Important New Hires and Battles with the National Cancer Institute

Art Robinson and Rick Hicks with LPISM visitors, 1977.

Art Robinson and Rick Hicks with LPISM visitors, 1977.

[A history of the Linus Pauling Institute of Science and Medicine, Part 2 of 8]

By the end of 1975, the Linus Pauling Institute of Science and Medicine found itself teetering on the brink of financial collapse. Linus Pauling was donating his entire salary and even personal funds from his bank account to LPISM, and every employee had taken meaningful pay cuts. Everyone involved realized that the organization could not hope to succeed if business was to continue as usual.

An important change came in March 1976, when Richard Hicks was hired to help with fundraising. This move proved to be a windfall as Hicks interjected new energy and ideas into the search for additional income. One of the Institute’s most important employees for many years, Hicks rather quickly utilized his talents to help alleviate the extreme financial problems of 1975.  With Hicks on board, the Institute was only treading water, but the imminent threat of drowning had lessened.

Later in 1976, Pauling published Vitamin C, the Common Cold, and the Flu, an updated version of his earlier book Vitamin C and the Common Cold. The book sold reasonably well and managed to bring some much needed cash in to LPISM, though not as much as the organization had hoped. Additionally, Ewan Cameron and Pauling published another paper on vitamin C and cancer, which stated that terminal cancer patients lived longer and enjoyed a higher quality of life when given supplemental vitamin C.

flu

Just as conditions were starting to improve, the Institute suffered another major setback when investigators from the National Cancer Institute visited LPISM to check on the progress of its hairless mice skin cancer study. In their report the investigators frowned upon the Institute’s tiny staff, what it deemed to be bad management by its administrators, and Pauling’s frequent absences. Their harsh judgement helped to “sink the Institute’s future grant requests” for many years afterward, thus forcing LPISM to redouble its efforts to secure new sources of private funding.

On the research front, Art Robinson began working with Kaiser-Permanente to set up a national sample bank with tens of thousands of blood and urine samples that LPISM could utilize for better research. The collaboration was moving along smoothly until Kaiser realized that the bill for the project would be in the neighborhood of $5.8 million, at which point Kaiser decided to scrap the deal in a most expedient fashion. In 1977, a year after negotiations had started, Robinson was informed that the plan was rejected because it was too ambitious and vague.

Robinson wasn’t the only one receiving that response. Pauling had been seeking grant funding from the NCI from the moment that its investigators’ report had been released. He reasoned that if the NCI was complaining that LPISM was too small, then they should give him more money to expand. By 1977 he had been turned down four times by the organization, each time under the auspices of his proposals being too ambitious and vague.

In light of the bad press that accompanied the NCI’s dismissals, Pauling sent copies of his proposals and rejection letters to twenty-four members of Congress, including the senators heading the committees on health and nutrition, Ted Kennedy and George McGovern respectively. He received no response, and in turn asked his lawyer if he could sue the NCI for bias. His lawyer advised him that there was no legal precedent for such a case, and that the chances of successfully suing a federal agency were “less than slim.”

Linus Pauling and Emile Zuckerkandl, 1986.

Linus Pauling and Emile Zuckerkandl, 1986.

In early 1977, LPISM hired two people, both of whom ended up making major contributions to the Institute. First they hired Emile Zuckerkandl to lead their research on genetics. Zuckerkandl brought a different type of personality to the Institute. He and his family had fled Austria shortly before the onset of World War II, as they were wealthy and Jewish. In fleeing they had managed to bring with them some of their rare artwork collection, which Zuckerkandl would show to his coworkers at LPISM from time to time. A renowned scientist, Zuckerkandl had worked previously with Pauling at Caltech, collaborating and co-developing a theory of molecular evolution.

The second person of note to be hired was Stephen Lawson, who was brought on board to assist with direct-mail solicitations for fundraising. Lawson’ s position was very much at the entry level.  When he was hired he was not associated with the Institute in any way, and his only concrete knowledge of Linus Pauling harkened back to a chapter during his student days at Stanford University, when he saw Pauling protesting the firing of a tenured instructor.

About this time, the NCI also brought someone in: a new head named Vincent DeVita. He was more open-minded about Pauling and his vitamin C work, and was aware of how much public support Pauling had accumulated. As a result he consented to speak with Pauling and, after a multi-hour meeting, agreed to set up a conclusive clinical trial on vitamin C and cancer. When asked about the apparent reversal of the NCI’s opinion of Pauling’s work, DeVita responded that Pauling “can be a very persuasive man.” By March DeVita had arranged for the trials to be carried out at the prestigious Mayo Clinic, headed by the esteemed Dr. Charles G. Moertel. Pauling and DeVita met again in April to discuss the details of how the trial would be conducted.

Vincent DeVita, 1999.

Vincent DeVita, 1999.

On the eve of the Moertel study, circumstances appeared to be improving across the board for the Institute. With more apparent support for his research, Pauling expanded his program and in 1977 began a new series of tests designed to determine the effect of vitamins on tumor growth. The tests utilized 600 hairless mice as subjects. Additionally, LPISM managed to acquire enough funds to hire a professional direct-mail company for fundraising, and was able to place a number of successful advertisements in major financial periodicals including Barron’s and the Wall Street Journal. With these changes, LPISM saw a hefty boost in its incoming funds.

