by David J. Hess
Cloth, 244 pp., 1997
review by Jule Klotter
Why do some avenues of medical research prosper and others struggle
for recognition? Why are some theories accepted and others - even
though supported by scientific research - dismissed? Using the theory
that bacteria causes cancer as an example, anthropologist David. J.
Hess looked for answers to these questions in hope of determining ways
to evaluate alternative medical research with greater care and
thought. When Hess first came upon the bacteria-cancer theory, he
"found it so preposterous that [he] was curious enough to check some
of the sources." For five years, he researched the theory, its
history, proponents, and adversaries. Hess presents his findings about
this theory, in particular, and about the need for policy changes in
medical research in his book Can Bacteria Cause Cancer?
One proponent of the bacterial theory whose research impressed Hess is
American surgeon and cancer researcher William B. Coley. Although his
work focused on the therapeutic use of killed bacteria to treat cancer
rather than cancer etiology, Coley believed that cancer was
infectious. After losing his first patient to bone cancer despite a
successful amputation (the accepted treatment for sarcoma at that
time), Coley sought more information about the disease. He researched
all cases of sarcoma at New York Hospital for the previous 15 years
and, in 1891, tracked down a patient who had recovered from sarcoma.
Seven years before, this patient had survived erysipelas, a
streptococcal bacterial infection characterized by skin inflammation
and high fever, after a fourth incomplete surgical attempt to remove
the cancer. The man was alive and well; the cancer had disappeared and
not returned.
During this same period, Coley studied German and French medical
literature and learned that, as early as 1882, several German doctors
had tried inoculating inoperable cancer patients with erysipelas.
Coley found that erysipelas alone was not effective. He developed a
mixture of killed Streptococcus pyogenes and Bacillusprodigiousus (now
known as Serratia marcescens cultures). He used the mixture for the
first time in January 1893, on a 19 year-old boy with inoperable
abdominal and bladder cancer. After four months of injections, the
tumor disappeared. The patient died 17 year later from a heart attack.
During the 20th century, the Coley toxins were used at the Memorial
Hospital (now Memorial Sloan-Kettering Cancer Center), the Mayo
Clinic, and by numerous US and European doctors. The treatment's
efficacy is dependent upon the site, dosage, frequency of injections
given over a period of three to four months. The object is to incite
the high fever (102'F - 104'F) that characterizes erysipelas. Because
commercial preparations of the toxins (produced by Parke, Davis, and
Co. in the US) tended to be weaker than those made by Coley's
bacteriologists, clinicians could not always get the necessary febrile
reaction and their results were inconsistent. When Coley's protocol
and mixture were used, the results were impressive. In a 1975 treatise
for the Cancer Research Institute, Helen Coley Nauts (Coley's
daughter) reported that "85%, of the osteogenic sarcoma cases
receiving toxins for three to four months survived five to 50 years."
Clinical trials in the 1950s, 1960's, and in the 1990s have shown that
the toxins, when given according to Coley's protocol, are effective.
So, why has Coley's work been largely ignored? Certainly, the weak
commercial toxins affected its acceptance. The method also demands
considerable time and effort on the part of the oncologist. Although
Coley was respected as a pioneer in cancer research, his toxins did
not receive the support of men in power. Coley's therapy has a history
of being forced aside by the arrival of new therapies. In the 1920s,
James Ewing, Medical Director of the Memorial Hospital, threw his
support to radiotherapy, which displaced the Coley toxins as a
treatment for inoperable cancer. Patients, however, could still
receive Coley's therapy at Memorial Sloan- Kettering, which began
producing the bacterial mixture in 1946. After World War II, the era
of chemotherapy began. Then Memorial medical director Cornelius Rhoads
supported the new therapy. This time, however, Rhoads wanted to
discontinue the use of Coley's toxins altogether. According to Helen
Coley Nauts, '...in October 1995 Rhoads arbitrarily stopped the
production of the toxins at Sloan Kettering while several patients
were under treatment.' Today, US researchers view Coley's toxins
simply as a precursor of today's cancer immunotherapies. Bacteria
products used in immunotherapy are viewed as stimulating the general
immune system rather than specifically attacking "purported"
oncobacteria.
Cornelius Rhoaes' affinity for chemotherapy blocked the work of
another researcher of the cancer-microbe theory. He kept the research
of Virginia Livingston-Wheeler from receiving exposure at conferences
by bullying potential sponsors and by threatening to withhold news
releases from the press if they reported the work of Livingston and
her colleagues. Rhoads also convinced a dying director of the
Black-Stevenson Cancer Foundation to sign a codicil that prevented
Livingston and her colleagues from spending their portion of a
$750,000 grant in 1951, 'without the permission of Dr. Rhoads's
Memorial Center." Given Rhoads' antipathy to the microbial theory, the
laboratory devoted to the research of biological cancer treatments
that Livingston and colleagues had hoped to fund with the grant never
materialized. Despite Rhoads' effort to suppress her work, Livingston
developed a network of allies and fellow researchers - many of whom
were independently turning up evidence of bacterial cause for cancer.
