Part
1 of this article originally appeared in our August/September
2004 issue.
Part 2 was in print in October 2004.
Part 3 is an online publication
only, August 2006.
Emanuel Revici's difficult publishing history began in Paris on the eve
of World War II and continued through the end of the war in Mexico City, where
US physicians visiting the medical facility he had opened witnessed the results
of his lipidic treatment for cancer. Most of Revici's publishing history
took place in New York City, after he moved to the US in 1946, and where, a
year later, he founded the Institute of Applied Biology (IAB), which specialized
in clinical cancer research. Revici's 50-year struggle to publish exemplifies
the problems most originators of non-standard approaches to cancer experience
in seeking mainstream understanding and acceptance of their therapies.
Publications, 1930s & 1940s
Emanuel Revici's medical research commanded attention during his years
in France (1936-41). Between 1937 and 1938, the sub-director of the Pasteur
Institute deposited five papers by the Romanian-born physician in the National
Academy of Sciences, a prestigious way of registering scientific innovations.8
These papers summarized observations Revici had made about the influence
of lipids in pathological pain and cancer.
In 1943, a year after establishing his Institute in Mexico City, Revici sought
to acquaint visiting US physicians with his findings, hoping they would assist
in publishing them in peer-reviewed English-language journals. His associate
and friend Gaston Merry, in a personal letter dated September 5, 1945, aired
his suspicion that the US doctors had intended to publish Revici's findings
as their own. Perhaps with that aim in mind, these physicians took a glancing
swipe at Revici. The Journal of the American Medical Association (JAMA),
August 18, 1945, printed a letter signed by these physicians under the heading, "A
Mexican Treatment For Cancer—A Warning." The letter, not referring
to Revici by name, disparaged both his theories and results.
"What seems to be behind the paper," Merry wrote, "is the desire
to work along the ideas of Revici and to claim the paternity of some of his ideas.
A hint is given by an article published in Cancer Research on
page 480 of the August number and called 'The Effects of 3–4 Benzpyrene on the
Auto Oxidation of Unsaturated Fatty Acids.' It is signed by G.C. Meuller and
H.P. Rusch, the latter being the doctor from Wisconsin who came at the end
of
1943 to spend about 5 weeks here and who came again at the end of 1944."
"His article," continued Merry, "is the reproduction of an
experiment made in Paris, the conclusions of which having been published at two
or three occasions. When Dr. Rusch was here in December 1943, I was present at
the conversations as an interpreter, and Revici candidly discussed his findings
at length, mentioning specifically the linoleic and linolenic acids which are
also the ones used by Dr. Rusch who took plenty of notes during the conversations…As
you know, according to Revici's classification, 3–4 Benzpyrene is
one of the first bodies to be considered as Lipobase. Dr. Rusch does not go
so far as to talk about Lipobases and Lipoacids but his method is a close reproduction
of the technique mentioned by our friend. I am afraid that all the notes taken
18 months ago and later will serve as subjects for publications which so far
could not be made from here."
Merry ended: "I guess the best thing would be to liquidate what we have
here and have Revici working in a laboratory in the States with the proper
help to repeat all his experiments in support of his theory and especially
the suitable collaboration for writing up the publications. It is a great handicap
for him that his English is too poor for writing the necessary articles. This
is what we asked for when the Texas and Wisconsin gang came here but they acted
deaf."9
From the moment Revici co-established the IAB in Brooklyn, New York, in 1947,
the Institute reported on its investigational programs. Summaries of Revici's
findings prior to the opening of the IAB appeared in booklet form, printed
and bound in blue paper covers, with each booklet devoted to a single subject.