Buoyed by the success of the direct-mail strategy, LPISM began focusing its fundraising on this type of marketing. The move proved to be very effective and non-governmental donations increased from 50% of LPISM’s funding to 85% -the organization received almost $1.5 million in private donations in 1978 alone. For the first time in its short history, LPISM wasn’t suffering from financial hardships.

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Vitamin C, the Common Cold and Controversy

By Tom Hager

[Part 3 of 3. For the full text of this article, originally presented as a lecture sponsored by Oregon Health Sciences University, please see this page, available at http://thomashager.net]

Portuguese edition of Vitamin C and the Common Cold, a book that was translated into nine different languages.

Pauling’s reading of the literature convinced him that the more vitamin C you took, approaching megadose levels, the lower your chances of getting sick, and the less sick you got.  It was at this point that Pauling made what I consider to be a fundamental mistake. He decided to publish his ideas without peer review, in the form of a popular book.

He did not feel he could wait. He had, he thought, good evidence that a cheap, apparently safe, easily available nutrient could prevent at least an appreciable fraction of a population from suffering through an affliction that made millions of people miserable. And there might be even greater results. Pauling had read of small villages, snowbound in the winter, where no one got colds because there was no reservoir of respiratory viruses to pass around. When visitors arrived in the spring, they would bring colds with them, and everyone would suffer. What if, through the use of vitamin C, a great many more people strengthened their resistance to colds? The two hundred or so cold viruses rampant in the world would have many fewer places to replicate themselves. The spread of colds would lessen; the population of cold viruses would decrease. “If the incidence of colds could be reduced enough throughout the world,” Pauling thought, “the common cold would dis­appear, as smallpox has in the British Isles. I foresee the achievement of this goal, perhaps within a decade or two, for some parts of the world.” Vitamin C, properly and widely used, might mean the end of the common cold.

Packaging for commercial cold remedies pasted by Pauling into his research notebook, July 1970.

This, of course, would not only greatly lessen the amount of suffer­ing in the world; it would increase the fame of Linus Pauling. He was nearing seventy years of age. It had been nearly twenty years since he had captured international attention for his scientific work with proteins, and won the Nobel Prize for chemistry. His efforts had gone to politics in the years since, and none of his recent scientific work had had much impact. Science was moving on without him. He was becoming a historical figure.

Pauling did not feel like one. He was not ready for emeritus status, trotted out at honorary occasions, shunted aside while the young men made the discoveries. He was still strong, still smart, still a fighter. Or­thomolecular medicine was the newest of his grand plans, and no one had shown that his ideas about creating an optimal molecular environ­ment for the body and mind were wrong. The evidence he had uncov­ered about ascorbic acid and colds, evidence that showed human health could be improved by increasing the amount of vitamin C in the body, was the strongest indication yet that he was right. Bringing it to the public’s attention would not only be good for the public; it would be a striking example of the correctness of his general theory.

Pauling’s book Vitamin C and the Common Cold, written in his usual clear, well-organized, straightforward style, presented the results of his literature search. He discussed the findings of five controlled trials that supported his idea, several anecdotal instances of physicians who had treated colds with vitamin C, and evidence that ascorbic acid was safe in large doses. Pauling felt confident that a several-gram daily dose would do no more harm than to cause loose stools, that vitamin C was safe, especially compared with potentially toxic, commonly avail­able over-the-counter medications such as aspirin. The rest of the book was a summary of his orthomolecular thinking and Irwin Stone’s ideas about evolution. A good deal of space was devoted to the topic of bio­chemical individuality, which resulted in a wide personal variation in the need for vitamin C and other nutrients.

On November 18, 1970, prepublication galleys were released to the press, and an unprecedented public roller-coaster ride began. The next day, the New York Times quoted Pauling as saying that humans needed between 1 and 4 grams of vitamin C per day to achieve optimal health and prevent colds. Pauling also took the occasion to slam the medical establishment – from drug companies to medical journals and physicians – for attempting to quash the evidence in favor of ascorbic acid. Why would they do that? the reporter asked. Look at the cold-remedy industry, Pauling said: It was worth $50 million per year, and that bought a lot of advertising space in medical magazines.

This quickly alienated both physicians and the editors of medical journals, neither of whom liked the implication that profits were more important than health. The medical establishment felt it necessary to respond, and respond quickly, once they saw how Pauling’s idea took off.

The book sold wildly, and so did vitamin C.  Pauling’s timing, at least on the public side, was superb. The 1960s had seen a resurgence of interest in “natural” health based on a holistic attitude that said body, mind, and soul were one. Many streams fed into this alternative health movement: a back-to-the-land, organic-foods orientation; a fas­cination with yoga, acupuncture, meditation, and other Eastern health practices; the rediscovery of the lost Western arts of naturopathy and homeopathy. Pauling’s message about vitamin C resonated with mil­lions of people who were reacting against corporate, reductionistic, paternalistic medicine, with its reliance on drug therapy, with people taking a renewed responsibility for their own health and trying to do it naturally. It was delivered just as natural food stores were popping up on corners in every town in America, each one stocked with a section for herbal remedies, a rack for magazines on alternative health regi­mens, and plenty of shelf space for vitamins.

