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Chapter One

Does Medicine
Have a Bad
Attitude?

James P. Carter

"... And besides, looking through those spectacles
gives me a headache."

Professor Cesare Cremonini in 1610,
explaining why he would not look through Galileo's
telescope at the moons of Jupiter.

ARROGANT IGNORANCE

The sort of excuse above has delayed medical discoveries for decades, even half-centuries. Canadian nutritionist Dr. David Rowland describes this repression of medical innovation as a bad attitude which he termed "arrogant ignorance." This negative attitude toward many great discoveries represents a tremendous ego threat. Today such negativity is compounded with the industrialization of medicine, which has brought on that "greed is good (for me)" philosophy expressed in the recent movie Wall Street. Segments of the medical profession take what they want when they can get it.

    Arrogant ignorance has followed science and medicine throughout history. Beginning with the learned colleagues of Galileo who refused to even look through the glass of his new invention, the telescope, because they believed they already knew all about the laws of physics, that not-invented-here attitude is alive and well at the dawn of the twenty-first century. Is it only a coincidence that "not invented here" shares initials with our government's National Institutes of Health?

    Past suppressions—at least those safely back in past centuries—arereadily admitted by contemporary medicine. French explorer Jacques Cartier, for example, in 1535 learned from the American Indians that pine-needle tea prevented and cured scurvy, a vitamin C deficiency disease. Upon his return to France, Cartier excitedly shared his discovery with French doctors, who turned a cold shoulder—such a primitive therapy was witchcraft. If we pass this off as Eurocentrism, we miss the similarities to present-day rejections of alternative healing methods that are getting the cold shoulder. The case of Dr. Charles Peres, M.D., of Ft. Meyers, Florida, provides an excellent example.

    Dr. Peres was diagnosed with a stage D2 prostate cancer spread throughout his body. In lay terms, you can't have a gloomier prognosis. After he adopted a natural regimen based on a low-fat vegetarian macrobiotic diet, his cancer went into complete remission. Naturally overjoyed, upon his return to functional living he noticed that many of his medical colleagues actually appeared angry that he had survived. Would they rather he die than heal himself with this unorthodox treatment? This very same disdain has been noted by cancer patients who have sought out alternative cancer doctors and have gone into permanent remission, only to be told by their first doctor that they never had cancer to begin with (despite the complete diagnostic work-up that he had witnessed). Negative reactions range from obvious anger to feigned indifference. It must also be told that there are doctors who secretly recommend alternative treatments but warn their patients to never tell the wrong party lest the doctor get in trouble.

    In 1747, James Lind, a surgeon's mate in the British Navy, conducted dietary experiments on board ship. He concluded that citrus fruits prevented and cured the killer disease scurvy which ravaged sailors. Captain Cook was one of the first ship commanders to supplement his sailors with rations of lime. The captain sailed throughout the world for over three years without a single death from scurvy—unprecedented for that time.

    But it took forty-eight years before the British Admiralty made it official policy to distribute one ounce of lime juice daily for each sailor. This simple nutritional supplement of vitamin C was a factor in Britain's ascent to being the world's greatest sea power. It was as though they doubled their forces. Britain sailed farther than any other navy into uncharted territory, easily defeating weakened enemies who had lost many sailors to scurvy.

    Now, neither the British nor the American Indian performed any double-blind, cross-over studies to arrive at their discovery. In their respective ways, they learned that it worked very well for their needs. James Lind had conducted empirical studies (based on observation) to determine that a citrus fruit could save naval forces from certain death. Ridiculed by their rivals for this use of lime juice, the British were derisively referred to as "limeys." Had they never conducted their simple experiment, or had another sea power done so, world history could have been altered.

    Dr. Jenner, a British doctor, discovered in the early 1800s that milkmaids who had previously contracted cowpox were protected against smallpox. Jenner scientifically developed a vaccine from the crusty lesions of smallpox patients to inoculate others against smallpox. It took more than fifty years for the medical power structure to endorse his simple remedy for a killer disease.

