Impact of Medical Censorship on Patient Care: Part 4
the American Cancer Society and distribute its shameful and colossal
to cancer patients. Nobody can point to a single
major research development from the billions that have been given the
society. That institution is a disgrace.
– Patrick McGrady, Jr., "The Cancer Patient's Quandary," Newsday,
At its inception, the Society should have played the role of ombudsman
for cancer victims, keeping researchers and doctors on their toes,
calling foul when new drug development is roadblocked by the FDA, testing
unusual methods that showed some promise. Instead, it has become a
major part of the problem. It eschews sponsorship of clinical and research
innovation and instead goes in for propaganda . . . and it ritually
condemns and suppresses unorthodox methods which, incidentally, it
does not even trouble itself to investigate thoroughly.
– Patrick McGrady, Jr., "The American Cancer Society Means Well,
but the Janker Clinic Means Better," Esquire, April 1976.
I devoted my column in November's issue, the third in a series
about censorship in medicine, to the American Cancer Society (ACS)
and a list of unorthodox cancer treatments it has circulated for decades.
The Society has labeled these approaches "unproven," a
bland word obscuring the fact that the ACS has historically equated "unproven" alternative
treatments with snake oil and other forms of quackery. The Society's
coded twist on "unproven" has turned the list of therapies
it views as departing from medical orthodoxy, into a blacklist.
The ACS blacklist concerns me – and should concern many Americans – because
it factors in a major way into the withholding of information about
therapies that might prove, if fairly evaluated, beneficial to cancer
patients, particularly those with resistant disease.
My November column broke off after reviewing the origin and growth
of the ACS. This column reviews criticism of the Society for its fund-raising
pitches and promotion of the war against cancer. It also analyzes the
evaluative biases pervading the blacklist, and later discredits an
article recently published in an ACS journal, which contended that
certain treatments regarded by the Society as "unproven" have
Some readers may wonder why so much of history about the ACS precedes
scrutiny of its blacklist and an article related to it. That extensive
history is necessary to appreciate how the blacklist has functioned
as merely one means through which the Society has worked to influence
cancer care in the US. The ACS's funding campaigns and its lobbying
for greater government investment in research, its chief means, have
fitted hand-in-glove with the blacklist in the Society's efforts
to control research priorities and access to treatment since the 1940s.
Criticism of the ACS for Fomenting "Cancer
In the first years of the take-over
of the Society, a member of the ACS inner circle began "his fund-raising speeches," reported
Ralph Moss in The Cancer Industry,2 "with a dramatic 'One
in five of us here – every fifth person in this audience – will
die of cancer.'"
Early Society publications, observed James Patterson in The
Dread Disease,3 "outlined
the frightening ramifications" of cancer. Lumping the expense
of treatment, loss of work, and productivity, the annual toll of the
disease was $2 billion in the late 1940s. Deaths were rising fast;
160,000 in the mid-1940s, 200,000 by 1950. Projections had 17 million
Americans then alive eventually dying of cancer. An ACS poster (1947)
hammered home the bad news: "Every Three Minutes Someone Dies
of Cancer. Guard Those You Love. Give to Conquer Cancer."
Stoking fears of cancer scared Americans into writing checks to the
ACS. Keeping the heat on by stressing the horrors of cancer stirred
concerns about the Society's scare tactic. Patterson cited three
noteworthy critics. In 1948, the medical director of the American Psychiatric
Association "complained that 'propaganda' about cancer
was inspiring fear of death and fomenting popular panic."
In 1952, a woman who went public with the story of her battle to survive
the disease incorporated her objections in her book.4 "Cancer,
Our Number Two Killer," she wrote. "Great posters blaze
this unfortunate – equally unhelpful – truth across the
countryside. Shocking the Sunday afternoon reading public into action?
No, into hiding."
In 1955, Dr. George Crile, one of the first American surgeons to dissent
against radical mastectomies, published a book that castigated the
ACS for its incessant harping on fears about cancer. Patterson quoted
Crile's book (Cancer and Common Sense): "They have portrayed
cancer as an insidious, dreadful, relentless invader. With religious
fervor they have fashioned a devil out of cancer. They have bred in
a sensitive public a fear that is approaching hysteria. They have created
a new disease, cancer phobia, a contagious disease that spreads from
mouth to ear. It is possible that cancer phobia causes more suffering
than cancer itself."
