Vitamin C and Cancer: Raising the Stakes

1976i2

Ewan Cameron, Ava Helen and Linus Pauling. Glasgow, Scotland, October 1976.

[Part 3 of 4]

By 1970, the year that Linus Pauling published Vitamin C and the Common Cold, the federal government’s “war on cancer” was soon to arrive. The National Cancer Act, passed in 1971, increased federal funding for treatment and prevention research, embracing cytotoxic treatment solutions like chemotherapy. That same year, Pauling began to push for investigations between nutrition and cancer, especially concerning vitamin C. Since the role of vitamin C in immune defense is arguably much less significant than Pauling supposed, the idea that intake of vitamin C should prevent or treat cancer seemed ludicrous to many physicians. Incredibly, evidence is now emerging that the opposite might be true.

In hindsight, there is a tendency for critics to see Pauling simply as a politically liberal proponent of alternative medicine; one who lashed out against a consumerist medical establishment that was firmly supported by conservative citizens, among others. However, proponents of alternative health and holism in the 1960s and 1970s prescribed to a broad range of political ideologies; Pauling was just one among many people who were searching for better preventative and alternative treatments.

In 1980, when Pauling was actively campaigning for a vitamin C treatment for cancer, Americans spent 13.1 billion dollars on cancer diagnosis and treatment. Five years later, a survey of over one-thousand individuals showed that a majority believed clinics using unorthodox cancer therapies should be permitted to operate in the U.S., and just over half said they would seek alternative treatment if seriously ill.

Pauling and his ideological positions are remembered now as having been central to the vitamin C “movement.” Perhaps this is because he was renowned in many arenas and easily attracted a great deal of media attention. Or perhaps, especially knowing his penchant for protesting against nuclear weapons testing and war, this was another issue on which Pauling was the most outspoken opponent of what he saw as a wrong to be made right.


1979p.1_new

Table from “Ascorbic acid and cancer: a review”, co-authored by Pauling and Cameron, 1979.

For Pauling, the continuing suffering of cancer victims was unnecessary, since a useful treatment was already cheap and readily available. He argued that,

The involvement of ascorbic acid (vitamin C) in the natural defense mechanisms is now known to be so great that we hope that a really significant control of cancer might be achieved by the proper use of ascorbic acid.

Of the studies that Pauling found so convincing, none were as crucial as those conducted at the Vale of Leven Hospital, near Glasgow, Scotland. There, Dr. Ewan Cameron found that mega doses of vitamin C (10 grams daily or more) seemed to slow and even reverse cancerous growth in some patients. He wrote to Pauling in 1971, who eagerly responded that this “attack” on cancer was the most promising application of vitamin C that he knew of.  Pauling, who had been studying the role of dietary vitamin C in issues of orthomolecular psychiatry such as schizophrenia, now shifted his focus to cancer.

Far from being the flaky alternative health guru that many came to see him as, Pauling’s work with vitamin C— like all his research on the subject of orthomolecular medicine (a field that he spearheaded)— was consistent with a biomedical model of molecular disease. Since Pauling saw this work as fitting within the framework of molecular biology, it was frequently unclear to him why the medical community resisted what was, to him, a straightforward and significant scientific endeavor.

Further complicating matters was the fact that Stanford University, Pauling’s academic home at the time, rejected his request for additional lab space to pursue cancer research. Now the target of regular media pummelings, Pauling’s ideas were becoming a potential source of bad press for the university. Refusing to take no for an answer, Pauling and his young lab assistant, Arthur Robinson, solicited private funding to continue their work on vitamin C outside of the university setting. Raising $50,000 in donations from wealthy supporters of vitamin therapies, the duo helped to found the Institute for Orthomolecular Medicine in 1973, subsequently renamed the Linus Pauling Institute of Science and Medicine (LPISM) one year later.