    In 1848, Dr. Semmelweis, a graduate of the prestigious University of Vienna Medical School, introduced a revolutionary idea while assisting in the Vienna Obstetrical Clinic: he required medical students to wash their hands in chlorine water before entering the clinic. There was an immediate and dramatic decrease in the high death rate from puerperal (childbirth) fever. The good doctor became an outspoken advocate, pleading with obstetricians to tend maternity patients only after proper hand washing. After a vicious attack on his personal and professional integrity, he was fired from the hospital where he had just eradicated a cause of death.

    This courageous, principled doctor then spent ten years gathering evidence to prove that hand washing would prevent terrible misery and death from childbirth fever. He published his research in 1861 and distributed the medical text to the major medical societies throughout Europe. It was completely ignored. In one of those years, 40 percent of the maternity patients in Stockholm, Sweden, contracted the fever; 16 percent of those new mothers died.

    The deadly fever continued to ravage women while the hand washing prevention/cure was "put on hold" by Organized Medicine. The poor doctor could no longer cope with the preventable death and misery of so many women. In 1865 he died after a mental breakdown; such tragedies still occur among gifted researchers whose great discoveries are ignored. So, from the safety of the next century, Dr. Semmelweis can be credited by the medical profession with his lifesaving discovery—hand washing.

    In 1867, Dr. Joseph Lister introduced sanitation in surgery, but not without a big fight with the leading surgeons of nineteenth-century England. His paper, "On the Antiseptic Principle in the Practice of Surgery," was read before the British Medical Association in Dublin, Ireland. His noteworthy summary concluded:

Since the antiseptic treatment has been brought into full operation, my wards though in other respects under precisely the same circumstance as before, have completely changed their character, so that during the last 9 months not a single instance of pyemia, hospital gangrene or erysipelas has occurred in them.

    Dr. Lister's contribution outraged the leading surgeons of the day. An 1869 conference of the BMA devoted the surgery address to a scathing attack on the antiseptic theory. What presumptuous London surgeon would believe a lowly provincial from Scotland who was telling them how to improve surgical protocol?

    As evidence of similar incredible intolerance in the United States, U.S. Senator Paul Douglas related the following story, which was recorded in the Congressional Record in 1963:

I spent a part of 1923 with Dr. W. W. Keen. In the Civil War he was a surgeon and had seen many men die from the suppuration of wounds after he had operated.

He went to Scotland and studied under Lister. Dr. Keen came back from Scotland. He was referred to as a crazy Listerite. He was denied an opportunity to practice in every hospital in Philadelphia.

Finally there was one open-minded surgeon in the great Pennsylvania General Hospital. He said, "Let us give this young fellow a chance!" So they let him operate.

No one died from infection under Keen. Keen began to chronicle the results in statistical articles. He was threatened with expulsion from the Pennsylvania Medical Society.

This was in the 1890s. Finally he was accepted as the greatest surgeon in the United States.

    Next came Dr. Louis Pasteur, a chemist. His germ theory for infectious diseases provoked violent opposition from the medical community of the late 1800s. How could a mere chemist poach upon their scientific turf?

    Dr. Harvey's monumental work on the theory of blood circulation was forbidden to be taught at the University of Paris Medical School twenty-one years after Harvey published his findings. And it doesn't end there.

    Austrian botanist Gregory Mendel's theory of genetic composition was generally ignored for thirty-five years. His pioneering work was dismissed as that of an idle, rich dilettante by the leading scientists of his day.

    Dr. Fleming's mid-twentieth-century discovery of the antibiotic penicillin was ridiculed and ignored for twelve years before this life-saver was admitted into the medical circle. Once scorned, Dr. Fleming was eventually knighted and received the Nobel Prize in Medicine for what had once been denounced.

    As a final example, Dr. Joseph Goldberger unraveled the mystery of pellagra, a disease which ravaged especially the poor in the American South. Pellagra was at first thought to be an infectious disease causing the three Ds of dermatitis, diarrhea and dementia. Goldberger discovered that, like scurvy, pellagra was a vitamin-deficiency disease. The milling or refining process of corn removed important vitamins and minerals from the husk. Those people dependent on corn-based foods such as grits, corn bread, etc., became deficient in vitamins and minerals. Goldberger's recommendation—to re-fortify corn flour—is now a routine practice in refining most flours. But the foot-dragging over this minor business expense by the greedy flour barons of the time dragged on for fifty years.