Later critics of the ACS's "weapon of fear" (Patterson)
have weighed in on the Society's excessive employment of this
Criticism of the ACS for Inflating Cancer "Cure" Rates
Damping (but retaining) the fear element
in its appeals, the ACS coupled good news with bad. Treatment was better,
the Society said, cancer
patients were living longer, mortality rates were slowing, and just
around the corner, or on the horizon, or perhaps down the road a
decade, researchers in hot pursuit of cancer would slay the "beast." Don't
forget, meanwhile, to send a check: the human and animal denizens
of the research labs take steady feeding.
That has been, and continues to be, a self-assigned endeavor for
the ACS – working the money pump for cancer research. Patterson quoted
Kenneth Endicott, NCI director in the 1960s, on how the Society interacted
with the NCI in enlarging the latter's research funds: "A
secret of really effective working relationship between the Society
and the NCI is to let them take the lion's share of the credit
and don't get uptight about it. Because they reciprocate by pushing
for a big budget for NCI. Okay, let them get the headlines, what the
And push the ACS did! Until, presto, the Society's leaders, utilizing
their ties to President Richard Nixon and Democratic and Republican
members of Congress, brought forth in 1971 the federal government's
officially-declared "war on cancer." That was an ACS brainchild – placing
the NCI "generals" in charge and swelling the flow of Congressional
research appropriations – which the Society has nurtured and
defended to this day.
At first, the ACS faced few questions and challenges, which the Society
felt free to disregard. Many Americans approved the mobilization of
the nation's science resources in quest of a cancer cure. NCI
researchers relished the federal flood of dollars, eager to plunge
more heavily armed into battle.
Dean Burk, PhD, head of the NCI's cytochemistry section, addressed
an open letter to the NCI director in 1973, "re: the Achilles
heel of the National Cancer Act of 1971" (the Act formally committing
the US to war against the dread disease). The Cancer Control Society
published Burk's letter the same year. As Patterson and Moss
have detailed, the mainstream media and the American public still held
positive attitudes about the ability of scientists to solve medical
puzzles, still incautiously swallowed publicity releases by the ACS
and other establishment institutions about research advances in cancer;
so the media apparently didn't pick up on Burk's negative
Here is the gist of that critique, relevant today. Virtually all FDA-approved
anticancer chemotherapy is toxic in humans, markedly immunosuppressive,
and usually carcinogenic in animals. FDA-approved drugs yield five-year
survivals in just five to 10% of advanced cancer cases.
Nevertheless, Burk's critique contended, officials of the American
Cancer Society and even of the National Cancer Institute have continued
to present to the public, optimistic statements about the cure rate, "but-seldom
if ever backed up with the requisite statistical or epidemiological
support for such a statement to be scientifically meaningful, however
effective for fund gathering."
These passages are the tail end of the fundamental contention of his
critique, specifically: It is a professional and popular fallacy to
think that if a therapeutic agent can't harm the host, it can't
be effective against a cancer that attacks the host. Such a fallacy,
in his opinion, was preventing a search for agents safer and more effective
than FDA-approved chemotherapies.
An article that did circulate widely, "A Critical Look at Cancer
Coverage," came out in the Columbia Journalism Review in
1975. The author, Daniel Greenberg, a science writer in Washington,
in the politics of science. Moss set the context for Greenberg's
article: "Years of cultivating the press had made the American
Cancer Society virtually sacrosanct. From 1945 to 1975 one could search
in vain for an incisive, critical article on the Society or its methods.
Then, in the mid-1970s, criticism suddenly burst into the open about
the whole topic of cancer. The 'war on cancer' had made
the leading organizations visible and vulnerable."
Greenberg's article, according to Moss, was part of that explosion
of criticism. Studying recent NCI data and interviewing cancer clinicians
and researchers, Greenberg arrived at extremely critical conclusions.
Moss included a quote from Greenberg: "Today's patient,
who is supposedly the beneficiary of the burgeoning of cancer research
that began in the early 1950s, has approximately the same chance of
surviving for at least five years as a patient whose illness was diagnosed
before any of that research took place."
