VITAMIN C AND CANCER: MEDICINE OR POLITICS?

Transcription

1 VITAMIN C AND CANCER: MEDICINE OR POLITICS?

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3 Vitatnin C and Cancer: Medicine or Politics? Evelleen Richards Science and Technology Studies Dept University of Wollongong, Australia M MACMILLAN

4 Evelleen Richards 1991 Softcover reprint of the hardcover 1st edition 1991 All rights reserved. No reproduction, copy or transmission of this publication may be made without written permission. No paragraph of this publication may be reproduced, copied or transmitted save with written permission or in accordance with the provisions of the Copyright, Designs and Patents Act 1988 or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, 33-4 Alfred Place, London WC1E 7DP. Any person who does any unauthorised act in relation to this publication may be liable to criminal prosecution and civil claims for damages. First published 1991 Published by MACMILLAN PROFESSIONAL AND ACADEMIC LTD Houndmills, Basingstoke, Hampshire RG21 2XS and London Companies and representatives throughout the world British Library Cataloguing in Publication Data Richards, Evelleen Vitamin C and cancer: medicine or politics? 1. Man. Cancer. Drug therapy. Drugs. Testing. I. Title ISBN ISBN (ebook) DOI /

5 To Warwick, whose idea this was

6 Contents Acknowledgements xi Introduction 1 Why the Vitamin C and Cancer Controversy? Telling It Like It Is 6 9 PART I: Interested Parties and the Background to the Controversy 1 Charting the Terrain Introducing Vitamin C The Battlefield: The Treatment of Cancer National Differences in Medical Organization and Practice Cancer Clinical Trials 28 2 The Vitamin C 'Believers' Linus Pauling Ewan Cameron The Linus Pauling Institute The Robinson Affair Megavitamin Therapy and Orthomolecular Medicine The Holistic Health Movement and the 'Freedom Fighters' for Alternative Cancer Treatments The Health Food Industry 49 3 The Vitamin C 'Nonbelievers' Dr Charles Moertel The Cancer Establishment The National Cancer Institute The Food and Drug Administration The American Cancer Society 61 vii

7 viii PART II: Vitamin C and Cancer Orthodox Nutritionists, 'Quackbusters', and the Fight Against 'Nutritional Quackery The New England Journal of Medicine and the Profession of Medicine Reconstructing the Vitamin C and Cancer Controversy The Cameron-Pauling Hypothesis and the Vale of Leven Trials 4.1 The Cameron-Pauling Hypothesis: Vitamin C and PHI 4.2 The Pilot Vale of Leven Trials 4.3 The PNAS Affair 4.4 Cameron's Pilot Trial Findings and his Presentation Strategy 4.5 Refining the Vale of Leven Trials 4.6 Publicity 4.7 A Time of Optimism 4.8 The Conclusion of the Sloan-Kettering Trial 5 The First Mayo Clinic Trial: Pauling's 'Head-On Collision with the Scientific Method'? 5.1 The First Mayo Clinic Trial 5.2 The Second Mayo Clinic Trial is Announced 5.3 Pauling, Moertel, and the Laetrile Controversy 5.4 Of Mice and Men 5.5 Cameron's Continuing Research 6 The Second Mayo Clinic Trial: 'A Conspiracy to Suppress the Truth'? 6.1 The Second Mayo Clinic Trial 6.2 The Pauling-Cameron Criticisms 6.3 Ploys and Tactics 6.4 The Publication Game 6.5 Closing the Controversy PART III: The Politics of Therapeutic Evaluation 7 The Social Shaping of the Vitamin C and Cancer Controversy 171

8 Contents ix 7.1 The Social Negotiation of the Efficacy of Vitamin C as a Cancer Treatment More Negotiations: The Social Character of the Publication Process Fact-making and the Media, with a Law Suit on the Side The Importance of Rhetoric The Rhetorical Deployment and Malleability of Ethical Claims The Centrality of Method Talk: Its Rhetoric and Political Functions Comparative Analysis of the Controversy: Vitamin C, 5-Fluorouracil, and Interferon Fluorouracil: 'The Breakthrough That Never Was' as Conventional Cancer Treatment The Adjudicating Community: The Profession of Medicine Interferon: From 'Pseudoscience' to Professionally Accredited Cancer Treatment 206 Conclusion: Making and Creating Choices 216 Options and Pressures for Change 219 Implications of this Study for the Evaluation and Social Implementation of Therapies 230 ~ ~ e m Bibliography 241 Index 260