Itemizations of new or ongoing studies periodically circulated as mimeographed
typescripts. For example, "Report on the Research Conducted at the Institute
of Applied Biology," issued 10/15/48 by the Cancer Research and Hospital
Foundation (the IAB's funding arm), listed over 20 different experiments. "The
fixation of oxygen, sulfur, and selenium in unsaturated fatty acids" was
the second experiment in this itemization. The 21st experiment was "The
influence of lipids in healing of tissue injured by radium emanation."10
Revici's research on radiation injury had blipped onto the US Navy's
radar screen 18 months earlier. A letter from a Colonel Thomas G. Cassady,
dated just four days before the IAB report, confirmed the Navy's interest:
(Military scientists were testing nuclear weapons on isolated atolls in the
Pacific Ocean in the late 1940s, seeking to protect servicemen on the battlefront
from lethal radioactive fallout.)
"I have had several conversations," Cassady wrote, "at the
Naval Medical Research Center at Bethesda, MD, regarding Dr. Revici…About
a year-and-a-half ago …they had conversations with the Doctor. They were
interested in his research work and offered him certain facilities…As well
as I could, in my layman's language, I told them of his further research
in the matter in question. They will see him again as it is their policy to leave
no stone unturned in seeking relief or a possible cure for the type of injury
in which the Doctor has made some progress."11
Twice in the late 1940s, the Office of Naval Intelligence cleared Revici to
work on this top-secret project. Twice he declined, preferring to work on
radiation primarily in relation to the broad problem of cancer.
Publications and Presentations, 1950s
Between July 1950 and June 1951, three papers about Revici's findings
on lipids and radiation came to the attention of the clinical research community.
Robert Ravich, a colleague at the IAB (fresh out of the College of Physicians & Surgeons,
Columbia University), read a paper by Revici at the Sixth Annual Congress of
Radiology in London on July 26, 1950. Titled "The Influence of Irradiation
Upon Unsaturated Fatty Acids," this paper dwelt on abnormally conjugated
lipids, which clearly fit Samuelsson's description of leukotrienes published
in 1987.6 Revici didn't use the terms "leukotrienes" or "prostaglandins" here,
but in later publications, he indicated the role these substances play in inflammation,
and he attributed the high bioactivity of prostaglandins to a "twin formation…which
appears through the cyclization of arachidonic acid."
Dr. Ravich presented another paper by Revici (co-authored by Ravich) before
the American Association for the Advancement of Science in Cincinnati in
December 1950. The paper bore the title, "The Effect of n-Butanol in Sodium
Salt
Solutions Upon Shock and the Survival of Mice Exposed to Severe Thermal Burns."12
Waldemar Kaempffert, a senior science writer for The New York Times,
devoted a column to Ravich's presentation in the March 4, 1951 issue of the
Times,
stressing the potential value of Revici's findings on radiation injury
should American cities be hit by A-bombs.13
"Fall-out" from a paper delivered by Leonard Goldman, MD, at a meeting
of the AMA in Atlantic City, NJ, in June 1951 marked the first documented instance
of mainstream opposition to independent clinicians trying to follow Revici's
line of research. Notice of Goldman's study, titled the "Use of Lipids
to Enhance the Effect of Roentgen Therapy in the Treatment of Pain from Advanced
Cancer,"14 made its way into a dossier that the American Cancer Society
(ACS) maintained on Revici. The dossier was labeled, "Summary of information
contained in the American Cancer Society, Inc.'s files concerning the Institute
of Applied Biology and Dr. Emanuel Revici, as well as other persons concerned
in the matter."15 Here's an entry about a memorandum from Dr. B.
Aubrey Schneider of the ACS, who had heard Goldman's paper, to Dr. Charles
Cameron, scientific director of the national ACS: "In his memorandum to
Dr. Cameron, Dr. Schneider adds that in a private conversation with Dr. George
Cooper, Director of the Virginia Division of the Society, he indicated that
he was going to try out the Lipid therapy on some cases now under his care
at the
University of Virginia Hospital. A copy of Dr. Goldman's paper is in the
files."
