Some 20 years ago I watched a young woman friend of my mother die of ovarian cancer. My mother, an indomitable Spaniard with an almost obsessive interest in good food - to the point where she had been known to march into restaurant kitchens and re-cook her own dinner - fed Ludmilla aggressively and devotedly through nine months of chemotherapy. Perhaps as a result, Ludmilla, a buxom Czech, seemed scarcely affected. Within less than half a year, however, the cancer returned.
I visited Ludmilla at the Churchill Hospital in Oxford where she had been operated on because a tumour was obstructing her intestines. Again, she did not appear particularly ill. But after my mother's sustaining Mediterranean feasts, I was concerned to see Ludmilla subsisting on made-up powdered soups, synthetic 'fruit' juices and trays of nameless sludge. I could not imagine how someone could rally and recover on such dead food. (Much later this sentiment would echo for me in the words of a Japanese doctor explaining why in Japan food in hospitals is provided by the patient's family. 'We certainly cannot expect a sick person to eat hospital food, which is not edible even for a healthy person.'
I did not see Ludmilla for two weeks, during which time her condition worsened and she was transferred to the Royal Marsden. When I next saw her, this 38-year-old in her luxuriant prime was now a scarcely recognisable crone, a living mummy.
My mother asked Ludmilla if she could fetch her anything from her home in Oxford. Ludmilla had only one wish: a pair of black satin pyjamas. In view of her appearance, an infinitely pitiable request. Three days later she was dead. What struck me was that Ludmilla appeared to have died not so much of cancer as of malnutrition, and I was convinced this must be preventable.
A few years after this, Dr George Blackburn of Harvard Medical School published a paper, 'The Skeleton In the Hospital Closet', which backed this up. He pointed out that conventional intravenous feeding of terminal cancer patient accelerates the wasting process by feeding the cancer large amounts of sugar and the patient insufficient protein. Dr Blackburn drastically reversed the proportions of such formulas.
Other American oncologists, notably Dr Keith Block at Edgewater Hospital, University of Illinois Medical School, followed suit. About the same time Dr Charles Simone, an oncologist who treated President Reagan, was heard to tell a story of a patient at the National Cancer Institute, Washington, who was totally cured of cancer by conventional therapies. Yet he was still dying - as a result of his treatment - not of cancer but of pellagra, the Vitamin B3 deficiency usually associated with the Third World, not a top cancer institute in the First.
Nutritional deficiencies, a result both of cancer and its treatment, are alarmingly common in cancer patients. In one study 46 per cent were shown to have such low levels of Vitamin C that they technically had scurvy, while 76 per cent had below normal levels of C.
Malnutrition is a treatable and often preventable condition. Treatment can be a complex business, given the metabolic derangement of 'terminal' cancer patients, but not impossible. There are drugs, such as insulin or hydrazine sulphate, that switch off cancer's supplies of sugar in the liver, and particular nutrients such as the omega 3 fatty acids in fish oil or the synthetic hormone, megestrol acetate, that can put a substantial spoke in this devastating process. Yet, such is the mindset of the medical establishment that when 'cachexia' - the wasting process of late cancer - sets in, so does medical fatalism.
This medical fatalism is largely based on ignorance. Some years ago at a meeting in Westminster on 'Diet And Cancer', organised by the Parliamentary Committee for Alternative and Complementary Medicine, I met Dr Sandra Goodman, a biochemist. She had had the same surreal experience that I had. We both stumbled on a massive amount of scientific research on nutrition and cancer, literally thousands of studies worldwide, and realised the paradox of its existence alongside an oblivious medical community fighting the greatest cancer epidemic ever known. (In the last half century cancer incidence has gone up by 50 per cent, with a current rate of growth of 2.1 per cent per year.)
It's as if there were a glass wall between nutritional scientists and cancer doctors in the UK. An otherwise excellent cancer textbook by two distinguished professors at a notable London teaching hospital contains a page headlined 'Cancer Quackery', dismissing in one sentence the notion that nutrition can have any part to play in cancer treatment.