From 1973 to 1976, Pauling published co-authored articles with Cameron, who continued to study the effects of vitamin C on cancer from his base in Glasgow. And in 1975, Pauling and Robinson secured additional funds to begin their own animal testing. Two years later, the collaborators began reporting their results in the Institute’s newsletter.  In 1979 Cameron and Pauling likewise published an extensive review article in Cancer Research that cited previous studies corroborating their own conclusions. The duo published their book, Cancer and Vitamin C, that same year.


Sci 11.044, 44.14

A sample of Pauling’s notes compiled in response to the Mayo Clinic trials, 1979.

Cameron and Pauling’s data seemed to show that vitamin C would be especially valuable for cancer patients. Whereas a daily intake of 10 g of vitamin C in a healthy individual would bring the vitamin C level in the blood to a saturation point that could not be exceeded by increasing or prolonging intake, cancer patients showed a different pattern. Known already to have abnormally low blood levels of vitamin C, the patients in fact achieved just over half the same level of vitamin C blood saturation found in healthy individuals subscribing to a daily intake of 10 grams. For those afflicted with cancer, it was seen as necessary to take 10 grams a day just to reach the normal level of vitamin C found in healthy individuals who did not take supplements at all.

To Pauling, this alone justified continued research on the matter. After persistently stating his case to Dr. Vincent De Vita, director of the National Cancer Institute, two rounds of trials were conducted through the Mayo Clinic to solve what the medical community perceived to be problems in Cameron’s studies. When the trials indeed failed to produce anything like Cameron’s results, funding effectively dried up for vitamin C research – a significant blow to LPISM’s functional well-being.

In response, Pauling and his supporters argued that the Mayo Clinic was missing the point. The Mayo trials had attempted to measure the effectiveness of vitamin C in a manner similar to drug treatments, because the advent of chemotherapy and antibiotics, and the biases of the pharmaceutical industry, had placed primary medical emphasis on the disease, and not on the patient. Pauling saw the results of the Mayo studies not as a definitive defeat, but as the triumph of a complex of interdependent federal and private organizations that held a vested interest in supporting the chemotherapy status quo.


Pauling had claimed that, with vitamin C, lifespan could be increased, tumors could regress, and even full recovery was possible. For many in the medical community, these were not only foolish assertions, they were dangerous as well.

Dr. Charles Moertel, chairman of the Department of Oncology at the Mayo Clinic, was particularly vocal in his rebuke, stating that

For such a message to be conveyed to desperate and dying people, with the endorsement of a Nobel laureate, the presumption must be that it is based on impeccable scientific methodology.

Moertel’s implication, of course, was that Pauling’s argument was instead based on unsound science and certainly lacked the scientific basis to challenge the use of chemotherapy.

Yet vitamin C retained a broad appeal because many saw the prevailing treatment, and its manifold side effects, as inhumane. John Cairn, head of the Mill Hill Laboratory of the British Imperial Cancer Research Fund, provided a voice to the other side the coin by calling out the survivorship data. To wit: in 1986, 200,000 patients were receiving chemotherapy and, by 1991, five year survival rates for colon cancer remained at just 53%. Cairn spoke for many in suggesting that, when it came to the prevailing course of treatment, “the benefit for most categories of patients has yet to be established.”


1981i.3

Ava Helen Pauling, June 1981.

For Pauling, the debate turned from the public to the personal when, at the height of his study of vitamin C, his wife Ava Helen was diagnosed with stomach cancer. Following Ewan Cameron’s advice, she took 10 grams of vitamin C daily, and did not receive chemotherapy.  Throughout her treatment, Linus clung to the belief that mega doses of vitamin C would work for Ava Helen, just as it had for Cameron’s success stories in Scotland.

“Daddy was convinced that he was going to save her,” remembered Linus and Ava Helen’s daughter, Linda. “And that was, I think, the only reason he was able to survive… He said to me after she died that until five days before, he thought he was going to be able to save her.”

