vaccines (including one made from bacteria taken from the patient’s urine); a vegetarian diet that excludes chicken, eggs, and sugar; vitamin and mineral supplements; visualization; and stress reduction. She claimed to have a very high recovery rate but published no clinical data to support this. Scientists who attempted to isolate the organism she postulated found that it was a common skin bacterium. Researchers at the University of Pennsylvania Cancer Center compared 78 patients with advanced cancer treated at the center with 78 similar patients who had been given various vaccines, a vegetarian diet, and coffee enemas at the Livingston- Wheeler Clinic. The study found no difference between average survival time of the two groups. However, the Livingston-Wheeler patients reported more problems with appetite and pain.70 Fresh cell therapy, also called live cell therapy and cellular therapy, involves injections of fresh embryonic animal cells taken from the organ or tissue that corre- sponds to the unhealthy organ or tissue in the patient. Proponents claim that the recipient’s body automatically transports the injected cells to the target organ where they repair and rejuvenate the ailing cells. The originator of this approach was Paul Niehans, a Swiss physician who died in 1971. The ACS71 states that fresh cell therapy has no proven benefit and has caused serious side effects (infections and immunologic reactions to the injected protein) and death. Hariton Alivizatos, a Greek physician who died in 1991, claimed to have developed a blood test that can determine the type, location, and severity of any can- cer. He also claimed to have developed a “serum” that enabled the patient’s immune system to destroy cancer cells and helped the body rejuvenate parts destroyed by cancer.72 Knowledgeable observers believe the princi- pal ingredient of the so-called Greek Cancer Cure was niacin. Insulin potentiation therapy (IPT) involves giving substandard doses of chemotherapy drugs after insulin is administered intravenously. Proponents claim that the insulin increases the effect of medications so that lower doses can be used. They also suggest that the insulin somehow makes cells more permeable so that certain drugs enter more easily. However, there is no logical reason to believe this is true, and no scientific evidence shows that IPT is safe or effective as a cancer treatment.73 Devices. Many gadgets have been falsely claimed to diagnose and/or treat cancer.74 One of the most notorious was the Orgone Energy Accumulator, which was claimed by Wilhelm Reich, M.D., to treat disease by absorbing “blue bions” or “Cosmic Orgone Energy.” In 1956 Reich and an associate were sentenced to prison for violating an earlier injunction against distributing his devices. Devices used or marketed by others have included Hulda Clark’s “zappers” and other equipment that pass low-voltage electrical current through tumors or the body; low-level magnetic devices; “electroacupuncture” devices purported to measure the electrical resistance of so-called “acupuncture points” for diagnosis and prescription; colonic irrigation machines claimed to “detoxify the system”; electrical devices said to “charge” blood samples that are taken from and later returned to patients; negative ion generators claimed to have an effect against tumors; radionics devices (such as Rife machines) claimed to diagnose and cure cancer by ana- lyzing and emitting radio waves at the correct frequen- cies; magnets claimed to cure cancers by “improving circulation” or by intracellular effects; crystals alleged to have curative powers; pendulums used to diagnose or locate tumors in a manner similar to that of divining rods; pyramidal objects alleged to focus occult energies for healing purposes; and a brassiere claimed to prevent breast cancer and either increase or decrease the size of the bosom. Neither quacks nor their victims seem to have any limit to the scope of their imagination. Psychologic approaches. Various psychologic methods are promoted to cancer patients as cures or as adjuncts to other treatment. The techniques include imagery, visualization, meditation, progressive muscle relaxation, and various forms of psychotherapy. These techniques may reduce stress, alleviate depression, help control pain, and enhance patients’ feelings of mastery and control. Individual and group support can have a positive impact on quality of life and overall attitude. Part Four Personal Health Concerns342 A positive attitude may increase a patient’s chance of surviving cancer by increasing compliance with proven treatment. However, it has not been demonstrated that emotions directly influence the course of the disease. Bernie Siegel, M.D., author of Love, Medicine & Miracles and Peace, Love & Healing, is a surgeon who claims that “happy people generally don’t get sick” and that “one’s attitude toward oneself is the single most important factor in healing or staying well.” He also states that “a vigorous immune system can overcome cancer if it is not interfered with, and emotional growth toward greater self-acceptance and fulfillment helps keep the immune system strong.” No scientific study supports these claims. Siegel coauthored a report of a 10-year study that found that 34 breast cancer patients participat- ing in his Exceptional Cancer Patients program lived no longer after diagnosis than comparable nonparticipants.76 The program consisted of peer support, family therapy, individual counseling, and the use of positive imagery. O. Carl Simonton, M.D., claims that cancers can be affected by relaxation and visualization techniques. He asserts that this approach can lessen fears and tension, strengthen the patient’s will to live, increase optimism, and alter the course of a malignancy by strengthening the immune system. However, he has not published the results of any well-designed study testing his ideas. He and his wife, Stephanie (a psychotherapist), taught patients to imagine their cancer being destroyed by their white blood cells. However, there is no evidence that white cells actually attack cancer cells in this manner. Simonton’s book Getting Well Again included re- ports on patients who got better after using his methods. However, Friedlander77 analyzed five of the reports he thought might impress laypersons most and noted that two of the patients had undergone standard treatment, one had a slow-growing tumor, and one probably did not have cancer. The fifth patient’s tumor was treatable by standard means. Some suggest that Simonton’s program may have positive psychologic effects because it may help people relax and give them a feeling that they are doing some- thing positive. However, scientific studies have found no clear-cut relationship between emotions, personality factors, stresses, and cancer. Simonton has done some studies, but the American Cancer Society and others have questioned their design.78 Although his method is physically harmless, it may encourage some patients to abandon effective care. British researchers have reviewed 30 studies that examined whether psychologic factors can influence survival from cancer. Twenty-six investigated the as- sociation between coping styles and survival, and 11 investigated their effect on recurrence. The parameters evaluated included “fighting spirit,” “hopelessness/ Personal Glimpse A Victim’s Experience In 1982 my father-in-law was diagnosed as having unresectable, incurable, widely disseminated cancer of the lung, and advised that essentially his condition was terminal. As could be expected, the family was distraught, and we began to grasp at straws and looking into alternative modes of treatment. . . . Some of the local press carried stories about . . . so-called immuno-augmentative therapy. . . . Soon thereafter he went to the Bahamas to get the treatment. His main symptom had been pain from the tumor. It had metastasized to the bones. When he went down there, he was told to go off pain medication and to begin the serum injections, and that . . . the serum injections, if they work and dissolve the tumor, will cause pain. So he went down there knowing he had a tumor growing in him and causing him pain, and through a pretty good ploy he came back convinced that the pain he was having was a cure. In addition, he was told the tumor was shrinking. The x-ray film they took was overexposed, which has the technical problem of making masses look smaller than they really are. Upon his return I encouraged him to go to Fox Army Hospital and have another chest x-ray made. Several radiolo- gists corroborated that they could see no evidence of any shrinkage in the tumor. I was then faced with the unpleasant task of telling my father-in-law for the second time he was dying. It was interesting that both he and his wife came back with total euphoria—that he was cured. They told everyone they saw he was cured. When they realized that they had been fooled, it was really a shock, and, of course one doesn’t usually go around telling people you have been fooled. He died approximately 2 months after he returned. In addition to the emotional turmoil and being away from the rest of the family for essentially half the remaining life he had, this cost them approximately $10,000, including travel and lodging, for this phony cancer cure. Carl Barnes, M.D.75 Chapter Sixteen Cancer 343 helplessness,” “denial or avoidance,” “stoic acceptance or fatalism,” “anxious coping/anxious preoccupation,” “depressive coping,” and “active or problem-focused coping.” Noting that positive findings tended to be confined to studies that were small or poorly designed, the authors concluded: There is little consistent evidence that psychological coping styles play an important part in survival from or recurrence of cancer. People with cancer should not feel pressured into adopting particular coping styles (including ‘positive think- ing’) to improve survival or reduce the risk of recurrence.79 Subsequent reviews of published reports have concluded that existing data do not support the claim that psychotherapy prolongs cancer survival and that a large-scale trial would be a poor investment of research funds because the claim is implausible.80,81 Worthless diagnostic tests. H.H. Beard, a biochem- ist, claimed that his Beard Anthrone Test could detect cancer in the body within 2 or 3 weeks after it started by measuring a sex hormone in the urine. He was indicted for mail fraud in 1967 and subsequently received a 6-month suspended prison sentence. William Kelley, D.D.S., a dentist who treated can- cer patients, used two tests. His Protein Metabolism Evaluation Index was based on the premise that cancer is a foreign protein. His Kelley Malignancy Index was claimed to be “the most accurate and extensive cancer detection system ever developed.”82 A booklet by Kelley claimed “at least 86% of all cancer conditions can be treated by diet alone” and that “cancer is nothing more than a pancreatic enzyme deficiency” caused by eating too much of the wrong kind of protein. “If people would not eat protein after 1:00 PM,” the booklet stated, “83% of cancer in the United States could be eliminated.” In 1970 Kelley was convicted of practicing medi- cine without a license after witnesses testified that he had diagnosed lung cancer on the basis of blood from a patient’s finger and prescribed dietary supplements, enzymes, and a diet as treatment. His dental license was subsequently suspended, but he continued to promote his methods until the mid-1980s. Treatment said to be similar is still provided today by Nicholas Gonzalez, M.D., of New York City, who claims to have analyzed Kelley’s records and drafted a book about his findings. The manuscript was never published, but experts who evaluated its chapter on 50 cases found no evidence of benefit. In 1994, after investigating six of