Yet diet has been estimated to be the cause of up to 60 per cent of all cancers. Now that cancer prevention through diet has become a trendy nostrum, and so much is now known about how the molecular biology of cancer and nutrition interact at the level of the gene, 'not to assess and treat every cancer patient nutritionally is a form of malpractice by omission', according to the American Dr Jeffrey Bland.
It is illogical to say that nutrition can prevent cancer but has no role in treatment. It is an unscientific notion too, contradicted by hundreds of animal studies in which tumours have regressed, or survival has been considerably extended precisely through nutritional manipulation.
If human trials are relatively thin on the ground, there is a basic reason. Much cancer research is controlled by the drug industry, whose chief interest must be in producing drugs, not investigating unpatentable natural compounds. And the drug industry dominates doctors' therapeutic education.
But all this may be about to change. In the past two decades an extraordinary mainstream medical movement has sprung up in America, spearheaded originally by twice Nobel-prize winner Linus Pauling, dedicated to bringing nutritional therapies into clinics along side conventional treatment. The thesis is not only that such therapies protect patients against the rigours of treatment and dangers of infections, (which cause some 67 per cent of cancer deaths), but actually enhance the effects of conventional treatment so that less is needed and survival is extended. Virtually every major American medical school and university hospital is to a greater or lesser degree involved in this movement, as are many smaller clinics.
The M. D. Anderson Cancer Centre in Texas, for example, has done research into nutritional status and outcome in childhood cancers, indisputably establishing its importance. Nearly every issue of the Journal of the National Cancer Institute carries items or articles on nutrition and cancer. There are more than 1,000 doctors in America treating cancer not just with vitamins and diet but with a host of 'biological response modifiers', natural compounds known, from extensive investigation, to modify the cancer process.
The list is endless: enzymes, glandular and organ extracts such as thymosin, T3 thyroid, melatonin, amino acids, green tea, grapeseed extract, garlic, algae, mistletoe, ginkgo biloba and saw palmetto - established in the Journal of the American Medicine Association as a viable treatment for prostate pre-cancer. Other herbs, in particular Chinese mixtures, soy extracts, spices, such as turmeric, citrus pectin, alkylglycerols from shark oil and mothers' milk, have an anti-tumour effect while protecting from the side effects of radiation.
Dr Hugh Riordan's intravenous high dose vitamin C (now in phase II trials), is a broad spectrum tumour cell killer particularly effective against kidney cancer. Then there's Venus fly trap, nucleic acids, urea and Dr Burzynski's 'anti-neoplastons', peptides derived from human urine which have demonstrated considerable efficacy against otherwise untreatable brain tumours.
The list is so exotic it sounds medieval and one can almost hear the 'quackbusters' muttering 'sorcery' under their breath. But the fact is that all these compounds have been and are the subject of rigorous scientific scrutiny. A trial of melatonin plus the immune system hormone interleukin-2 showed a remarkable 45 per cent one-year survival rate in lung cancer patients compared to 19 per cent on chemotherapy.
Chekhov, in his incarnation as doctor, once said: 'If many cures are proposed for a disease, it is a sure sign that it is incurable.' Most cancers to date have been incurable unless caught early.
In a definitive survey, the German statistician Ulrich Abel found that chemotherapy alone cures fewer than 3 per cent of all advanced epithelial cancers.
The quietly revolutionary notion of the American movement is to combine all the supposed 'cures' into one arsenal so that each individual input is enhanced, and then added to conventional approaches. To this is further added spiritual, emotional, physical and psychological care in a model of integration which for the present may be the only way to push through the success plateau of current treatments. Instead of treating just the symptoms of cancer, these pioneer doctors - of whom there are a handful in the UK - have heeded Pasteur's deathbed pronouncement: 'Le terrain, c'est tout.'
The wonder cures of tomorrow are some way off. When Gordon McVie of Cancer Research UK said cancer cures were realistically 50 years away, the medical journal The Lancet headlined its editorial against him 'Over-optimism about cancer.'