9 Acknowledgements I owe debts of gratitude to a great many people who contributed to the making of this book. My greatest debts must be to Linus Pauling and Ewan Cameron, who first welcomed me to the Linus Pauling Institute of Science and Medicine in With courage and generosity they gave me unrestricted access to their personal correspondence, manuscripts and referees' reports. Over the years, Ewan Cameron in particular, they unstintingly provided me with supplementary material, and responded patiently and graciously to my many questions and demands for information. Without them, in more senses than the obvious one of their centrality to the vitamin C and cancer dispute, this book could not have been written. Although they have not always agreed with my interpretation of their material, they have scrupulously refrained from any intervention in my project. They have given generously their permission for the many quotations from their private correspondence that I have used in my reconstruction of the controversy. I have great pleasure in thanking them both. Emile Zuckerkandl, Director of the Linus Pauling Institute, was unfailingly courteous and hospitable, and provided some crucial material and information. I thank him for these and for our enjoyable debates on the social construction of science. Other Institute members I would like to thank include Mrs. Dorothy Monro, for her unflagging assistance in finding relevant correspondence and material in the vast, and as yet uncatalogued, Pauling Archives; Richard Hicks, Executive Vice President, who patiently answered my questions on Institute funding and resources; and Steve Burbeck, Zelek Herman, Raxit Jariwalla, Rick Marcuson, Ruth Reynolds, Fred Stitt, Constance Tsao, and Dick Willoughby, for discussion of their research and Institute matters. I should also like to thank Dr. Robert Paradowski, Rochester Institute of Technology, who is working on the official Pauling biography, for his generous sharing of some valuable material. For interviews or correspondence by mail, I would like to thank Dr. Robert E. Wittes and other personnel at the National Cancer Institute; Dr. Charles Moertel, Dr. Edward Creagan and Robert Horton of the Mayo Clinic; and Professor Kenneth J. Carpenter of the Department of Nutritional Sciences at the University of California, Berkeley. I would also like to thank the investigative journalists, Peter Chowka and Ralph Moss, for their valuable information on the American alternative health network; and Ian Anderson, West Coast correspondent for xi

10 xii Acknowledgements New Scientist, who gave generous access to his press clippings and files. I owe much to Elizabeth Newland, who worked as research assistant in the initial phases of the project, and who is now waging her own brave struggle against cancer. Brian Martin gave encouragement, valuable advice, and ungrudgingly read and commented on each of the chapters of the book. Jerry Markle and Edward Yoxen kindly reviewed the manuscript at very short notice and offered stimulating and supportive comments. Other friends and colleagues who read chapters or gave intellectual encouragement or support include Ditta Bartels, Harry Collins, Louise Crossley, Anni Dugdale, David Edge, Richard Gillispie, Ron Johnston, Charles Kerr, Everett Mendelsohn, Harry Paul, Stewart Russell, Steven Shapin, John Schuster, David Turnbull, and Evan Willis. Anni Dugdale and David Selden gave research support in the final stages of manuscript preparation. I also wish to thank the students in my course on the 'Politics of Medicine and Health' at the University of Wollongong, who, over the years, were a responsive sounding board for many of the ideas contained in this book. This research was aided by grants from the Australian Research Grants Scheme from 1981 to 1983, and from the University of Wollongong in 1983 and I am grateful to Sage Publications for permission to use materials from: EvelleenRichards, 'The Politics of Therapeutic Evaluation: The Vitamin C and Cancer Controversy', Social Studies of Science, 18 (1988): by Sage Publications, London, Newbury Park and New Delhi.

11 We must become the masters of medicine, not its servants. Let there be no misunderstanding: in the politics of medicine, it is we who must have the power, we who must set the policies. Ian Kennedy, The Unmasking of Medicine (Kennedy, 1980) The next thing [the judge] is going to say to me is, 'Look, I am an educated man and I wouldn't presume to decide between Linus Pauling and the Mayo Clinic. Here is a Nobel prize winning biochemist and here are fifteen doctors from the world's leading something and one tells me yes and the other tells me no, and how the hell am I going to decide? I don't know anything about biochemistry.' So he will say, 'Look Mr. [Attorney], you make a very interesting and persuasive argument, but on the other hand Mr.-- over here makes a very persuasive argument and I mean isn't this a question for scientists to decide? The history of science for a thousand years is that someone comes up with an idea, the establishment ridicules him, then fifty years later they find he was right and he becomes a saint. That's just life, and Pauling is in the great tradition of outcasts.' That's if I had a good judge. The worst is if I had a bad judge. He'd say, 'Look, Pauling is not a doctor- these guys are doctors; that's enough for me.' That could happen. An Attorney's Advice to Linus Pauling at the height of the vitamin C and cancer controversy (Linus Pauling Institute, 1985c)