The NCI and the ACS tried to slough Greenberg off, contending that
he had relied on outdated statistics that poorly reflected progress
in the war on cancer, then in its fourth year (Moss). Around the mid-1980s,
the ACS and its friends found it much harder to answer critics skeptical
about establishment communiqués that trumpeted upturns in five-year
survivals and downplayed uncomfortable facts about incidence and mortality
A decade after Greenberg's article, these later critics still
could detect no significant progress in the war against cancer. Like
Dean Burk, they were embedded in the cancer research establishment.
Like Burk, they also concentrated on the data from which the rosier
rates were figured, exposing the artifacts and other statistical manipulations
which the ACS and its allies had resorted to in justifying more federal
bucks for the war. Then, they struck at the underlying premise of the
mainstream warriors – that the war was winnable, that researchers
were accumulating enough clues about the nature of cancer to verge
on a cure – and they urged a rethinking of strategy. Invest more
in prevention, they recommended. We have solid clues on prevention.
Following up on them might well improve survival, mortality, and incidence
rates for many cancers.
Space here doesn't permit more than due mention of the names
of the most respected critics in the 1980s and a footnote citing their
key articles: Drs. John Bailar, John Cairns, and Hayden Bush first
and foremost.5 I'd be remiss, though, if I didn't mention
more recent articles by two less familiar critics of the war on cancer,
Drs. Michael Sporn and Jerome Groopman.
Sporn began a commentary on this medical war in the Lancet in
1996 (May 18), quoting from Charles Dickens' Bleak House.
Sporn's first sentence linked the quote to his article, and together
an unforgettable statement: "Dead, your majesty. Dead, my lords
and gentlemen. Dead, Right Reverends, and Wrong Reverends of every
order. Dead, men and women, born with Heavenly compassion in your hearts.
And dying thus around us every day." (Dickens)
"This magnificent quotation provides
a unique summary on the total success
of the 'War on Cancer' during the past 25 years." (Sporn)
In the early 1990s, Sporn was in charge of "chemoprevention" at
the NCI (prevention through natural compounds as well as synthetic
drugs). His Lancet review has
the sound and substance of profoundly expert opinion: "Common carcinomas continue to be a major cause
of death and suffering, particularly in adults. We must develop new
approaches to control this plague of death, adopting an ethic of prevention,
based on a more sophisticated understanding of the process of carcinogenesis
and the potential to prevent disease before it becomes invasive and
metastatic. Reductionist molecular biology can only proceed so far
with its brilliant analysis of all the bits and pieces that comprise
the organism. Carcinoma is not a disease of an individual cell. Carcinoma
is ultimately a more complex failure in homeostasis, a chronic, maladaptive
tissue and organismic response to injury. Carcinogenesis is a contextual
process in which epithelium and mesenchyme fail to communicate properly
with each other, resulting eventually in invasion and metastasis."
Groopman's article, titled "The Thirty Years' War" – subheaded "Have
we been fighting cancer the wrong way?" – appeared in The
New Yorker (6/4/01). Action behind-the-scenes
enlivened his history of the war on cancer. Interviews with Drs. Samuel
Broder and Richard
Klausner, once directors of the NCI, and Dr. Harold Varmus, former
director of the NIH, highlighted the piece. All voiced misgivings about
the goals and conduct of the war.
Varmus felt that cancer didn't "deserve unique distinction
for funding," that cancer genetics alone wouldn't suffice
to understand the complex mechanism of cancer; it would require advances
in physics, chemistry, and computer science.
"Given the performance of the targeted therapies available so far," said
Broder, it was "premature to invest more in the federal bureaucracy
that oversees clinical trials." (The words in quotes are Groopman's
paraphrasing of Broder.) "Initiative and creativity have moved
to the private sector," noted Broder.
Klausner suggested that the best way to move cancer research ahead
was to call off the war. He pictured cancer as an intricate puzzle,
with the knowledge and tools to solve it presently lacking. Since clues
could come from any discipline, the NCI needed more disciplinary openness.
Under his tenure, he broke up the clinical-trials bureaucracy so that
it no longer operated like "a closed shop controlled by inbred
Effects of the ACS Blacklist: "Disproving" Vickers
The ACS sword, a symbol the Society "inherited" from
the ASCC, has two cutting edges, with two serpents usually intertwined
around the hilt. In my imagination, I can see the point and one edge
stabbing and slashing at cancer (often symbolized as a crab). I sometimes
fancy that the second edge is for repelling treatment approaches the
Society regards as dubious.