In the face of persecution by the FDA and extraordinary penalties and legal sanctions for doctors who try to practise medicine in a way that honours the premise 'First do no harm', the American movement is making great strides. The National Institutes of Health (NIH) now has an Office for Alternative and Complementary Medicine with an annual budget of $68 million. Human trials for the nutritional approaches to cancer are part of this programme. The most noteworthy is that of Dr Nicholas Gonzalez's enzyme and nutrition therapy for pancreatic cancer, a test case if ever there was one. Pancreatic cancer is the most deadly of cancers, with most patients dead within weeks to months of diagnosis. Yet in a small study in 1994 Gonzalez took 11 pancreatic cancer patients. Nine survived a year, five survived two years, four survived three to four years, and two are still alive and well today.
These results were unheard of. Since the newest chemotherapy, gemcitabine, seems to offer at best a few extra months, NIH decided to trial Gonzalez's approach in a big way, coffee enemas and all. They have only one problem: few patients want to be on the chemotherapy comparison arm of the study.
By the time my friend and old Oxford tutor, Michael Gearin-Tosh, was diagnosed in 1994 with multiple myeloma, an incurable blood cancer, I had come a long way from my innocent observations at Ludmilla's death-bed. I was armed with knowledge of this new and promising field, 'nutritional oncology'. Textbooks and articles lined my shelves. I knew a number of key doctors and scientists, such as Linus Pauling's founding associate, Dr Abram Hoffer of the International Society for Orthomolecular Medicine. Thus I was able to help Michael devise a regime tailored to his particular needs that is remarkably similar to the Gonzalez regime tested by the NIH. Michael's random chance of surviving eight years, without the chemotherapy he rejected, was .05 per cent. If he was just lucky, he is very, very lucky indeed. The predictable cries of protest from UK doctors - luck, impossible, not proven, a danger to other cancer patients - merely show their lack of curiosity and their ignorance.
Dr Peter Gravett, a more enlightened UK cancer doctor who routinely uses nutritional and other therapies with chemo and bone marrow transplants and has demonstrated their benefits, puts it succinctly. 'Oncologists here in Great Britain must be among the world's most conservative and least innovative. Though it may be unfair to attribute the poor performance of UK oncology entirely to the inertia of our oncologists, constrained as they are by the health service and its financial restrictions and the rationing imposed by organisations such as NICE, nevertheless our consistent position near the bottom of the European league table in results for treatment of disease such as cancer attests to the tenacity with which the average practitioner persists with treatments that he or she is perfectly well aware are ineffective, and to the suspicion, if not positive hostility, with which new developments are greeted.'
Is it surprising, economics aside, that we find ourselves in the present appalling situation? A multi-pronged approach that supports every aspect of a patient's life has greater gains to offer.
Moreover, such approaches are not dependent on access to the newest chemotherapy or radiation treatment. Much can be done now, by patients for themselves, even while they wait, however long, for standard treatment. The UK-registered charity, Orthomolecular Oncology, was set up to show patients the way. Medical history shows that doctors have often overlooked the obvious with tragic consequences: Lind's lime cure for scurvy was implemented only after his death, though the cause of scurvy had actually been known for nearly three centuries; both Semmelweis and Lister were originally laughed to scorn when they made their basic observations on antisepsis, connecting poor hygiene by doctors with killer epidemics of childbed fever and post-operative infections; Goldberger was similarly derided when he connected pellagra epidemics with consumption of polished rice.
Cancer is more complex, of course. Yet the 'simple' approaches still have something fundamental to offer.
If Michael and I are 'credulous', as Dr Theodore Dalrymple stated, we are in the company of some very modest and truly eminent men. Never mind Professor Sir David Weatherall, or Dr Robert Kyle at the Mayo Clinic, a true seeker after truth and one of the giants of the Myeloma world.
As Schopenhauer said, medical truths have always evolved thus: first they are ridiculed, then they are violently opposed, and finally they are accepted as self-evident. Ludmilla and my mother, both now at the eternal banqueting table, will drink to that.
· Dr Carmen Wheatley is director of the cancer charity Orthomolecular Oncology: www.canceraction.org.gg
·'Living Proof' by Michael Gearin-Tosh is published by Scribner at £14.99