Livingston's research career began during World War II when a nurse
asked Livingston to look at a skin condition, which Livingston
diagnosed as scleroderma. Upon examining the nurse's skin tissue under
a microscope, Livingston discovered a pleomorphic mycobacteria (which
changes form during its life cycle) related to leprosy and TB
bacteria. The relationship to leprosy was supported by the nurse's
(and, later, other scleroderma patients') favorable response to
leprosy medication. Livingston published her work on scleroderma, and
her observations were confirmed by researchers at the Brussels Pasteur
Institute and in the US. In her attempt to learn more about the
mycobacteria, Livingston inoculated animals with it. Many of them
developed cancer. She then asked colleagues for tumor samples from
human patients. In these samples, she found microbes that looked like
the scleroderma microbes. When Livingston cultured the cancer microbes
and injected them into mice, many of the animals developed cancer or a
collagen disease such as scleroderma or lupus erythematosis.
Livingston's research led her to develop a cancer protocol that used
autogenous vaccines and a diet high in abscisic acid similar to the
Gerson diet.
The reproducible work of researchers like Livingston made Hess
question why research concerning the microbial-cancer theory has been
ignored, even suppressed. The difficulty of culturing the same microbe
from cancer samples, a painstaking process, has caused many
researchers to ignore this line of research. Until recently,
microbial-cancer research was further hampered by a lack of
technology, such as electron microscopy and molecular biology which
could help provide evidence. Traditional microbiological
classification systems and lack of general acceptance of pleomorphic
microbes have also restricted research. Although some groups of
bacteria are recognized as being pleomorphic (e.g., Cell Wall
Deficient Bacteria), pleomorphic bacteria are considered aberrations
and unlikely to cause illness. Any bacteria found in human cancer
tissue is seen as the result of contamination or as an opportunistic
secondary infection that has little to do with tumor growth.
In addition to research limitations, the orthodox cancer research
culture, which arose in the 1930s and 1940s, had its own biases and
the power to enforce them. Hess cites the work of science studies
analyst R.F. Bud (1978). Bud showed that Sloan- Kettering and the
Institute for Cancer Research 'imported organizational models from
industrial research laboratories." The industrial culture values
efficiency, standardization, assembly-line production, hierachy,
centralized organization, and synthetic products. Unlike chemotherapy
and radiation therapy, autogenous vaccines and pleomorphic bacteria do
not fit into that culture. Hess says that "those who advocated radium
and chemotherapy prevailed over those who advocated bacterial vaccines
... because they offered therapeutic research programs that were
better adapted to the ecological pressures of the
industrial-capitalist society in which they were operating." He does
not see this as a conscious conspiracy. Rather, Hess considers it the
result of a research community with its own culture which, like all
cultures, evaluates everything according to its own values and logic.
Unfortunately, if one cultural view dominates, etiological theories
and medical treatments that do not fit into that view are ignored when
research funds are distributed, or actively castigated and suppressed.
To circumvent the biases of the dominate cancer research culture, Hess
recommends public funding to investigate cancer therapies that have
shown clinical evidence of safety and effectiveness - effectiveness
that can be explained by a theory involving a 'credible biological
mechanism." Bacteria vaccines, large-dose dietary supplements, the
Gerson and related diets, some herbs, and psychotherapies with
measurable psychoimmunological effects meet these criteria in his
view. Hess also recommends that social scientists take an active part
in reconciling opposing cultures by neutrally analyzing controversies.
"Skeptics may oppose these proposals as a tremendous waste of taxpayer
dollars but this economic argument is misleading," writes Hess. 'If
skeptics turn out to be right, and if the major alternative therapies
mentioned above ... all turn out to be inefficacious, then cancer
victims and their friends will have better information that will help
them to avoid making bad financial and health-care decisions."
Can Bacteria Cause Cancer? does not answer the question in its title.
The book does, however, try to explain why a significant body of
scientific research has been largely ignored by cancer research
institutions. Hess has clearly demonstrated the valuable role that
social scientists can have in offering a neutral perspective on
medical research and how it is shaped by cultural bias. Only when bias
is set aside can medical theories be evaluated on their scientific
merits.
Townsend Letter for Doctors and Patients
October 1998
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