    These examples are just a handful of so very many courageous doctors and scientists who braved a battle with Organized Medicine on behalf of what could help patients. They have the honor and distinction of representing "The Enemy of the People" that was portrayed in Ibsen's drama of that name.

    The role of deficiency in causing disease is carried a step further by Dr. Max Gerson in his text for doctors, A Cancer Therapy—The Results of Fifty Cases. He exposes the depletion of farm soil from chemical fertilization as early as the 1930s and concludes that the depletion subsequently affects nutritional levels in the plants growing in depleted soil.

IT'S THE SAME IN SCIENCE

Throughout the course of Western Civilization, there has been a strong resistance to new information in the other scientific fields. There is so much evidence of this bigotry that only a few brief examples are offered here.

    Thomas Kuhn's book The Structure of Scientific Revolution (2nd Edition, University of Chicago Press, 1970) relates the typically bitter conflict between an independent science researcher who discovers something important and the current power structure which fights to maintain the status quo.

    German biologist Hans Zimmer wrote, "Academies and learned societies are slow to react to new ideas, this is in the nature of things ... The dignitaries who hold high honors for past accomplishments do not like to see the current of progress rush too rapidly out of their reach!"

    In his 1966 book, DeGrazia recounted the mistreatment of scientist Immanuel Velikovsky for his theories in astronomy. Velikovsky had proposed that the catastrophic events recorded in the Old Testament and in Hindu Vedas and Roman and Greek mythology were due to the earth repeatedly passing through the tail of a comet during the fifteenth to seventeenth centuries, B.C.

    DeGrazia wrote,

What must be called the scientific establishment rose in arms, not only against the new Velikovsky theories but against the man himself. Efforts were made to block dissemination of Dr. Velikovsky's ideas, and even to punish supporters of his investigations. Universities, scientific societies, publishing houses, and the popular press were approached and threatened; social pressures and professional sanctions were invoked to control public opinion.

The issues are clear: Who determines scientific truth? Who are its high priests, and what is their warrant? How do they establish their canons? What effect do they have on the freedom of inquiry and on public interest? In the end, some judgment must be passed upon the behavior of the scientific world, and if adverse, some remedies must be proposed.

    Philosopher and professor of physical chemistry Michael Polanyi commented in 1969, referring to the persecution of Velikovsky, that new ideas in science are not accepted in a rational manner, based on factual evidence, but instead are determined by random chance, the ruling economic/political powers, or the ruling ideology.

    A recent paper by sociologist Marcell Truzzi, "On the Reception of Unscientific Claims," delivered at the annual American Academy for the Advancement of Science, proposed that it is even harder today for new discoveries and ideas to break through, due to the escalating economics of research. Truzzi wrote, "Unconventional ideas in science are seldom positively greeted by those benefitting from conformity." Truzzi predicted that new forms of vested interest will emerge from today's programs that must compete for massive funding. He warned, "This has become a growing and recognized problem in some areas of modern science."

    There is another reason for resistance to scientific discoveries. Many of the major advances have come either from a scientist in another scientific discipline or from researchers who just don't qualify for membership in the scientific elite (as in high school "in crowds"). No wonder advances so often come not from the "in crowd" who are blinded or corrupted by prevailing dogma.

ORGANIZED MED IGNORES SUCCESS

Currently there exists impressive statistical and clinical (case study) data on alternative approaches to reversing or controlling some cancers without the use of chemotherapy, radiation and surgery. But covert politicking and overly rigid systems of testing and approval suppress these biological approaches that Americans are increasingly accessing. Desperate cancer patients rarely learn about all their medical options; in fact, a full 80 percent of those who travel outside the U.S. for alternative cancer therapies are so terribly advanced in their diseases that it is too late, even for alternative approaches. This fact alone obscures the value of these therapies when they are promptly applied under competent medical supervision and not tried as a last resort, following, for example, chemotherapy. Chemotherapy alone can destroy a patient's immune system, and biological methods usually require a functioning immune system.