Ava Helen Pauling passed away in December of 1981. And though he was badly shaken by his wife’s death, belief in the value of vitamin C in the fight against cancer did not fade from Pauling’s mind. Suffice it to say, the medical community remained whole-heartedly unconvinced.

Advertisements

The Departure of Art Robinson and Fallout from the First Mayo Clinic Study

Art Robinson, 1974.

Art Robinson, 1974.

[A history of the Linus Pauling Institute of Science and Medicine, Part 3 of 8]

By late 1978, the Linus Pauling Institute of Science and Medicine had reformed its fundraising strategy, an action which proved to be quite successful. As a result, for the first time in its five years of existence, LPISM was not struggling to keep its head above water.

This wave of good fortune carried with it unforeseen negative consequences. In particular, Rick Hicks and Art Robinson began to come into conflict over the best way to invest this sudden surplus. Robinson suggested that LPISM move to Oregon – which had recently announced “Linus Pauling Day” in honor of its native son – and build a campus of its own. The idea was not popular with many staff, most of whom did not want to leave the Bay Area.

At the same time, Robinson began cultivating ties with the Orthomolecular Research Institute in Santa Cruz, California, which was headed by Arnold Hunsberger. Linus Pauling was not pleased with this idea, as he felt Hunsberger’s research hypotheses to be off the mark. Pauling had also met Hunsberger and had said that his impression was “not a very favorable one.”

Robinson continued to press for closer ties between LPISM and ORI, a source of growing tension between him and Pauling. In particular, Pauling was angered when he learned that Robinson had begun to tailor experiments in accordance with Hunsberger’s ideas without first consulting Pauling. When confronted, Robinson defended his decision and redoubled his arguments for collaboration. Their relationship continued to sour and morale at LPISM plummeted as the tension between Pauling and Robinson mounted.

In June 1978, Pauling issued a memorandum to Robinson, ordering him to consult the Executive Committee – comprised of Pauling, Robinson, and Hicks – before making “any important decisions.” Robinson responded by immediately firing Hicks. Pauling responded in turn by overruling the termination and demanding Robinson’s resignation within thirty days. He then proceeded to issue a memorandum informing Institute staff that he had stripped Robinson of his position, and that the staff was to disregard all further instructions from Robinson. The next day, the staff arrived at work to find a second memorandum from Robinson, declaring that he was still the president, that neither Pauling nor Hicks had the authority to relieve him of his duties, and that he would not resign.

Pauling memorandum of July 10, 1978.

Pauling memorandum of July 10, 1978.


The Board of Trustees met in mid-July to try and settle the dispute. They decided to place Robinson on a thirty day leave of absence, empowered Pauling with all executive authority and told him to resolve the issue. On August 15, with Robinson’s leave expired, Pauling was elected President and Director of LPISM. On August 16, Pauling promptly informed Robinson that he was taking over all of Robinson’s research, Emile Zuckerkandl was being appointed Vice-Director, and that Robinson was fired.

Now that Robinson was gone, LPISM attempted to consolidate and return to normal. Pauling asked Steve Lawson to assume a portion of Robinson’s research agenda, a request to which Lawson consented. Over the course of 1978, Lawson had steadily become less involved with the financial arm of LPISM and more involved with its scientific work. Zuckerkandl also tasked Lawson with setting up a cell culture facility where the two would conduct research on the differences between primary and metastic cancer cells, as revealed by protein profiling. Lawson worked closely with UC-San Diego, University of Colorado, and SRI International. He was later joined on that project by Stewart McGuire, Eddy Metz, and Mark Peck, all fellow employees at LPISM.

Robinson, however, did not take his firing lightly and on August 25, LPISM was informed that Robinson was suing the organization for $25.5 million, alleging a breach of contract and unlawful termination among other charges. LPISM’s lawyers began gearing up for a serious legal battle, standing firm in their conviction that the Institute had done nothing wrong.