Figuratively speaking, the ACS has turned that second edge against
treatments departing from accepted oncology practice, or approches
not based on accepted concepts about managing disease.
The Society's literal weapon of choice against nonconventional
therapy has been the list drawn up by its Committee on Unproven Methods
of Cancer Treatment, renamed the Committee on Complementary and Alternative
Medicine a few years ago. If the ACS has subsequently renamed the list,
but wields it in the old hostile way, it remains a blacklist. Historically,
inclusion in the ACS list has had serious punitive effects. Nonconventional
doctors have been hauled before state medical boards when mainstream
physicians heard about their approaches, learned that the ACS believed
them suspect, then filed complaints with the boards. Insurers have
refused to pay for treatment prescribed by doctors whose names appeared
on the Society's list. Blacklisted by the ACS, medical scientists
have lost research grants or had grant applications denied. Blacklisted,
clinical researchers have found it impossible, or extraordinarily difficult,
to publish their studies in peer reviewed journals.
Doubtless, the Society feels that in acting as gatekeeper for treatments
it believes to be dubious it is performing a responsible, valuable
public service. But the value of such a service derives from how responsibly
it is performed. Has the ACS behaved responsibly, properly, in compiling
and publicizing its list?
I quote from an open letter written in 1973 by Dean Burk, then head
of the NCI's cytochemistry section. "The word 'unproven' as
used by the ACS," said Burk, "is a highly and unjustifiedly
weighted word." Burk rated the Society's evaluations of
treatments it believes to be "unproven" as having "close
to zero scientific worth."
Burk wasn't the only mainstream scientist in his day aware that
the Society's evaluations of treatments on its blacklist were "unjustifiedly
weighted." Not many mainstreamers echoed him publicly. The ACS,
Moss showed, directly or indirectly has had a hand in numerous powerful
medical institutions. Speak out against the ACS sharply enough to provoke
it, and the Society might strike back. Like Indian deities portrayed
in art with scores of arms and legs, it could lash out with one, many,
or all of them.
Independent critics did reveal the disingenuous basis of the ACS blacklist.
In the 1970s, before Ralph Moss brought out his exposé of the
cancer care complex, science writer Robert Houston and investigative
journalist Peter Barry Chowka published magazine articles that picked
apart the shortcomings of the ACS evaluations. All three have since
taken swipes at the Society, its methods, and its blacklist – notably
Houston in Repression and Reform in the Evaluation of Alternative
Cancer Therapies, published by Project
CURE in 1989.
Patrick McGrady, Jr., the late author of bestsellers on health care,
stormed against the ACS and its blacklist for many years. Usually,
he'd direct his Jovian thunder and lightning bolts at the NCI
and FDA as well, for he was apt to rage against all bureaucratically-minded
institutions and organizations that blocked effective avant-garde treatments
from reaching cancer patients.
Note that the establishment (Patterson included) has associated these
critics with people and groups it labels the "cancer counterculture." As
the saying goes, you couldn't pay these individuals to write
one word they believe untrue. And none of them are slouches at research
and thorough documentation. The salient thing about them is their independence.
I don't have room to go into every problem with the ACS blacklist
that independent writers have spotlighted. Here, without specific illustration,
is the gist of their investigations into the credibility of the Society's
Studies showing positive results under treatments on the list are often
omitted, even if conducted by reputable independent investigators and
published in peer review journals, even when they meet the gold standard
of therapeutic evaluation – the randomized double-blind clinical
trial. When they are mentioned and discussed, their findings tend to
be dismissed, distorted, misrepresented, or misunderstood.
Studies showing negative results for treatments are almost always cited
as proof that these approaches are virtually worthless. It doesn't
count if such studies fall shy of the gold standard, or the trial design
is poor, or the methodology slack, or that the investigators violated
trial protocols, or failed to replicate faithfully prior trials indicating
efficacy,6 or that the negative studies are exceptions to a heap of
positive studies. In a few odd cases, studies said by the investigators
to be inconclusive are somehow interpreted by the ACS as definitively
That's it, in the colloquial nutshell. Consult a copy of Moss,
part two, for deep dissection of the blacklist treatment-by-treatment.