    Sadly, in this supposed age of enlightenment, the ridicule of the medical orthodoxy and a rigid system of testing and approval (calcified by the same suspicions of alternative therapies that plagued discoveries for centuries) keeps these treatments from ill patients who might benefit from them, as De Felice, Director of the Foundation for Innovation in Medicine, in 1987, lamented:

One of the tragedies of our times is that over the past 20 years, a pervasive and aggressive regulating system has evolved that has effectively blocked the caring clinical innovator at nearly every step. Let there be no doubt that we have quietly, but effectively, eliminated the Louis Pasteurs of our great country.

DR. HORROBIN'S CALL FOR AN END
TO THE SUPPRESSION OF INNOVATION

The Journal of the American Medical Association (JAMA) in March, 1990, published selections from the first International Congress on Peer Review in Biomedical Publications. Dr. David Horrobin presented "The Philosophical Basis of Peer Review and The Suppression of Innovation," a classic presentation. Dr. Horrobin stressed that the ultimate aim of peer review in biomedical science cannot differ from the ultimate aim of medicine—"to cure sometimes, to relieve often, to comfort always." (Believed to be a French folk saying of medieval origin, this beautifully simplistic description of medicine's intent is inscribed on the statue of Edward Trudeau at Saranac Lake, New York.)

    Dr. Horrobin stated that the purpose of peer review should be nothing less than to facilitate the introduction of improvements in curing, relieving and comforting. Even in the fields of biomedical research that are remote from clinical practice, the peer reviewer should always ask whether the proposed innovation could realistically lead to improvements in the treatment of patients.

    He notes the necessity for a creative tension between innovation on the one hand and quality control on the other. The innovators who generate the future are often impatient with the precision and systematic approach of the quality controllers. On the other hand, the quality controllers are often exasperated by the seeming lack of discipline and predictability of the innovators. If either side dominates, research progress falters.

    The public is the ultimate source of money for medical research. They agree to this use of their money for the sole purpose of improving their medical care. When improvement does not progress satisfactorily, support for medical research (and medical journals) will dwindle. The public wants satisfactory progress; if such progress is not forthcoming, the present medical research enterprise will crumble. For satisfactory results, quality control must comprise only one side of the editorial equation. There must also be an encouragement of innovation. Presently, quality control is overwhelmingly dominant, and encouragement of innovation receives very little attention. Without appropriate balance, peer review fails its purpose.

    Dr. Horrobin notes that, in the last six decades, the accuracy of medical articles has improved substantially but so has a failure to acknowledge innovation. Between 1930 and 1960, patient care improved dramatically. Many infectious diseases were controlled by drugs and immunization. Prototypes of drugs used today were discovered during that time. However, by 1960 (despite major developments, especially in the field of diagnosis), patients increasingly felt dissatisfied, and we must accept the fact that their dissatisfaction stems from our trading innovation for quality control.

    Dr. Horrobin presents many situations in which, through peer review, Organized Medicine has tried to suppress an innovative concept but failed. He shows how the use of peer review influences journals, conference choices and grant awards.

    Pathologist Charles Harris has written editorials about the "Cult of Medical Science" in which he says pseudo-science in medicine is currently a cult which inhibits innovation and considers participation in clinical drug trials (which have been designed by statisticians) as the work of scientists because these trials reject so-called anecdotal evidence based on clinical observations alone. But this narrow attitude is not real science which leads to discovery. It is merely indoctrination and a pledge of allegiance to the flag of pseudoscience.

    Harris also asserts that diagnosis, which is supposed to be the determination of the nature of disease either by examination or by exclusion, is not being practiced as it should be. Diagnosis today too often does not consist of examination, exclusion, clinical or therapeutic trials; rather, it often consists only of a rushed referral to a medical specialist under the guise of a diagnosis. The specialist may accept and act on the initial diagnosis which was not valid in the first place. The initial diagnosis serves to justify referral and satisfy the CPT code in order for the doctor to get reimbursed.