Gonzalez’s cases, New York State licensing authorities concluded that (a) his “alternative protocol” did not entitle him to an al- ternative standard of care, (b) he had failed to correctly interpret signs and symptoms of disease progression, (c) he had treated the patients incompetently, and (d) his record-keeping was inadequate. He was placed on probation for 3 years with stipulations that he undergo retraining and his work be supervised by the Office of Professional Conduct. In 1997 a jury in New York City awarded $2.5 million in actual damages and $150,000 in punitive damages to a former Gonzalez patient. The woman testi- fied that she had been diagnosed with an early stage of uterine cancer and underwent a hysterectomy. Instead of undergoing medically recommended radiation and chemotherapy, she consulted Gonzalez who discouraged her from following this advice. Gonzalez prescribed up to 150 dietary supplement pills a day plus frequent cof- fee enemas. Later he claimed that the cancer was cured even though it was progressing. It eventually damaged her spine and left her blind. An appeals court upheld the $2.5 million verdict but dismissed the punitive damage award. Despite these problems, the NIH’s National Center for Complementary and Alternative Medicine awarded a $1.4 million grant to Columbia University to study Gonzalez’s work. The study found no benefit.83 “Metabolic Therapy” “Metabolic therapy” is based on the idea that cancer and other chronic illnesses result from a disturbance of the body’s ability to protect itself. The components of metabolic therapy vary from practitioner to practi- tioner. No controlled study has shown that any of its components has any value against cancer or any other chronic disease. However, many people find its concepts appealing because they do not seem far removed from scientific medicine’s concerns with diet, lifestyle, and the relationship between emotions and bodily responses. Metabolic therapy’s most visible proponent was Harold Manner, Ph.D., a former biology professor who left his academic position to market his ideas. Manner defined metabolic therapy as “the use of natural food products and vitamins to prevent and treat disease by building a strong immune system.” He theorized that environmental chemicals cause many primitive cells to become cancerous. He said that when the immune system is functioning normally, the cancer cells are destroyed. But if it is weakened by poor nutrition, environmental pollutants, or debilitating stress, cancer cells are unin- hibited and multiply rapidly. Therefore, cancer can be treated by revitalizing the body’s immune system with diet, dietary supplements, and “detoxification.” During 1988 Manner’s Tijuana clinic charged $7500 for its 21-day program of vegetable juices, “natural foods”; intravenous Laetrile; coffee enemas; Part Four Personal Health Concerns344 inspirational messages; and large amounts of vitamins, minerals, enzymes, glandular extracts, and other prod- ucts. Although Manner claimed a very high success rates, there is no evidence that he kept track of how patients fared once they left his clinic. That same year, a reporter who attended Manner’s “Advanced Course in Metabolic Therapy” by pretending to be a chiropractor observed that attendees were instructed to use standard code numbers on insurance claims so they could be paid for their services. The reporter also noted that those who joined the Manner Metabolic Foundation were promised a $200 “referral fee” for each patient they referred to Manner’s Mexican clinic.84 Manner died in 1988, but the clinic continued to operate for several years. proMoTion of QuesTionable MeThods Cancer treatment methods that lack a scientific basis are readily available and aggressively promoted. The promoters run the gamut from ignorant individuals to highly educated scientists with advanced degrees. Some even hold medical degrees. Such individuals typically (a) discount biopsy verification, (b) fail to keep adequate records, (c) spread claims through the media rather than through scientifically acceptable channels subject to peer review, (d) tend to be isolated from established scientific facilities or associates, and (e) claim persecution by the medical establishment. Many promoters claim that cancer is the result of adverse environmental influences, excess protein intake, self-pollution by bad habits, and incorrect spiritual atti- tudes. Their “corrective” methods include meatless diets; “cleansing” of the body by special diets, enemas, and antioxidants; megadoses of vitamins and trace minerals; and various spiritual approaches. Cassileth85 has noted: Most [such programs] are within the control of the patient, who can choose which part . . . to accept, which part to cheat on, and which part to amplify. There is no FDA regulation of most of these programs since the FDA has no jurisdiction over dietary theories, personal vitamin consumption or spiritual improvement. What’s more, no action can be taken against the proponents for claiming that orthodox approaches are unnatural and bad. Dubious Information Sources Cancer patients can obtain information about question- able methods in many ways: 1. Personal contacts. Referrals may be made by friends, neighbors, or other people who know someone supposedly helped by nonstandard treatment. In some communities, traffic in questionable methods is so well organized that proponents infiltrate hospitals to tout their methods during “chance meetings” in waiting rooms. 2. Magazines and books. Articles promoting ques- tionable treatments appear frequently in magazines that cater to the health-food industry and sporadically in other magazines. The titles of books that promote dubi- ous cancer treatments typically contain buzzwords such as alternative, answer (rhymes with cancer), cleanse, curing, detoxify, foods, healing, herbal, immune,

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