Goldman had reported on the palliative effects of Revici's therapy. He
next proposed a trial of its therapeutic effects, requesting approval from
the Institutional Review Board (IRB) at Queens General Hospital, where he
served as a resident. Another entry from the ACS dossier on Revici picked up
the story: "Early in January, Dr. Cameron received a phone call from Dr. Alfred Angrist,
Pathologist
at Queens General Hospital. Dr. Cameron prepared a memorandum which is in
the files. Dr. Angrist felt that Dr. Revici exerted strong psychotherapeutic
influences
on patients and discussed his personal feelings, as Chairman of the Hospital
Committee on Research and Publications, with regard to hospital approval
of a paper on the Revici treatment by Dr. Goldman. Because of Dr. Angrist's
strong 'anti' feelings, an ad hoc committee had been appointed
to consider the particular paper, and Dr. Angrist felt that the committee's
membership had been stacked. At his request, Dr. Cameron suggested Drs. Gellhorn,
Bodansky, and Schoenbach as additional committee members."16
Minutes from meetings of the IAB's board of directors in 1952 relate
that the "restacked" IRB at Queens General denied Goldman approval.
In 1986, Dr. Goldman addressed the Regents of the State of NY, in a written
plea supporting Revici's struggle with the OPMC to remain in practice.
He noted his early interest in Revici's treatment, and—for the
first time publicly – he disclosed that his studies on lipid therapy
had cost him his residency privileges.
While the ACS and associated elements in mainstream medicine were helping
to clip Dr. Goldman's wings behind the scenes, The New York Times printed
a feature on the IAB in its December 2, 1952 issue.17 The writer, William
L.
Laurence, was probably the most distinguished science reporter at that time;
the US had broken the news of the A-bombing of Hiroshima and Nagasaki under
his byline. The first three paragraphs of Laurence's report on the IAB
ran as follows:
Animal experiments and tests on patients
in advanced stages of cancer were described last night by leaders
in medicine as lending "strong
support" to a new concept of malignant disease that may lead
to a radically new approach to its ultimate control. The progress
reports on the new
methods,
developed at the Institute of Applied Biology, Brooklyn, were presented
at the fifth
annual dinner of the Cancer Research and Hospital Foundation at
the Waldorf-Astoria Hotel. More than 400 leaders in medicine and
other professions,
as well as leaders in industry and civic affairs, were present.
One of the reports was prepared by Dr. John Masterson of Brooklyn, former
president of the Medical Society of the State of New York and a member
of the House of Delegates of the American Medical Association. He is now
attending the AMA meeting at Denver and the report was read in his absence.
Other reports were presented by Dr. John M. Galbraith, past president of
the Nassau County Medical Society; Dr. Emanuel Revici, scientific director
of the Institute; and Dr. Robert Ravich, assistant director.
Laurence's last paragraph, notes: "Prof. Jacques Maritain
of the Institute of Advanced Study at Princeton, NJ, one of the world's
leading philosophers, is a director of the Cancer Research and Hospital
Foundation, a non-profit organization to raise funds for the cancer
research program of the Brooklyn Institution."17
By the mid-1950s, at least one of Revici's associates believed a distinct
pattern had become discernible in the reception of papers submitted to peer-reviewed
journals by the IAB. In a letter to one of the Institute's chief funders,
dated 11/12/55, Robert Ravich recounted the publication history of an article
he had co-authored with Revici, titled, "Antihemorrhagic Action of n-Butanol
in Advanced Cancer" (Angiology, December 6, 1953).18 Bear in mind that
butanol – the higher sterol Revici gave to control bleeding in Resistance
fighters in southern France – worked so well, it set the Nazis on its
developer's trail; in effect, it amounted to his "ticket" out
of Europe. (See Part 1 for details.)