    The New York Times, on March 26, 1991, carried an article by Philip J. Hilts entitled "How Investigation of Lab Fraud Grew Into a Cause Celebre" recounting how scientists turned a tangled dispute into a defense of science. This article is about a draft report which had been recently released by the newly-established Office of Scientific Integrity at the National Institute of Health. This office had been investigating the case of Dr. Thereza Imanishi-Kari and a paper she published with Dr. David Baltimore in the April, 1986, issue of the scientific journal Cell about the basis of an immune reaction. Questions about the paper arose when Dr. Margot O'Toole, a post-doctoral fellow in Dr. Imanishi-Kari's laboratory, went to Dr. Baltimore (who was then at the Massachusetts Institute of Technology) and told him her reasons for doubting the authenticity of the data in the article. She alleged that the paper made false statements, a conclusion she reached after seeing seventeen pages of data that supposedly, but did not, support claims in the paper. She persisted in her accusations, and, as a result, two scientific reviews of the paper were conducted in 1986—one at MIT, where the work was done, and the other at Tufts University, where Imanishi-Kari was seeking employment. Both of these reviews found problems with the work but found no reason to believe misconduct was involved. Dr. O'Toole, who was eventually fired from her job at MIT, had been told by Dr. Baltimore that she could publish her objections to the paper, but that if she did he would also publish his views of it.

    The matter lay dormant for two years after the initial scientific reviews conducted at MIT and Tufts, until Representative John D. Dingell, who heads the House Subcommittee on Oversight and Investigations, asked the Secret Service to examine Dr. Imanishi-Kari's notebooks for their authenticity. This action raised the hackles of the scientific community. Supporters of Dr. Baltimore criticized Dingell for prying into the notebooks of science and, described his panel as the "science police." Dingell revealed that his committee was soon buried in letters from scientists concerned with the subcommittee's actions, but he also said that in perhaps 50 percent or more of the letters the scientists included disclaimers, saying that they did not know the facts of the case. What had begun as a small dispute within Dr. Imanishi-Kari's laboratory had become a national debate, pitting Dr. Baltimore and his many supporters in the scientific community against Dingell's House Subcommittee and generating bitter controversy over a period of five years.

    The controversy was eventually addressed by the National Institute of Health's Office of Scientific Integrity and put to rest by its draft report. In that report, the OSI concluded that Dr. O'Toole's actions were heroic and that Dr. Baltimore's response was troubling because he, instead of ending the matter within weeks of its beginning, allowed it to mushroom into a national debate. Dr. O'Toole's allegations were vindicated, and most of Dr. Baltimore's supporters have withdrawn their objections to the Congressional action after confronting the evidence uncovered by the OSI and presented in their draft report.

    This case of scientific fraud illustrates the need for an office such as the Office of Scientific Integrity. Dr. David Goodstein, Vice-Provost of the California Institute of Technology, helped to write the rules for dealing with misconduct. He stated in regard to the Imanishi-Kari/Baltimore case, "The scientific community until recently was disposed to believe that fraud didn't exist. So, in the rare cases that it did come up, the community was not prepared for it."

    Having established that fraud can exist in the scientific community and having acknowledged the need for an agency to investigate such fraud, we now need to address a disturbing question: What about fraud and deceit that is conducted by individuals who work for organizations such as the AMA and the FDA? Why doesn't the Office of Scientific Investigation inquire about what happened with the Koch reagents and how an injunction was issued by the FDA prohibiting interstate shipment and the making of any medical claims, without the FDA even investigating them? What about the recall by the FDA of all contaminated tryptophan products sold in health food stores while allowing the continued use of the contaminated product in infant formulas and in intravenous pharmaceutical preparations?

    The statute of limitations has expired in the case of the Koch reagents, but it is arguable that there should be no statute of limitations in science, particularly regarding a therapeutically useful drug. In any case, the statute of limitations has not expired in the recent contaminated tryptophan case. Why is this case not investigated by the OSI? If their mandate is not to investigate cases like this, then what is it? Surely their mandate goes beyond an occasional nabbing of a cheating researcher. It appears that the Office of Scientific Integrity is prepared to investigate individual instances of fraud but not collusion and conspiracy within the ranks of the government itself.