The publication of Pauling’s book triggered a nationwide run on vitamin C. Sales skyrocketed, doubling, tripling, quadrupling, within a week of its appearance. Druggists interviewed in newspapers across the nation told of people coming in to buy all the vitamin C they had. Wholesale stocks were depleted. “The demand for ascorbic acid has now reached the point where it is taxing production capacity,” said a drug company spokesman less than a month after Pauling’s book ap­peared, adding, “It wouldn’t pay to increase production capacity since we’re sure it’s just a passing fad.”

The reaction was swift. The physician-head of the Food and Drug Administration (FDA), Charles C. Edwards, announced to the press that the national run on vitamin C was “ridiculous” and that “there is no scientific evidence and never have been any meaningful studies in­dicating that vitamin C is capable of preventing or curing colds.” The FDA, Pauling found, had proposed in 1966 that no vitamin C tablets over 100 mg be available without a prescription, and he responded to Edwards with sarcasm. If the FDA had its way and he wanted to take 10 grams of vitamin C to fight off a cold without going to a physician for a prescription, Pauling said, he would have to take 100 tablets. “I think I would have as much trouble swallowing all these tablets as I would swallowing some of the statements made by the Food and Drug Ad­ministration in proposing these regulations,” he said.

The medical press was equally critical of Pauling. The American Journal of Public Health said that Pauling’s book was “little more than theoretical speculation.” The Journal of the American Medical Association said of Pauling’s book, “Here are found, not the guarded statements of a philosopher or scientist seeking truths, but the clear, incisive sentences of an advertiser with something to sell. . . . The many admirers of Linus Pauling will wish he had not written this book.” The Medical Letter launched the harshest attack yet, saying Pauling’s conclusions “are derived from uncontrolled or inadequately controlled clinical studies, and from personal experience” and pointing out that there was no good evidence that vitamin C was safe when taken over a long period of time in large doses.

The controversy over Pauling’s book arose from a simple fact: He had not made his case. The book was a combination of his interesting but unproven speculations about orthomolecular medicine and the human evolutionary need for ascorbic acid, coupled with a select handful of studies that indicated that vitamin C could prevent or ame­liorate colds in a fraction of a population. That might make an inter­esting conference paper, but it was little reason to advocate a wholesale change in the dietary habits of a nation. His critics pointed out that he had no clear theory of how vitamin C exerted it powers and that there was no good study – no study at all – establishing that the long-term ingestion of megadoses of vitamin C was safe. The current dogma in the medical profession was that vitamins were needed only in the small amounts provided by a well-balanced diet. Taking grams of vitamin C every day might cause everything from gastric upset to kid­ney stones, and who knew what else?

The way he had gone about publicizing his ideas, sidestepping the normal channels of scientific peer review to publish a popular book, also fueled criticism. He was behaving like a health faddist, not a scien­tist. In the eyes of most physicians – generally conservative about new therapies, disdainful of the holistic health movement, trained to be­lieve that vitamin C was needed only to prevent scurvy – Pauling looked like a nutritional quack, a vitamin pusher who was essentially prescribing without a license.

Typically, Pauling fought back. To pursue his ideas, in 1973 he cofounded (with Arthur Robinson, a young colleague who later moved to Oregon and this year ran for Congress) the Institute of Orthomolecular Medicine in Palo Alto, California.

He went on to publish more books, adding the flu as another disease vitamin C could fight, then Vitamin C and Cancer, and finally compiled all his ideas into How to Live Longer and Feel Better.

Anecdote published in Chemtech, September 1994.

Criticism from the medical community has never let up. A general belief still exists in most – although not all – of the medical community that Pauling went off his rocker.

However, despite what many physicians believe, the jury is still out. A significant amount of active biomedical research research continues to examine the effects of micronutrients on a variety of conditions. For instance the Linus Pauling Institute at Oregon State University (successor to Pauling’s Orthomolecular Institute) maintains a highly successful research program in 12 laboratories funded with millions of dollars of competitive grant funding. The Institute’s head, Balz Frei, believes that Pauling’s basic approach remains sound – but that his arguments with physicians might have caused as much damage to the study of nutritional science as they did good. In my own view, by putting personal controversy ahead of reasoned consensus both Pauling and his critics polarized the public into groups that still have trouble communicating with each other.

Pauling’s work helped give birth to today’s booming market in nutritional supplements. Vitamin C remains the world’s largest-selling supplement. A large number of advocates strongly believe that ingesting vitamins in amounts far above the RDA can help optimize human health, especially by preventing chronic disease. There is a growing understanding that the key in these studies – as Pauling pointed out long ago – is not to look for vitamins to act like pharmaceuticals, exerting significant effects at low doses, but more like nutrients, with less dramatic effects that accumulate at much higher doses.

Linus Pauling himself lived an active life well into his nineties, performing useful research until the end. He was taking many grams of Vitamin C every day.

Will the controversy he started ever end? Was he a genius, or a crank?