Get hold of Houston's Repression and Reform (obtainable
from PeopleAgainstCancer.com), and skim to the sections refuting ACS
about treatments pioneered by Lawrence Burton, Stanislaw Burzynski,
and Emanuel Revici.
At the beginning of my first column on the ASC, I promised to scrutinize
the evidence cited in an article appearing last Spring in one of the
Society's journals.1 I commented on this article earlier, reiterating
its assertion "that many alternative cancer therapies have been 'disproven.'" The
author, Andrew Vickers, is a research methodologist at Memorial Sloan-Kettering
Cancer Center (MSKCC). Reading between the lines, one senses that he
may be stating a view the ACS and MSKCC share, which the Society won't
or can't express publicly.
To test Vickers, I spotchecked his handling of Dr. Stanislaw Burzynski's
antineoplastons, hydrazine sulfate, and high dose vitamin C – three
of the 12 treatments he "disproved." I figured a 25% sample
would suffice to gauge the soundness of the manner in which Vickers
chose and interpreted his evidence.
Referring to studies published by Burzynski on his antineoplastons,
Vickers characterized their design as "rather unclear." He
omitted standard trials done independently in Japan indicating efficacy.
He also ignored the fact that for the past 15 years Burzynski's
own studies have followed trial designs approved by the FDA. Vickers
concentrated on one trial of six glioma patients conducted here under
NCI auspices. Previously treated unsuccessfully with radiation, the
patients were terminal. Objecting to the NCI selection of patients
and changes in design which violated the original protocol, Burzynski
predicted failure and walked away from the trial. Though the investigators
cautioned that the sample was too small to draw "definitive conclusions," Vickers
concluded it was time to "deep-six" Burzynski's antineoplastons.
To "disprove" hydrazine sulfate, developed by Dr. Joseph
Gold, Vickers referred to several early clinical trials that had suggested
possible benefit. Then he selected one of these trials as an example,
a randomized study of 65 patients with advanced nonsmall cell cancer,
in which one arm got chemo alone and the other hydrazine plus chemo.
In the hydrazine group, he stated, "overall survival was non-significantly
higher." Later trials of hydrazine enrolled larger numbers of
patients having, respectively, advanced colorectal cancer, newly-diagnosed
nonsmall cell lung cancer, and advanced nonsmall lung cancer. The colorectal
patients received "no other oncologic therapy." The advanced
lung cancer patients got cisplatin and vinblastine. The newly-diagnosed
lung cancer patients were concurrently treated with cisplatin and etoposide.
Vickers wrote, "hydrazine sulfate did not improve survival in
any of these settings." He said nothing about Gold's crucial
objection to these trials; they used substances known to be incompatible
with hydrazine sulfate, vitiating its effects. A General Accounting
Office investigation (Congress) strengthened Gold's position.
It's old news that hydrazine produces few long-term remissions.
What about improving quality of life? Large Russian trials and several
good ones at the University of California, LA, have shown that hydrazine
is active against cachexia. No word from Vickers on the Russian trials,
a mere mention of one UCLA trial showing that patients on hydrazine
survived 48% longer than those in the control group.
He zeroed in on trials at the Mayo Clinic that reported no benefits
in patients given vitamin C orally, discussing the findings at length.
He did include one objection by Linus Pauling, PhD, co-author of the
high dose protocol investigated: Mayo enrolled patients pretreated
with chemo, and that, said Pauling, would have compromised host immunity,
weakening the effects of C. Almost in passing, Vickers referred to
reseachers who had suggested that the failure at Mayo may have resulted
from oral administration of vitamin C. In the Pauling study, C was
given both orally and intravenously. Recent studies have demonstrated
that intravenous administration produces much higher plasma levels
of vitamin C than oral administration. Vickers didn't let on
that these recent studies were conducted under NIH auspices. Or add
that further studies under the NIH confirmed that vitamin C in concentrations
obtainable only through IV usage kills cancer cells.7
In 1992, the late Dr. Emanuel Revici – on the ACS blacklist since
1961 – was treating a boy from Ontario with brain cancer. His
parents hoped to control the tumor under Revici's nontoxic treatment,
sparing him from radiation therapy, which might lower his IQ by 20
or more points. The boy felt well. Scans indicated tumor stabilization.