    The story of vitamin C and cancer was thoroughly researched by Dr. Evelleen Richards and published in "Social Studies of Science" in 1988. Her paper received much publicity. Dr. Richards documented in great detail the failure of two Mayo Clinic studies to test vitamin C in the correct manner proposed by Nobel winner Linus Pauling and his associate E. Cameron.

    Richards noted the repeated refusal of the New England Journal of Medicine to publish letters and articles by Pauling and Cameron that demonstrated why the second Mayo trial was not a test of their hypotheses. Cameron showed that highly toxic treatments for cancer, including 5-fluorouracil for colon cancer, continued to be used despite their failure to demonstrate efficacy in placebo-controlled trials. Richards proposed a valid question: Why does the full weight of disapproval fall on vitamin C (which has low toxicity), when toxic drugs with no demonstrated efficacy are widely used?

    Dr. Horrobin contends that the peer-review process harbors antagonism toward innovation. While this is not the norm, it certainly is not the exception. Editors must encourage innovation as much as they ensure quality control, and that will require a conscious effort of will. He points out that the hypercritical reviews and behaviors of many distinguished scientists are unwarranted and pathological. Such professionals are gate-keepers against innovation unless the new thought or discovery is their own.

    Dr. Horrobin concludes with a call for editors to muster the courage to select reviewers of the highest caliber without vested interest, or at least to note when vested interest is present. Editors must stop rejecting innovative articles for minor details which never keep establishment-approved articles out of the journals. An editor must never lose sight of the ultimate aim of biomedical science—to improve the quality of patient care. Only after scrupulous study of both the article's contents and the peer review should the editor make an objective decision.

WE MUST STOP PERSECUTING
ALTERNATIVE PRACTITIONERS

To refuse to learn from history is to repeat it. The medical profession continues to libel and slander innovative doctors. The term "quack" has no legal definition. It is often misused to libel a doctor who is bright, full of initiative and well-loved by patients, and who has made an original discovery or happened to acquire the non-toxic methods that in the U.S. are referred to as alternative. Real charlatans should certainly be stopped. But should there be these programs aimed at American doctors such as the chelation doctors or those who employ alternative methods for treating cancerous tumors or other chronic diseases such as arthritis, multiple sclerosis, etc.?

    This moral injustice should be halted. The involved branches of business, government and medical profession will in the near future have to answer the well-documented evidence spanning the twentieth century, that, hidden from the trusting public, a horrible orchestration of doctor-bashing has occurred to destroy the competition.

    And what does Organized Medicine say for itself?. Why, they believe in an overly-rigid definition of what constitutes scientific proof. The Canadian agriculturalist who developed the double-blind study never intended for it to be used in such a rigid manner. It was intended to eliminate the subjective bias of scientific investigators and their research assistants, not to become the gold-standard bearer for scientific proof in clinical medicine. Most genuine scientists (the term excludes the majority of the medical profession) do realize this fact. Real scientists understand that all science starts with careful observation and the recording of events.

    This point can be best illustrated with a story. In the time of Julius Caesar, there was a legendary bandit by the name of Procrustes. Now, a Procrustean bed which bears his name is an adjustable hospital bed. Legend had it that Procrustes would kidnap people, bring them to his home and force them to lie down on his bed. If they were too tall to fit his bed, he just cut off their legs and they bled to death. Too short? He put them on a rack and stretched them until they died screaming. The highly regarded Dr. Edward Whitmont, homeopathic physician of New York City, likens the rigidity of the cruel Procrustes to the rigid adherence to a methodology that blinds one to an obvious truth in medicine—that an alternative treatment works. The obsession with a rigidly narrow definition of what constitutes scientific proof is more slavishly believed by physician scientists than by modern physicists. Recognizing only this rigid, narrow definition of proof, orthodox medicine holds a sword of Damocles over their competition.

    Do they really believe that they can keep alternatives out of medicine? Or do they know that the exclusion will end in the near future and so "make hay while the sun still shines"?