In the US after the war, Revici had developed butanol for cancer patients too
ill to stem internal hemorrhages surgically. Injected intravenously, it sped
through the blood system to the site of a severed artery or vein, permanently
constricting the muscle tissue circling the vessel at the rupture point. The
Revici-Ravich paper reported on two small series of patients, one group injected
with butanol and the other, control arm, not given Revici's antihemorrhagic
agent. (Revici discovered the mechanism of action after publication.) Ravich's
letter started with an assertion: "I told you that the Institute of Applied
Biology had encountered a mysterious form of censorship whenever it attempted
to have an article concerning cancer published in the regular channels. The
following is a case history which…bears out my statement."19
In short, Ravich's case history of the butanol paper goes like this:
rejection in 1951 by Cancer (after a recommendation to accept by the reviewer);
rejection in 1951 by the Journal of Laboratory and
Clinical Medicine and the
Journal of the National Cancer Institute; and rejections in 1953 in the original
submission and resubmission to the New York State
Journal of Medicine. The
editors cited various reasons. Consultants didn't think the paper represented
a controlled clinical experiment (Cancer). The subject was not of sufficient
interest to readers (Journal of Laboratory and Clinical
Medicine). Not suitable
for publication here: try a journal of a more general nature (Journal
of the American Cancer Institute). It was doubtful that n-Butanol had any relation
to the cessation of hemorrhage in the patients studied (New
York State Journal of Medicine).
Dr. Ravich closed his letter with these paragraphs:
On August 12, 1953, the article was submitted
to Angiology. It was
accepted without comment and was published on December 6, 1953. Angiology is
a journal with very limited circulation, and not one that is likely to
be read by
doctors interested in cancer or by general practitioners who might find
the article
of value. We have received requests for reprints from all over the country
and the world and some interesting comments and observations.
The experience with this paper indicates beyond any question that the problem
of publishing our work on cancer is not a simple one. Why this invisible form
of censorship is permitted to exist in scientific and medical publications
and how it operates are questions that I am not able to answer. But I do believe
we are justified in saying, on the basis of such experiences, that the normal
channels of publication have been closed to us and that we are therefore forced
to take any other way that may be open, to get our findings before the medical
and scientific public.
Then Ravich added a postscript, dredging up a wider, deeper history
of attempts by Revici and the IAB to publish in the peer-reviewed literature:
Every paper we have submitted on subjects
outside the field of cancer has been accepted; every one concerned
with cancer has been rejected. When four
articles were submitted by Dr. Revici by title alone, for presentation
at the International Cancer Congress in Paris in 1950, all of them
were rejected. Only seven papers in all were rejected, and almost
a thousand read. I learned from Dr. Oberling that they had been rejected
because of the intervention of Dr. Rhoades [sic] and others in this
country on the program committee.19
Dr. Charles Oberling, a French academic
physician who relocated in the US after World War II, was highly
regarded by American oncologists.
He would have known the circumstances behind the rejection of Revici's
papers. Dr. Cornelius Rhodes, the first major postwar director of Memorial
Hospital in New York City (later, Memorial Sloan-Kettering Cancer Center),
had headed the Chemical Warfare division of the Office of Strategic
Services (OSS), the predecessor of the CIA. Rhodes had used his wartime
post to experiment with mustard gas – a chemical agent used in
World War I – on human cancer. The Congress to which Ravich referred
was the International Union Against Cancer, whose president and editor
on different occasions was Prof. Joseph Maisin of Belgium.
Through the 1950s and early 1960s, IAB papers slipped into medical
journals,20 and The New York Times covered a few of the IAB's research advances,
in areas where the papers or research didn't concern Revici's theories
and therapeutic applications in cancer.21 From time to time, research on lipids
and cancer not originating at the IAB appeared in the scientific literature,
focused on abnormal lipid metabolism, a prime Revici area of study.22
Publications, 1960s
In 1961, D. Van Nostrand and Co. decided to distribute a text by Revici under
its imprint. Research in Physiopathology as Basis
of Guided Chemotherapy, With Special Application to Cancer had been in various draft stages for several
years: IAB newsletters voiced news of its progress in the late 1950s. Close
to 800 pages in print, Revici's monograph summed up his prolific findings
from the mid-1920s through the 1950s.