Meanwhile, the Institute’s vitamin C research continued on despite the added burden of the Robinson lawsuit. In early October 1978, Pauling convinced Ewan Cameron to accept a one-year appointment to LPISM while the two worked on a book about vitamin C and cancer. Additionally, Pauling, Cameron, Lawson, and their coworker Alan Sheets began an experiment to determine the effects of vitamin C on chemotherapeutic drugs. The research took the form of a toxicology experiment in which multiple groups of fish were subjected to chemotherapeutic agents in their water, after which various groups were given different amounts of vitamin C while the research team observed the results.


The year 1979 started with good news. LPISM was informed by Hoffmann-LaRoche, the world’s largest producer of vitamin C, that they had seen sales more than double during the 1970s, and they fully recognized that Pauling was the cause. As a thank you, they had decided to donate $100,000 a year to the Institute.

The happy days were not to last long. In April, LPISM received an advanced release of the results of the major Mayo Clinic study on the treatment of cancer with ascorbic acid. Its primary investigator, Charles Moertel, had concluded that vitamin C did absolutely nothing to help cancer patients. Pauling was stunned and immediately began writing to Moertel to discuss the study in detail.

Then, over the summer, Art Robinson filed six more charges against LPISM and Pauling, bringing the total number of suits to eight and the total requested damages to $67.4 million. The year-long and highly publicized suit was greatly hurting LPISM’s reputation, and the Institute noticed a subsequent decrease in the donor funds flowing their way.

"Vitamin C Fails as a Cancer Cure," New York Times, September 30, 1979.

“Vitamin C Fails as a Cancer Cure,” New York Times, September 30, 1979.

Things then went from bad to worse when, on September 27, the New York Times published the Mayo Clinic study, definitively stating its conclusion that vitamin C was useless in treating cancer. Pauling immediately responded by pointing out that the patients involved in the test were undergoing cytotoxic chemotherapy, which he felt crippled their immune system. He also asserted that the trial was not conducted for long enough to develop accurate results.

Pauling's response to the New York Times article, October 24, 1979.

Pauling’s response to the New York Times article, October 24, 1979.

Charles Moertel returned fire, defending his results and questioning Pauling, implying that he was fanatical in his zeal for vitamin C and refused to acknowledge the truth. Pauling and Moertel began exchanging volleys in public, writing articles and giving interviews that attacked the research and competence of the other. Unfortunately for Pauling, he took the worst of it, as many people began to agree with Moertel, thinking Pauling to be too enamored with vitamin C to see any negatives. Funding plummeted as donations shrank and LPISM began finding large numbers of grants rejected outright with no chance for an appeal.

Pauling refused to give up. Shortly after the New York Times article was released, he and Cameron published their book, Cancer and Vitamin C. Pauling personally bought 16,000 copies of the publication and mailed them to every member of Congress and to countless other physicians and researchers. This action helped Pauling’s cause significantly as many of the recipients read the book, or at least glanced through it. And even those recipients who didn’t read the text were made more aware of Pauling and his research. Likewise, in the marketplace the book sold well despite the bad reception it received from professional reviewers – the public seemed interested in Pauling and Cameron’s ideas.

In light of this, National Cancer Institute head Vincent DeVita agreed to a second round of trials. However, in doing so DeVita once again chose the Mayo Clinic to host the trials and chose Moertel to lead them. Pauling was furious with these decisions, an understandable point of view considering that he and Moertel had spent the past few months publicly accusing one other of being incompetent.  Pauling was also now without his co-author: their book completed, Ewan Cameron returned to Scotland to fulfill his duties at Vale of Leven Hospital. Before leaving, he was appointed a Research Professor at LPISM for a period of five years.

With a new decade approaching, the easier times of the mid-1970s were clearly gone and by early 1980 the future was once again uncertain. While the tensions evident during the Art Robinson era were now history, his lawsuits and the Mayo Clinic trials severely detracted from the future prospects of LPISM. Unfortunately for the Institute and Linus Pauling, their immediate future was not going to be a happy one.

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.