The parents were prepared to treat with conventional radiation immediately,
if he showed signs of failing.
Radiologists in Ontario petitioned the court to turn over custody of
the child, so they could administer therapy as soon as possible. A
court-appointed lawyer for the child contacted Revici's office:
Could Revici send studies on the efficacy and side effects of the conventional
and nonconventional treatments in this case to the court? I was a political
consultant to Revici at the time; it was part of my job to handle such
business. I conduced extensive research, and mailed a number of studies
Months later, I received a fax from the lawyer. It was the decision
on the boy, denying the request for custody. I was astonished. In the
US, when parents refuse or delay mainstream treatment for minors that
doctors think necessary, judges usually give custody to the doctors.
Canada, the boy's lawyer told me, has a Charter of Rights, similar
to our Bill of Rights, but the Canadian Charter makes no distinction
between adults and minors in matters affecting the security of an individual.
Regardless of age, Canadians are entitled to reject treatment that
doesn't allow them to handle disease with dignity.
The ACS deals with adults as US courts tend to deal with minors. Give
the Society authority under law, it probably would force as many advanced
patients as it could into conventional chemotherapy proven ineffective
in 93 out of 100 cases.8 With its immense influence and powerful connections,
it does funnel hosts of patients into largely useless mainstream care.
At bottom, the ACS's autocratic attitude and coercive policy
rest on an arrogant, elitist arrogation of the right to decide who
lives, who dies.
Well-to-do people created the modern ASC in the mid-1940s, constituting
its lay leadership for over a generation. They excelled in advertising
and public relations skills picked up through their businesses. Clarence
Little, the last scientist to run the overall operations of the ACS,
felt these newcomers had a poor grasp of the complexities of cancer.
They had gotten into cancer, he complained, as a "civic interest." Little
especially disliked the lay group's "unjustifiable, troublesome,
and aggressive attitude of 'knowing it all.'" (Patterson)
Though the original lay leaders have died, the pitchman remains at
the core of the Society's soul. A pitchman mentality drives the
activities of the ASC. This mindset holds that the end justifies the
means – be it playing on fear of cancer in funding campaigns,
selling the war on cancer and then rigging mortality rates to proclaim
progress in the war, or employing a blacklist to "censor" information
about plausible alternatives to mainstream treatment.
Taking charge of the ACS, the business-oriented group disbanded the
Women's Task Force, a million volunteers who had successfully
raised money and public awareness of cancer nationwide. In the eyes
of the new leadership, these women were "do good amateurs." Since
the business makeover, the Society's funding campaigns have been
remarkably professional. But in this period, the ACS has also become
the very embodiment of a "do good" zealot. So anxious has
the Society been to fence off doctors and patients from information
about treatment it deems suspect, it has countenanced means that are
themselves thoroughly suspect. The ACS blacklist is not an isolated
instance, just the most evident.
1. Vickers A, Alternative cancer
cures: "unproven" or "disproven," Ca
A Cancer Journal for Clinicians, March/April
2. Ralph Moss, The Cancer Industry (Equinox
Press, B'klyn, NY, 1996).
3. James T. Patterson, The Dread Disease: Cancer and Modern
American Culture (Harvard University
Press, Cambridge, MA, 1987).
4. Edna Kaehele, Living with Cancer (Garden
City, NY, 1952).
5. Bailar JC et al, Progress against cancer? The New England
Journal of Medicine, 5/8/86.
Bailar JC et al, Cancer undefeated, The New England Journal
Cairns J, The treatment of diseases and the war against cancer, Scientific
American, November 1985.
Bush H, Cure, SCIENCE 84 Magazine, September 1984.
6. Carter SK, In: Clinical Trials in Cancer Medicine.
Eds. U. Veronesi and G. Bonadonna; pp. 1–20 (Academic Press, 1985). Carter dealt
with problems in clinical trials generally, not with specific reference
7. Padayatta SJ et al, Vitamin C pharmacokinetics: oral and IV use, Annals of Internal Medicine,
8. "Chemotherapy results in durable response in only 4% of patients
and substantially prolongs the life of an additional 3% of patients
with advanced cancers." Smith TJ et al, Efficacy and cost-effectiveness
of cancer treatment: rational allocation of resources based on decision
analysis, Journal of the National Cancer Institute,