When it undertook to bring out Revici's monograph, D. Van Nostrand had
been publishing scientific volumes from its main office in Princeton, NJ, since
1848. It had earned a solid reputation for quality. A letter from the president,
Edward M. Crane, on June 8, 1961, spoke of the publishing firm's "keen
interest" in an "important and valuable book."23
Earlier that spring, in the March-April issue, Ca, a Journal
for Clinicians had come out with a feature on Revici's method of cancer control, characterizing
it as "unproven." How Van Nostrand expected to sell Revici's
text after the ACS publicly questioned the effectiveness of his therapy is
something of a mystery. Crane, D. Van Nostrand's president, in a telephone
interview in the late 1980s (conducted by the writer), said he thought there
was room at that time for another approach to cancer.
Revici had filled his book with explanations of his theories, with reports
of experiments on their clinical application, as leads to follow and independently
prove or disprove the efficacy of his therapy. He viewed his method as a way
to manage cancer that differed in critical particulars from standard therapy:
his treatments were comparatively non-invasive, negligible in toxicity, and
individually guided. He also felt that the results of his treatment were equal
or superior to the outcomes of treatments in common practice in a significant
percentage of cases, especially in cases resistant to other approaches.
In blacklisting Revici's method of cancer control, the ACS aimed to keep
patients from his therapy. To an incalculable extent, the Society succeeded.
There's no telling how many of Revici's medical insights might
have proven of value, had clinicians been able to get hold of his text, to
familiarize themselves with his method, to test his treatments in practice.
Most importantly, had the ACS not discouraged sales of his book, there's
no estimating the number of patients who might have benefited from the free
circulation of his ideas.
Publication of Revici's monograph was the high point of his efforts to
disseminate his findings in the US—for that matter, in the world. This
publication was also to prove the near terminal event in his attempts to acquaint
his peers with his clinical research: one paper on the narcotic addiction treatment
Revici developed in the early 1970s appeared by invitation in a Canadian government
journal on addictions in Quebec in 1973.
Part 1,
Part 2, Part 3
Notes
1. Personal communication from C. Pouret, archivist, [French] Academy
of Sciences, to Revici, 5/21/85, giving the deposit numbers and years:
11273 (4/12/37), 11322 (8/30/37), 11391 (2/28/38), 11417 (4/25/38),
11440 (7/4/38).
2. Letter from Gaston Merry to Col. Gustave Freeman, MD, 9/5/45.
3. Cancer Research and Hospital Foundation. Report on the research
conducted at the Institute of Applied Biology. 10/15/48.
4. Letter from Col. Thomas G. Cassady to Andre Girard, 10/11/48.
5. Ravich RA, Revici E. The effect of n-butanol in sodium salt solutions
upon shock and the survival of mice exposed to severe thermal burns.
A paper presented before the American Association for the Advancement
of Science, Cincinnati, Ohio, 12/50.
6. Kaempffert W. Burns are treated with n-butanol. "Science In
Review". The New York Times. 3/4/51.
7. Goldman L. Use of lipids to enhance the effects pf Roentgen therapy
in the treatment of pain from advanced cancer. A paper delivered at
the meeting of the American Medical Association at Atlantic City, NJ,
in June 1951.
8. The ACS file on Revici and the IAB comes from documents bequeathed
by Fanny Holtzmann, Esq., to the American Jewish Archives, Hebrew University,
Cincinnati, Ohio. Holtzmann, a celebrity lawyer with powerful political
connections, was a staunch supporter of Revici's work at the
IAB from the 1950s until her death.
9. Identification of two of the three doctors added to the committee
Angrist chaired at Queens General is not certain. Bodansky is almost
certainly Oscar Bodansky; Gellhorn is probably Alfred Gellhorn. Later,
Bodansky and Gellhorn were affiliated with more prestigious institutions.
10. Laurence W. Cancer attacked by a new method. The
New York Times.
12/2/52.
11. Revici E and Ravich A. Anti-hemorrhagic action of n-butanol in
advanced cancer. Angiology. 1953;4:510–515.
12. Letter from Robert Ravich, MD, to Mrs. Ethel Pratt, 11/12/55.
13. The following list represents a selection of papers published in
the peer review literature by Revici and his colleagues at the IAB.
The full list, seven pages long, was compiled by the late Prof. Harold
Ladas, a patient of Revici. With his wife, Dr. Alice Ladas, Harold
Ladas organized and helped fund Revici's patients in their successful
campaign to prevent the NY Health Dept. (OPMC) from revoking Revici's
medical license in the mid-1980s. An asterisk at the beginning of a
citation signals that Revici was a co-author.
- *Blechmann M, et al. The
effect of unsaponifiable fraction of lipids (sterols) on morphology
and growth metabolism of mycobacterium tuberculosis
var. hominis
and var. bovis (BCG). The American Review of
Respiratory Diseases. 1964;89(3):
448–49.
- *Blechmann M, et al. Ring and lysis zones in cultures of
tubercle bacilli in medium enriched with unsaponifiable lipid fractions
The American Review
of
Respiratory Diseases. 1963;87(5).
- LeShan L. Psychological states as
factors in the development of malignant
disease: a critical review. J Nat. Cancer
Inst. 1959; 22 : 1–18.
- LeShan
L. Basic psychological orientation apparently associated with
malignant
disease. Psychiatric Quarterly. 1961.
- LeShan L. The world of the
patient in severe pain of long duration. J. Chronic
Diseases. 1964; 17: 119–26.
- Ravich RA. Relationship of colloids
to the surface tension of urine. Science.
1953;117: 561.
- Ravich RA. Pain—controlled and uncontrolled.
Science. 1953;118 (3057): 144–45.
- Revici E, et al. Surface tension of urine in old age. Geriatrics.
1954;9(8) : 386–89.
- Welt B. Head and neck pain: role of biological imbalance in
its pathogenesis and
therapy. AMA Archives of Otolaryngology. 1955; 61:280–312.
- Welt
B. Vertigo: a further contribution to therapy based upon its
physiopathological aspect. Archives
of Otolaryngology. 1956;
63: 25–29.
- A letter from Henry L. Williams, MD, to Bernard
Welt, MD, 1/29/54, referred to an article Prof. Ladas did not
include in IAB bibliography.
Williams
was at the Mayo Clinic, Rochester, Minnesota, Welt at the IAB.
The full text
of this short letter follows: "I read with considerable
interest your article on a new theoretical approach in vertigo
which came out
in the September Archives [Archives of Otolaryngology, an AMA journal]. I have tried your
method of therapy on some cases of vertigo and several with headaches.
They
have given very good
response.
"I have been asked by the Academy of Ophthalmology and Otolaryngology to
organize a symposium on the treatment of headache to be given in New York
City for a two day period between September nineteenth and twenty- fourth. This
is
to be in the teaching section, a two hour session being held on each of
the two days. The members of the panel will discuss their treatment for ten minutes
apiece
during the first hour. The second hour will be devoted to the answering
of questions from any auditor present. Your therapy is extremely new and unusual
and I would
be very happy indeed if you would agree to be a member of this panel."
14. Schmeck HM, Jr. Chemists study adrenal action. The
New York Times. 9/19/59.
15. Letter from Fanny Holtzmann, esq., to S.A. Logan, First
National City Bank, 4/13/55. The pertinent paragraph reads: "In the current issue of CANCER,
official organ of the American Cancer Society (March, April 1955) there is
an article by Dr. Marion Barclay, et al., entitled "Lip-Proteins in Normal
Women and in Women with Advanced Carcinoma of the Breast." The title
carries the unusual footnote "The authors wish to thank Dr. Cornelius
P. Rhodes for suggesting this problem and for his continuing support and interest." The
article concludes that cancer patients have abnormal Lip-Protein metabolism "which
is associated with a severe defect in lipid metabolism. This
is precisely the premise from which Dr. Revici set out on his
biochemical
explorations
more
than thirty years ago."
16. Letter from Edward M. Crane to Mrs. Sherman Pratt. 6/8/61.
Marcus A. Cohen
Health Trends
8 East 96th St., 1C
New York, New York 10128 USA
212-427-0707
Fax: 212-348-8288
marcusacohen@aol.com
|